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Medical Student 8 Hour Buprenorphine Training
Session 4: Patient Evaluation
Session 4: Patient Evaluation
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Video Transcription
Welcome back. I am Dr. Kelly Fedorio. Before we move into Module 4, take a moment and reflect on Modules 2 and 3. If there's another student in your school engaged in the course, consider having a brief conversation with them about what you've learned thus far. In this module, we'll be discussing how one evaluates a patient for an opioid use disorder and whether this patient would be appropriate for medication. Take a minute to look over the objectives. One of the most important aspects in working with patients with substance use disorders is building a therapeutic alliance. The attitude with which the provider initiates the interview will be most important in obtaining the most open, honest, and therefore reliable information from the patient. Maintaining a nonjudgmental stance will allow the provider to remain open to the patient and their own unique situation. By maintaining a certain curiosity, you can better understand the genetic, psychiatric, and environmental variables that led this particular patient into developing an opioid use disorder. It's important that the provider remain empathic to the suffering associated with this disease that all patients experience, no matter how they themselves are presenting on the outside. Remember, all of these patients had hopes and dreams for the future as young people that did not include the development of an addiction. As with all patients, we need to remain respectful as a health care provider. The provider must recognize the adversity and at the same time the strengths that are part of every individual patient's story. Make attempts to use non-stigmatizing language, which we'll review in more detail later in this module, but words like junkie and drug addict are pejorative and it's not helpful in forming your therapeutic alliance. Recognize that honesty is an important aspect of recovery. It's a primary principle of the 12-step recovery programs. It'll be important for both the patient and provider to work towards an honest, open relationship. In the development of honesty between the provider and patient, it's important that the patient understand the absolute confidentiality of information being gathered. At the same time, the patient should understand that we as providers have a duty to warn if their safety or the safety of others, and in particular children, are at risk. In patient evaluation, a comprehensive assessment is vital. As described, it's initially important to establish that good therapeutic alliance. Whenever possible, collateral information can provide an alternative perspective on the development and severity of the patient's disease and should be sought whenever possible. As with any initial assessment, one should review medical history, psychiatric history, along with physical evidence of disease and concurrent problems. During this module, we will review this and other aspects of the initial evaluation, including signs and symptoms of withdrawal, how to make the diagnosis, how to assess for acute risk, the appropriateness for treatment, and how to establish an initial plan. In 2006, the federal government determined the importance of establishing state prescription drug monitoring programs, and it was signed into law. It's important that this tool be utilized by all providers of controlled substances in monitoring where patients may be getting their medications and which other providers may be prescribing them. At the initial assessment, the patient should sign a consent for treatment and allow the provider to obtain collateral information from other providers by signing a release of information form. The patient needs to understand your clinic's policy surrounding treatment. There are a number of treatment plans available for review on the PCSS website linked here for your use if you want more information. These are a public domain, so you can cut and paste and individualize them in a way that makes them most appropriate for your clinic. Like so many other practices of medicine, the provision of opioid use disorder treatment takes a team. One of the barriers to good care is how patients are greeted when they walk into the office. It's important how clinic administration, nursing, and counselors understand the importance of this work. The team should be provided education to be on the same page about giving this care. People come to this work with a myriad of perspectives, and it's important that the whole staff meet as a team to voice their opinions and figure out how they can work most effectively for the patient. It does take a team, and the entire staff needs to feel that they are part of the process. It's important to continue to bring the staff back to a place of focusing on the patient's needs. Sometimes it takes regularly scheduled reviews of individual patients. If done appropriately, this can be a hugely rewarding practice for the whole team to experience. What is important to review in taking a medical history? Think about how it might be different for a patient with substance use disorder. Taking a medical history for a patient with a substance use disorder is actually not that different from any other patient. Let's use our patient Gwen, a 62-year-old woman who presents saying, I want to stop using drugs. With Gwen, we'll review what current signs or symptoms she might be experiencing, any prior laboratory information, and previous testing. As a provider, I'll need to stay attentive to her other medical problems, particularly those associated with her substance use. I'll also want to know what chronic illnesses Gwen has, what current treatments are being provided, and how she's responding to those treatments. I'll also take a good surgical history. Since Gwen is female, I also need to obtain her obstetrical and gynecologic history, as I would with any female. If Gwen were of childbearing age, I would also clarify whether she's currently pregnant