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
