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35th AM (2025) - Poster Session
An Evidence-Based Clinical Guideline for the Outpa ...
An Evidence-Based Clinical Guideline for the Outpatient Management of MUD and Complex Comorbidities
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Pdf Summary
This guideline presents an evidence-based, outpatient clinical protocol for managing Methamphetamine Use Disorder (MethUD) complicated by psychiatric, medical, and social comorbidities. Developed by UC Davis and Sacramento County Mental Health, the protocol aims to standardize high-quality MethUD care, enhance provider confidence, and improve patient safety in community settings.<br /><br />The authors reviewed current research, expert consensus, and clinical best practices to create a stepwise, practical approach suitable for clinic implementation. Key components include stratifying patients by psychiatric comorbidity, assessing MethUD severity, and tailoring treatment accordingly. Foundational care begins with enrolling patients in contingency management, offering naloxone and fentanyl test strips, performing relevant labs (HIV, HCV, STI screenings), and coordinating social supports.<br /><br />Pharmacological options, used off-label, target symptoms and comorbidities: <br />- Bupropion XL (up to 450 mg daily) and naltrexone (injectable or oral) are primary choices.<br />- Long-acting stimulants benefit those with co-occurring ADHD but are avoided in psychosis or cardiovascular disease.<br />- Mirtazapine assists with insomnia and low BMI.<br />- Topiramate, titrated as needed, supports patients with alcohol use and high BMI, though cognitive side effects require monitoring.<br /><br />Comorbid psychiatric conditions guide medication choices: bipolar disorder requires mood stabilization plus naltrexone; psychosis favors long-acting injectable antipsychotics and avoids stimulants; PTSD and generalized anxiety disorder are treated with SSRIs/SNRIs plus naltrexone and therapy.<br /><br />Special situations like pregnancy, cardiovascular disease, and weight extremes influence tailored pharmacotherapy and behavioral interventions.<br /><br />Withdrawal management is symptom-targeted, using trazodone, olanzapine, and hydroxyzine as needed.<br /><br />The guideline outlines monitoring protocols including urine drug screens, prescription monitoring, weight, and adverse effects. Overall, it offers a unified, clinic-ready framework to reduce treatment variability, increase safety, and guide future research and policy. Its comprehensive, comorbidity-driven approach aims to improve MethUD outcomes in outpatient settings.
Keywords
Methamphetamine Use Disorder
outpatient clinical protocol
psychiatric comorbidities
pharmacological treatment
contingency management
naloxone and fentanyl test strips
bupropion and naltrexone
long-acting stimulants
comorbidity-driven care
withdrawal management
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