and what forms of birth control she might be using, as I would with all women of that age. We typically encourage women of childbearing age to be on birth control during their treatment for substance use disorder. It's also not uncommon to see poor dental care in patients with long-standing opioid use problems, and that's also true of Gwen. It's in part due to them not taking care of themselves in general, including their teeth, but also using opioids on a regular basis makes you less aware of minor dental pains, and consequently, dental caries can fester. Lastly, I need to be clear about what medications the patient is currently taking, what she may have tried in the past, particularly as it pertains to the treatment of chronic illnesses and psychiatric problems. In understanding how all patients responded to previous treatments, one can often get an indication as to their compliance with medications. In reviewing psychiatric medications, I'll ask about side effects. Part of the treatment plan will include how your office is going to respond if the patient were to lose or have their medication stolen, particularly with control medications. As we reviewed previously in Module 1, there's a strong association between substance use and mental health problems. I will review with Gwen what symptoms she has, particularly as it pertains to mood and anxiety. Not infrequently, there's a strong association between the misuse of substances, anxiety, and depression. Getting a timeline for when the symptoms started will help separate substance abuse from mental illness. Gwen has lived with depression for most of her life. Many of these patients will have experienced either childhood traumas or traumas associated with drug use. It's important to understand and help the patient address it or offer a referral. The stressors the patient experiences can help determine the appropriate level of care the patient may need. Consequently, all this information will help in planning the patient's treatment. You've already been presented the variety of determinants in early life that can lead to the development of a substance use problem. That's why it's so interesting to get a good birth and early developmental history. We'll ask Gwen questions about her early childhood and growth into adulthood. Understanding family history and the association with substance use and other psychiatric problems is not only part of the genetic history, but plays into the environment in which the patient may have grown up. We'll also ask her how she progressed through her education, her work history, marital status, living situation. All of this gives us information about her overall stability. This information is then used to help determine her overall stability and whether she can be successful in the treatment in my setting. In this first visit, I'm attempting to determine with her what the intensity of treatment she needs and whether that level is possible in my clinical setting. It should be noted that legal status is no longer a part of the DSM-5 diagnostic criteria of substance use problems, as it was in previous editions. However, asking about legal problems can give you another level of insight into the patient's life and history, as well as their psychosocial issues. In obtaining the substance use history, it is important to ask about all prior substance use. A good format to do this is to ask the first use of substance, how it has progressed over time or changed, and what is the current level of use. Gwen, like a lot of patients, particularly those who are injection drug users, currently uses tobacco products. Tobacco, for Gwen, was the first substance used. And this has changed somewhat in the younger patients, that more and more we see cannabis products are the drug that was first used. But addressing nicotine dependence remains a very important aspect in establishing long-term health for the patient and should never be overlooked. After reviewing the use of tobacco products, we'll typically start with alcohol or cannabis and then go to other drugs, cocaine, amphetamines, benzodiazepines, and hallucinogens. Most frequently, opioids will have been addressed in the history or the chief complaint. It's important to establish what other drug use problems the patient has had and how they may have been addressed. You want to understand whether the patient has had significant periods of abstinence, meaning significant time off opioids, and if so, how were they able to maintain that sobriety? I would ask Gwen, once you were sober, what experience were associated with relapse or what were your triggers for starting to use opioids again? We'll also obtain information on the patient's understanding of their loss of control and the use of various drugs. What forms of treatment has the patient found most helpful and has she been involved in mutual support groups like Alcoholics Anonymous or Narcotics Anonymous? What was her experiences with these groups? This information can be helpful later in establishing a treatment plan. I'd also ask Gwen, what's your understanding of tolerance, intoxication, and withdrawal, and how have these affected your life? It may be important to explain to the patient what is tolerance and let her know that it's associated with needing more of a drug to get a similar effect or finding that the same amount of a drug does not do for them what it once did. All patients will experience some degree of tolerance to the opioids with withdrawal symptoms on discontinuing them. Understanding the difficulties that patients experience during intoxication and other drugs builds your insight into their drug use but also can help the patient's motivation for treatment as they think about these problems that are associated with their drug use. Asking Gwen if she has had extremely difficult problems associated with withdrawal is also a key question. Withdrawal from opioids is not typically seen as a dangerous experience, but it can be truly miserable. It is only a critical problem when associated with other chronic illnesses. This is not true, however, for alcohol, and if the patient is using