Drug Misuse Management in the Acute Hospital Setting Guidelines
|
|
- Mary Hart
- 8 years ago
- Views:
Transcription
1 Drug Misuse Management in the Acute Hospital Setting Guidelines This procedural document supersedes: PAT/T 21 v.1 Guidelines for the Management of Patients with Drug Misuse in the Acute Hospital Setting. Did you print this document yourself? The Trust discourages the retention of hard copies of policies and can only guarantee that the policy on the Trust website is the most up-to-date version. If, for exceptional reasons, you need to print a policy off, it is only valid for 24 hours. Author/reviewer: (this version) Date written/revised: July 2013 Approved by: Date of approval: 9 October 2013 Date issued: 17 October 2013 Next review date: October 2016 Target audience: Shane Peagram Drug and Alcohol Liaison Nurse Specialist DRI Policy Approval and Compliance Group on behalf of the Patient Safety Review Group Trust wide Page 1 of 63
2 Amendment Form Please record brief details of the changes made alongside the next version number. If the procedural document has been reviewed without change, this information will still need to be recorded although the version number will remain the same. Version Date Issued Summary of changes Author 2 17 October 2013 General restructuring of contents to improve access and flow of subject material. Contents presented to reflect National Drug Policy focus on Recovery. (DOH 2010) Clinical governance framework incorporating NICE QS23 (2012) New content - General guidance on prescribing by substance of misuse. New content Equity and diversity issues for Assessment. New content inclusion of contact details for Trust child Protection Nurses and Doncaster and Bassetlaw social services departments. New content Methadone Pharmacology. New content Buprenorphine Pharmacology New content Patients own supplies, linked to PAT/MM1B v.4 New content Pain management. Major revision Discharge planning, to reflect need for TTA doses of OST at weekends and holidays. New content APPENDIX 3 ICD 10 Dependency diagnosis. (WHO 1992) Revised content Summary card amended to reflect updated discharge planning arrangements. S. Peagram Page 2 of 63
3 Contents Page Section No 1 INTRODUCTION 6 2 PURPOSE 6 3 DUTIES AND RESPONSIBILITIES GENERAL GUIDANCE Overview Rationale for prescribing Prescribing considerations Exceptional circumstances PRESCRIBING BY SUBSTANCE - OVERVIEW Opiates Benzodiazepines Alcohol Stimulants Cannabis New psychoactive substances ASSESSMENT Overview Equity and diversity Aims of a full assessment Urine screening Opiate withdrawal syndrome Opiate intoxication Drug using parents Cardiac assessment EXISTING COMMUNITY METHADONE / BUPRENORHINE PATIENTS Pre prescribing checks Out of hours Missed doses Administration ILLICIT OPIATE (HEROIN) USING PATIENTS Overview Precautions Choosing and appropriate opioid substitute Risk factors METHADONE PHARMACOLOGY Peak plasma concentration Peak clinical effects Duration of action (half life) Metabolism Excretion Dosing Page 3 of 63
4 Equivalence Tolerance METHADONE INDUCTION PROCESS NEW STARTER Indication Precautions Contraindications Investigations Principles of safe induction Dosing Administration Risk factors Other points to consider BUPRENORPHINE PHARMACOLOGY Peak plasma concentration Peak clinical effects Duration of action (Half life) Metabolism Excretion Dosing Equivalence Tolerance BUPRENORPHINE INDUCTION PROCESS NEW STARTER Indication Precautions Contraindications Investigations Principles of safe induction Dosing Dosing Administration Risk factors for overdose Buprenorphine + Naloxone (Suboxone) Precipitated withdrawal OPIOD DETOXIFICATION Overview Consent Unsuitable populations Opiods and alcohol Opioids and benzodiazepines Methadone or Buprenorphine Lofexidine Clonidine Dihydrocodeine Other symptomatic medications Lofexidine dosing Lofexidine regime RELAPSE PREVENTION PRESCRIBING (NALTREXONE) Benefits Risks Investigations Dosing Page 4 of 63
5 14.5 Loss of tolerance GENERAL MANAGEMENT Ward management Drug related deaths Reducing drug related deaths Dealing with emergency overdose Sleeplessness Patients own supplies Pregnancy Mental capacity Illicit opiate use on top of prescribed medication Drug misusers not admitted to hospital and not in treatment PAIN MANAGEMENT Overview Methadone and pain Buprenorphine (subutex / Suboxone) and pain Naltrexone and pain Peri operative pain DISCHARGE PLANNING TTO - Existing community patient Caution TTO - New starter Caution TRAINING / SUPPORT MONITORING COMPLIANCE WITH THE PROCEDURAL 45 DOCUMENT 20 DEFINITIONS EQUALITY IMPACT ASSESSMENT ASSOCIATED TRUST PROCEDUAL DOCUMENTS REFERENES 46 APPENDICIES: Appendix 1 Clinical Governance Framework Clinical Guidelines Appendix 2 NICE quality standard Appendix 3 Cardiac assessment and monitoring for methadone prescribing 51 Appendix 4 ICD-10 Diagnostic Guidelines Dependency 53 Appendix 5 Methadone assessment prior to administration of methadone 54 Appendix 6 Methadone Safety Care Plan 56 Appendix 7 Safer Injecting Care Plan 58 Appendix 8 Methadone summary card Page 5 of 63
6 1. INTRODUCTION These guidelines are intended for both medical and nursing staff to act as a resource in the management of patients with drug misuse issues when prescribing for maintenance or detoxification. The main source of evidence used within these guidelines is taken form the Drug Misuse and dependence UK Guidelines on Clinical Management, (2007) and should be read in conjunction with, Guidance on methadone and buprenorphine for the management of opioid dependence (NICE) ; Drug misuse: opioid detoxification (NICE) ; Naltrexone for the management of opioid dependence (NICE); Guidance for the use of substitute prescribing in the treatment of opioid dependence in primary care (RCGP 2011): Medications in Recovery Re-orientating Drug Dependence Treatment (NTA 2012). 2. PURPOSE The purpose of these guidelines is to offer a comprehensive structure that will provide treatments within the context of the National Drug Strategy 2010 s overarching aims to: Reduce illicit and other harmful drug use: and Increase the numbers recovering from their dependence Our ultimate goal is to enable individuals to become free from their dependence [DOH 2010] 3. DUTIES AND RESPONSIBILITIES 3.1 DOCTORS RESPONSIBILITIES It is acknowledged that drug misusers have the same entitlement as other patients to the services provided by the National Health Service and it is the responsibility of all Doctors to provide care for both general health needs and drug-related problems, whether or not the patient is ready to withdraw from drugs. [DOH, 1999] All doctors must provide medical care to a standard, which could be reasonably, expected of a clinician in their position. The focus for the clinician treating a drug misuser is on the patients themselves. However, the impact of their drug misuse on other individuals especially dependant children and on communities should be taken into consideration. [DOH, 2007] 3.2 PRESCRIBERS RESPONSIBILITIES It is the responsibility of the prescriber (Doctor, NMP) to identify the purpose of prescribing e.g. maintain the continuity of existing community prescribing [sec 7] or to initiate new prescribing [sec 8]. Page 6 of 63
