This may be indicated when the patient is reporting that the dose is not sufficiently suppressing opioid withdrawal symptoms for the full 24 hours. The symptoms typically have their onset during the evening and overnight, are most marked in the hours before their usual dosing time and are markedly relieved within an hour or two of dose consumption. (See Signs and Symptoms of Opioid Withdrawal and Intoxication/Overdose).
This may occur as the result of:
Where continued, or relapse to illicit opioid use is reported:
Where, after careful clinical assessment, the decision is to trial an increase in dose, the G.P should contact the Addiction Liaison Clinician. Dose increases should be titrated up at no more than 5 to 10mgs at intervals of 5 to 7 days. It is advised to consider a temporary return to daily dispensing whilst re-stabilising, so that the pharmacist can also provide support and observe for any signs of sedation.
If there is evidence of injecting, provide harm reduction information related to safer injecting practices and access to needle exchange. Notify Addiction Liaison Clinician.
There are occasions when patients request an increase in dose to manage acute or chronic pain. We advise consultation with the Addiction Liaison Clinician before increasing the dose for pain relief. It is generally advised to add short-term additional medication for pain relief rather than altering OST medication.
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