Resources for Providers

When a patient requests opioids for pain

• Physician Handout: Summary CDC Guidelines for Treating Pain with Opioids - 12.27-2023 (pdf)
• Physician Handout : The Genetics and Neurobiology of Opioid Use Disorder - 12/27/2023 (pdf)

When a Patient Might Have Opioid Use Disorder

• Physician Handout: I am concerned - 12/27/2023. What to say When You Think Your Patient Might Have Opoid Use Disorder
• Physician Handout: Buprenorphine and Methadone for Opioid Use Disorder - 12/27/2023 (pdf)
• Physician Video: Corey Waller & Andrea Rubinstein Role Play talking to Patients on Opioids. Corey Waller, M.D., Andrea Rubinstein, M.D., California Health Care Foundation
• Physician Video: How to talk to Patients About Reducing Opioids. Corey Waller, M.D. California Health Care Foundation

Recent guidance (Nov. 2022)

• CDC's Treatment for Opioid Use Disorder Before, During, and After Pregnancy Contains sections: Medication for Opioid Use Disorder (MOUD) During Pregnancy; Treatment for an Infant Affected by Neonatal Opioid Withdrawal Syndrome (NOWS); Management of NOWS with the Use of Medication; Breastfeeding; After Hospital Discharge; Plans of Safe Care; Treatment for People with Opioid Use Disorder after Delivery; Screening for Other Mental Health Conditions.
• CDC's About Opioid Use During Pregnancy
  General information. Imbedded links to ACOG bulletin, CDC guidelines for pain.

Older guidance that contains useful information

• Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants (pdf).
  Prenatal Care: 8 factsheets, including prenatal screenings, therapy initiation, changing pharmacotherapy, polysubstance use, peripartum pain relief.
  
  Infant care: 5 factsheets, including Neonatal Abstinence Syndrome, breastfeeding, developmental assessment.
  
  Maternal Postnatal Care: 3 factsheets, including pharmacotherapy, relapse.
• American College of Obstetricians and Gynecologists Bulletin 771, Aug 2017 Opioid Use and Opioid Use Disorder in Pregnancy
• Neonatal Opioid Withdrawal Syndrome
  Patrick, S.W., Barfield, W.D., Poindexter, B.B. er al., American Academy of Pediatrics, 2020, 146(5).
  
  OUD in Pregnancy and NOWS, Assessment and Clinical Presentation, Clinical Presentation of NOWS in Neonate, Screening and Testing, Diagnosis and Treatment, Clinical Management of NOWS, Pharmacotherapy, Preparing for Discharge
• CDC Polysubstance Use in Pregnancy
  Contains information and additional links to information regarding polysubstance use during pregnancy.

• Physician Handout: General Buprenorphine Treatment Guidelines - 12/27/2023 (pdf)
• Physician Handout: Low dose buprenorphine protocols for patients using fentanyl - 12/27/2023 (pdf)
• Physician Link: Physician Link to source to check for guideline updates
• Physician Handout: Clinical Opiate Withdrawal Scale (pdf)
• Physician Handout: Low dose buprenorphine protocols for patients using fentanyl - 12/27/2023 (pdf)
• Warm Line Phone Numbers for Assistance Treating Patients
  1. University of California, San Francisco National Clinician Consultation Center
     • California Substance Use line 1-844-326-2626
     • National Line 1-855-350-2595

• Physician Handout: MAT Referral Guidelines. Which Type of Program - 12/27/2023 (pdf)
• Physician Handout: MAT Referral Form - 12/27/2023 (pdf)
• Physician Handout: Medication Assisted Treatment for (MAT) Providers - 12/27/2023 (pdf)

Excellent and extensive source of free provider resources related to SUD. Mentors also available. For the standard 8 hr buprenorphine training, under MOUD Course, click "physicians" for the training formats/options. There are many other educational opportunities available here.

