04-Treatment-Options-for-Opioid-Use-Disorders

Treatment Options for Opioid Use Disorders

The AHA acknowledges there is a fuller continuum of care in and outside of the hospital. There are many other screening and treatment options than those listed here. We will continue to add more resources on this topic and include other options and corresponding resources as appropriate.

  • Opioid Overdose Prevention Toolkit (June 2018). This toolkit offers strategies to health care providers, communities, and local governments for developing practices and policies to help prevent opioid-related overdoses and deaths. Access reports for community members, prescribers, patients and families, and those recovering from opioid overdose.
  • stopoverdose.org. This website was created to help individuals and communities in Washington State respond to prevent opioid overdose. It houses resources like toolkits and how-to resources, training materials, flyers and posters, promotional materials.
  • How HRSA is Addressing the Opioid Crisis (April 2018). Page provides an overview of HRSA initiatives, resources, and training to integrate behavioral health into primary care and stem the opioid epidemic.
  • TIP 63: Medications for Opioid Use Disorders. This Treatment Improvement Protocol reviews the use of the three Food and Drug Administration-approved medications used to treat opioid use disorder (OUD)—methadone, naltrexone, and buprenorphine—and the other strategies and services needed to support recovery for people with OUD. 
  • Pathways to Care: Treating Opioid and Substance Use Disorders (2018). Pathways to Care: Treating Opioid and Substance Use Disorders offers practical and applicable approaches to fixing America’s frayed substance use disorder treatment delivery system.
  • Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study (June 2018). Opioid overdose survivors have an increased risk for death. Whether use of medications for opioid use disorder (MOUD) after overdose is associated with mortality is not known. The purpose of this study is to identify MOUD use after opioid overdose and its association with all-cause and opioid-related mortality.

Rural

  • Rural Opioid Educational Resources (June 2018). Compendium of all Rural Opioid Educational Resources available across the NOSORH website to aid individuals looking for education, tools, and other resources. This includes reports, webinar presentations, meeting presentations, and a compendium of resources and lessons learned from grantees of the Federal Office of Rural Health Policy's Rural Opioid Overdose Reversal (ROOR) grant program.
  • Opioid Misuse Resource Map (June 2018). An interactive map to learn about, access or replicate actions rural leaders are taking in small towns across the country to address the opioid epidemic through prevention, treatment and recovery opportunities.
  • Centers for Disease Control and Prevention (CDC): Preventing Opioid Overdoses among Rural Americans (March 2018). This policy brief is a companion to CDC’s Morbidity and Mortality Weekly Reports on rural health, Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Non-metropolitan areas — United States but will focus on opioid use and overdose in rural America. The brief will explore policy options and other strategies that may help prevent opioid overdoses and reduce overdose death in rural areas. The brief also includes three case studies that present examples from the field.

Data/Maps

Screening

  • Trust for America’s Health “Pain in the Nation” A Strategy to Save Lives (November 2017). This webpage shares information on prevention, early identification and treatment. It includes a report that provides extensive background information and data about the opioid epidemic, in addition to strategies that can be used to stem the tide of the opioid epidemic. This webpage also houses an interactive map which shows death from alcohol, drugs and suicide since 1999 with projections through 2025. 
  • AHRQ Data Show Impact of Opioid Crisis at County Level (March 2018). The Agency for Healthcare Research and Quality (AHRQ) released an online statistical resource that for the first time provides county-level comparisons of hospitalization rates for substance use, including opioids, alcohol, stimulants and other drugs. AHRQ’s new resource also allows a focused look at hospitalization rates for specific substances, a feature with the potential to support policymakers and public health advocates seeking to prioritize and tackle local substance use challenges. For example, Cook County, Ill., had an opioid-related hospitalization rate of 440 per 100,000 people in 2014. The rate for Starr County, Texas, meanwhile, was only 18 per 100,000 people.
  • National Institute for Drug Abuse Drug Screening Tool (2013). This tool can be used by providers to screen patients for drug use.
  • Screening, Brief Intervention and Referral to Treatment (SBIRT) (2016). The screening, brief intervention and referral to treatment training is a way for providers to quickly recognize opioid use disorder and either treat or refer patients to more substantial treatment.

