1. Medi-cal covered inpt tx in SoCo?
Opioid Use Disorder (1)
C.L.I.P.S.
Who is at risk? What is at stake?
Everyone! Opioid rx > 3 mths increases risk.
Enough norco circulating for everyone in US to take 5/325 mg q4h for 6 weeks
2006 to 2009, 80% increase in CA tx program admissions for rx opioids
24% Sonoma Co 11th graders have taken rx opioids compared to 17% rest of CA
2014 data shows majority of heroin users seeking tx started use with rx opioids
OUD is a fatal dz. So Co drug OD mortality rate 14.1/100K vs 10.5/100K rest of CA
Treatment of OUD is primary prevention for HIV/HCV!
Screen for risk before prescribing
Opioid Risk Tool
5 categories (Fam or personal hx SUD, age 16-45, Hx of preadolescent sexual abuse, psych dx)
Sens 0.58, spec Not great. 
Screen for mental health
PHQ2, PHQ9
Screen for risk of respiratory depression
STOP-BANG, sleep apnea screening tool
Screen for compliance and diversion
Urine drug screening
Patient Activity Report
Pill counts
Dependence vs Abuse vs Addiction
Doesn’t matter with DSM-V
No “abuse.” Spectrum of “Use Disorders”
More clear. Less pejorative. 
Medi-cal covered inpt tx in SoCo?
DAAC, WRS, CHD
37 non-CDJ beds
2-3 week wait
[CDC]

2. Opioid Use Disorder (2)
C.L.I.P.S.
Opioid Use Disorder Criteria
Opioids taken in larger amounts or over longer period than intended
Persistent desire or failure to cut down/control opioid use
Great deal of time spent trying to obtain or use opioids or recover from effects
Craving
Continued use despite failure to fulfill obligations at work, school, or home
Continued use despite persistent social/interpersonal problems caused by use
Give up other activities because of use
Recurrent use in situations in which it is physically hazardous
Continued use despite knowledge of persistent physical or psychological problems caused by use
Tolerance*
Withdrawal*
Severity
Mild: 2-3
Moderate: 4-5
Severe: 6+
Recent actions on the epidemic
Pill mills shut down
Pain guidelines revised
Norco rescheduled
Naloxone FDA approved
PDMPs enhanced
Macklemore on the mic
What can you do?
True or False?
Tolerance and withdrawal are excluded from the diagnostic criteria if opioids are prescribed and taken properly.
TRUE!
JAMA Psychiatry. 2014;71(7):
Updated 1/16 K.Greer