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OUD

CE / CME

Module 6: Opioid Use Disorder

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurses: 1.00 Nursing contact hour

ABIM MOC: maximum of 1.00 Medical Knowledge MOC point

Optometrists: 1.00 COPE CE credit 

ABP MOC: maximum of 1.00 MOC point

ABS MOC: maximum of 1.00 Continuous Certification credit

ABOHNS MOC: maximum of 1.00 Part II Self-Assessment Credit

ABPath MOC: maximum of 1.00 Lifelong Learning point

Dental Professionals: 1.00 ADA CERP credit

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: May 31, 2023

Expiration: May 30, 2026

Timothy Atkinson
Timothy Atkinson, PharmD, BCPS, CPE
CME/CE Information

Activity

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Course Completed

Treatment Setting Considerations OBOT vs OTP per Guidelines

This is a comparison of OTPs vs OBOT and the guideline recommendations for each.27 First, if an OBOT program has the resources for successful treatment, then that setting should be encouraged. This is the setting in which the patient has good psychosocial support, based on history with the practice. However, if a patient experiences multiple relapses or setbacks in treatment, then it may be necessary to reevaluate whether OBOT has the resources that are necessary for that patient.

That being said, the guidelines are also very clear that some treatment is better than no treatment, and if there is no OTP or more intensive treatment setting that is geographically accessible to the patient, then OBOT may be the best alternative.

Payor Priorities vs Guideline Recommendations

Psychosocial interventions and care coordination have not been a payor priority over the years. Payors often recommend 12 step facilitation programs like Alcoholics Anonymous or Narcotics Anonymous instead, because they are free. They often will not authorize payment for inpatient services or residential rehab because of the cost and will recommend outpatient treatment where possible.

Payors are now investing heavily in care coordination services because they have noticed that when patients repeatedly overdose and are admitted to ICUs, that turns out to be very expensive. Connecting patients with care between episodes can dramatically decrease cost and is, of course, better for patients.

Provider/Patient Counseling Strategies

Many forms of counseling have been shown to be effective in OUD treatment and it is important to match the method to the individual case.27,39 Contingency management, cognitive behavioral therapy, community reinforcement approach, standard individual counseling, motivational interviewing, and 12 step facilitation or peer support groups can all be quite helpful. The hope is that there are resources to find the best strategy for each patient.

Contingency management probably has the highest level of evidence at this time and includes positive reinforcement to change behaviors. It can be as simple as allowing patients to take treatment doses home when they have reached a stable point in their treatment. This can be very motivating for patients.

Care Coordination/Case Management

Care coordination and case management help patients deal with their environment in which they may have had social cues and peer pressure for use.27 There can be so many different social aspects that need to be navigated, including family, housing, legal issues, or food insecurity. Care coordination and case management can make an extraordinary difference in someone’s ability to maintain recovery.

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