Medication-Assisted Treatment (MAT)

  • Medications for Opioid Use Disorder: Treatment Improvement Protocol 63 (May 2020) This Treatment Improvement Protocol (TIP) from the Substance Abuse and Mental Health Services Administration reviews the use of the three Food and Drug Administration (FDA)-approved medications used to treat OUD—methadone, naltrexone, and buprenorphine—and the other strategies and services needed to support recovery for people with OUD.
  • Black Hills Doctor Offers Medication Assisted Treatment For Opioid Addiction (March 2019). This article from the Midwest Medical Edition provides information on how Dr. Tamang implemented a medicated assisted treatment after understanding the need for it in the community. Despite challenges of implementing this evidence-based approach, including significant time and resources, this article details the success and expansion of this program with the support of integral partners. 
  • Guidelines for Medication for Addiction Treatment for Opioid Use Disorder within the Emergency Department (January 2019). The Massachusetts Health and Hospital Association (MHA) worked in collaboration with the Massachusetts College of Emergency Physicians (MACEP) and through a member workgroup composed of practitioners from member hospitals, including specialists in emergency medicine, addiction medicine, behavioral health, and nursing, to develop guidelines to assist with a specific provision within Chapter 208 of the Acts of 2018. (Please see Appendix VI for a full list of MHA’s MAT for OUD Workgroup members.) Chapter 208 requires acute care hospitals that provide emergency services within an emergency department and satellite emergency facilities to have the capacity to initiate opioid agonist therapy to patients that present after an opioid-related overdose. The patient must also be directly connected to continuing treatment prior to discharge.
  • Using Telehealth to Support Opioid Use Disorder Treatment (November 2018). Telehealth can connect geographically dispersed patients and providers and is a promising approach to expand access and enhance quality of Medication-Assisted Treatment (MAT) for Opioid Use Disorder (OUD).
  • Substance Abuse and Mental Health Services Administration’s (SAMHSA) Medication-Assisted Treatment (2016). This webpage includes multiple resources for how to use medication-assisted treatment for patients with substance use disorders.
  • SAMHSA Medication-Assisted Treatment of Opioid Use Disorder (2016). This guide is for physicians using medication-assisted treatment for patients with opioid use disorder. It discusses various types of approved medications, screening and assessment tools, and best practices for patient care. Available for free download.
  • The National Practice Guideline (2015). The American Society of Addiction Medicine developed the National Practice Guideline to provide information on evidence-based treatment of opioid use disorder, and is the first to address all of the FDA-approved medications available to treat addiction involving opioid use and opioid overdose in a single document.
  • Providers’ Clinical Support System for MAT (2017). PCSS-MAT is a national training and clinical mentoring project developed in response to the opioid use disorder crisis. The overarching goal of PCSS-MAT is to provide the most effective evidenced-based clinical practices in the prevention, identification, and treatment of opioid use disorders.
  • Caring for Ms. L. — Overcoming My Fear of Treating Opioid Use Disorder, New England Journal of Medicine, (February 15, 2018). This perspective piece in the New England Journal of Medicine is about one physician’s journey to overcoming fear of Treating Opioid Use Disorder.
  • SAMHSA TIP 63: Medications for Opioid Use Disorders (February 2018). This Treatment Improvement Protocol (TIP) reviews the use of the three Food and Drug Administration (FDA)-approved medications used to treat opioid use disorder (OUD)—methadone, naltrexone, and buprenorphine—and the other strategies and services needed to support recovery for people with OUD.
  • SAMHSA Fact Sheet: Finding Quality Treatment for Substance Use Disorders (February 2018). This fact sheet serves as a guide for individuals seeking behavioral health treatment. It provides three necessary steps to complete prior to utilizing a treatment center and the five signs of a quality treatment center, which include a review of the accreditation, medication, evidence-based practices, position on the role of families, and support networks.
  • SAMHSA Fact Sheet: Finding Quality Treatment for Substance Use Disorders (February 2018). This fact sheet serves as a guide for individuals seeking behavioral health treatment. It provides three necessary steps to complete prior to utilizing a treatment center and the five signs of a quality treatment center, which include a review of the accreditation, medication, evidence-based practices, position on the role of families, and support networks.
  • Expanding Treatment Opportunities for Hospitalized Patients with Opioid Use Disorders, Journal of Hospital Medicine (October 18, 2017). The prevalence of opioid use disorders (OUDs) is rising across the United States. This article discusses changes in policy and practice to expand opportunities to engage patients with OUDs in opioid agonist treatment during their inpatient hospitalizations.

