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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.