The American Society of Addiction Medicine Standards describes the value of “comprehensive evaluation.” The “comprehensive assessment” is known as the “a critical aspect of patient engagement and treatment planning’’ and should be conducted during the initial phase of treatment.” The treatment should start with this test. (“ASAM Stand. Care Addict. Spec. Physician,” 2004)
The evaluation of the patient is not essentially the initial visit. The assessment is a critical process and determines the emergency problems. There are concomitant physiological and psychiatric situations which may complicate the treatment of the patient. Due to this reason, the patient needs high attention and care. They have to be transferred to a higher degree of medical history as the regular use of drugs may cause poor treatment results. There are pieces of evidence that show that the use of some drugs during opioid use disorder may result in a poor prognosis. (Author links open overlay panelUdi E.GhitzaDavid H.EpsteinKenzie L.Preston, 2007)(Lions et al., 2014)(Preston et al., 1998)
This history should have the following considerations
· The testing for concomitant disease or medical conditions
· Determination of medications
· Identification of allergies
· Identification of pregnancy
· Determination of family medical history
· Determination of the patient’s social history
Special Attention Seekers
Ø Patients with infectious disease history, such as HIV, hepatitis, and TB
Ø Acute trauma patients
Ø Psychiatric patients
Ø Patients with a history of substance use, addiction treatment, or addictive behavior
Ø Patients with a history of pharmacotherapy
It is examined by a professional and experienced physician, any other authorized person, or any prescribing physician. All the records should be maintained and recorded before the start of medication for the opioid disorder.
The assessment should comprise of identification of “objective physical signs” of opioid withdrawal or intoxication. Table 1 shows some common signs of withdrawal.
Table 2 shows a list of physical signs of substance (opioid) use disorders. Special care should be made in the identification of IDU by noting the presence of old or new puncture marks. Mostly, injection sites are inside the elbow at the cubital fossa and forearm, but they can be some sites on the extremities.
Evaluation and History taking for Females
The utilization of contraceptive pills and pregnancy are some of the important factors for determining the best treatment. It should be noted that as the treatment becomes effective, the fertility also increases. For the management and treatment of females, sessions with gynecologists are essential.
Lab Tests and Reports
The initial lab testing should include reports of HIV and hepatitis. Mostly, vaccination and serology are advised.