Naloxone

Buprenorphine

Buprenorphine Training Programs (CE available, sign-up required)

Neonatal Abstinence Syndrome

  • Healthy Pregnancy Healthy Baby Fact Sheets (Aug 2018). This Substance Abuse and Mental Health Services Administration (SAMHSA) resource is series of four fact sheets that emphasizes the importance of continuing a mother's treatment for opioid use disorder (OUD) throughout pregnancy. The series includes information on OUD and pregnancy, OUD treatment, neonatal abstinence syndrome, and considerations to address before hospital discharge.
  • ASTHOREPORT: The Role of State Health Leaders in Addressing Substance Use Disorders Among Women, Infants, and Families (December 2018). As states address the growing challenges associated with substance use disorder (SUD) and neonatal abstinence syndrome (NAS), many are beginning to implement strategies that systematically consider the needs of women, infants, and their families. This report highlights six public health approaches for addressing the rising incidence of SUD and NAS and draws out the critical role that state health leaders play in each.
  • Maternal OUD Resources (2018). The Council on Patient Safety in Women’s Health Care created an initiative called the Alliance for Innovation on Maternal Health (AIM). This initiative has resources including a Patient Safety Bundle for Obstetric Care for Women with Opioid Use Disorder which lays out steps to be taken by patients and families and by providers at different stages of Maternal OUD: Readiness, Recognition & Prevention, Response, and Reporting & Systems Learning.
  • Neonatal Abstinence Syndrome: A Critical Role for Medicaid in the Care of Infants (June 2018). This Informational Bulletin provides states with considerations when designing approaches to treatment of infants with Neonatal Abstinence Syndrome (NAS), including Medicaid coverage options and limitations. It contains a summary of some current studies on such treatment, which suggest possible strategies states may want to consider in building effective coverage programs. It further discusses ways in which Medicaid can support the mothers, fathers, and caregivers of the infants in providing care that can improve health outcomes for their infants with NAS.
  • Protecting Our Infants Act: Final Strategy (2017). This document “Protecting Our Infants Act: Final Strategy” (Final Strategy) retains the overall structure of the original strategy and, for convenience, the summary of the findings of the original report with regard to prevention, treatment and services. Each section has a corresponding table of recommendations, revised based on public comment, which encapsulates the strategy. The Final Strategy will be used to inform planning and policy across HHS, although full implementation will be contingent upon funding. As the Act requires, the Final Strategy is publicly available at: https://www.samhsa.gov/specific-populations/age-gender-based#poia.
  • Neonatal Drug Withdrawal (2012). The American Academy of Pediatrics’ clinical report explains the impact of opioid use and multiple drug use on infants at the time of birth. This resource discusses topic-specific challenges for preterm infants, use of multiple drugs, differential diagnosis and assessment and nonpharmacologic treatment. It provides a list of clinical insights on these topics and suggestions for creating departmental protocols, creating scoring sheets for identification of signs of withdrawal, and more.
  • Neonatal Abstinence Syndrome (NAS). (2015) Cincinnati Children’s provides information on signs of NAS, treatment and answers to frequently asked questions.
  • Memorial Healthcare: Reducing Infants Born with Neonatal Abstinence Syndrome (October 26, 2016). Speakers on this webinar explain what drove the creation of this initiative, the team members who implemented the treatment program and how it has improved access to care as well as quality outcomes for mothers and babies.
  • Perinatal Addiction Treatment Program – Dartmouth-Hitchcock Medical Center, Lebanon, NH (February 2017). Collaboration between psychiatry and OBGYN providers in coordinating education and treatment for pregnant women with substance abuse disorder and infants born with neonatal abstinence syndrome.
  • Maternal Opiate Medical Support Project – MetroHealth Medical Center, Cleveland, OH (January 2017). Partnership between health care system, social service agencies and the justice system to promote improved health outcomes for opiate-dependent mothers and their babies with neonatal abstinence syndrome.

