Procedures for Medication-Assisted Treatment of Alcohol or Opioid Dependence in Primary Care

by Keith G. Heinzerling, Allison J. Ober, Karen Lamp, David De Vries, Katherine E. Watkins

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Medical providers in primary care settings can play an important role in treating patients who have a substance use problem. FDA-approved medications are now available for primary care doctors in their offices to treat appropriate patients. The addition of these medications to a standard drug or alcohol counseling program or self-help program may improve outcomes over counseling or support alone. This guide is divided into three parts: Part I reviews the approach that primary care providers should take in discussing alcohol or opioid dependence with their patients. Part II is a step-by-step guide to treating alcohol-dependent patients with extended-release, injectable naltrexone in primary care settings. Part III is a reference guide for primary care practitioners administering buprenorphine/naloxone to patients with opioid dependence.

Table of Contents

  • Part I

    Introduction to Medication-Assisted Treatment of Alcohol or Opioid Dependence in Primary Care

  • Part II

    Administering Extended-Release, Injectable Naltrexone for Patients with Alcohol Dependence: A Step-by-Step Guide for Primary Care Practitioners

    • Section One

      Quick Guide for Administering Extended-Release, Injectable Naltrexone

    • Section Two

      Determining Patient Appropriateness for Treatment with Extended-Release, Injectable Naltrexone: Visit 1

    • Section Three

      Administering Extended-Release, Injectable Naltrexone: Visit 1 or 2

    • Section Four

      Assessing Treatment Progress and Adverse Events and Administering Medication, If Appropriate: Follow-Up Visits

    • Appendix A

      Pre-Injection Checklist for Appropriateness for Extended-Release, Injectable Naltrexone

    • Appendix B

      Introduction to the Risks of Extended-Release, Injectable Naltrexone Worksheet (English and Spanish Versions)

    • Appendix C

      Step-By-Step Instructions for the Preparation and Injection of Extended Release, Injectable Naltrexone

    • Appendix D

      Follow-Up Visit Pre-Injection Checklists

    • Appendix E

      DSM-IV Alcohol Dependence Diagnosis Worksheet

    • Appendix F

      CIWA-Ar Worksheet

    • Appendix G

      Wallet Cards

    • Appendix H

      Local Referral Resources

  • Part III

    Administering Buprenorphine/Naloxone to Patients with Opioid Dependence: A Quick Reference Guide for Primary Care Practitioners

The research described in this report was sponsored by the National Institute on Drug Abuse and conducted by RAND Health.

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