7 In either case the prescriber must ensure that an adequate assessment has been carried out prior to prescribing. [sec 6] Where continuity of community prescribing is the goal; Confirmation of Drug, dose and time last taken should be established and documented. [sec 7.1] Missed doses and appropriate actions should be documented. [sec7.3] Discharge arrangements including Drug, dosage, take home quantities and date of next community prescribing agreed with the responsible community prescriber and documented. [sec17] Where initiation of treatment is the goal; Attention must be paid to the aim of treatment stabilisation abstinence detoxification [sec 8] The choice of treatment [sec 8.3] Discharge arrangements [sec 17] NOTE: While it is important to liaise with the relevant community Drug Team regarding ongoing treatments it is worth noting that their operational policies may be different from our own. In the event that a scenario should arise which is not covered within these guidelines the first point of contact should be the Drug and Alcohol Clinical Nurse Specialist Shane Peagram (DRI Blp 1491) Valerie Wood (BDGH Blp 2417) Methadone and buprenorphine should only be prescribed following liaison with the community drug team and there is a documented plan for continuation of treatment upon discharge. 3.3 NURSES RESPONSIBILITES It is the responsibility of nursing staff to ensure the safe administration of medicines as per PAT/MM 1. For existing community methadone / buprenorphine patients; Confirmation of Drug, dose and time last taken should be established and documented. [sec 7.1] Missed doses and appropriate actions should be documented. [sec7.3] Page 7 of 63
8 Discharge arrangements including Drug, dosage, take home quantities and date of next community prescribing agreed with the responsible community prescriber and documented. [sec 17] For new treatments; The presence of an opiate withdrawal syndrome should be assessed [sec 6.5] and documented. [Appendix 5] Where Methadone is prescribed, the Methadone Assessment Prior to Administration checks are completed [sec 6.6] and documented. [Appendix 5] Methadone and buprenorphine should only be prescribed following liaison with the community drug team and there is a documented plan for continuation of treatment upon discharge. 3.3 PATIENT RESPONSIBILITIES It is the patients responsibility to provide details of current treatment, prescriber and dispensing arrangements including any missed doses. Patients in possession of community dispensed medication must inform nursing staff. 4. GENERAL GUIDANCE 4.1 OVERVIEW Problematic drug users experience increased rates of morbidity and mortality due to their substance misuse, and although drug misuse exists in every sector of society, it is most prevalent in areas of social deprivation where individuals are more likely to experience poorer health outcomes, independent of substance misuse. (RCGP 2011) Generally, there is a greater prevalence of certain illnesses amongst the drug-misusing population, including viral hepatitis, bacterial endocarditis, HIV, tuberculosis, septicaemia, pneumonia, deep vein thrombosis, pulmonary emboli, abscesses and dental disease. (DOH 1999) 4.2 RATIONALE FOR PRESCRIBING For many people, prescribed treatment is an important part of their recovery journey. It is a component of a broader recovery-orientated system of health and social care and support that harnesses the full range of individual, social and community assets. Before deciding to prescribe, the clinician should be clear as to what the functions of prescribing are. A prescription can: Page 8 of 63
9 or Maintain current community prescribing. Reduce or prevent withdrawal symptoms from illicit drugs Offer an opportunity to stabilise drug intake and lifestyle whilst breaking with previous illicit drug use and associated unhealthy behaviours Promote a process of change in drug taking and high risk behaviour Help maintain contact and offer opportunity to work with the patient Achieve abstinence 4.3 PRESCRIBING CONSIDERATIONS Current community treatment plan The overall treatment plan for the individual client National and Locally agreed protocols The clinicians experience and competencies Discussion with member of a multi-agency team Advice, where necessary from a specialist in drug misuse Methadone and buprenorphine should only be prescribed following liaison with the community drug team and there is a documented plan for continuation of treatment upon discharge. 4.4 EXCEPTIONAL CIRCUMSTANCES Only in exceptional circumstances should the decision be made to offer substitute medication without specialist advice being sought i.e. a drug misuser presenting with opioid withdrawal in late pregnancy a patient with serious concomitant physical or psychiatric illness where withdrawal is complicating the clinical problems someone who is opioid-dependent and demonstrating withdrawal. Indeed, in such circumstances it is vital that the doctor fulfils their responsibilities by ensuring adequate assessment and appropriate management that facilitates the retention of the patient in treatment. (DOH, 1999). 5 PRESCRIBING BY SUBSTANCE - OVERVIEW 5.1 OPIATES Heroin users are the largest single group in treatment and use an especially tenacious, habit forming drug in the most dangerous ways. (NTA 2012) Page 9 of 63
10 There is robust evidence showing that Opiate Substitution Therapy can significantly improve outcomes for most opioid dependent people. Treatment can reduce symptoms of dependence, and being in treatment can help to reduce associated difficulties. OST allows people the time, space and platform to make meaningful choices. OST: Prevents people dropping out of treatment. Suppresses illicit use of heroin. Reduces crime. Reduces the risk of BBV transmission Reduces risk of death. Exiting treatment prematurely can harm individuals, especially if it leads to relapse, which is also harmful to society. Coming off OST can lead to greater risk of relapse, BBVs and overdose; and that treatment orientated to rapid abstinence produces worse outcomes than treatment initially orientated to maintenance. (National Drug Strategy 2010) Prescribing options Methadone [sec 9] Buprenorphine [sec 11] Detoxification [sec 13] 5.2 BENZODIAZEPINES Benzodiazepines prescribed for benzodiazepine dependence should be at the lowest possible dose to control dependence and doses should be reduced as soon as possible. It is common to consolidate Benzodiazepine use to a single preparation i.e. Diazepam and divide doses evenly. Prescribing options Diazepam [BNF] Benzodiazepines should only be prescribed following liaison with the community drug team and there is a documented plan for continuation of treatment upon discharge. 5.3 ALCOHOL Acute alcohol withdrawal syndrome is a medical emergency and requires timely and appropriate intervention to prevent potentially life threatening complex symptoms. Prescribing options Chlordiazepoxide, Lorazepam, Diazepam, Midazolam For guidance on alcohol withdrawal management refer to PAT/T STIMULANTS There are no licenced pharmacological treatments to eliminate the symptoms of withdrawal from stimulants (including cocaine). Page 10 of 63
11 Prescribing options There is limited evidence supporting the use of Dexamphetamine in the treatment of habitual amphetamine use. Treatment should only be considered by experienced practitioners within specialist drug treatment settings. Short term symptomatic relief of agitation with Anxiolytics may be considered i.e. Diazepam. [BNF] For psychosis short term management with Antipsychotics i.e. Haloperidol. 5.5 CANNABIS There are no licenced pharmacological treatments to eliminate the symptoms of withdrawal from cannabis. Short term symptomatic relief of agitation or insomnia with Anxiolytics may be considered i.e. Diazepam. [BNF] 5.6 NEW PSYCHOACTIVE SUBSTANCES New psychoactive substances (NPS) so called designer drugs or legal highs such as Mephadrone present a unique challenge as users might not know exactly which compound has been taken as many are sold under a variety of brand names. Prescribing options no substitute medications, consider symptomatic relief. In all cases of acute intoxication or poisoning TOXBASE should be consulted 6 ASSESSMENT 6.1 OVERVIEW Good assessment is essential to the continuing care of the patient. (DOH 2007), Furthermore, Assessment for recovery aims to deliver an informed understanding of the person s wishes, substance use, and the severity and complexity of clinical and other problems: and it needs to identify their strengths and key obstacles to their recovery. (NTA 2012) 6.2 EQUITY AND DIVERSITY All assessments should be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. People who need a comprehensive assessment should have access to an interpreter or advocate if needed. Page 11 of 63
