Example Clinician Tools

Resource Name

Brief Description

Example Treatment Agreement

This link provides a sample Patient Treatment Agreement that providers can use as a template to create their own consent agreements for administering buprenorphine treatment with new patients.

Drug Use Screeners

Within this folder, providers can find examples of drug use screeners used in practices around the country. The folder includes: a Texas Christian University (TCU) Drug Screen (based on the DSM-V criteria for substance use disorder), the Opioid Risk Tool, the NIDA Quick Screen V1.0, and the Drug Abuse Screening Test (DAST-10). 

Opioid Withdrawal and Dependence

The Clinical Opiate Withdrawal Scale (COWS) is an 11-item scale designed to be administered by a provider. This tool can be used to rate signs and symptoms of opiate withdrawal and for monitoring purposes, in both inpatient and outpatient settings.

Readiness to Change

The University of Rhode Island Change Assessment (URICA) is an example assessment of Readiness to Change. The questionnaire is designed to help providers improve services and features a listing of 32 items that describes how a person may feel when beginning therapy or otherwise approaching issues in their lives.

Monitoring Client Progress

The Oklahoma Pain and Wellness Center has designed a suboxone/buprenorphine therapy progress report which features questions that ask patients: to describe how they are doing through questions oriented at addiction, mental and physical symptoms; whether they have used any alcohol or drugs since their last visit; any life changes, triggers or stressors they have recently experienced; their work and schooling status; their involvement in differing support groups; and whether they feel that they need a change in their suboxone/buprenorphine doses.