Medications for Opioid Use Disorder – Adult – Ambulatory External Clinical Practice Guideline Endorsement Summary Target Population: Adults with an opioid use disorder (OUD) diagnosis who are interested or would benefit from medications for OUD (MOUD). Link to Full Guideline: Medications for Opioid Use Disorder - Adult - Ambulatory Summary of the challenge and associated care model at UW Health • Opioid use disorder (OUD) is a chronic medical condition for which ongoing patient-centered care across all healthcare settings is required to effectively treat symptoms, reduce harm, and achieve and maintain recovery. o OUD is a significant public health threat, affecting 1.6 million Americans in 2019 and causing significant adverse effects for the individual, their loved ones, and society as a whole.1 o There is a major gap between the number of people needing treatment for OUD vs. available services, and there is a critical need to expand access to effective treatments for OUD.2,3 • To help increase access to safe and effective OUD treatment services, UW Health has implemented a Hub and Spoke model of care. o In this care model, the Hub is capable of providing more complex, specialized services for OUD and unstable psychiatric conditions. o Centers of Excellence within Primary care provides complex care not requiring an Addiction Psychiatrist. o Multiple Spoke sites (primary care offices) provide acute care for OUD with less complexity. o In this model, both the spectrum of locations offer medications for OUD (MOUD) as part of a comprehensive treatment plan. Recommendations • UW Health endorses the recommendations pertaining to MOUD found within the Medications for Opioid Use Disorder Treatment Improvement Protocol 63 (TIP 63) produced by the Substance Abuse and Mental Health Services Administration (SAMHSA).3 A high-level summary of the MOUD care process is outlined in Appendix A. • All patients with a diagnosis of moderate to severe OUD should receive counseling about the risks and benefits of all FDA-approved MOUD options and be offered treatment as clinically appropriate: 1) methadone, 2) buprenorphine and buprenorphine/naloxone formulations, 3) naltrexone. (UW Health Moderate Quality of evidence, Strong recommendation). • Some helpful summaries of medication-specific considerations can be found in the following resources: o Exhibit 2.14 Comparison of OUD Medications to Guide Shared Decision Making (pg. 2-19) o Exhibit 2.15 Treatment Setting Based on Patient’s Choice of OUD Medication (pg. 2-21) o Exhibit 3A.1 OUD Medications: An Overview (pg. 3-6) o Exhibit 3A.5 OUD Medications: Formulations (pg. 3-14) • Succinct summaries of buprenorphine considerations can be found in the following quick start guides available through SAMHSA listed below: o Buprenorphine Quick Start Guide (samhsa.gov) o Buprenorphine Quick Start Pocket Guide (samhsa.gov) • It is important to note that medications for OUD are only one important component of care. Other critically important aspects of care include: o Providing brief supportive education and counseling o Referring to ancillary psychosocial services o Offering harm reduction measures o Naloxone prescription for overdose treatment Effective 2/23/2023. Contact CCKM@uwhealth.org for previous versions. Copyright © 2023 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 03/2023 o Referring to psychiatric and medical care if not directly provided by the healthcare professional prescribing or administering OUD medication o Assessment and treatment of other substance use disorders o Counseling and recovery support services A valuable resource for UW healthcare providers seeking guidance in treating their patients' substance use disorder is the UW Addiction Consultation Hotline. Through this resource, addiction specialists can provide advice on the medical management of substance related issues. References 1. U.S. Department of Health and Human Services Office of the Surgeon General. What is the U.S. Opioid Epidemic? Updated October 27, 2021. Accessed July 28, 2022. https://www.hhs.gov/opioids/about-the-epidemic/index.html 2. U.S. Department of Health and Human Services. Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf 3. Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63. Publication No. PEP21-02-01-002. Rockville, MD: Substance Abuse and Mental Health Services Administration, 202 Effective 2/23/2023. Contact CCKM@uwhealth.org for previous versions. Copyright © 2023 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 03/2023 Appendix A. MOUD Care Process Effective 2/23/2023. Contact CCKM@uwhealth.org for previous versions. Copyright © 2023 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 03/2023