12 6.3 AIMS OF A FULL ASSESSMENT A comprehensive assessment should consider both drug use and resources for recovery and include: treating the emergency or acute problem confirming the person is taking drugs (history, examination and drug testing) (Table 1) assessing the degree of dependence (Table 2, 3 and 4 ) assessing physical and mental health identifying social assets, including housing, employment, education and support networks assessing risk behaviour including domestic violence and offending determining the person's expectations of treatment and desire to change determining the need for substitute medication obtaining information on any dependent children of parents who misuse drugs, and any drug-related risks to which they may be exposed. (Table 5 ) The clinician must ensure that an adequate assessment has been made before prescribing substitute opioids or controlled drugs. 6.4 URINE SCREENING Urine analysis should be regarded as an adjunct to the history and examination in confirming drug use, and should be obtained at the outset of prescribing and randomly throughout treatment (request Full Drug Screen). Results should always be interpreted in the light of clinical findings, as false negatives and positives can occur. If results do not correspond to the patient s history, repeat the urine toxicology test before taking any action, as laboratory errors can occur. If the urine test is negative for opioids, and there is no evidence of opioid withdrawal symptoms; the drug misuser is very unlikely to be physically dependent on opioids and needs to be reassessed in the light of this. Table 1 Drug detection times Drug Or Its Metabolite(s) Amphetamine/amfetamines, including methylamphetamine and MDMA Benzodiazepines Ultra-short-acting[half-life 2h] [e.g. midazolam] Short-acting [half-life 2-6h] [e.g. triazolam] Intermediate-acting [half-life 6-24h] [e.g. temazepam, Duration of Delectability 2 days 12 hours 24 hours 2-5 days Page 12 of 63
13 chlordiazepoxide] Long-acting [half-life 24h] [e.g. diazepam, nitrazepam] 7 or more Buprenorphine and metabolites 8 days Cocaine metabolite 2 3 days Methadone [maintenance dosing] 7 9 days Codeine, dihydrocodeine, morphine, propoxyphene 48 hours [heroin is detected in urine as the metabolite morphine] Cannabinoids Single use 3 4 days Moderate use [three times a week] 5 6 days Heavy use [daily] 20 days Chronic heavy use [more than three times a day] up to 45 days PAT/T 21 v.2 Detection times are only approximate and highly dependant upon dose, frequency, route of administration and urine excretion and concentration. 6.5 OPIATE WITHDRAWAL SYNDROME The onset of physical withdrawal symptoms is a key characteristic of opiate dependency and there presence is required to establish a diagnosis. Table 2 Opiate Withdrawal Syndrome Signs and Symptoms Heroin Methadone Drug craving, anxiety, drug seeking 6 hours - Yawning, sweating, running nose, lacrimation 8 hours hours Increase in above signs and: Dilated pupils, goose-flesh, tremors, hot/cold flushes, aching bones/muscles, loss of appetite, abdominal cramps and irritability Increase in intensity of above and: Insomnia, increased blood pressure, low grade fever, increased respiration, increased pulse rate, restlessness, nausea and vomiting Increase in intensity of above and Weight loss, diarrhoea, weakness, febrile, foetal position (curled up on a surface), increased blood sugar 12 hours hours 36-4days hours hours 36-4days Page 13 of 63
14 Table 3 Opiate Withdrawal Syndrome Objective signs of opiate withdrawal Yawning Coughing Sneezing Runny nose Lacrimation Raised blood pressure Increased pulse Dilated pupils Cool, clammy skin Diarrhoea Nausea Fine muscle tremor Subjective signs of withdrawal Restlessness Irritability Anxiety [The signs above may also be useful objective signs] Sleep disorders]depression Drug craving Abdominal; cramps Source: Ghodse (1998) The use of a clinical tool such as the Short opiate Withdrawal Scale is recommended to establish the presence of a physical withdrawal syndrome. The Short Opiate Withdrawal Scale is include as part of the Methadone Assessment Prior to Administration Tool [ Appendix 5 ]. 6.6 OPIATE INTOXICATION Mortality rates amongst Opiate users are 12 x higher than their none opiate using peers, and rise to 22 x higher for Intravenous drug users. The ability to identify and respond to acute opiate intoxication is key to maintaining patient safety. (DOH 2007) Table 4 - Opioid Intoxication SIGNS Euphoria/Relaxation Constricted pupils (pinned) Drowsiness Slurred speech Unsteady gait Smell (alcohol) SYMPTOMS Feelings of well-being Poor attention/concentration Slurred speech Methadone Pre Administration checklist and assessment The Methadone Pre Administration checklist needs completing by the person dispensing the initial dose (nurse, doctor or pharmacist) the same person should also assess patient, [sec 3.2,3.3] completing the pre administration checklist. [Appendix 5] The assessment should ensure that the patient is not showing evidence of intoxication due to opioids, alcohol or other drugs. (Table 4) Page 14 of 63
15 Patients who appear intoxicated with CNS depressant drugs should not be given their usual dose of methadone but be reassessed at a later time when they are no longer intoxicated. If intoxication mild the patient may be given a delayed or reduced dose but only after being reviewed by the prescriber. The Pre Administration Methadone Assessment Checklist needs completing prior to every dose [Appendix 5] 6.7 DRUG USING PARENTS A third of drug misusers in treatment have child care responsibilities. NTA (2009) Table 5 Child Protection Considerations The following should be taken into consideration: Effect of drug misuse on functioning, for example, intoxication, agitation Effect of drug seeking behaviour, for example, leaving children unsupervised, contact with unsuitable characters. Impact of parent s physical and mental health on parenting How drug use is funded, for example, sex working, diversion of family income. Emotional availability to children Effects on family routines, for example, getting children to school on time Other support networks, for example, family support. Ability to access professional support Storage of illicit drugs, prescribed medication and drug-using paraphernalia With consent, information should be gathered from other professionals If risk of significant harm to a young person is found, involve other professionals according to local child protection requirements. Referral to Social Services in Doncaster Referral to Social Services in Bassetlaw For more information or advice about Child Protection Policies and Procedures within BDGH contact Safeguarding Team, Named Nurse for Children on ext PAT/PS 10 - Safeguarding and Promoting the Welfare of Children. Page 15 of 63
