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Opioid Use Disorder: Partnering Clients, Health Care, and Addiction Professionals

Overview and Context

1. Counseling clients who take OUD medication requires understanding:

A. Basic information about OUD.

B. The role and function of OUD medications.

C. Ways to create a supportive environment that helps clients work toward recovery.

D. All of the above.


2. Increasing the dose of which of the following increases the effect?

A. Mu-opioid receptor full agonists

B. Mu-opioid receptor partial agonists

C. Mu-opioid receptor antagonists

D. All of the above


3. Medication helps establish and maintain OUD remission.

A. True

B. False


4. Counseling and ancillary services should target patients’ needs and should be arbitrarily required as a condition for receiving OUD medication.

A. True

B. False


5. The law requires _____ prescribers to be able to refer patients taking OUD medication to counseling and ancillary services.

A. Buprenorphine

B. Naltrexone

C. Both (A) and (B)

D. None of the above


6. When properly taken, medications do not cause tolerance or physical dependence.

A. True

B. False


7. The new DSM-5 distinction says that patients taking medication for OUD are still considered to be addicted.

A. True

B. False


8. Short-term medically supervised withdrawal:

A. May increase the risk of unintentional fatal overdose because of decreased tolerance after withdrawal completion.

B. Rarely prevents return to use.

C. Both (A) and (B).

D. None of the above.


9. For clients who seek a self-directed, purposeful life, counseling can help them:

A. Improve problem-solving and interpersonal skills.

B. Build a set of techniques to resist drug use.

C. Replace drug use with constructive, rewarding activities.

D. All of the above.


10. Clinical trials have not shown that cognitive-behavioral therapy added to buprenorphine treatment with medical management is associated with significantly lower rates of illicit opioid use.

A. True

B. False


11. To be effective, treatment must:

A. Address the individual’s drug abuse.

B. Address any associated medical, psychological, social, vocational, and legal problems.

C. Be appropriate to the individual’s age, gender, ethnicity, and culture.

D. All of the above.


12. Counselors must:

A. Agree with clients’ decisions.

B. Respect clients’ decisions.

C. Both (A) and (B).

D. None of the above.


13. New clients should be educated about:

A. Addiction as a chronic disease influenced by genetics and environment.

B. How medications for OUD work.

C. The benefits of longer term medication use and the risks of abruptly ending treatment.

D. All of the above.


14. The confrontational / expert model that characterized much of SUD treatment in the past may harm some patients and inhibit or prevent recovery.

A. True

B. False


15. When trying to reach out to family who hesitate to engage, try to:

A. Recognize that they have been harmed.

B. Ask them to recall some positive experiences.

C. Help them understand OUD, the treatment process, and medication’s role in recovery.

D. All of the above.


16. Trauma histories and trauma-related disorders may increase clients’ risk for various problems, including early drop-out from treatment and greater problems with pain.

A. True

B. False


Quick Guide to Medications

17. After taking opioids, molecules bind to and activate the brain’s opioid receptors and release _____ in a brain area called the nucleus accumbens, causing euphoria.

A. Serotonin

B. Dopamine

C. Adrenaline

D. Noradrenaline


18. Few people with OUD re-experience the euphoria they obtained early in their opioid use, yet they continue to seek it.

A. True

B. False


19. Which of the following becomes overactive from repeated drug use?

A. The amygdala

B. The frontal cortex

C. Both (A) and (B)

D. None of the above


20. By acting directly on the same opioid receptors as misused opioids, medications can stabilize abnormal brain activity.

A. True

B. False


21. Which of the following fully activates the opioid receptor, reduces craving, and blocks the euphoric effect of opioids?

A. Buprenorphine

B. Methadone

C. Naltrexone

D. All of the above


22. Buprenorphine reduces:

A. Opioid misuse

B. HIV risk behaviors

C. Risk of overdose death

D. All of the above


23. Which group is at a particular risk for buprenorphine overdose?

A. Children who accidentally ingest the medication.

B. Patients who also use CNS depressants.

C. Both (A) and (B).

D. The effects of buprenorphine do not increase after a certain dosing level, so it is not possible to overdose.


24. Patients must be in opioid withdrawal when they take their first dose of buprenorphine.

A. True

B. False


25. The extended-release formulation of buprenorphine lasts for 1 month, can be repeated monthly, and is appropriate for patients who have been stabilized on the films or tablets for at least:

A. 3 months

B. 1 month

C. 7 days

D. It can be started immediately


26. Which of the following is slow in onset and long acting, avoiding the highs and lows of short-acting opioids?

A. Buprenorphine

B. Methadone

C. Naltrexone

D. All of the above


27. Which of the following can be a warning sign of potential overdose?

A. Sleepiness

B. Sweating

C. Swelling of the hands and feet

D. All of the above


28. Which of the following does not activate opioid receptors?

A. Buprenorphine

B. Methadone

C. Naltrexone

D. All of the above activate opioid receptors


29. Naltrexone reduces:

A. Opioid craving

B. Opioid withdrawal

C. Both (A) and (B)

D. None of the above


30. Someone starting naltrexone must be abstinent from long-acting opioids for at least 7 days before taking the first dose.

