Opioid-use disorder

Focused assessment #

Establish opioid type, route, last use, prior overdose, tolerance, withdrawal, sedatives/alcohol, pregnancy and medical/psychiatric comorbidity. Assess immediate respiratory and sedation findings.

Discuss goals, treatment history, housing/support and access barriers. Investigations should address the clinical question, including infection risks where relevant; tests do not replace the interview.

Medication options #

Buprenorphine and methadone support ongoing agonist treatment; induction requires a supervised protocol matched to opioid exposure and clinical findings. Naltrexone requires a suitable opioid-free interval and can precipitate withdrawal.

Explain options, monitoring and continuity. Formulations are not automatically interchangeable; product and service authorization must be checked locally.

Overdose prevention #

Discuss naloxone access, how companions recognize overdose and how to obtain emergency help. Reduced tolerance after abstinence or stopping treatment increases overdose vulnerability.

Naloxone may wear off before the opioid. Support breathing, seek emergency assistance, give repeat doses according to the device instructions and continue observation. A response is not a declaration of safety.

Continuing care #

Review craving, withdrawal, opioid/other substance use, adverse effects, mental health and practical barriers. Match visit frequency and psychosocial support to need.

Avoid arbitrary medication end dates. If withdrawal or tapering is chosen, explain relapse risks and arrange continuing treatment and overdose prevention. Plan uninterrupted care during transfers.

Related tools & reading #

Clinical Opiate Withdrawal Scale (COWS)

Buprenorphine reference

Buprenorphine naloxone reference

Methadone reference

Naltrexone reference

Naloxone reference

Substance use disorders

Medication emergencies