Levels of Care for OUD Treatment and Treatment Courts
- When The ASAM Criteria are applied
in treatment courts, the full continuum
of levels of care should be available to
participants.
- Team members should understand the
levels (and sublevels) of care within The
ASAM Criteria.
- Level 0.5: Early Intervention, Level 1.0:
Outpatient Services, Level 2.0: Intensive
Outpatient/Partial Hospitalization
Services, Level 3.0: Residential/Inpatient
Services, and Level 4.0: Medically
Monitored Intensive Inpatient Services.
- Incarceration is not a level of care.
Participants are not incarcerated to
obtain access to (or due to the absence
of) detoxification services and
sober living quarters while awaiting a
residential treatment bed, to prevent
overdose, or to achieve other clinical or
social service objectives. Using jail to
prevent OUD-related self-harm should
be done rarely if at all.4 Decisions to use
jail in this way must comport with legal
standards and procedural requirements
at least as stringent as those required
to civilly commit an at-risk person living
with mental illness to a locked inpatient
psychiatric facility.
- Even brief incarceration without
medication for OUD increases the risk
of overdose immediately after release. The level of care a participant receives
for treatment should match that person's
severity of illness and functional
level. A one-size-fits-all approach is not
appropriate when determining the level
of care for participants.
- The participant should not be placed in
a residential setting if there is no clinical
reason that requires a 24-hour setting
(i.e., high potential for continuing use
with imminent danger and toxic living
environment).
- Specific provision of services, including
medication for OUD, should be available at
every level of care, including residential.
- Participants should not terminate
treatment with agonist or antagonist
medications without careful consultation
with the prescribing physician, as
discontinuing treatment increases the
risk of withdrawal, recurrence, overdose,
and death.
- For all participants in treatment courts,
medication for OUD should be provided
in combination with psychosocial
treatment, as it can prevent recurrence of
use, overdose, and death at every level of
care. Thus, all persons with OUD should
be referred immediately to be assessed
for medications to treat withdrawal
symptoms and to prevent withdrawal,
opioid craving, recurrence, overdose, and
death.
- All participants, including those in
treatment courts, should have access to
all three types of medications for OUD,
with individualized treatment based
on clinical assessment and participant
preference.
