Drug Misuse
The role of supervised consumption in early maintenance treatment:
 | Supervision
of methadone or buprenorphine consumption gives the prescriber and dispenser
the confidence to progressively increase the dose in order to achieve
stability of lifestyle as early as possible in treatment |
| It
also reduces the likelihood of diversion of prescribed medication on
cessation of supervision |
| It
is best practice to keep the length of time spent in supervised consumption
to a minimum. A rough guide to this would be to move to daily (with
Sunday’s dose dispensed Saturday) instalment prescribing about 2 weeks
after last dose increase ie not
necessarily wait until 3 months from commencement as indicated in Orange
Book Guidelines |
| Loss
of stability may result in a further episode of supervised consumption |
| Please
make use of alternate day dosing once individuals are stable on
buprenorphine ie double the daily dose taken on alternate days |
| There
are legitimate exceptions to the general rule ‘…supervised consumption
at the commencement of all new prescriptions…’. Otherwise some will be
unnecessarily excluded from treatment. |
| Patients
forced to travel long distances for Supervised Consumption may drop out of
treatment. If patients are walking more than 15mins (30min round trip) to
the nearest pharmacy with a Supervised Consumption place available this may
be a reason to reconsider and use daily pick up at a closer pharmacy. |
‘…successful
ongoing maintenance…’
– a definition
Stability
of lifestyle achieved by the use of a substitute opioid in combination with
psycho-social support, which gives an individual the option to separate
themselves from a drug using lifestyle and to begin building an alternative
Markers
of stability:
Successful ongoing maintenance will probably be characterised by –
| The
cessation of daily illicit opiate use – complete abstinence
from street drugs may or may not be an early goal but any continuing opiate
use needs to have a pattern which does not threaten lifestyle stability eg
by putting the person at risk of offending |
| The
successful engagement of the
patient by the therapist in a meaningful dialogue leading to a mutually
agreed treatment (care) plan |
| Significant
length of time in treatment without gaps |
| Probable
dose range (for methadone) higher
than historical average and closer to the range 80-120mg |
Drs
Steve Brinksman and Nigel
Modern,
Lead GPs
with Special Interest (Substance Misuse), Birmingham
Drug Action Team (Primary
Care) 0121
233 7437/8 Jan 2004