16 6.8 CARDIAC ASSESSMENT Methadone and QT prolongation The Medicines and Health Care Product Regulatory Agency [MHRA] recommended in 2006 that patients with the following risk factors to QT interval prolongation are carefully monitored whilst taking Methadone: heart or liver disease, electrolyte abnormalities, concomitant treatment with CVP 3A4 inhibitors, or medicines to cause QT interval prolongation. In addition any patient requiring anymore than 100mg of methadone per day should be closely monitored. Further information is included in the product information. Clinicians must make a balanced judgement for each patient according to the MHRA guidance [and any later expansion or revision] Monitoring, will usually include checking other medications, general monitoring of cardiovascular disease, liver function tests and urea and electrolytes. As the risk factors for the QT interval prolongation increase, e.g. high methadone dose or multiple risk; clinicians will need to consider ECGs. The MHRA recommendation, suggests that an ECG might be considered before induction onto methadone, or before increases in methadone dose and subsequently after stabilisation at least with doses over 100 mg per day and in those with substantial risk. [APPENDIX 3] 7 EXISTING COMMUNITY METHADONE / BUPRENOPHINE PATIENTS Good communication between hospital and community team is essential to ensure safe management of the admission and discharge of existing community treatment. 7.1 PRE PRESCRIBING CHECKS Prior to prescribing Methadone or Buprenorphine the following safety checks need confirming and documenting. Drug type and strength (i.e. Methadone 1mg/1ml) Daily dose Pick up frequency (daily, 3 x weekly, 2 x weekly, weekly) Community Pharmacy Date last collected Missed doses [sec7.3] Prescribing agency / keyworker Amount and whereabouts of any community supplies brought to hospital by the patient. [sec15.6] Page 16 of 63
17 Information provided by the patient may not be reliable and needs corroborating with the community pharmacy and community drug team and documenting. Liaise with the community prescriber as early as possible so that the community prescriber can cancel the existing community prescription and be prepared to recommence the prescription on discharge of the patient. 7.2 OUT OF HOURS Where there is evidence of acute opioid withdrawal and it is not possible to corroborate the patients information i.e. outside of pharmacy hours, Bank holidays etc., Opioid Substitution Therapy medications can be prescribed with the following precautions. Assess the patient [Section 6] Evidence onset of withdrawal syndrome using Short Opiate Withdrawal Scale. [Appendix 5] Methadone 1mg/1ml (PRN) 5 10mg 4hrly Max 40mg in 24 hrs Methadone Assessment Prior to Administration checklist to be completed prior to every dose. [Appendix 5] TO BE INCLUDED ON RE PRINT AMMEDMENT Confirm community dose at earliest possible opportunity and review patient in light of findings. CAUTION Patients presenting out of hours in receipt of existing community opiate substitution therapy may have been dispensed advanced supplies for Weekends and Bank Holidays. This may be in their possession. Patients do not always disclose this information on admission. Every effort should be made to establish the whereabouts of patients own supplies and reassure the patient that continuity of treatment will be maintained throughout admission and upon discharge. [sec3.2 sec 3.3 sec15.6] 7.3 MISSED DOSES OST is reif patient has missed OST doses, for whatever reason, they will need to be reassessed for intoxication and withdrawal before OST administration is recommenced. [sec 6.5] [sec 6.6] Where patients miss OST doses they may use illicit opiates or other drugs including central nervous system depressants such as alcohol and benzodiazepines. When OST doses are missed for 3 days or more days, tolerance to opioids may be reduced placing patients at increased risk of overdose when introduced. Page 17 of 63
18 Table 6 Action to be taken in the event of Missed doses Number of days missed One day Two days Three days Four days Five days or more Action to be taken No change in dose If no evidence of intoxication administer normal dose. Administer half dose in discussion with prescriber. Patient must see prescriber. Recommencement at 40mg half dose which ever is the lower. Regard as a new medication. (Australian Gov, 2000) 7.4 ADMINISTRATION In order to maintain patient safety and reduce drug related deaths [sec 15.3] an assessment of intoxication [sec 6.6] is required prior to administration. The Drug and Alcohol Service Methadone Assessment Prior to Administration Checklist [Appendix 5] needs completing immediately before each administration. 8 ILLICIT OPIATE (HEROIN) USING PATIENTS 8.1 OVERVIEW Patients who are physically dependent on opioids may need OST to relieve the distressing symptoms of opiate withdrawal whilst in hospital. Failure to address the patients dependency may result in continued used of illicit opioids i.e. heroin within the ward environment or premature discharge from hospital. 8.2 PRECAUTIONS Do not give in to undue pressure to prescribe immediately. Take time to assess the patient. Remember a patient who is experiencing withdrawal symptoms may not be able to co-operate fully with medical or surgical treatment. A patient suffering from abstinence withdrawal will present with objective and subjective withdrawal. [See tables 2 and 3] For safety s sake rely more on objective signs of opioid withdrawal.[see tables 2 and 3] Page 18 of 63
19 Poly-drug and alcohol misusers may develop multiple withdrawal syndromes and hospital doctors will need to differentiate these to prioritise treatment. Methadone may initially mask alcohol and benzodiazepine withdrawal symptoms. Exercise particular care in cases of respiratory disease, head injury and liver diseases. It is important to be extremely careful when prescribing additional drugs such as sedatives. It may be necessary, in some cases, to contact the relevant pain control team for further advice on improving pain control. If a urine test is negative for opioids and there is no evidence of opiate withdrawal symptoms, the drug misuser is very unlikely to be physically dependent on opiates and should be reassessed in the light of this. It is not appropriate to offer OST to patients who do not meet the diagnostic criteria for opioid dependency. [Appendix 4] If there is doubt about the degree of dependence it is advisable and safer to withhold prescribing of substitute medication initially and observe the patient until the physical manifestations of opioid withdrawal are evident.[armstrong, 2003] 8.3 CHOOSING THE APPROPRIATE OPIOID SUBSTITUTE Opioid substitution Therapy should only be considered following liaison with the community drug services. Appropriate arrangements for exit prescribing will need to be in place to ensure a seamless transfer of care back into to community The clinical need for prescribing should always be paramount [sec 4.2] [sec 5.1] [Appendix 4] Methadone and buprenorphine are both approved for the treatment and prevention of withdrawals from opioids. Both are approved for maintenance and detoxification programmes (NICE 2007a) NICE recommends the if both drugs are equally suitable, methadone should be prescribed as the first choice. because: Its clinical effectiveness is supported by extensive research. It alleviates opioid withdrawal symptoms. It is taken orally, thus reducing the risk of injection. The dose can be carefully titrated to the optimal level. Blood levels can be kept stable, thus eliminating post dose euphoria and pre dose withdrawal. Page 19 of 63
Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care
Hull & East Riding Prescribing Committee Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care 1. BACKGROUND Patients who are physically dependent
More informationCOMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE
COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE INTRODUCTION High dose sublingual buprenorphine (Subutex) tablets are available in the following strengths 0.4 mg, 2 mg, and 8 mg. Suboxone tablets,
More informationAdjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.
Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,
More informationSCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE
SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE 1 P a g e The following Operational Guidance Manual has been prepared with input from both community and prison addictions specialists
More informationNaltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance
Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Introduction Indication/Licensing information: Naltrexone is licensed for use as an additional therapy, within
More informationNORTHERN IRELAND GUIDELINES ON SUBSTITUTION TREATMENT FOR OPIATE DEPENDENCE
NORTHERN IRELAND GUIDELINES ON SUBSTITUTION TREATMENT FOR OPIATE DEPENDENCE Department of Health, Social Services & Public Safety February 2004 NORTHERN IRELAND GUIDELINES ON SUBSTITUTION TREATMENT FOR
More informationDRUG AND ALCOHOL DETOXIFICATION: A GUIDE TO OUR SERVICES
01736 850006 www.bosencefarm.co.uk DRUG AND ALCOHOL DETOXIFICATION: A GUIDE TO OUR SERVICES An environment for change Boswyns provides medically-led drug and alcohol assessment, detoxification and stabilisation.
More informationKAP Keys. For Physicians. Based on TIP 40 Clinical Guidelines for the Use of Buprenorphine in the Treatment. of Opioid Addiction
Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction Knowledge Application Program KAP Keys For Physicians Based on TIP 40 Clinical Guidelines for the Use of Buprenorphine
More informationBuprenorphine: what is it & why use it?
Buprenorphine: what is it & why use it? Dr Nicholas Lintzeris, MBBS, PhD, FAChAM Locum Consultant, Oaks Resource Centre, SLAM National Addiction Centre, Institute of Psychiatry Overview of presentation
More informationSubstitution Therapy for Opioid Dependence The Role of Suboxone. Mandy Manak, MD, ABAM, CCSAM Methadone 101-Hospitalist Workshop, October 3, 2015
Substitution Therapy for Opioid Dependence The Role of Suboxone Mandy Manak, MD, ABAM, CCSAM Methadone 101-Hospitalist Workshop, October 3, 2015 Objectives Recognize the options available in treating opioid
More informationTreatments for drug misuse
Understanding NICE guidance Information for people who use NHS services Treatments for drug misuse NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases and
More informationThis controlled document shall not be copied in part or whole without the express permission of the author or the author s representative.
This document can be made available in large print and other formats and languages, upon request. Please call NHS Grampian Corporate Communications on 01224 551116 or 01224 552245. This controlled document
More informationTHE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011
RCGP Conference May 2011 Community Based Medically Assisted Alcohol Withdrawal THE BASICS An option for consideration World Health Organisation 2011 Alcohol is the world s third largest risk factor for
More informationAugust 2011. A. Introduction
Recommendations of the Expert Group on the Regulatory Framework for products containing buprenorphine / naloxone and buprenorphine-only for the treatment of opioid dependence August 2011 A. Introduction
More informationHeroin. How is Heroin Abused? What Other Adverse Effects Does Heroin Have on Health? How Does Heroin Affect the Brain?
Heroin Heroin is a synthetic opiate drug that is highly addictive. It is made from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears
More informationEPIDEMIOLOGY OF OPIATE USE
Opiate Dependence EPIDEMIOLOGY OF OPIATE USE Difficult to estimate true extent of opiate dependence Based on National Survey of Health and Mental Well Being: 1.2% sample used opiates in last 12 months
More informationConsiderations in Medication Assisted Treatment of Opiate Dependence. Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT
Considerations in Medication Assisted Treatment of Opiate Dependence Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT Disclosures Speaker Panels- None Grant recipient - SAMHSA
More informationInformation for Pharmacists
Page 43 by 42 CFR part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. Information for Pharmacists SUBOXONE (buprenorphine HCl/naloxone HCl
More informationCo-morbid physical disorders e.g. HIV, hepatitis C, diabetes, hypertension. Medical students will gain knowledge in
1.0 Introduction Medications are used in the treatment of drug, alcohol and nicotine dependence to manage withdrawal during detoxification, stabilisation and substitution as well as for relapse prevention,
More informationA prisoners guide to buprenorphine
A prisoners guide to buprenorphine 2 The Opium poppy In the land of far, far away the opium poppy grows. The seed pods of this poppy are scratched until they drip with a sticky resin called opium. Raw
More informationCare Management Council submission date: August 2013. Contact Information
Clinical Practice Approval Form Clinical Practice Title: Acute use of Buprenorphine for the Treatment of Opioid Dependence and Detoxification Type of Review: New Clinical Practice Revisions of Existing
More informationLike cocaine, heroin is a drug that is illegal in some areas of the world. Heroin is highly addictive.
Heroin Introduction Heroin is a powerful drug that affects the brain. People who use it can form a strong addiction. Addiction is when a drug user can t stop taking a drug, even when he or she wants to.
More informationIntegrating Medication- Assisted Treatment (MAT) for Opioid Use Disorders into Behavioral and Physical Healthcare Settings
Integrating Medication- Assisted Treatment (MAT) for Opioid Use Disorders into Behavioral and Physical Healthcare Settings All-Ohio Conference 3/27/2015 Christina M. Delos Reyes, MD Medical Consultant,
More informationHeroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health?