Opioid Use Disorder Treatment Options Case Examples

  • CHA Issues Hospital Overdose Education and Naloxone Distribution Guidelines (December 2019) - As part of Colorado’s Opioid Solution: Clinicians United to Resolve the Epidemic (CO’s CURE), CHA and its partners have released new guidelines for Colorado hospitals, highlighting education on opioid overdoses and providing guidance for hospital-based naloxone distribution programs. Because health care providers on the front lines are in an ideal position to identify and treat patients at risk for an opioid overdose, this guide provides suggestions for hospitals to ensure those vulnerable patients are discharged with naloxone or a reliable plan to obtain it from a pharmacy.
  • The ideal practices for hospital-based overdose education and naloxone distribution includes five key components:
    • Hospital screens and identifies patients at-risk for substance and/or opioid use disorders.
    • Hospital clinicians, nurses and staff are trained in harm reduction, overdose education and naloxone distribution.
    • Hospital implements an overdose education and naloxone distribution (OEND) program.
    • Hospital dispenses naloxone directly to high-risk patients, their families and close contacts.
    • Hospital works closely to ensure the OEND program is sustainable and not dependent on external factors like grant funding.
  • Black Hills Doctor Offers Medication Assisted Treatment For Opioid Addiction (March 2019). This article from the Midwest Medical Edition provides information on how Dr. Tamang implemented a medicated assisted treatment after understanding the need for it in the community. Despite challenges of implementing this evidence-based approach, including significant time and resources, this article details the success and expansion of this program with the support of integral partners. 
  • Medication-Assisted Treatment for Opioid Use Disorder, Washington, DC (October 29-31, 2018). The Committee on Medication-Assisted Treatment for Opioid Use Disorder hosted a public workshop to hear from individuals with relevant experience and expertise in the evidence base on medication-assisted treatment (MAT) for opioid use disorder (OUD), the barriers to and opportunities for improving access to MAT for OUD, and the patient and community perspective. The Medication-Assisted Treatment for Opioid Use Disorder: Proceedings of a Workshop—in Brief" publication is available to download.
  • Pilot program hopes to reduce opioid overdose deaths in Boone County (June 2018). This pilot program is designed to foster collaboration between emergency room treatment and long-term care for opioid overdose patients in Boone County. 
  • Avera Expands Substance Abuse Treatment to Rural Areas Through Telemedicine (June 2018). South Dakota’s rural communities often lack resources to combat drug and alcohol addiction. Thanks to a new grant, Avera Health is looking to expand its telehealth services in some under-served areas. 
  • Project SHOUT (Support for Hospital Opioid Use Treatment): Zuckerberg San Francisco General, San Francisco, CA (November 2018). Hospitalizations are a time of risk and promise for patients with opioid use disorder. Patients who are in treatment with buprenorphine or methadone may have their medications discontinued, increasing the risk of relapse. However, hospitalizations can be a chance to solidify recovery for patients in treatment, and to start treatment for patients who are not yet engaged. Learn how Project SHOUT helps hospitals start buprenorphine and methadone during ED visits and inpatient hospitalizations, and hear about the example of Zuckerberg San Francisco General.
  • Commonwealth of Pennsylvania: Opioid Epidemic (2018). The prescription opioid and heroin overdose epidemic is the worst public health crisis in Pennsylvania. A webpage was created to help address this challenge. This webpage includes an Opioid Data Dashboard, information on their Prescription Drug Monitoring Program, standing order prescription for naloxone, in addition to many other topics. 
  • An Ounce of Prevention for Mothers and Newborns: Reducing In-Utero Opioid Exposure in Missouri (June 2018). In this policy brief, Missouri Hospital Association seeks to quantify the incidence of NAS in Missouri using both conventional and novel surveillance techniques, and propose a Medicaid policy-centered interventional approach aimed at reducing the number of infants born with opioid withdrawal in Missouri.
  • Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: a Randomized Clinical Trial. This study tested the efficacy of 3 interventions for opioid dependence including screening and referral to treatment (referral); screening, brief intervention, and facilitated referral to community-based treatment services (brief intervention); screening, brief intervention, ED-initiated treatment with buprenorphine/naloxone, and referral to primary care for 10-week follow-up (buprenorphine). The article has information on results and conclusions.
  • Brief: How medical-legal partnership services can help address the opioid crisis (March 2018). This issue brief from the National Center for Medical-Legal Partnership examines how legal services delivered alongside medical and behavioral health services can help support successful recovery from substance use disorders. It highlights case studies of individuals in recovery who were aided by medical-legal partnership (MLP) services, and looks at how existing recovery-based MLP programs in Ohio, Indiana, and Nevada operate. The brief offers a window into how legal services, integrated into existing recovery efforts, can play a role in alleviating the crisis.
  • Quartz: The opioid epidemic is tearing communities apart. Here’s how one city came together to fight it (2018). Winchester’s approach to tackling the opioid epidemic isn’t revolutionary, but it is uniquely effective. It is characterized by an unusually active local coalition of actors impacted by substance abuse and addiction in the Winchester region, called the Northern Shenandoah Valley Substance Abuse Coalition, a progressive law enforcement effort, and the contributions of the local community, from religious leaders to neighborhood volunteer groups.