Websites

1. American Association for the Treatment of Opioid Dependence (AATOD) - Educational materials regarding opioid use disorder and its treatment.
2. American Society of Addiction Medicine (ASAM) - Courses that meet the new DEA requirments for SUD Education (residents $99; members and early career providers $149; non-members $199) for 2023
3. ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update – an excellent, fairly up-to-date guideline.
4. CDC
   1. Prescribing Opioid for Pain
      1. Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. A wealth of up-to-date evidence-based information regarding prescribing opioids for acute, sub-acute, and chronic pain, and for identifying and responding to opioid use disorder.
      2. Training for Healthcare Professionals -Updated June 2023. Link Connects to 8 training modules: "CDC" 2022 Clinical Practice Guideline for Prescribing Opioids for Pain", Buprenorphine for the Treatment of Opioid Use Disorder", Assessing and Addressing Opioid Use Disorder", and "Motivational Interviewing".
   2. Preventing/Treating OUD
      1. Prevent Opioid Use Disorder – Updated Oct. 2022
      2. Opioid Use Disorder: Preventing and Treating – Updated Feb. 2023
   3. Opioids / Opioid Use Disorder During Pregnancy
      1. About Opioid Use During Pregnancy – Updated June 2023
      2. Resources on Opioid Use During Pregnancy – Updated Jun 2023
      3. Treatment for Opioid Use Disorder Before, During, and After Pregnancy – Updated Dec. 2022
      4. MAT-LINK: MATernaL and Infant Network to Understand Outcomes Associated with Medication for Opioid Use Disorder during Pregnancy – Updated April 2023
5. National Clinician Consultation Center (NCCC) – Scroll down to "Substance Use Management" for substance-use disorder resources, links to key treatment guidelines, 24/7 warm lines.
6. National Institute on Drug Abuse (NIDA) many useful resources under the clinical resources tab.
7. Providers Clinical Support System (PCSS)- Excellent and extensive source of free provider resources related to SUD. Mentors also available. Free courses that meet the new DEA requirements for SUD education. For the standard 8 hr buprenorphine training, under MOUD Course, click “physicians" for the training formats/options. MANY other education opportunities.
8. Substance Abuse and Mental Health Services Agency (SAMSHA)
   1. General Website
   2. Evidence Based Practices Resources Center
   3. May 2021 Executive Summary for Healthcare and Addiction Professionals, Policymakers, Patients, and Families. Medications for Opioid Use Disorder: A Treatment Improvement Protocol TIP 63.
   4. May 2021 TIP 63 Full document
   5. SAMHSA Quick Start Buprenorphine Guidelines
   6. SAMHSA Advisory: Evidence-Based Whole Person Care for Pregnant People who have Opioid Use Disorder.

Videos

1. Addiction Neuroscience 101/Addiction Overview. Corey Waller, M.D., Complex Care
2. Corey Waller & Andrea Rubinstein Role Play talking to Patients on Opioids. Corey Waller, M.D., Andrea Rubinstein, M.D., California Health Care Foundation
3. How to talk to Patients About Reducing Opioids. Corey Waller, M.D. California Health Care Foundation
4. Corey Waller: Medication-Assisted Treatment during Pregnancy. Corey Waller, M.D. California Health Care Foundation
5. Understanding Opioid Addiction: The Role of Genetics and Neurobiology. Lyn Raible, M.D., Ph.D., Modesto Junior College Health Living Series, Spring 2023 Lecture 2

Power Points

1. Alternative Buprenorphine Induction Strategies, Clement Chen, June 2021, Rutgers

Isotonitazene- synthetic opioid more potent than fentanyl

1. Public Alert - N-Desethyl Isotonitazene

Xylazine - large animal tranquilizer mixed with fentanyl to prolong fentanyl action, no reversal agent, severe necrotic skin ulcerations

1. CDPH Alerts
1. CDPH Xylazine Information

   Basic information about xylazine, California’s action plan, and links to resources, including: Xylazine Wound Care Fact Sheet and other wound care links; webinar “Xylazine: An Introduction for Service Providers Working with Unhoused Individuals.

2. All Facilities Letter : Xylazine in the Illicit Drug Supply and Patient Practice
3. Issue Brief : Xylazine, Health Risks and Harm Reduction Strategies
4. March 2023 : Letter to Local Health Officers from CDPH and State Public Health Officer
5. California Health Alert Network (CAHAN): Xylazine in Illicit Fentanyl in the United States
2. 11-8-2022 FDA announcement
3. FDA letter to stakeholders
4. White House Action Plan