Module 3: Assessment

Question 1

Assessment: high risk behaviours

Answer 1

using alone
history of opioid poisoning(s) (overdose)
unsafe sex
tattooing
unsafe injection practices
driving while intoxicated
using heavy machinery

Question 2

Screening investigations

Answer 2

• CBC - specifically MCV (high - EtOH use, low - iron def)
• Hep A, B, C and HIV (with consent)
• GGT - elevated in chronic liver disease from EtOH/substance use
• ALT - liver inflammation from Hep
• AST - liver disease, chronic alcohol use
• ALP - liver disease or elevated bone cell activity
• UDT - to rule in/out drug use
• Beta-HCG
• TB skin test (if risk factors exist)

Question 3

Medical examination for OUD

Answer 3

• signs of opioid withdrawal or intoxication - signs of automatic hyperactivity (e.g., dilated pupils, tachycardia, hypertension, goose bumps, tremor, sweating, lacrimation and active bowel sounds).
• needle tracks and abscesses
• malnutrition
• jaundice
• vital signs
• cardiac murmurs
• hepatosplenomegaly

Question 4

Confirming diagnosis

Answer 4

1. DSM-5-TR Criteria
2. UDS

Question 5

double-doctoring

Answer 5

a criminal offence in Canada
must tell your prescriber if they’ve been to another in the last 30 days

Question 6

Components of a treatment agreement

Answer 6

1. Discussion of all possible tx options (informed consent)
2. Co-developed/signed with client and entire treatment team
3. Discuss SDH including: medical, mental health, relationship/parenting issues, household and employment needs.

Typically also signed (or separate agreement) with pharmacist.

Question 7

Key parts of informed consent for OAT:

Answer 7

1. MOA (opioid, agonist)
2. Treatment course (titration, years long commitment)
3. Side effects (sedation, constipation, arrythmia, weight gain, loss of libido)
4. Risks of use (sedation, careful with driving)
5. Risks of misuse (overdose, fatality if diverted, oversedation w/ EtOH)
6. Safe use (missed doses, carries and locking)
7. Monitoring (UDS, observed use b/c sedation)

Question 8

Confidentiality with justice system

Answer 8

• Probation/parole officers may request UDS test results
• Must have client consent to release them (except in cases of duty to report b/c danger)