Patients with this risk level are using illicit opioids (for example: heroin and fentanyl) in ways that can have important implications for their health, and may meet DSM-5 criteria for Opioid Use Disorder at a lower level of severity. They are at some risk for adverse outcomes associated with their heroin use, including overdose.
Display Title
Opioids Risk Level: Problem use - Risk for Adverse Outcomes
Tool Type
Drugs of Abuse
Risk Level
Moderate
Additional Resources
Opioid Use Resources
- Prescribe to Prevent
- Opioid Overdose Prevention Toolkit – SAMHSA
- Medication Assisted Treatment (MAT) Resources – SAMHSA
- Providers' Clinical Support System For Opioid Therapies – PCSS
- Providers’ Clinical Support System for Medication Assisted Treatment – PCSS
- National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use – ASAM
- Opioid Use Disorder Education Program – Harvard Medical School
- SAMHSA TIP 63: Medications for Opioid Use Disorder – SAMHSA
General Resources
- Screening, Brief Intervention & Referral to Treatment Training Manual – Yale School of Medicine
- Behavioral Health Treatment Services Locator – SAMHSA
- Motivational Interviewing Skills Practice – NIDA
- OARS Essential Communication Techniques – Oregon.gov
- Principles of Drug Addiction Treatment: A Research-Based Guide (3rd ed.) - Behavioral Therapies – NIDA
Suggested Action
The suggested intervention for patients in the “problem use” group is to explore the severity of problem use through a clinical interview using DSM-5 Opioid Use Disorder criteria as a guide.
- Express concern through a brief intervention and recommend quitting.
- Use the FRAMES components and motivational interviewing techniques (see references for specific resources) to encourage change.
- Provide on-site counseling or a referral for off-site counseling and/or support group to complement medication treatment.
- Educate on overdose prevention and prescribe/provide naloxone.
- Assess and manage any co-occurring problems, such as pain and depression that may be impacting opioid use.
- Assess for Hepatitis-C and/or HIV infection risk, especially from injection use.
- Review any prescribed medications to identify those that may increase the risk of overdose (other opioids, benzodiazepines).
- Educate patient on risks associated with injecting stimulants with heroin and with combining heroin with alcohol or other drugs.
- Advise not to use opioids and drive.
- Arrange follow-up