  • Effective Programs for Identification and Treatment of Pregnant Addicted Women. (2014) One inpatient program increases access to providers, addresses stigma associated with “treatment centers” and provides options for detoxification of pregnant mothers. Another program provides an overview of an outpatient recovery program.
  • Stretching the Scope — Becoming Front-line Addiction-Medicine Providers (2017). This New England Journal of Medicine article describes how an infectious disease practice (i.e., not traditional addiction medicine specialists) is actively providing MAT to patients, highlighting that clinicians of many specialties can take the steps to provide MAT.
  • Essentia Health’s Chronic Opioid Analgesic Therapy (COAT) Program Reduces Opioid Addiction (2016). The COAT program is designed to help people with a history of chronic opioid use reduce or eliminate their dependence on the medications for noncancer-related pain. It works to target chronic opioid users through careful monitoring of their prescription history, educating them about the dangers of overuse and, when appropriate, guiding them through a gradual weaning process to a safer level of use. The speakers share how all Essentia primary care providers, surgeons and specialists were trained in COAT protocol and briefed on ways to detect signs of dependence and addiction in patients and nonaddictive treatment methods. Since October 2015, Essentia’s COAT program has reduced the number of patients that were diverting or inappropriately using opiate medications by roughly 10 percent.
  • Empowering Patients and Families in Times of Crisis: BWFH Emergency Department offers take-home nasal naloxone kits to those struggling with opioid addiction. (n.d.) A program at Brigham and Women’s Faulkner Hospital provides patients and their families with the tools they need to treat an overdose at home using nasal naloxone, in an effort to save a life in the event of a future overdose.
  • Memorial Healthcare System: Maternal Addiction Treatment - Preventing Neonatal Abstinence Syndrome (2016). Speakers on this webinar explain what drove the creation of this initiative, the team members who implemented the treatment program and how this has improved access to care as well as quality outcomes for mothers and babies. Speakers provide details of the program structure and how it is a cost-effective use of resources. They also share stories about treating in utero some of the youngest victims of the state’s opioid epidemic; the majority of these babies were born drug free.
  • Hospital and Health Systems Impacting the Opiate Crisis: Alexian Brothers Behavioral Health Hospital’s Approach (2016). This webinar features Alexian Brothers Behavioral Health Hospital and their innovative inpatient and outpatient “rapid opiate detox” program. Clayton Ciha, president and CEO, and. Greg Teas, M.D., CMO at Alexian Brothers Behavioral Health Hospital, AMITA Health, Hoffman Estates, Ill., share how this initiative has helped opioid dependent patients, how those with an opioid use disorder without chronic pain problems move to and live in recovery, and how medication-assisted treatment can serve patients in a variety of settings.
  • Project ASSERT: To improve Alcohol & Substance Use Disorder Services, Education and Referral to Treatment (2017). Project ASSERT was the first nationally published program in an ED to deploy peer counselors/educators as motivators and navigators to identify and intervene with patients with unhealthy alcohol and drug use. The Project ASSERT team of outreach workers provided the “in-reach” that the ED staff needed to bridge the gap between what patients needed and what they had the capacity to provide.
  • Tackling the opioid crisis in a rural community (2017). Bridgton family practice physician Craig Smith, M.D., a member of the Bridgton Hospital medical staff, is on the front line in the battle against the crisis that is harming people of all ages and all walks of life – not just in Maine but in communities large and small across the country. They worked to set up medication-assisted treatment – or MAT – to treat OUD in his primary care practice. MAT pairs nondrug therapies, such as counseling or cognitive behavioral therapy, with a Food and Drug Administration-approved medication, like Suboxone, to treat patients suffering from OUD.
  • Improving the Hospital and Emergency Department Response to Substance Use Disorders: A Project ASSERT Case Study (October 2017). Development and implementation of Project ASSERT (Alcohol & Substance Use Disorder Services, Education and Referral to Treatment) in Boston City Hospital’s ED, which deploys peer counselors/educators as motivators and navigators to identify and intervene with patients with unhealthy alcohol and drug use.
  • St. Vincent Medical Center Riverside Trains ‘Peer-Recovery Specialists’ (September 20, 2017). Program that places peer-recovery specialists – former drug users who have received special education and training – in the ED to steer opioid overdose patients toward treatment.
  • Christiana Care Health’s Project Engage seizes 'reachable moment' to treat substance use disorder (August 16, 2017). Program that screens ED patients who exhibit signs of a substance use disorder, and asks them if they would like to talk to a peer counsellor about the problem; if they say yes, the counsellor works with a hospital social worker to connect patients with community resources that put them on the path to recovery.

Other Multimedia:

  • USDA: Opioid Misuse in Rural America (February 2018). This webpage has resources to support communities in Rural America. This page provides resources for prevention, treatment, and recovery opportunities for those in need.

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