What is the best approach when discussing a potential Opioid Use Disorder (OUD) diagnosis with a patient?

Best Approach for Discussing OUD Diagnosis

Express concern about safety and offer a treatment plan including evidence-based therapies (e.g., buprenorphine) is the correct approach when discussing a potential OUD diagnosis with a patient. 1

Communication Framework

When you suspect OUD, the CDC guidelines explicitly recommend that you:

• Discuss your concerns directly with the patient in a non-judgmental manner and provide an opportunity for them to disclose related concerns or problems 1
• Frame the conversation around safety concerns rather than blame or fault 1
• Assess for OUD using DSM-5 criteria during this discussion 1

Immediate Treatment Offering

You should offer or arrange evidence-based treatment immediately, which means medication-assisted treatment with buprenorphine or methadone combined with behavioral therapies. 1 The CDC gives this recommendation a Category A rating with evidence type 2, making it one of their strongest recommendations. 1

For college students and younger populations specifically, initiate buprenorphine/naloxone maintenance treatment immediately using a medication-first approach. 2

Why Other Approaches Are Wrong

Immediate Discontinuation and Detox Referral

This approach is dangerous and contradicts evidence-based practice. Abrupt opioid discontinuation increases overdose risk, and detoxification alone lacks scientific evidence for effectiveness. 3 Medication-assisted treatment reduces mortality by up to threefold compared to detoxification alone. 1

Reassuring Continued Long-Term Opioid Therapy

This ignores the diagnosis of OUD entirely. Once OUD is identified, the treatment paradigm shifts from pain management to addiction treatment with medication-assisted therapy. 1

Emphasizing Fault and Blame

This approach is stigmatizing and counterproductive. The evidence consistently emphasizes collaborative, non-judgmental communication. 1 Using an opioid taper agreement or informed consent that emphasizes collaboration and teamwork—not blame—is recommended when treatment changes are needed. 1

Evidence-Based Treatment Components

Your treatment plan should include:

• Buprenorphine or methadone maintenance therapy as first-line treatment (methadone has the strongest evidence for effectiveness) 4, 5
• Behavioral therapies in combination with medication, which reduce opioid misuse and increase retention 1
• Naloxone for overdose prevention provided to all patients with OUD 2
• Indefinite maintenance treatment, as OUD is a chronic relapsing condition requiring long-term management 2, 3

Practical Implementation

If you prescribe opioids but lack sufficient OUD treatment capacity in your community, you should strongly consider obtaining a SAMHSA waiver to prescribe buprenorphine. 1 No waiver is needed for naltrexone. 1

If you cannot provide treatment yourself, arrange for the patient to receive care from a substance use disorder treatment specialist or SAMHSA-certified opioid treatment program. 1

Critical Pitfall to Avoid

Never abandon the patient or discontinue their care abruptly. The goal is patient safety and engagement in evidence-based treatment, not punishment or immediate cessation of all opioids without appropriate medication-assisted treatment in place. 1, 2