Using Suboxone for Opioid Withdrawal: What do clients think?

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1 Using Suboxone for Opioid Withdrawal: What do clients think? Cutting Edge 2012 Project by Sheridan Pooley and Hayley Theyers (CADS Consumer Team)

2 Thanks to: The clients who participated in this project Hayley (ex-consumer Liaison for CADS Medical Detox Services) who undertook the project and spoke with the clients CHDS staff who encouraged their clients to take part

3 Aim of project To find out about CADS clients' experiences of Suboxone for opioid withdrawal To use their feedback to inform the development of consumer focused information and resources.

4 Project design Project ran May Nov IPU (In Patient Unit) and CHDS (Community & Home Detox Service) clients Initial questionnaire followed by a structured telephone interview with Detox Services' Consumer Liaison post-withdrawal.

5 Have you used methadone to withdraw from opiates in the past? 4 people never 13 people 1-5 times in the past 3 people 5 or more times

6 Have you ever used Suboxone to withdraw from opiates in the past? 4 people said never 16 people 1-5 times No one had used it more than 5 times

7 Where did you first hear about Suboxone? Akld Opioid Treatment Service Another service 1 CADS 4 CHDS 0 Detox IPU 4 Friends and family 2 Internet 1 Other: Australia 3 3

8 Did you receive enough relevant information about Suboxone withdrawal? 14 people (70%) said yes 6 (30%) said no I would have preferred to know more about its effects and usefulness. However not knowing was also useful as I had no expectations and very few preconceptions.

9 Information contd. If I had been told what to expect I would have been too frightened to do it There s not enough info from people who have done it Listening to others experiences has not been helpful

10 Information contd. Look on the internet, because you will get more info there than from CADS people. The doctor or nurse will explain to you what suboxone does, and that is enough. If you need to know more you can read the little book.

11 What info would be helpful? Stress it s important to reduce use as much as possible and wait before the first dose to avoid precipitated withdrawals. Expect withdrawals after you ve stopped taking Suboxone Tell people it is easier to come off and is a lot more tolerable than methadone a much smoother detox Tell people what supportive meds are available; that d be a real help

12 12 people prefer Suboxone because: It's quicker and smoother; milder withdrawal, especially with supportive meds like Clonidine It s easier to sleep Less risk for abuse; it can t be shot up, and it doesn t cause any cravings (for me anyway) Prejudice against methadone I find methadone a hard drug to manage and think that people coming off narcotics would be well served to try suboxone first With methadone the focus seems to be on maintenance rather than a real or advocated option for withdrawal. Methadone is useful as a harm reduction tool though.

13 5 prefer methadone for withdrawal because: Suboxone is too sweet Delayed withdrawals Still hanging out on the third day of using it Broken sleep throughout withdrawal process

14 and I would prefer pethidine for one week, then palfium for one week, then stop both, they have such a short half life 2 people said they had used other opioids on top of Suboxone by waiting 4-6 hours after their dose

15 Comments about the medication The big ones are better than the little ones, they explode in your mouth later, they dissolve better, fizz better. BUT they taste horrible, they are a bitter lemon flavour that makes you salivate. You really need a good 10 minutes of silence to dissolve them. It is hard when people talk to you and you are expected to answer them.

16 Watch out on day three! 50% commented on (and warned about) significant post-withdrawal symptoms, esp methadone users Timing of day 3: my withdrawals started on a Friday and there was no-one to contact for support over the weekend Post-withdrawal symptoms were way more intense than expected

17 Post-withdrawal experiences contd. Suboxone prolonged my withdrawal. On day three I suffered the worst withdrawals ever. I literally didn t sleep for 10 days. Obviously it is for heroin withdrawal, not methadone withdrawal which takes longer. I got Clonidine to help but it made me feel even worse, like a zombie After two weeks off suboxone I am still really cold and shaky. I was only expecting to be sick for a couple of days. It is 2 months later and I am still not sleeping well. I was not aware how long this would take. It is now 3 weeks later and I am still not sleeping properly.

18 Client suggestions Do withdrawal in the community then admit to in-patient setting for post-withdrawal support and symptomatic relief Use Suboxone for heroin, homebake and codeine withdrawal from but not for methadone because it seems to draw out the methadone withdrawal.

19 Findings The majority of respondents had used Suboxone more than once for opioid withdrawal. Half reported experiencing significant postwithdrawal symptoms. It is unclear whether people had been informed of this prior to it occurring. Most did not appear to receive medications for symptomatic relief. Nearly a third of people (30%) prefer to use methadone for opioid withdrawal.

20 Considerations Use of Suboxone for repeated opioid withdrawals? How in-patient services are utilised: BEFORE and AFTER rather than DURING withdrawal process? Use of supportive meds Options for clients: methadone or Suboxone or?

21 Recommendations 1. Inform staff of client experiences and preferences 2. Update the information CADS give to clients receiving Suboxone. 3. Consider admitting people into IPU for hours prior to first dose. Provide symptomatic relief during this time. 4. Develop strategies to provide more support and to minimise disengagement of CHDS clients after their last Suboxone dose

22 Recommendations contd. 5. Provide more flexibility and client choice: longer withdrawal process, methadone and Suboxone. 6. Build assertive follow-up into CHDS pathway. 7. Provide supportive meds or prescriptions for symptomatic relief meds before the person gets their last dose.

23 Recommendations contd. 8. Actively facilitate referral to other services CADS Counselling, physiotherapy, etc. 9. Access to in-patient unit (residential or day stay) or social detox for people struggling with post-withdrawal syndrome. 10. Additional support such as Peer Support/ Support Worker and AOD helpline.

24 Outcomes Changes to the client pathway and clinical practice Consumer focused information for clients was developed: - Facts about buprenorphine (Suboxone ) an information sheet - Buprenorphine (with naloxone) treatment with CADS booklet Free Suboxone!!

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