alcohol concurrently, it will be important to determine the severity of withdrawal symptoms in the past and what concurrent illnesses may put the patient at risk as they attempt to withdraw from alcohol. With the information you have now obtained, one should be able to make at least an initial substance use diagnosis. After determining the level of severity and medical, psychiatric, and social needs, you'll be better equipped to make the recommendation and establish a treatment plan. We'll talk in depth about screening, brief intervention, and referral treatment, SBIRT, later in this course. For now, know that there are validated screening tools that can be used in general medical settings that can help determine underlying substance use and psychiatric problems. These include a general screening test for drug use, the Drug Abuse Screening Test, or DAST-10. The Clinical Opioid Withdrawal Scale is also helpful and is used to establish the level of withdrawal the patient is currently experiencing by assessing signs and symptoms of withdrawal. The Alcohol Use Disorders Identification Test, or AUDIT, comes in a variety of different forms but is a well-validated screening tool to assess for levels of risk associated with the patient's use of alcohol. And the PHQ-9 is the patient health questionnaire that is used to screen for depression and anxiety symptoms. This is a view of the Clinical Opioid Withdrawal Scale, which we showed you once before in an earlier module. Included here are the scores indicating level of severity. There are both objective and subjective signs and symptoms associated with the scale. It's important when assessing the patient that some signs are identified, increasing the validity of the assessment. Some of these symptoms are noted as initially subjective, like GI upset, stomach cramps, but then eventually the patient is experiencing objective signs like diarrhea and vomiting. The same can be true for tremor. The patient is feeling tremulous, but eventually there are clear signs of tremor or muscle twitching. This scale will be discussed further as we consider the initiation of treatment with buprenorphine in the opiate-dependent patient. Here's a copy of the AUDIT used in screening for alcohol use. It's an excellent screening tool used widely in healthcare settings. The use of alcohol with opioids, including buprenorphine and methadone, can increase the potential for overdose. Consequently, it's important that the use of alcohol and all other sedatives be assessed in patients and that patients are given clear warnings about the risk of using alcohol with any opioids. This is a PHQ-9. As stated, it's a screening questionnaire to determine symptoms of depression and often associated anxiety. It should be noted that question number 9 asks about thoughts associated with the patient feeling they would be better off dead or hurting themselves in some way. If the patient says yes to this question, this should trigger a more urgent or emergent assessment for safety. With Gwen, as with all of our patients, we will do a physical exam. On completing the physical exam of the patient with an opioid use disorder, there are a variety of signs that can indicate current use or withdrawal. There may be signs indicating injection drug use, particularly associated with markings on the skin. There may also be indicators of medical problems associated with chronic substance use, and in particular injection drug use. Although opioids themselves are not as toxic to the body as other substances like alcohol, chronic use can result in high-risk use, including injection drug use, high-risk sexual activity, and general exposure to trauma. You've now had some previous exposure to both signs of intoxication and withdrawal to opioids. As you'll see with Gwen, opioids are a depressant. Consequently, during intoxication, you see droopy eyelids, slowed respirations, and a nodding head. You may also see consistent physical attributes associated with the use of opioids, like constriction of the pupils. Withdrawal symptoms are a result of the compensatory response the body has taken to the chronic sedation associated with long-term use of opioids. After long-term use, when the opioid is taken away, this compensatory response is now unchecked, resulting in a significant norepinephrine release. Patients then experience profound restlessness, insomnia, abdominal cramping, and diarrhea. Sometimes they also have vomiting. They have consistently dilated pupils, sweating, and pylorerection. It's these last three signs, the dilated pupils, sweating, and goosebumps, that are important to identify when assessing the timing for the initiation of buprenorphine. Baseline laboratory screening should include a pregnancy test for all women of childbearing age and drug screening. Drug screening is done most typically at the point of care, utilizing immune assays for common drugs of misuse. This is usually done at every visit. More extensive laboratory testing is important mostly in determining problems the patient may have overlooked secondary to poor health care and those that may be associated with their injection drug use, for example, HIV and Hep C. Hepatitis C is endemic in this population. Liver function studies are important to determine because the medications for opioid use disorder are metabolized in the liver. Both Hep C and HIV can be treated concurrently with the use of medications for opioid use disorders. If the liver enzymes are three times normal, it's appropriate to obtain hepatic consult. However, there's no clear indication that the treatment of an opioid use disorder should be withheld while you investigate or treat hepatic disease. Patients should be aware of the complications that could result from the use of either buprenorphine or more importantly naltrexone when there is some level of hepatic impairment. Also, a complete blood count is listed here because megaloblastic anemia is often associated with a level of risky alcohol use. This is an important laboratory marker because it is such a commonly ordered test and it can be an indication of the patient's misuse