Heroin Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown
More informationGuidelines for Titration onto Buprenorphine in Opioid Dependence
NHS Fife Community Health Partnership Addiction Services Guidelines for Titration onto Buprenorphine in Opioid Dependence Intranet Procedure No. A7 Author Dr L. Cockayne Copy No 1 Reviewer Lead Clinician
More informationHulpverleningsmodellen bij opiaatverslaving. Frieda Matthys 6 juni 2013
Hulpverleningsmodellen bij opiaatverslaving Frieda Matthys 6 juni 2013 Prevalence The average prevalence of problem opioid use among adults (15 64) is estimated at 0.41%, the equivalent of 1.4 million
More informationNew York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery
New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification
More informationOne example: Chapman and Huygens, 1988, British Journal of Addiction
This is a fact in the treatment of alcohol and drug abuse: Patients who do well in treatment do well in any treatment and patients who do badly in treatment do badly in any treatment. One example: Chapman
More informationGuidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling
Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling Patients with a substance misuse history are at increased risk of receiving inadequate
More informationPrior Authorization Guideline
Prior Authorization Guideline Guideline: CSD - Suboxone Therapeutic Class: Central Nervous System Agents Therapeutic Sub-Class: Analgesics and Antipyretics (Opiate Partial Agonists) Client: County of San
More informationUse of Buprenorphine in the Treatment of Opioid Addiction
Use of Buprenorphine in the Treatment of Opioid Addiction Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Executive Summary Which of the following is an
More informationHeroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health?
Heroin Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown
More informationA G U I D E F O R U S E R S N a l t r e x o n e U
A GUIDE FOR USERS UNaltrexone abstinence not using a particular drug; being drug-free. opioid antagonist a drug which blocks the effects of opioid drugs. dependence the drug has become central to a person
More informationDANGERS OF. f HEROIN. ALERT s alert
AKA > Smack, H, hammer, skag, horse, dope, rocks... WHAT IS HEROIN? Heroin comes from the opium poppy. 1 Heroin is sold as white granules, pieces of rock or powder with a bitter taste and no smell. It
More informationMethadone treatment Information for service users Page
South London and Maudsley NHS Foundation Trust Methadone treatment Information for service users Page What can happen if I stop using heroin? If you are addicted to or dependent on heroin, you develop
More informationSupport to Primary Care from Derbyshire Substance Misuse Service for prescribed / OTC drug dependence
Support to Primary Care from Derbyshire Substance Misuse Service for prescribed / OTC drug dependence SUMMARY 1) Derbyshire Substance misuse service provides Psycho-social treatment interventions for ALL
More informationMEDICALLY SUPERVISED OPIATE WITHDRAWAL FOR THE DEPENDENT PATIENT. An Outpatient Model
MEDICALLY SUPERVISED OPIATE WITHDRAWAL FOR THE DEPENDENT PATIENT An Outpatient Model OBJECTIVE TO PRESENT A PROTOCOL FOR THE EVALUATION AND TREATMENT OF PATIENTS WHO ARE CHEMICALLY DEPENDENT ON OR SEVERLY
More informationMEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION
MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION Mark Fisher Program Administrator State Opioid Treatment Adminstrator Kentucky Division of Behavioral Health OBJECTIVES Learn about types of opioids and
More information13. Substance Misuse
13. Substance Misuse Definitions Misuse or abuse this is the taking of something with the intention of producing pleasurable mind-altering effects, intoxication or altered body image. The mind-altering
More informationElements for a public summary. VI.2.1 Overview of disease epidemiology. VI.2.2 Summary of treatment benefits
VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology Pain is one of the most common reasons for a patient to seek medical attention. Moderate or severe intensity pain can be acute
More informationWORCESTERSHIRE MENTAL HEALTH PARTNERSHIP NHS TRUST GUIDELINES FOR THE MANAGEMENT OF ADULT OPIATE DEPENDENT PATIENTS IN THE ACUTE HOSPITAL SETTING
WORCESTERSHIRE MENTAL HEALTH PARTNERSHIP NHS TRUST GUIDELINES FOR THE MANAGEMENT OF ADULT OPIATE DEPENDENT PATIENTS IN THE ACUTE HOSPITAL SETTING This policy should be read in conjunction with Worcestershire
More informationGuidance for Disease Management in Correctional Settings OPIOID DETOXIFICATION
1145 W. Diversey Pkwy. 773-880-1460 Chicago, Illinois 60614 www.ncchc.org Guidance for Disease Management in Correctional Settings OPIOID DETOXIFICATION NCCHC issues guidance to assist correctional health
More informationNon medical use of prescription medicines existing WHO advice
Non medical use of prescription medicines existing WHO advice Nicolas Clark Management of Substance Abuse Team WHO, Geneva Vienna, June 2010 clarkn@who.int Medical and Pharmaceutical role Recommendations
More informationProgram Assistance Letter
Program Assistance Letter DOCUMENT NUMBER: 2004-01 DATE: December 5, 2003 DOCUMENT TITLE: Use of Buprenorphine in Health Center Substance Abuse Treatment Programs TO: All Bureau of Primary Health Care
More informationOpioid Treatment Services, Office-Based Opioid Treatment
Optum 1 By United Behavioral Health U.S. Behavioral Health Plan, California Doing Business as OptumHealth Behavioral Solutions of California ( OHBS-CA ) 2015 Level of Care Guidelines Opioid Treatment Services,
More informationSPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE
SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT OF ALCOHOL MISUSE Date: March 2015 1 1. Introduction Alcohol misuse is a major public health problem in Camden with high rates of hospital
More informationThe Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office
The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office Adopted April 2013 for Consideration by State Medical Boards 2002 FSMB Model Guidelines
More informationManagement of benzodiazepine misuse
York Service Management of benzodiazepine misuse Version 2 JT July 2013 page 1 background Note: not all those who use benzodiazepines are dependent, and not all those who are dependent will benefit from
More informationOpioid Addiction and Methadone: Myths and Misconceptions. Nicole Nakatsu WRHA Practice Development Pharmacist
Opioid Addiction and Methadone: Myths and Misconceptions Nicole Nakatsu WRHA Practice Development Pharmacist Learning Objectives By the end of this presentation you should be able to: Understand how opioids
More informationMedications for Alcohol and Drug Dependence Treatment
Medications for Alcohol and Drug Dependence Treatment Robert P. Schwartz, M.D. Medical Director Rschwartz@friendsresearch.org Friends Research Institute Medications for Alcohol Dependence Treatment Disulfiram
More informationBNSSG Health Community s Traffic Light System Shared Care Guidance
NHS Bristol NHS North Somerset NHS South Gloucestershire North Bristol NHS Trust University Hospitals Bristol NHS Foundation Trust Weston Area Health NHS Trust BNSSG Health Community s Traffic Light System
More informationMOH CLINICAL PRACTICE GUIDELINES 2/2008 Prescribing of Benzodiazepines
MOH CLINICL PRCTICE GUIELINES 2/2008 Prescribing of Benzodiazepines College of Family Physicians, Singapore cademy of Medicine, Singapore Executive summary of recommendations etails of recommendations
More informationFrequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction
Frequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction March 3, 2008 By: David Rinaldo, Ph.D., Managing Partner, The Avisa Group In this FAQ What medications are currently
