Where does buprenorphine assessment fit in your agency?
Consider your agency’s existing processes for screening, assessment, and determining level of care.
- Are there opportunities to add or integrate buprenorphine eligibility assessment?
- How will patients deemed eligible flow to the inducting prescriber?
- How will you make assessment information available to the inducting prescriber?
Your process might look something like this:
The screening and assessment process
Most organizations follow a similar process to assess a client’s type and severity of opioid abuse, using a variety of validated screening tools. The process identifies key factors to weigh in selecting the most appropriate treatment for each client.
Standard screening and assessment items for determining a patient’s appropriateness for buprenorphine treatment include:
- Meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria for opioid dependence.
- Sustained dependence for one to five years.
- The ability to self-administer a Schedule II narcotic, based on mental status and diversion history and risk.
- Being free from psychosis or active suicidal ideation.
- Lab work, which may include hepatic function, a urine drug screen, a pregnancy test, a hepatitis panel, HIV status, and Complete Blood Count.
- Access to and engagement in appropriate psychosocial substance use disorder treatment.
- Evidence of withdrawal syndrome, based on the COWS (Clinical Opiate Withdrawal Scale) or other clinical tool to ensure there is no risk of precipitated withdrawal upon buprenorphine induction.
Health and safety considerations
Chronic use of opioids, alcohol, and other drugs can cause serious withdrawal symptoms. Many clients seeking addiction treatment are addicted to more than one substance. The initial screening may indicate that the person should go to the closest emergency department or detoxification unit, call 911, or make an appointment for an assessment.
BupPractice.com: How-to Guide: How to Conduct Buprenorphine Induction