A. True

B. False


31. People in early _____ treatment are required by federal regulation to visit the OTP six to seven times per week to take their medication under observation.

A. Buprenorphine

B. Methadone

C. Naltrexone

D. All of the above


32. When would the methadone dose need adjustment?

A. If the patient returns to opioid use.

B. If the patient experiences side effects such as sedation.

C. If the patient starts new medications that may interact with methadone.

D. Any of the above.


33. There is only one dose level for injected naltrexone, so prescribers cannot adjust the dose.

A. True

B. False


Counselor - Prescriber Communications

34. Compared to prescribers, a counselor will probably:

A. See patients more frequently

B. Have a more complete sense of patients’ issues

C. Help patients take medications appropriately

D. All of the above


35. Which of the following is the most secure way to discuss patient cases?

A. Phone calls

B. Text messaging

C. Faxes

D. Email


36. What item should patients be advised to take with them to facilitate refills from a new medication-dispensing facility?

A. Medication containers of currently prescribed medications (even if empty)

B. Packaging labels that contain dosage, prescriber, and refill information

C. Any payment receipts that contain medication information

D. All of the above


37. All collaborative care team members, including counselors and prescribers, should inform patients from intake onward that the program will only readmit them if they do not drop out.

A. True

B. False


Creation of a Supportive Counseling Experience

38. It should be emphasized that a person given naloxone to reverse overdose must go to the emergency department, because overdose can start again when naloxone wears off.

A. True

B. False


39. People taking OUD medication rely on it to maintain daily function, like people with diabetes rely on insulin.

A. True

B. False


40. Patients taking medication for OUD is not covered under the Americans With Disabilities Act, therefore, employers can discriminate against these patients.

A. True

B. False


41. People with OUD released from prison or jail who don’t take OUD medication have higher risk of overdose death during their first few weeks in the community.

A. True

B. False


42. Why are those with OUD at a very high risk for overdose early after release from prison or jail?

A. Decrease in opioid tolerance while incarcerated.

B. Lack of appropriate OUD therapy while incarcerated.

C. Both (A) and (B).

D. None of the above.


43. Treatment with which of the following is not recommended during pregnancy?

A. Buprenorphine

B. Methadone

C. Naltrexone

D. All of the above


44. Medically supervised withdrawal during pregnancy is advised.

A. True

B. False


45. Mothers stabilized on medication for OUD are discouraged from breastfeeding, as the medication can pass into the breast milk and harm the infant.

A. True

B. False


46. Narcotics Anonymous (NA), the most widely available program, treats illicit opioids and OUD medications equally in gauging abstinence and recovery, and does not consider people taking OUD medication “clean and sober.”

A. True

B. False


Other Common Counseling Concerns

47. When patients’ primary care providers, prescribers of medication for OUD, and addiction-specific counselors do not work for the same entity, patients must consent for them to share information.

A. True

B. False


48. Why would a patient not consent to communication among providers?

A. If they have experienced discrimination in healthcare systems.

B. If they have developed OUD after taking opioid pain medication.

C. If they have legitimate cause not to trust providers.

D. Any of the above.


Provider Tools and Sample Forms

49. The clinic diversion control policy should include counseling patients to:

A. Keep methadone locked up and out of children’s reach.

B. Never share or sell medication to anyone.

C. Take medication on an as-needed basis.

D. All of the above.


50. The goal of the first week of treatment with buprenorphine is to reduce cravings.

A. True

B. False


51. Patients being treated with buprenorphine should tell their provider if they feel _____ within 1 to 4 hours after their dose.

A. Sedated

B. Euphoric

C. Either (A) and/or (B)

D. None of the above


52. The use of _____ with buprenorphine increases the risk of overdose and death.

A. Alcohol

B. Benzodiazepines

C. Either (A) and/or (B)

D. None of the above


53. When is there the highest risk of methadone overdose?

A. The first day of treatment.

B. The first two weeks of treatment.

C. The first month of treatment.

D. There is no risk of methadone overdose.


54. Patients should plan to avoid driving or operating heavy machinery for as long as they are taking methadone.

A. True

B. False


55. The patient should seek immediate medical help if which of the following symptoms appear while on naltrexone?

A. Hives

B. Shortness of breath

C. Throat tightness

D. Any of the above


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