More informationSUMMARY OF PRODUCT CHARACTERISTICS 1 NAME OF THE MEDICINAL PRODUCT 2 QUALITATIVE AND QUANTITATIVE COMPOSITION
SUMMARY OF PRODUCT CHARACTERISTICS 1 NAME OF THE MEDICINAL PRODUCT Methadone 10mg/ml Injection / Physeptone 10mg/ml Injection 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Contains: Methadone Hydrochloride
More informationTreatment of Opioid Dependence with Buprenorphine/Naloxone (Suboxone )
Treatment of Opioid Dependence with Buprenorphine/Naloxone (Suboxone ) Elinore F. McCance-Katz, M.D., Ph.D. Professor and Chair, Addiction Psychiatry Virginia Commonwealth University Neurobiology of Opiate
More informationPrescription Drug Addiction
Prescription Drug Addiction Dr Gilbert Whitton FAChAM Clinical Director Drug & Alcohol Loddon Mallee Murray Medicare Local Deniliquin 14 th May 2014 Prescription Drug Addiction Overview History Benzodiazepines
More informationDRUGS OF ABUSE CLASSIFICATION AND EFFECTS
Drug and Drug use DRUGS OF ABUSE CLASSIFICATION AND EFFECTS A pharmaceutical preparation or a naturally occurring substance used primarily to bring about a change in the existing process or state (physiological,
More informationMedications Used in the Treatment of Addiction Developed by Randall Webber, MPH. Alcohol Withdrawal
Medications Used in the Treatment of Addiction Developed by Randall Webber, MPH Alcohol Withdrawal MEDICATION Long/intermediateacting benzodiazepines (e.g., chlordiazepoxide/ Librium, diazepam/valium)
More informationThis module reviews the following: Opioid addiction and the brain Descriptions and definitions of opioid agonists,
BUPRENORPHINE TREATMENT: A Training For Multidisciplinary Addiction Professionals Module II Opioids 101 Goals for Module II This module reviews the following: Opioid addiction and the brain Descriptions
More informationMaintenance of abstinence in alcohol dependence
Shared Care Guideline for Prescription and monitoring of Acamprosate Calcium Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist, Alcohol Services Dr Donnelly
More informationBuprenorphine/Naloxone Training Workshop for Medical Practitioners
Buprenorphine/Naloxone Training Workshop for Medical Practitioners Program developed by Dr Nicholas Lintzeris MBBS, PhD, FAChAM (RACP) Turning Point Alcohol and Drug Centre, Melbourne, Australia Federation
More informationOpioids Research to Practice
Opioids Research to Practice CRIT Program May 2011 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin
More informationSection Editor Andrew J Saxon, MD
Official reprint from UpToDate www.uptodate.com 2015 UpToDate Pharmacotherapy for opioid use disorder Author Eric Strain, MD Section Editor Andrew J Saxon, MD Deputy Editor Richard Hermann, MD All topics
More informationGuidelines for the use of unlicensed and off label medication within NHS Fife Addiction Services
NHS Fife Community Health Partnerships Addiction Services Guidelines for the use of unlicensed and off label medication within NHS Fife Addiction Services Intranet Procedure No. A11 Author Dr A. Baldacchino
More informationOVERVIEW OF MEDICATION ASSISTED TREATMENT
Sarah Akerman MD Assistant Professor of Psychiatry Director of Addiction Services Geisel School of Medicine/Dartmouth-Hitchcock Medical Center OVERVIEW OF MEDICATION ASSISTED TREATMENT Conflicts of Interest
More informationUpdate on Buprenorphine: Induction and Ongoing Care
Update on Buprenorphine: Induction and Ongoing Care Elizabeth F. Howell, M.D., DFAPA, FASAM Department of Psychiatry, University of Utah School of Medicine North Carolina Addiction Medicine Conference
More information1. According to recent US national estimates, which of the following substances is associated
1 Chapter 36. Substance-Related, Self-Assessment Questions 1. According to recent US national estimates, which of the following substances is associated with the highest incidence of new drug initiates
More informationINTOXICATED PATIENTS AND DETOXIFICATION
VAMC Detoxification Decision Tree Updated May 2006 INTOXICATED PATIENTS AND DETOXIFICATION Patients often present for evaluation of substance use and possible detoxification. There are certain decisions
More informationOVERVIEW WHAT IS POLyDRUG USE? Different examples of polydrug use
Petrol, paint and other Polydrug inhalants use 237 11 Polydrug use Overview What is polydrug use? Reasons for polydrug use What are the harms of polydrug use? How to assess a person who uses several drugs
More informationAssessment and Management of Opioid, Benzodiazepine, and Sedative-Hypnotic Withdrawal
Assessment and Management of Opioid, Benzodiazepine, and Sedative-Hypnotic Withdrawal Roger Cicala, M. D. Assistant Medical Director Tennessee Physician s Wellness Program Step 1 Don t 1 It is legal in
More informationmethadonefact.qxd 8/11/01 2:05 PM Page 1 INFORMATION Advantages of methadone treatment DEPRESSANT Methadone maintenance Pregnancy METHADONE
methadonefact.qxd 8/11/01 2:05 PM Page 1 INFORMATION Advantages of methadone treatment 10 DEPRESSANT Methadone maintenance Pregnancy METHADONE methadonefact.qxd 8/11/01 2:05 PM Page 2 WHAT IS METHADONE
More informationNaloxone treatment of opioid overdose
Naloxone treatment of opioid overdose Opioids Chemicals that act in the brain to relieve pain, often use to suppress cough, treat addiction, and provide comfort After prolonged use of opioids, increasing
More informationOpioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians
Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Although prescription pain medications are intended to improve the lives of people with pain, their increased use and misuse
More informationEast London Specialist Addiction Services (ELSAS) Prescribing Guidelines
East London Specialist Addiction Services (ELSAS) Prescribing Guidelines 1 Document Control Summary Title Purpose of document Electroninc file reference (authors) Electroninc file reference (network or
More informationDEVELOPING MANUFACTURING SUPPLYING. Naltrexone Implants. Manufactured by NalPharm Ltd WWW.NALPHARM.COM
DEVELOPING MANUFACTURING SUPPLYING Naltrexone Implants Background to Nalpharm NalPharm is a specialist pharmaceutical company supplying proprietary branded medications and generic drugs in the area of
More informationGuidance for the use of substitute prescribing in the treatment of opioid dependence in primary care
Royal College of General Practitioners Guidance for the use of substitute prescribing in the treatment of opioid dependence in primary care RCGP Substance Misuse & Associated Health (SMAH) formerly known
More informationHow To Treat A Drug Addiction
1 About drugs Drugs are substances that change a person s physical or mental state. The vast majority of drugs are used to treat medical conditions, both physical and mental. Some, however, are used outside
More informationOxford Health NHS Foundation Trust. A guide to Opioid Detoxification
Oxford Health NHS Foundation Trust A guide to Opioid Detoxification If you re considering detox, congratulations. You have obviously been visualising a drug free life and planning your future goals. Detox
More informationOPIOIDS. Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School
OPIOIDS Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School Rutgers New Jersey Medical School Fundamentals of Addiction Medicine Summer Series Newark, NJ July 24, 2013
More informationDMRI Drug Misuse Research Initiative
DMRI Drug Misuse Research Initiative Executive Summary Dexamphetamine Substitution as a Treatment of Amphetamine Dependence: a Two-Centre Randomised Controlled Trial Final Report submitted to the Department
More informationUNIT VIII NARCOTIC ANALGESIA
UNIT VIII NARCOTIC ANALGESIA Objective Review the definitions of Analgesic, Narcotic and Antagonistic. List characteristics of Opioid analgesics in terms of mechanism of action, indications for use and
More informationShare the important information in this Medication Guide with members of your household.
