Lesson 1Psychiatric history and current mental status: mood, suicidality, anxiety, trauma, psychosis, cognitive function, prior treatments and responseThis section explains how to gather psychiatric history and perform a mental status exam, including mood, suicidality, anxiety, trauma, psychosis, cognition, and prior treatments, to identify co-occurring disorders and guide integrated care in our local settings.
Screening for mood disorders and bipolar spectrumAssessment of suicidality and self-harm riskEvaluation of anxiety, PTSD, and trauma exposureIdentification of psychosis and cognitive impairmentReview of prior psychiatric treatments and responsesLesson 2Risk behaviours and safety assessment: overdose risk factors, current intoxication/withdrawal signs, injection practices, needle sharing, pregnancy risk, domestic violenceThis section covers systematic assessment of overdose risk, current intoxication or withdrawal, injection and sexual risk behaviours, pregnancy risk, and domestic or intimate partner violence to inform immediate safety planning and harm reduction strategies relevant here.
Assessment of overdose history and current risk factorsRecognition of intoxication and withdrawal signsInjection practices, needle sharing, and equipment useSexual risk behaviors, contraception, and pregnancyScreening for domestic and intimate partner violenceLesson 3Documentation and consent considerations: confidentiality, mandatory reporting, informed consent for medications, opioid treatment programme rulesThis section reviews legal and ethical requirements for documentation and consent in opioid use disorder care, including confidentiality, mandatory reporting, informed consent for medications, and opioid treatment programme rules and record keeping as per Zambian guidelines.
Essential elements of clinical documentation42 CFR Part 2 and HIPAA confidentiality rulesMandatory reporting and duty to warn situationsInformed consent for MOUD and off-label useOpioid treatment program policies and recordsLesson 4Screening instruments and structured assessments: COWS, Clinical Opiate Withdrawal Scale; ASSIST; AUDIT; PHQ-9; GAD-7; substance use disorder diagnostic checklistsThis section introduces validated screening tools and structured assessments used in opioid use disorder care, including COWS, ASSIST, AUDIT, PHQ-9, GAD-7, and diagnostic checklists, with guidance on scoring, interpretation, and clinical integration for our clinics.
Use and scoring of the Clinical Opiate Withdrawal ScaleASSIST and AUDIT for substance use screeningPHQ-9 and GAD-7 for mood and anxiety symptomsStructured SUD diagnostic checklists and criteriaIntegrating tool results into clinical decisionsLesson 5Social, occupational, legal and family assessment: housing, child custody, employment stability, intimate partner dynamics, social supports, forensic issuesThis section addresses assessment of social, occupational, legal, and family domains, including housing, employment, child custody, intimate partner dynamics, social supports, and forensic issues that influence treatment engagement and recovery planning in Zambia.
Housing stability, homelessness, and basic needsEmployment, income, and workplace functioningChild custody, parenting, and family rolesIntimate partner relationships and social supportsLegal charges, probation, and forensic concernsLesson 6Medical history focused on injection-related complications, infectious disease risk, chronic pain, liver disease, medications and allergiesThis section details how to obtain a focused medical history for patients with opioid use disorder, emphasising injection complications, infectious disease risk, chronic pain, liver disease, current medications, allergies, and implications for treatment planning locally.
Injection-related complications and soft tissue infectionsScreening for HIV, hepatitis B, hepatitis C, and STIsAssessment of chronic pain conditions and functional impactEvaluation of liver disease, labs, and medication safetyMedication reconciliation, allergies, and drug interactionsLesson 7Detailed substance use history: onset, patterns, routes, quantities, polysubstance use, periods of abstinence, previous treatments, overdose history, naloxone useThis section outlines how to obtain a detailed substance use history, including onset, patterns, routes, quantities, polysubstance use, abstinence periods, prior treatments, overdose events, and naloxone use to guide diagnosis and treatment selection effectively.
Age of onset, progression, and key milestonesPatterns, routes, and quantities of opioid usePolysubstance use and high-risk combinationsPeriods of abstinence and relapse triggersPrior treatments, overdoses, and naloxone access
