Medication-Assisted Treatment for Opioid Use Disorder

Introduction to MAT Protocol

The American Academy of Pediatrics recommends buprenorphine for adolescents and young adults (16+ years) with opioid use disorder due to its accessibility and favorable safety profile 1, 3
Buprenorphine offers the most practical option for college campus settings because it can be prescribed in office-based settings after completing an 8-hour training and obtaining a DEA waiver 1, 2, 4

Verify the patient is opioid-free for minimum 7-10 days for short-acting opioids to prevent precipitated withdrawal 2
Screen for depression, anxiety, and insomnia using standardized tools, as these conditions worsen treatment outcomes if unaddressed 5
Obtain baseline liver function tests due to potential hepatotoxicity risk 5
Check state prescription drug monitoring program (PDMP) data to identify concurrent controlled substances or dangerous combinations 6, 2
Perform urine drug testing to confirm opioid use and screen for other substances 2
Assess for DSM-5 criteria for opioid use disorder - must meet diagnostic criteria before initiating MAT 2, 7

Start with 8 mg sublingual buprenorphine when patient is in mild-to-moderate withdrawal, and titrate to 8-24 mg daily based on withdrawal symptoms and cravings 8
Consider extended-release injectable naltrexone (380 mg monthly) for highly motivated students who strongly prefer opioid-free treatment and can complete 7-10 day opioid-free period 2, 5, 3
Methadone has strongest evidence for treatment retention but requires daily visits to federally certified Opioid Treatment Programs, making it impractical for most college students 3

Arrange substance use disorder counseling - medication alone is insufficient, as behavioral therapy combined with MAT significantly reduces dropout rates and opioid use 2, 7, 3
Connect patient to campus mental health services for treatment of co-occurring depression, anxiety, or other psychiatric conditions 1
Provide overdose education and prescribe naloxone nasal spray for all patients, as overdose risk increases if treatment is discontinued 2, 7, 5

Document DSM-5 criteria met for opioid use disorder diagnosis 2
Record informed consent discussion covering risks, benefits, and alternatives 2, 7
Note PDMP review findings at initiation and ongoing visits 6, 2
Document treatment goals established with patient (e.g., abstinence from illicit opioids, return to classes, improved relationships) 2, 7
Record naloxone prescription provided for overdose prevention 2, 7, 3