of alcohol. Now that we've gathered this information, it would be relatively straightforward to identify the severity of Gwen's opioid use disorder. You've been presented with a table of the DSM-5 criteria for opioid use disorder. I want to point out again that tolerance and withdrawal symptoms are going to be apparent in anyone having taken opioids for even a couple of weeks. So the occurrence of these two criteria alone does not meet the criteria for opioid use disorder. On further review, you see that this is roughly a progression of disease. Using a larger amount over a longer period of time may lead a person to consider cutting back, but they find they can't cut back and when they try, their cravings get worse. So more and more time is spent revolving around their drug use. So they're missing out on other obligations like work and family. This, of course, can also result in using drugs in a more hazardous situation and ultimately losing consideration of the risks of using. Remember the neurobiological changes in the medial orbitofrontal cortex? All of this adds up to severe loss of control and continued use. Please remember that this is science and a biological problem. We are animals that respond to our environment and we create patterns of behavior that are identified by neurobiologic changes in our brains, but we can change them. Medications can reduce the impact, allowing us to then set up new patterns of behavior if we're motivated and remain mindful. But when we're referring to addiction, this is an incredibly difficult challenge. So we have now reviewed the initial patient assessment, which will help determine the level of care most appropriate for the treatment of the patient's opioid use disorder. As you consider Gwen's comprehensive assessment, ask yourself, would this patient be appropriate for your clinic considering these criteria? Obviously, you would want to know that the patient carries a diagnosis of moderate to severe opioid use disorder. You also want to feel comfortable treating or referring the patient for any co-occurring diseases, both medical and psychiatric. And there are other practical points, like will the patient be stable enough to be compliant with your treatment? Are there insurance considerations? What other treatment settings are available in your community? And which treatment option is the patient's preference? What are the risks and benefits to treating the patient for an opioid use disorder in an office-based setting? These are all important considerations prior to establishing a plan. It is important to review with Gwen the cost of treatment and what other options might be available in your community. There should be some understanding of the cost the patient will incur. This includes the medical visits, behavioral healthcare, and the cost of laboratory tests and medication. There are also costs associated with more intensive treatment, either in an intensive outpatient program or an inpatient program. Residential treatment is also an option, but typically only partially covered by commercial insurances. Again, before you establish a relationship with the patient and the treatment of their opioid use disorder, it's important that you feel comfortable with the fact that you can treat them suitably in your office-based setting. Therefore, it's important to consider, can Gwen adhere to the treatment requirements? And are there psychosocial circumstances that she's currently experiencing that would either add to the stability or be disruptive in this patient? This may include stable housing or drug use by others in their home. Is she taking medications that would interact with the buprenorphine? Clearly, the patient cannot be on naltrexone and an opioid antagonist. There are greater subtleties in the concurrent use of benzodiazepines or other sedatives, but also potential for significant risk. So we need to discuss this if the patient is not going to discontinue benzodiazepines. Are there resources available in your office to provide appropriate treatment? Is there adequate coverage during the off hours? If you take this patient on, are there others in the community that you could refer to for support or a transfer if the patient needs a higher level of care? Typically, the treatment plan with a patient would include items such as, the patient must understand the appropriate use of medications, which includes taking them as prescribed and not sharing them or misusing their buprenorphine by injecting it or diverting it by selling it. Avoid the use of alcohol or other drugs that may either increase the health risks associated with buprenorphine or put the patient at risk for relapse. And an awareness of and ability to contact the patient's primary care provider. It will be important for Gwen, as with all patients, to understand that the use of other drugs, including alcohol, while being treated for an opioid use disorder will put them at risk for adverse events, including relapse. We should assess for the potential of withdrawal symptoms the patient may experience in stopping the use of alcohol and refer them to an appropriate level of care if needed. The use of other drugs, for example, marijuana or cocaine, are not an absolute contraindication in treating a patient with buprenorphine. However, it does increase their potential for relapse to the drug of choice, which is opioids. There is somewhat controversial evidence around cannabinoid products and it's not a topic that's covered in this training. However, the patient should fully understand that there is clear evidence of addiction to cannabis. It has clear psychiatric associated problems along with cognitive impairment. Currently, there is no medication to help treat cocaine dependence, which is often seen in association with the use of opioids. This can complicate treatment significantly and it may mean that the patient needs a higher level of care. There are behavioral treatments that can be helpful, but this may not be available in an office-based setting. A goal of treatment is overall improvement in the patient's health and well-being and the use of any