MEDICATION GUIDE BUPRENORPHINE (BUE-pre-NOR-feen) Sublingual Tablets, CIII IMPORTANT: Keep buprenorphine sublingual tablets in a secure place away from children. Accidental use by a child is a medical
More informationPain and problem drug use
Pain and problem drug use Information for patients Prepared by the British Pain Society in consultation with the Royal College of Psychiatrists, the Royal College of General Practitioners and the Advisory
More informationUsing Buprenorphine to Treat Acute Opioid Withdrawal in the ED
Using Buprenorphine to Treat Acute Opioid Withdrawal in the ED Dr. Karine Meador MD CCFP DABAM Assistant Director Inner City Health and Wellness Team Physician Addiction Recovery and Community Health (ARCH)
More informationDeath in the Suburbs: How Prescription Painkillers and Heroin Have Changed Treatment and Recovery
Death in the Suburbs: How Prescription Painkillers and Heroin Have Changed Treatment and Recovery Marvin D. Seppala, MD Chief Medical Officer Hazelden Betty Ford Foundation This product is supported by
More informationProcedure for Community Detoxification using Prescribed Lofexidine with or without Naltrexone
NHS Fife Community Health Partnerships Subject Title Addiction Services Procedure for Community Detoxification using Prescribed Lofexidine with or without Naltrexone Intranet Procedure No. A2 Author Dr
More informationNeurobiology and Treatment of Opioid Dependence. Nebraska MAT Training September 29, 2011
Neurobiology and Treatment of Opioid Dependence Nebraska MAT Training September 29, 2011 Top 5 primary illegal drugs for persons age 18 29 entering treatment, % 30 25 20 15 10 Heroin or Prescription Opioids
More informationWITHDRAWAL OF DRUG(S) OF DEPENDENCE
WITHDRAWAL OF DRUG(S) OF DEPENDENCE Drug withdrawal can be a presenting feature or occur in a patient admitted for other reasons. There is now a Drug and Alcohol Liaison Service (DALT) for support in the
More informationOpioid dependence is a chronic relapsing condition that
PEER REVIEWED FEATURE Treatment of patients with opioid dependence NICHOLAS LINTZERIS BMedSci, MB BS, PhD, FAChAM The prevalence of opioid dependence is growing in Australia with the increased use of pharmaceutical
More informationOpiate Abuse and Mental Illness
visited on Page 1 of 5 LEARN MORE (HTTP://WWW.NAMI.ORG/LEARN-MORE) FIND SUPPORT (HTTP://WWW.NAMI.ORG/FIND-SUPPORT) GET INVOLVED (HTTP://WWW.NAMI.ORG/GET-INVOLVED) DONATE (HTTPS://NAMI360.NAMI.ORG/EWEB/DYNAMICPAGE.ASPX?
More informationHow To Treat Anorexic Addiction With Medication Assisted Treatment
Medication Assisted Treatment for Opioid Addiction Tanya Hiser, MS, LPC Premier Care of Wisconsin, LLC October 21, 2015 How Did We Get Here? Civil War veterans and women 19th Century physicians cautious
More informationBuprenorphine/Naloxone Maintenance Treatment for Opioid Dependence
Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence Information for Family Members Family members of patients who have been prescribed buprenorphine/naloxone for treatment of opioid addiction
More informationOpioid/Opiate Dependent Pregnant Women
Opioid/Opiate Dependent Pregnant Women The epidemic, safety, stigma, and how to help. Presented by Lisa Ramirez MA,LCDC & Kerby Stewart MD The prescription painkiller epidemic is killing more women than
More informationBenzodiazepines: A Model for Central Nervous System (CNS) Depressants
Benzodiazepines: A Model for Central Nervous System (CNS) Depressants Objectives Summarize the basic mechanism by which benzodiazepines work in the brain. Describe two strategies for reducing and/or eliminating
More informationCHARLES & SUE S SCHOOL OF HAIR DESIGN DRUG AND ALCOHOL POLICY DRUG AND ALCOHOL POLICY; SUBSTANCE ABUSE RESOURCES:
CHARLES & SUE S SCHOOL OF HAIR DESIGN DRUG AND ALCOHOL POLICY DRUG AND ALCOHOL POLICY; SUBSTANCE ABUSE RESOURCES: At Charles & Sue s School of Hair Design, the illicit use of drugs and/or alcohol by staff
More informationUnderstanding Addiction: The Intersection of Biology and Psychology
Understanding Addiction: The Intersection of Biology and Psychology Robert Heimer, Ph.D. Yale University School of Public Health Center for Interdisciplinary Research on AIDS New Haven, CT, USA November
More informationJoanna L. Starrels. 2 ND YEAR RESEARCH ELECTIVE RESIDENT S JOURNAL Volume VIII, 2003-2004. A. Study Purpose and Rationale
Outpatient Treatment of Opiate Dependence with Sublingual Buprenorphine/Naloxone versus Methadone Maintenance: a Randomized Trial of Alternative Treatments in Real Life Settings Joanna L. Starrels A. Study
More informationInformation About Benzodiazepines
Information About Benzodiazepines What are benzodiazepines? Benzodiazepines are psycho tropic drugs - drugs that affect the mind and are mood altering. They are commonly known as minor tranquillisers and
More informationDetoxification. Dr Keron Fletcher Shropshire
Detoxification Dr Keron Fletcher Shropshire 1 Stages of treatment Getting stable Staying stable Detoxifying (withdrawing) Staying drug-free 2 Getting stable Medical right dose of methadone/sbx Holds for
More informationOpioids Research to Practice
Opioids Research to Practice CRIT/FIT 2015 May 2015 Daniel P. Alford, MD, MPH, FACP, FASAM Associate Professor of Medicine Assistant Dean, Continuing Medical Education Director, Clinical Addiction Research
More information