1. Bassett-UMass
MAT ECHO

2. Bassett-UMass MAT ECHO 1.25.2017
Opioid Use Disorder: A Review of Diagnostic Criteria and
Tips for Assessment
Bassett-UMass MAT ECHO

3. Objectives Review of the dopamine reward pathway Analogy for patients
Criteria for Substance Use Disorders
Assessment: The 3 C’s
Our interpretation of 42 CFR Part 2
Review of knowledge
Focus on most challenging case
Knowing the criteria also helps identify progress

4. Neurobiology = source of compassion/understanding
Dopamine present = remember, when its not – nothing seems to stick
Memory, decision making, emotional reactions
Drugs artificially inflate dopamine secretion/duration at synapses
Drugs abnormally activate this system, and other activities that should no longer compare
Severity of drug use – long lasting chages in brain circuits, repeated relapse and intense drug craving

5. Hunger Analogy: Helping Patients Understand the DRP
Review of knowledge

6. Pharmacological Criteria
Impaired Control
Social Impairment
Risky Use
Pharmacological Criteria
Cognitive
Physiological
Behavioral

7. Mild: 2-3 symptoms Moderate: 4-5 symptoms Severe: 6 or
Substance Use Disorders
Mild: 2-3 symptoms
Moderate: 4-5 symptoms
Severe: 6 or
more symptoms
Abuse
Dependence
Grey Area

8. Impaired Control
Opioids are often taken in larger amounts or over a longer period than was intended.
There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
Craving, or a strong desire or urge to use opioids.
Early refills, difficulty following through with alternative treatment, requesting higher doses, fear/anger
Response to titration plans, loss of work, emotional symptoms (depression, anxiety, irritability)

9. Social Impairment
Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
Important social, occupational, or recreational activities are given up or reduced because of opioid use.

10. Risky Use
Recurrent opioid use in situations in which it is physically hazardous.
Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

11. Pharmacological Criteria
Tolerance, as defined by either of the following:
A need for markedly increased amounts of opioids to achieve intoxication or desired effect.
A markedly diminished effect with continued use of the same amount of an opioid.
Note: This criterion is not considered to be met for those taking opioids solely under appropriate medical supervision.
Withdrawal, as manifested by either of the following:
The characteristic opioid withdrawal syndromeOpioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.
Note: This criterion is not considered to be met for those individuals taking opioids solely under appropriate medical supervision.

12. Three C’s of Psychological Dependence
Control (loss of)/compulsive use
Craving
Consequences

13. Assessment with patients who lack insight
Very difficult – Time
Educate (hunger analogy)
Primary reliance on objective data in office (Utox screens, pill counts, appt show rate, openness to alternative treatments, interaction with other providers in your health system, Prescription monitoring programs)
Worsening mental health symptoms
Moving away from functional goals
Loop in family members
Normalize re-assessing for psychological dependence as part of safe prescribing
Mild indiscretion Repeated misuse Opioid abuse Opioid dependence

14. 42 Code of Federal Regulations (CFR) Part 2
42 CFR Part 2 are unique privacy protections for patient records that contain content regarding alcohol and drug abuse.
Rationale: stigma and fear of prosecution might discourage patients with SUDs from getting treatment.

15. Meet definition of “federally-assisted” Meet definition of a “program”
Subject to privacy restrictions under 42 CFR, part 2

16. Meet definition of “federally-assisted” Meet definition of a “program”
What qualifies as a “program” and who qualifies as working in a “program”? (SUD care = ETOH/Drug diagnosis, treatment OR referral to treatment)
A provider that does not provide care in a general medical care facility, but holds itself out as providing SUD care.
A provider is an identified unit (providing SUD care) within a general medical care facility.
A provider in a general medical care facility with other medical personal, is a program if its primary function is SUD care and is identified as such within the general medical care facility.
DEA-Licensed
Meet definition of “federally-assisted”
Meet definition of a “program”
Subject to privacy restrictions under 42 CFR, part 2

17. Bassett-UMass
MAT ECHO