The objectives of the patient assessment are to determine a given patient’s eligibility for treatment, to provide the basis for a treatment plan, and to establish a baseline measure for use in evaluating a patient’s response to treatment. Accordingly, the assessment should focus on the following:
- Establish the diagnosis of opiate addiction and opioid use disorder, including the duration, pattern and severity of opioid misuse; the patient’s level of tolerance; results of previous attempts to discontinue opioid use; past experience with agonist therapies; the nature and severity of previous episodes of withdrawal; and the time of last opioid use and current withdrawal status.
- Document the patient’s use of other substances, including alcohol and other drugs of abuse.
- Identify comorbid medical and psychiatric conditions and disorders and to determine how, when and where they will be addressed.
- Screen for communicable diseases and address them as needed (offer HIV and hepatitis testing at local LabCorp Diagnostics location). Evaluate the patient’s level of physical, psychological and social functioning or impairment;
- Assess the patient’s access to social supports, family, friends, employment, housing, finances and legal problems.
- Determine the patient’s readiness to participate in treatment. Assessment usually begins at the time of the patient’s first telemedicine video visit and continues throughout treatment.
- On initial evaluation the prescription monitoring program of the state the patient is in should be accessed for the patient.
- If there is no established diagnosis of opioid use disorder or the patient’s history cannot be corroborated with old records or with the help of the prescription monitoring program, consider sending a urine drug screen or other toxicologic screen confirming recent opioid use and to screen for unreported use of other drugs. Please inform the staff to have the patient undergo testing ordered either by their primary doctor, or send the test via LabCorp or remote drug testing via Sharetek (live video swab and ID verification performed by our staff).
- The treating physician should balance the risks and benefits of medication-assisted treatment in general – and treatment with buprenorphine in particular – against the risks associated with no treatment or treatment without medication. The various options include: Simple detoxification and no other treatment; Detoxification followed by antagonist therapy; Counseling and/or peer support without medication-assisted therapy; Referral to short- or long-term residential treatment; Referral to an OTP for methadone maintenance; Referral for treatment with buprenorphine or combined buprenorphine/naloxone in an office-based setting, when available where patient is located.
Note that patients may be suitable candidates for treatment with buprenorphine even if past treatment episodes were not successful. If a decision is made to offer the patient treatment with buprenorphine, the risks associated with possible misuse and diversion are such that the combination buprenorphine/naloxone product is preferable for most QuickMD patients. The monoproduct should be used only rarely except in patient who failed treatment with the naloxone product (cost considerations or patient preference cannot be taken into consideration for this decision).
When the decision is made to prescribe buprenorphine, it is important to educate the patient on how to take the medication and they should be cautioned to follow the directions exactly, particularly during the induction stage. Critical issues involve when to begin dosing, the frequency of subsequent doses, and the importance of avoiding the use of any other illicit or prescription opioid or alcohol. Discuss proper and secure storage of the medication. Particularly where there are young people in the patient’s home, the subject of safe storage and use should be revisited periodically throughout the course of treatment, with the discussions documented in the patient record.