Opiates

General Psychiatry, Initial Evaluation, Substance Use History|October 26, 2025|shrink_the_script

Opioid Assessment and Clinical Pitfalls

⚠️ Clinical Pitfall

Incomplete opioid assessment can miss opioid use disorder, increasing the risk of fatal overdose, especially with fentanyl contamination. Failure to identify use prevents initiation of evidence-based, life-saving treatments such as buprenorphine, methadone, or naltrexone.

🧠 Clinical Significance

Opioids pose unique psychiatric and medical risks, including respiratory depression, withdrawal syndromes, and infectious complications from injection. Understanding use patterns, route, and treatment history guides both acute management and long-term recovery planning. Comprehensive evaluation supports harm-reduction interventions and medication-assisted therapy.

🗣️ Key Assessment Questions

  • “Do you have any history with opioids—pain medications, methadone, heroin, or fentanyl?”
  • “What specific opioid or opioids do you use?”
    • Morphine, codeine (lean, syrup), heroin (H, dope, black tar), hydrocodone (Vicodin, Norco), oxycodone (OxyContin, Percocet, oxys), hydromorphone (Dilaudid), fentanyl (China white), methadone, buprenorphine (Suboxone, bupe), tramadol (Ultram)
  • “How do you use it—swallowing pills, injection, snorting, smoking?” (Demonstrating awareness builds rapport)
  • “Have you been tested for HIV, hepatitis B, hepatitis C, or tuberculosis?”
  • “Are you currently pregnant, or could you be?”
  • “Have you ever overdosed or come close to overdosing?”
  • “Do you use fentanyl test strips to check your drugs?”
  • “If you inject, do you have access to clean needles and syringes?”
  • “Are you connected with any harm reduction services or syringe exchange programs?”
  • “When did you last experience withdrawal symptoms?”
  • “Have you been prescribed or do you possess naloxone (Narcan)?”
  • “Have you tried treatment before—medication for opioid use disorder, counseling, inpatient or outpatient programs?”

💡 Clinical Pearl: Asking about harm-reduction behaviors (test strips, needle exchange, naloxone) conveys safety partnership, not judgment, and dramatically improves disclosure honesty.

🧩 Why This Information Matters

Comprehensive opioid assessment prevents fatal overdose, informs withdrawal and infection management, and supports linkage to evidence-based treatment. Identifying use patterns and prior treatment experiences allows tailoring of medication-assisted therapy and psychosocial interventions. Clinicians who demonstrate fluency in harm-reduction language foster trust, improve safety, and save lives.