Buprenorphine Checklist for Opioid Use Disorder Treatment
[checklist value="Does the patient have a diagnosis of opioid dependence?|Are there current signs of intoxication or withdrawal?|Is there a risk for severe withdrawal?|Is the patient interested in buprenorphine treatment?|Does the patient understand the risks and benefits of buprenorphine treatment?|Can the patient be expected to adhere to the treatment plan?|Is the patient willing and able to follow safety procedures?|Does the patient agree to treatment after a review of the options?|Can the needed resources for the patient be provided (either on‐ or offsite)?|Is the patient psychiatrically stable?|Is the patient actively suicidal or homicidal?|Has he or she recently attempted suicide or homicide?|Does the patient exhibit emotional, behavioral, or cognitive conditions that complicate treatment?|Is the patient pregnant?|Is the patient currently dependent on or abusing alcohol?|Is the patient currently dependent on benzodiazepines, barbiturates, or other sedative‐hypnotics?|Is the patient at low or average risk for continued use or continued problems?|Does the patient have a history of multiple previous treatments or relapses, or is the patient at high risk for relapse to opioid use?|Is the patient using other drugs?|Has the patient had prior adverse reactions to buprenorphine?|Is the patient taking other medications that may interact with buprenorphine?|Does the patient have medical problems that are contraindications to buprenorphine treatment?|Are there physical illnesses that complicate treatment?|Does the patient have a favorable recovery environment?|Are the patient’s psychosocial circumstances sufficiently stable and supportive?|Does the patient have an average or high level of motivation?|Is the patient's stage of change known and favorable?"] [checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).isNot('')"] reference: [link url="http://www.ncbi.nlm.nih.gov/pubmed/22514846" memo="#1"] Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2004.[/conditional]
There are 4 form elements.