BOPAS OST policy is not to replace doses under any circumstances e.g. lost, stolen, spilt, damaged, retched.
If in exceptional circumstances that can be verified (i.e. by a police report, eye witness by professional), the GP may (after discussion with the BOPAS OST service) offer to assess the patient 48 hours or more after their last dose was consumed and if there are signs of opioid withdrawal then part of subsequent doses may be replaced. When requests are made for replacement doses the GP should review the person's takeaway arrangements and notify the case manager and or Addiction Liaison Clincian.
BOPAS policy is to replace 50% of a vomited methadone dose when the patient vomits within approximately 30 minutes of consuming the dose, the vomiting was witnessed by a professional and the replacement is clinically appropriate. (eg. pregnancy)
As buprenorphine/naloxone is absorbed sublingually, there is no need to replace doses after vomiting.
If a second replacement dose for vomiting is requested within a short time, or there are regular requests for replacement doses, no further replacement doses should be authorized until the patient has been assessed by the GP and any underlying cause for the vomiting assessed and treated.
All replacement doses must be prescribed on a new H572M prescription and must be consumed in the pharmacy.
Note: repeatedly seeking replacement dose is likely instability indicator.
*See Section 5.3; 5.3.1; 5.3.2 Replacement Doses page 38 of " New Zealand Practice Guidelines for Opioid Substitution Treatment 2014"
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