Detoxification Protocol Map

Clinical Guidelines & Pathways (Draft v1.0)

Select Primary Lane

Lane 1

Stimulant Primary

Methamphetamine / Cocaine / Crack

Typical Profile

  • Primary substance: methamphetamine (or cocaine/crack).
  • Secondary: intermittent opioid use possible.
  • Not in acute opioid withdrawal on admission.

Qualifies When

  • No objective/clinical picture of acute opioid withdrawal.
  • Opioid use is intermittent/secondary OR historical.
  • Presenting issue is stimulant use + sleep/anxiety + 'cravings' (urge to alter mood).

Clinical Pathway

1

No Agonists

No buprenorphine. No methadone.

2

Comfort Meds

PRN for sleep/anxiety per assessment.

3

Psychosocial Focus

Treat 'cravings' as preoccupation/obsession → psychosocial + residential intensity.

4

Discharge Planning

Overdose-risk screen. If elevated opioid history → consider Vivitrol (naltrexone). If low risk → not indicated.

Required Documentation Phrases

"Client presents with stimulant-primary use disorder and is not in acute opioid withdrawal at intake."

"Reported 'cravings' are clinically assessed as addiction preoccupation/obsession rather than opioid withdrawal."

"Opioid agonist initiation (buprenorphine/methadone) is not clinically indicated for this presentation."

"Treatment plan emphasizes psychosocial interventions at an intensive residential level to address psychological drivers."

"Symptom-based comfort medications may be used as indicated for sleep/anxiety."

"Overdose risk evaluated; naltrexone (Vivitrol) considered when risk profile supports relapse/overdose prevention."

Program-Wide Standard Language

"Medication decisions are client-match, assessment-driven, and aligned with a defined path toward stabilization and progress."

"When MAT is used, it is implemented as part of a structured protocol with clear goals, monitoring, and documentation."

"Clinical rationale, consent, and individualized response are documented to maintain a clear medical and compliance-ready paper trail."