The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update

2020 Focused Update Guideline Committee members (alpha order): Chinazo Cunningham, MD, MS, FASAM Mark J. Edlund, MD, PhD Marc Fishman, MD, DFASAM Adam J. Gordon, MD, MPH, FACP, DFASAM Hendrée E. Jones, PhD Kyle M. Kampman, MD, FASAM, Chair Daniel Langleben, MD Marjorie Meyer, MD Sandra Springer, MD, FASAM George Woody, MD Tricia E. Wright, MD, MS, FACOG, DFASAM Stephen Wyatt, DO, FAOAAM, FASAM, Co-Chair 2019 Focused Update ASAM Quality Improvement Council (alpha order): John Femino, MD, DFASAM Kenneth Freedman, MD, MS, MBA, DFASAM, FACP, AGAF Chair R. Jeffrey Goldsmith, MD, DLFAPA, DFASAM Barbara Herbert, MD, DFASAM Margaret Jarvis, MD, DFASAM Margaret Kotz, DO, DFASAM P. Stephen Novack, DO, MHCDS David R. Pating, MD, FASAM Sandrine Pirard, MD, PhD, MPH, FAPA, FASAM Maureen Boyle, PhD, ASAM Staff Taleen Safarian, ASAM Staff Leah White, ASAM Staff 2019 Focused Update Research Triangle Institute International (RTI) Team Members (alpha order):Karen Crotty, PhD, MPH, Principal Investigator Mark Edlund, MD, PhD Janice Tzeng, MPH Meera Viswanathan, PhD Brittany Zulkiewicz, BS Disclosure information for the 2019 focused update Guideline Committee members and the ASAM Quality Improvement Council is available, respectively, in Appendices VII and VIII. 2015 Guideline Committee Members(alpha order): Sandra Comer, PhD Chinazo Cunningham, MD, MS Marc J. Fishman, MD, FASAM Adam Gordon, MD, MPH, FASAM Kyle Kampman, MD, Chair Daniel Langleben, MD Ben Nordstrom, MD, PhD David Oslin, MD George Woody, MD Tricia Wright, MD, MS Stephen Wyatt, DO 2015 ASAM Quality Improvement Council (alpha order): John Femino, MD, FASAM Margaret Jarvis, MD, FASAM, Chair Margaret Kotz, DO, FASAM Sandrine Pirard, MD, MPH, PhD Robert J. Roose, MD, MPH Alexis Geier-Horan, ASAM Staff Beth Haynes, ASAM Staff Penny S. Mills, MBA, ASAM, Executive Vice-President Special External Reviewer: Michael M. Miller, MD, FASAM, FAPA 2015 Treatment Research Institute Technical Team Members (alpha order): Amanda Abraham, PhD Karen Dugosh, PhD David Festinger, PhD Kyle Kampman, MD, Principal Investigator Keli McLoyd, JD Brittany Seymour, BA Abigail Woodworth, MS Disclosure information for the 2015 Guideline Committee members, the ASAM Quality Improvement Council, and external reviewers is available respectively in Appendices IV, V, and VI ASAM is honored that this clinical practice guideline has been endorsed by: American Academy of Physician Assistants American Association of Nurse Anesthetists American College of Nurse-Midwives American College of Preventive Medicine American Osteopathic Academy of Addiction Medicine Federation of State Physician Health Programs International Nurses Society on Addictions National Association of Addiction Treatment Providers Table of ContentsAbbreviations and AcronymsAA – Alcoholics Anonymous ACOG – American College of Obstetrics and Gynecology ACT – Assertive Community Treatment AIDS – Acquired Immunodeficiency Syndrome ASAM – American Society of Addiction Medicine CBT – Cognitive Behavioral Therapy CDC – Centers for Disease Control and Prevention CNS – Central Nervous System COWS – Clinical Opioid Withdrawal Scale DATA 2000 – Drug Addiction Treatment Act of 2000 DEA – Drug Enforcement Agency DSM-4 – Diagnostic and Statistical Manual of Mental Disorders, 4th Edition DSM-5 – Diagnostic and Statistical Manual of Mental Disorders, 5th Edition ECG – Electrocardiogram EMS – Emergency Medical Services FDA – U.S. Food and Drug Administration HBV – Hepatitis B Virus HCV – Hepatitis C Virus HIV – Human Immunodeficiency Virus IDU – Injection Drug Use IM – Intramuscular IV – Intravenous NA – Narcotics Anonymous NAS Neonatal Absence Syndrome NIH – National Institutes of Health NIDA – National Institute on Drug Abuse NIAAA – National Institute on Alcohol Abuse and Alcoholism NOWS – Neonatal Opioid Withdrawal Syndrome NSAIDs – Nonsteroidal Anti-inflammatory Drugs NSDUH – National Survey on Drug Use and Health OBOT – Office-Based Opioid Treatment OOWS – Objective Opioid Withdrawal Scale OTP – Opioid Treatment Program PMDP – Prescription Drug Monitoring Program RCT – Randomized Controlled Trial RAM – RAND/UCLA Appropriateness Method SAMHSA – Substance Abuse and Mental Health Services Administration SMART – Self-Management and Recovery Therapy SOWS – Subjective Opioid Withdrawal Scale TB – Tuberculosis UROD – Ultra-rapid Opioid Detoxification National Practice Guideline Glossary Abstinence: Intentional and consistent restraint from the pathological pursuit of reward and/or relief that involves the use of substances and other behaviors. These behaviors may involve, but are not necessarily limited to substance use, gambling, video gaming, or compulsive sexual behaviors.1 Use of FDA approved medications for the treatment of substance use disorder is consistent with abstinence. Abuse: This term is not recommended for use in clinical or research contexts. Harmful use of a specific psychoactive substance. When used to mean substance abuse, this term previously applied to one category of psychoactive substance-related disorders in the DSM. While recognizing that the term abuse is part of past diagnostic terminology, ASAM recommends that an alternative term be found for this purpose because of the pejorative connotations of the word abuse. Addiction: Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases. Addiction specialist clinician: A health professional involved in the assessment, diagnosis, and treatment of addiction, such as a physician, psychologist, nurse practitioners (NPs), physician assistants (PA), clinical nurse specialists, certified registered nurse anesthetists, certified nurse midwives (as distinguished from one specializing in research). Addiction specialist physician: Addiction specialist physicians include addiction medicine physicians and addiction psychiatrists who hold either a subspecialty board certification in addiction medicine from the American Board of Preventive Medicine, a board certification in addiction medicine from the American Board of Addiction Medicine, a subspecialty board certification in addiction psychiatry from the American Board of Psychiatry and Neurology, a subspecialty board certification in addiction medicine from the American Osteopathic Association, or certification in addiction medicine from ASAM. Adherence (see also compliance): Adherence is a term that health professionals have been using increasingly to replace the term compliance. Both terms have been used, sometimes interchangeably, to refer to how closely patients cooperate with, follow, and take personal responsibility for the of treatment terms may be applied to how patients to of of efforts to the of a treatment is to treatment These efforts a complex from to to to to and to to that or take and of and term the and in to a on approaches that engage and American Academy of as the of and to generally and of This may from Opioid Opioid ASAM ASAM use to a of an to be used for and treatment or and or or for use or and Assertive treatment for with and that a to and A health professional involved in the assessment, diagnosis, and treatment of medical such as a physician, psychologist, nurse practitioners (NPs), physician assistants (PA), clinical nurse specialists, certified registered nurse anesthetists, certified nurse midwives (as distinguished from one specializing in research). 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