Admission criteria of Opioid Withdrawal – American Society of Addiction Medicine.
|Level||Definition||Management||Typical patient||Treatment delivery|
|1||Mild withdrawal with daily or less than daily outpatient supervision||Ambulatory (outpatient) withdrawal management not requiring extended onsite monitoring||Has not used high-potency opioids (eg, injectable or smokable forms) daily for more than 2 weeks before admission, or opioid use is close to therapeutic level||Office setting, general medical or mental health facility, or addiction treatment facility (eg, day hospital program)|
|2||Moderate withdrawal with all day withdrawal management and supportive living arrangement or family for nighttime support||Ambulatory withdrawal management with extended onsite monitoring||Has moderate withdrawal symptoms, can be managed well during the day, and is motivated to obtain further therapy||Office setting, general medical or mental health facility, or addiction treatment facility (eg, day hospital program)|
|3.2||Moderate withdrawal with need for 24-hour support to increase likelihood of completing withdrawal management||Clinically managed residential withdrawal management (ie, “social detox”), emphasizing peer and social support||Is in moderate withdrawal and does not have a safe, supportive environment in which to withdraw||Typically, nonmedical facility with medical care available locally|
|3.7||Severe withdrawal with need for 24-hour nursing care and physician availability||Medically monitored inpatient (or residential) treatment for patients unlikely to complete withdrawal without medical and nursing monitoring||Is in marked withdrawal, requiring close medical monitoring, or has a comorbid condition that complicates or worsens withdrawal process (eg, chronic pain exacerbated by withdrawal, posttraumatic stress disorder with dissociative episodes)||Permanent inpatient facility (often in a specialty or step-down unit) or a freestanding withdrawal management/treatment facility|
|4||Severe, unstable withdrawal with need for 24-hour nursing care and daily physician visits to modify regimen and manage instability||Intensive medical management and counseling||Is in severe withdrawal, requiring monitoring or intervention more often than hourly, or is pregnant, requiring obstetric intervention for a complication (eg, bleeding, leaking amniotic fluid)||Permanent inpatient facility|
Citation: Data from Mee-Lee D et L: The ASAM Criteria. Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. 3rd ed. Carson City, NV: The Change Companies; 2013