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Updated guidance on management of patients who are dependent on opiates

September 3, 2019

Guidance regarding management of patients who are dependent on opiates has been updated.

The guidance is intended to help clinicians manage in-patients with opioid dependence. Though sometimes challenging and with complex social, psychological and physical health issues, these patients are entitled to the same high standards of care we afford to all. Opioids should always be prescribed with caution due to the risk of toxicity and death from respiratory depression in overdose. However, denial of appropriate prescription of opioids in such patients can also have a negative impact on their care, resulting in increased pain, symptoms of withdrawal, and an increased risk of self-discharge against medical advice before adequate treatment has been given.

There are three common scenarios that can cause uncertainty for clinicians not experienced in the management of such patients, and these are the focus of the guidance:

  • Patients already prescribed maintenance opioid substitution therapy (OST) prior to admission
  • Patients who take opioids without prescription (illicit drug use)
  • Pain management in opioid dependent patients

Note: The guidance also covers management of opioid withdrawal and advice regarding pregnant patients who are using opioids.

Please see guidance below for more information:

https://connect2.swbh.nhs.uk/index.php/methadone-opiate-dependent-patients-management-tox-002/