mind-altering substances with regularity is not healthy. If Gwen is using other non-prescribed medications or other drugs, they may need a more intensive level of care. These may be patients that would be better treated in an opioid treatment program using methadone. This is because there would be onsite daily administration of the medication and early stabilization of the patient, which allows for more frequent interaction with treatment providers. An alternative to this may be intensive outpatient programs or residential treatment. And often, a patient moves between these more intensive programs and office-based treatment. It's important to understand that buprenorphine is a medication for the treatment of opioid use disorders and no other drugs of misuse. It has no direct impact on the treatment of stimulants, cannabinoids, or alcohol. However, having patients return on a regular basis and be retained in treatment allows us some opportunity to monitor and talk to them about their other drug use. Misuse of other drugs is prevalent among this population, and it can clearly interfere with the overall treatment adherence and success. The provider should also keep in mind that patients may misuse their prescribed medications and continue to monitor for this. There's been concern about the misuse of gabapentin in this population, and so it should be monitored. However, there's no contraindication to the prescribing of gabapentin or any other pharmaceutical other than benzos during the treatment with buprenorphine. Buprenorphine products do have a street value. You will frequently have patients present for treatment having used buprenorphine that they obtained on the street or from a friend. Buprenorphine should be prescribed in a way to reduce the potential that your patient might be selling or giving away their medication to others. However, there is evidence that patients who've tried buprenorphine outside of a medical setting are often the most successful because they've experienced the reduction in their cravings and the ability to move forward in their lives while taking the medication. Lab results can provide some understanding of how the patient is taking their buprenorphine. Buprenorphine can be identified on point-of-care testing through immune assays, but using confirmatory testing can give you more helpful information. Confirmation by either gas chromatography mass spec or liquid chromatography mass spec will also include norbuprenorphine, an active metabolite of buprenorphine. Typically, norbuprenorphine will be close to three times the level of buprenorphine in a urine specimen. If there's no norbuprenorphine, then the patient likely put their medication directly into the specimen cup. If there's very little buprenorphine and a large amount of norbuprenorphine, then they have probably not taken their medication in greater than 24 hours. And if there's a large amount of buprenorphine and very little norbuprenorphine, they have not been taking it regularly, but just took it just prior to coming into the treatment that day. In order to reduce diversion, we can do a couple of things. Monitor urine drug screens, which we do for all patients, and we can do pill counts. Pill counts are most often only done with those patients where there's specific concern, and patients should be aware that this is a possibility ahead of time. Other ways of managing potential diversion may include attempting to use the lowest effective dose, that is the dose that reduces cravings. We'll talk more about dosing in the future, but typically doses greater than 16 milligrams will put the patient at risk for diversion, meaning that they can take a smaller dose to reduce their own cravings, and then they can share or sell the rest. Other things that can be helpful would be more frequent visits, shorter duration of prescriptions, and increasing therapeutic or psychosocial supports. There will be patients for whom it becomes clear that they need a higher level of care. It's essential to remember that this is a lethal disease, and that patients should not be discharged from your practice without a very clear referral to the higher level of care. If you've determined that they need more intensive care, the current status should be reviewed with the patient. Sometimes a review of the initial treatment agreement can be helpful. It can be used to clarify that the patient is no longer in agreement with that treatment, and then options should be made available to the patient for higher levels of care. Some examples are intensive outpatient treatment, partial hospitalization, referral to an opioid treatment program, the need for intensive psychiatric care, or even residential treatment. It may be appropriate to let the patient understand that successful treatment at one of these higher levels of care may result in them returning to you for ongoing treatment. Although we've spent most of our time talking about Gwen as an example of patients being initiated on buprenorphine, and this is in part because that is the medication for which you need this waiver training to be able to provide, it's important for you to understand that there is significant value to considering two other medications, naltrexone and methadone, for some patients. Naltrexone has been shown to be most effective when delivered as a long-acting injectable. There are patients that will benefit significantly with the use of this medication. Often these are patients who have a higher level of stability, and they do need to be completely free of opioids for seven to 10 days prior to starting the medicine. Typically, they have to have a high degree of motivation to attain this level of abstinence. There will be some patients that have tried agonist therapies and clearly want to try an antagonist treatment like naltrexone instead. There may be patients that have tried antagonist treatment in the past because there was no access to agonist treatment. There are also patients who have been in a controlled setting like incarceration or hospitalization with no access to opioids and want to be on an antagonist treatment so they don't have