Patients with this result are at high risk for adverse outcomes related to prescription opioid use (for example: Percocet, Oxycontin, etc.) and are highly likely to meet DSM-5 criteria for an Opioid Use Disorder.
Display Title
Opioids Risk Level: High Risk for Opioid Use Disorder
Tool Type
Drugs of Abuse
Risk Level
High
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 this risk level is to confirm diagnosis through a clinical interview using the DSM-5 Opioid Use Disorder criteria as a guide.
- Express concern and recommend cessation;
- Use the FRAMES components and motivational interviewing techniques (see references for specific resources) to encourage engagement in treatment.
- Consider prescribing medications to treat moderate to severe opioid use disorder.
- Office-based medication options include prescribing buprenorphine; and for patients who have achieved abstinence, consider prescribing naltrexone for relapse prevention. If you do not or cannot prescribe medications at your office, either refer to an opioid treatment program (for methadone maintenance treatment) or to a buprenorphine prescriber (you may use SAMHSA Behavioral Health Treatment Services Locator).
- 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, which may be impacting opioid use.
- Review any prescribed medications to identify those that may increase the risk of overdose (other opioids, benzodiazepines).
- Educate the patient about risks associated with combining opioids with alcohol or other drugs.
- In the case that a patient did not report heroin use, they may still be at risk of initiating illicit opioid use in the future due to cost and availability constraints of prescription opioids.
- Advise not to use opioids and drive.
- Arrange follow-up.