AUTHOR: Fred F. Ferri, MD
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From Jankovic J et al: Bradley and Daroffs neurology in clinical practice, ed 8, Philadelphia, 2022, Elsevier.
Males abuse opioids more commonly than females, with a male:female ratio of 3:1 for heroin and 1.5:1 for prescription opiates.
BOX 3 Symptoms and Signs of Opioid Withdrawal
From Jankovic J et al: Bradley and Daroffs neurology in clinical practice, ed 8, Philadelphia, 2022, Elsevier.
BOX 4 Commonly Used Psychostimulants
Methylphenidate (Ritalin) |
From Jankovic J et al: Bradley and Daroffs neurology in clinical practice, ed 8, Philadelphia, 2022, Elsevier.
The history is the most important part of the workup. A single-question screening test (How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?) should be incorporated in the medical history. Useful screening tools for OUD are the CAGE-AID (Table 1), the DAST-10 (Table 2), and the CRAFFT (Table 3). The CAGE-AID has a sensitivity of 70% and a specificity of 85% when two questions are answered in the affirmative. The DAST-10 can discriminate between current users versus former users. The CRAFFT is a useful screening tool for adolescents. A CRAFFT score of 2 or higher is optimal for identifying any problem (sensitivity 76%, specificity 94%), any disorder (sensitivity 80%, specificity 86%), and drug dependence (sensitivity 92%, specificity 80%).
TABLE 3 CRAFFT Screening Tool for Adolescents
Two or more questions answered in the affirmative require further assessment.
From Bowman S et al: Reducing the health consequences of opioid addiction in primary care, Am J Med 126:565-571, 2013.
TABLE 2 Drug Abuse Screening Test (DAST-10)
Two or more questions answered in the affirmative require further assessment.
From Bowman S et al: Reducing the health consequences of opioid addiction in primary care, Am J Med 126:565-571, 2013.
TABLE 4 Basic Components of Opioid Overdose Prevention Education Curriculum
From Bowman S et al: Reducing the health consequences of opioid addiction in primary care, Am J Med 126:565-571, 2013.
Education is the hallmark of prevention:
BOX 5 Treatment of Opioid Overdose
From Jankovic J et al: Bradley and Daroffs neurology in clinical practice, ed 8, Philadelphia, 2022, Elsevier.
TABLE 5 Organizations Providing Referral Information for Patients
Organization | Resources/Website | ||
---|---|---|---|
Substance Abuse and Mental Health Services Administration (SAMHSA) | Opioid treatment program directory: www.dpt2.samhsa.gov/treatment/. | ||
Physicians who provide buprenorphine | Buprenorphine physician and treatment program locator: www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine. | ||
Pain Action | Chronic pain management materials for patients: www.painaction.com/. | ||
Substance abuse treatment facilities | Substance Abuse treatment facility locator: http://dasis3.samhsa.gov/. | ||
Harm Reduction Coalition | Local risk reduction resources and programs, overdose prevention education, and naloxone prescribing information: www.harmreduction.org/. | ||
Narcotics Anonymous (NA) | General information and meeting information for NA, a 12-step program modeled after Alcoholics Anonymous: www.na.org/. |
From Bowman S et al: Reducing the health consequences of opioid addiction in primary care, Am J Med 126:565-571, 2013.
TABLE E6 Recommendations for Integrating Risk Reduction Strategies for Addressing Opioid Misuse in the Primary Care Setting
Risk Reduction Tools | Type of Client | Delivery Recommendations |
---|---|---|
Brief substance abuse screening | All clients, particularly those individuals prescribed opioid medications or with a history of substance abuse problems | Administer CAGE-AID∗ or similar screening tool as part of routine treatment. |
Motivational interviewing | Clients who have identified opioid use or abuse | Standard procedure may be delivered by primary care provider or other clinic staff. |
Comprehensive tools for safer injections, including safer injection education | Clients who have reported or are suspected of injection drug use; tools should be available to all patients, not just those identified as drug users | Resources including educational materials, syringes, alcohol wipes, etc., distributed and discussed by the primary care provider or other clinic staff. |
Naloxone prescription and distribution | Targeting individuals using illicit or prescribed opioids, including individuals prescribed opioids | Discussion, prescription of naloxone by the primary care provider; additional education may be delivered by other clinic staff |
Buprenorphine prescription | Targeting individuals using illicit or prescribed opioids, seeking medication-assisted treatment | Discussion and prescription by the primary care provider |
∗For a full definition of CAGE-AID, see Table 1.