OST Drug Issues Pathway - Treatment Completion
"Entering and staying in treatment, coming off opioid substitution treatment and exiting structured treatment are all important indicators of an individual's recovery progress, but they do not in themselves constitute recovery. Coming off OST or exiting treatment prematurely can harm individuals, especially if it leads to relapse, which is also harmful to society. Recovery is broader and more complex journey that incorporates overcoming dependence, reducing risk-taking behaviour and offending, improving health, functioning as a productive member of society and becoming personally fulfilled. These recovery outcomes are often mutually reinforcing. " The National Treatment Agency for Substance Misuse (2012) in the NZ Practice Guidelines for Opioid Substitution Treatment (2014) p26"
Where a patient expresses an intention or desire to withdraw from methadone or buprenorphine/naloxone please contact the Addiction Liaison Clinican for support with this.
- Motivation for withdrawal.
- Giving information to the patient e.g. the orange Coming off Methadone booklet.
- Discuss withdrawal options and develop a plan with the patient. BOPAS OST prefers clients are offered the opportunity to reduce "at request", so as to ensure they feel in control of their reduction regime at all times. For example the script can be annotated to "reduce 1mg per week at request".
- Patients may also stop reduction for a period or have small dose increases before recommencing reductions. As with the opening quote; Recovery is broader and more complex journey.
- Review the withdrawal process each time the patient is seen or at the patient's request.
- Offer and negotiate a 'window period' of between 0 and 12 weeks with the patient during and prior to the completion of the withdrawal from methadone or buprenorphine/naloxone. The window period is the time after the last methadone or buprenorphine/naloxone dose is consumed within which the patient can choose to immediately restabilise on methadone or buprenorphine/naloxone. (Note: The restabilisation on methadone or buprenorphine/naloxone will be carried out by BOPAS OST, and the patient transferred back to the GP programme as appropriate).
- Notify the Addiction Liaison Clinician of the date on which the patient last consumed methadone or buprenorphine/naloxone and of the negotiated window period.
- If the patient makes contact wishing to re-stabilize on methadone or buprenorphine/naloxone within the window period contact the Addiction Liaison Clinician about making an appointment at BOPAS OST for assessment regards restabilisation.
- If the patient makes contact wishing to recommence on methadone or buprenorphine/naloxone after the window period is completed then refer them to BOPAS for reassessment.
If you believe that positive treatment outcomes will be compromised by withdrawal contact the Addiction Liaison Clinician to arrange a joint appointment with the patient to discuss and decide on an appropriate course of action, or contact the BOPAS OST, medical officer for advice/support.
Last updated : Thursday, January 09, 2020
Next review date : Friday, January 08,2021
Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.