New tools to diagnose substance use disorders

These instruments may be used to increase diagnoses of opioid and stimulant use disorder.

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Identification of persons who might probably benefit from substance use disorder treatment requires aggressive efforts. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has criteria for moderate to severe opioid and/or stimulant use disorders. However, the instruments currently available to assess this are limited.

A new study by Yale School of Medicine (YSM) and NYU Grossman School of Medicine researchers demonstrates the validity of two new diagnostic tools—the Rapid Opioid Use Disorder Assessment and the Rapid Stimulant Use Disorder Assessment.

As these tools can be easily used by non-clinical personnel, they are more likely to increase diagnoses of opioid and stimulant use disorder and access to treatment.

In response to the need for diagnostic tools that can be quickly administered by non-clinicians and clinicians, the Rapid Opioid Dependence Screen (RODS) was developed in 2015. The tool was designed as a diagnostic tool to identify those with opioid dependence based on DSM-IV criteria with eight items.

The Rapid Opioid Use Disorder Assessment, an updated version of the Rapid Opioid Dependency Screen, includes fentanyl as a commonly misused opioid and adheres to the DSM-5 criteria for moderate-to-severe opioid use disorder.

Sandra Springer, MD, professor of medicine (infectious diseases), said, “To prescribe medications for opioid use disorder that reduce craving, relapse, and death, such as buprenorphine, methadone, or extended-release naltrexone, the patient must meet the DSM-5 criteria for moderate-to-severe opioid use disorder. Patients need to be diagnosed rapidly to receive these life-saving medications.”

“Even if people are not ready for treatment after you provide a rapid diagnosis of opioid and or stimulant use disorder, we could provide harm reduction services such as safe syringe services, naloxone for overdose, and drug testing strips.”

Similarly, the Rapid Stimulant Use Disorder Assessment was developed to identify moderate-to-severe stimulant use disorder by Angela Di Paola, Ph.D., a YSM postdoctoral associate. You can give the Rapid Opioid Use Disorder Assessment and the Rapid Stimulant Use Disorder Assessment either separately or together. However, the authors advocate using both together due to increased overdoses related to concurrent stimulant and opioid use.

Angela Di Paola, Ph.D., YSM postdoctoral associate, said, “While opioid use disorder can be treated with FDA-approved medications, stimulant use disorder requires an entirely different set of treatments, such as behavioral services. We created the Rapid Stimulant Use Disorder Assessment so people can rapidly receive a stimulant use disorder diagnosis which can link them to stimulant disorder treatments and harm reduction services.”

In the validation study, the Rapid Opioid Use Disorder Assessment and the Rapid Stimulant Use Disorder Assessment were just as successful at detecting people with moderate-to-severe opioid and/or stimulant use disorders as the Mini International Neuropsychiatric Interview version 7, the industry-leading validated diagnostic tool for substance use disorders. The researchers concluded that the Rapid Stimulant Use Disorder Assessment and the Rapid Opioid Use Disorder Assessment are trustworthy and simple to use by non-clinical personnel.

Springer said, “Rapid diagnoses need to be accompanied by plans to provide immediate help to people with opioid and stimulant use disorders. We need to think about developing our healthcare system, training our clinicians, and creating collaborative care agreements with pharmacists, behavioral therapists, nurses, peer navigators, and community health workers to turn diagnosis into immediate access to treatment and prevention services in the communities where people live. We need to be proactive.”

Journal Reference:

  1. Angela Di Paola, David Farabee et al. Validation of Two Diagnostic Assessments for Opioid and Stimulant Use Disorder for Use by Non-Clinicians. Psychiatric Research and Clinical Practice. DOI: 10.1176/appi.prcp.20230022
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