to have re-exposure to an opioid. One could also consider using an antagonist in a setting where there's been a shorter duration of an opioid use disorder. Long-acting injectable naltrexone has shown significant evidence of helping patients with opioid use disorder and helping them move on with their lives. And what about methadone? Which patients might be most successful or referred for this level of care? What ideas do you have about this? I would consider patients that need more structure and would do better with observed dosing of their medications. There often is concurrent behavioral care at opioid treatment programs which allows patients to be provided their medication and behavioral treatment at a single location. If the patient lives in a poorly structured setting where they can't safely store their buprenorphine, they may also do better at an opioid treatment program where the medication is given on site. We'll be talking more about co-occurring pain, but there has been reason to believe that patients needing ongoing pain medications in the form of full opioid agonist might be better treated with methadone, which is also a full opioid agonist. There's also some conflicting evidence that higher doses of methadone increase the compliance and success of patients with an opioid use disorder better than standard doses of buprenorphine. It should be clear, however, that methadone has been highly successful for patients for nearly 50 years in helping them stabilize their opioid use disorder, reduce infectious diseases associated with injection drug use, reducing criminal activity, improving social functioning, and reducing overdose deaths. As we've now reviewed the initial assessment of our patient, Gwen, the determination of treatment modality and level of care, let us now finish this module with a discussion of the development of the treatment agreement. At this point, the patient should understand the goals of treatment and your expectation of patients and treatment in your setting. There should also have been a discussion and potential signing of the treatment agreement and a release of information from other providers associated with the patient's care. The use of the treatment agreement is to outline your treatment expectations and the patient's expectations of your office. This should include information for patients about safe use and storage of buprenorphine. There are a variety of clinical tools on the PCSS website that include consent forms and examples of treatment plans that can be used to develop your own treatment plan, one that is more appropriate for your setting. The treatment agreement should include various key components. Patients should arrive at their appointments on time. They should be courteous to other patients and staff. Patients will not come to the office under the influence of other drugs. They will agree not to share or give their medications to others. They will agree not to be involved in illegal activity associated with the sale of drugs. They will understand that medications will be provided at their office visits and not over the phone. Patients will also be responsible for the safe storage of their medications. They will agree to inform you if they see other providers or are prescribed other medications. And patients agree to take the medication as prescribed. As you begin to do this work, it's important to consider again how prepared is your office and the people that work in your office to do this successfully. It really does take a team. It's very important that you continue to talk with everyone in your office that has a role in this care, including administration, about their understanding, experiences, and comfort with working with these patients. Once it's established, it is frequently found that the team will find this a highly satisfying area of healthcare as they watch patients' lives improve. From all that we've discussed, what are the most important points that you will remember? Now that you've considered what you've learned from this module, take a look at the summary.
Video Summary
In this video, Dr. Kelly Fedorio discusses the evaluation of patients with opioid use disorder and the importance of building a therapeutic alliance with the patient. She emphasizes the need for healthcare providers to maintain a nonjudgmental attitude and to remain empathic towards the patient's suffering. Dr. Fedorio highlights the importance of using non-stigmatizing language and maintaining patient confidentiality while also prioritizing patient safety. <br /><br />She discusses the comprehensive assessment of patients, including obtaining a medical and psychiatric history, reviewing physical evidence of disease, and seeking collateral information from other providers. The video also mentions the importance of using screening tools to assess for underlying substance use and psychiatric problems. Dr. Fedorio explains the significance of conducting a physical examination to identify signs of current opioid use or withdrawal.<br /><br />The video discusses the treatment options available for patients with opioid use disorder, including buprenorphine, naltrexone, and methadone. Dr. Fedorio emphasizes the need for patients to understand the appropriate use of medications and the potential risks associated with alcohol and other drugs. She also mentions the importance of monitoring patients through urine drug screens and pill counts to reduce the risk of diversion.<br /><br />Lastly, Dr. Fedorio talks about the importance of establishing a treatment agreement with the patient and involving the entire healthcare team in providing effective care. She concludes by highlighting the need for ongoing support and monitoring to ensure successful treatment outcomes.
Keywords
opioid use disorder
therapeutic alliance
comprehensive assessment
treatment options
monitoring
patient safety
substance use
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Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 and grant no. 1H79TI085588 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
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