This app provides clinical guidance based on the latest evidence-based recommendations for providers looking to start patients on buprenorphine or naltrexone for the treatment of opioid use disorder (OUD). Treatment for OUD with methadone is also discussed, as well as the use of naltrexone for alcohol use disorder (AUD). The app offers information on acute and chronic pain management strategies for patients already on buprenorphine or naltrexone. Guidance is also provided on medication classes to help manage acute opioid withdrawal symptoms.

Drug overdose deaths continue to rise in the United States, with more than 107,000 fatal overdoses in 2021. Overdose deaths from synthetic opioids—primarily illicitly manufactured fentanyl—are driving this epidemic, along with psychostimulants such as cocaine and methamphetamine.

More than 46 million people aged 12 or older (or 16.5% of the US population) met the DSM-5 criteria for having a substance use disorder (SUD) in the past year based on the latest data from the 2021 National Survey on Drug Use and Health (NSDUH). However, only about 6% of people received any treatment for their SUD. Providing addiction treatment, including the use of FDA-approved medications and behavioral health therapies, has been shown to save lives and increase retention in treatment.

The interactive clinical algorithms in this app walk you through each step of the clinical decision-making process to help you care for patients with an OUD or AUD. The clinical algorithms are also available in PDF format for easy viewing along with ability to securely text message patient tools to get started on buprenorphine. Additionally, several other clinical tools and resources related to SUD are included.

BMC MAT QUICK START FEATURES:

CLINICAL ALGORITHMS
* Buprenorphine Quick Start Guide: Pathways for starting patients with an opioid use disorder on buprenorphine with various levels of opioid dependence: those not currently physically dependent on opioids, opioid-dependent and not yet in withdrawal, and opioid-dependent and in active withdrawal.
* Initiation of Monthly Injectable Buprenorphine: Guidance for starting a patient on monthly injectable buprenorphine.
* Naltrexone Initiation for Alcohol Use Disorder: Guidance for starting a patient on extended-release injectable naltrexone for the treatment of alcohol use disorder.
* Naltrexone Initiation for Opioid Use Disorder: Guidance for starting a patient on extended-release injectable naltrexone for the treatment of opioid use disorder. Includes strategies for managing opioid withdrawal during the required “washout period” prior to starting naltrexone and avoiding precipitated withdrawal.
* Pain Management While on Buprenorphine for Opioid Use Disorder: Guidance for managing acute and chronic pain in patients already on buprenorphine for opioid use disorder.
* Pain Management While on Naltrexone: Guidance for managing acute pain (both anticipated and unanticipated) and chronic pain in patients already on naltrexone for opioid use disorder.
* New! List of medication classes to assist in the management of opioid withdrawal symptoms.

CLINICAL TOOLS
* DSM-5 criteria for diagnosis of an opioid use disorder
* Clinical Opiate Withdrawal Scale (COWS) to measure the severity of opioid withdrawal
* Alcohol Use Disorders Identification Test (AUDIT-C) to identify risky drinking patterns

PATIENT HANDOUTS
* Buprenorphine Initiation Guide (available in English and Spanish): A guide to give to patients who are starting buprenorphine in the home or community setting.

Note: This app is designed exclusively for the use of healthcare providers. This app is not intended for use to diagnose a disease or to cure, mitigate, treat, or prevent any condition or disease. It is the responsibility of the treating clinician to rely on their own experience and knowledge about their specific patient to determine dosages and the best treatment for that patient.