Abstinence-Based Protocol Map
Transitioning from long-term maintenance to recovery-centered practice
60+%
Stimulant Cases
30%
Opiate Cases
Pathways & Triage
Intake Pathway
Stimulant / Polysubstance
Methamphetamine / Cocaine / THC
Clinical Profile
- Primary goal is Abstinence.
- Represents 60+% of primary intake cases.
- Often involves polysubstance use (THC, alcohol, sporadic opiate exposure).
Criteria & Qualifiers
- Not in a clinic and not in acute withdrawal.
- CASPER is negative and UDS is negative for primary opiate dependency.
- Caution: Fentanyl-positive UDS must be evaluated for amphetamine cutting vs. opiate dependency.
Clinical Pathway
1
No MAT
No medication-assisted treatment is used for this category.
2
No Medical Detox
Clarification: You cannot 'medically detox' from stimulants.
3
Comfort Meds
Comfort medications only when clinically appropriate (e.g., amphetamine-related psychosis).
Key Directives & Notes
Pathway is strictly abstinence-based.
If CASPER is negative and UDS is negative, the client belongs in this lane.
Communicate 'No long-term maintenance' policy clearly at intake.
Implementation Action Items
@Clinical Team (Evaluators)
- Gather detailed history (frequency, source, clinic involvement).
- Cross-verify UDS and CASPER before recommending Lane 2.
- Communicate "No long-term maintenance" policy at intake.
- Send Dr. Kuhn a concise clinical impression & recommendation.
@Medical Team (Dr. Kuhn)
- Manage seizure-risk protocols for alcohol and benzo cases (or refer out).
- Execute 1-7 day Suboxone bridge followed by Sublocade injection.
- Review intake referrals in-person with clinician consult.
- Continue methadone ONLY for pregnant individuals already maintained on it.