What is the principle of OST?
Replace illict drugs (with a short half life) with legal drugs that have a long half life (eg, methadone and buprenorphine)
This decriminalises the person, and gets them into the habit of taking drugs less often
What are the benefits of OST to society?
Reduce drug related crime to reduce public fear and increase their percieved safety
Save money spent within the criminal justice system
Save money on health costs
What are the therapeutic doses for methadone and buprenorphine?
And should these be titrated?
Methadone --> 60-120mg per day
30mg day 1, then 10mg 4 hours later...or 5/10mg daily increases from then on to 60mg
Buprenorphine --> 12-16mg per day (may need 32mg)
4mg day 1 then 4mg 6-8 hours after. Then 12-16mg day 2.
First dose must be taken when in withdrawal (and potentially in a split dose to reduce the change of precipitated withdrawal), and cannot be taken if heroin has been taken within 6 hours
What should be monitored before commencing OST?
Exact (poly) drug use
UDS (urine dip stick) on the day to find out what drugs are in the system
BP and pulse
LFTs --> Mainly for buprenorphine as metabolised in the liver
Injecting sites used if applicable
What is the 'Three Day Rule'?
And why is it important?
Tolerence drops naturally over time when not on opioids...but there is no way of telling how much by.... so if 3 days are missed of OST then the script becomes invalid and a new titration needs to be started
Important to ensure that we don't OD someone on their OST!
When should water be given to patients undergoing supervised OST on buprenorphine or methadone?
Buprenorphine --> Before
Methadone --> After
Teeth should also be brushed after taking methadone
How is supervised consumption commisioned in the UK?
It is not an essential contractual service.... so you can techincally refuse to do it
Name some positives and negatives of supervised consumption
Positives --> Prescriber knows the patient is taking treatment, pharmacy get daily contact with the addict, the patient doesnt have to manage his own medicines and encourgaes compliance, also prevents deaths
Negatives --> Patients can be problematic, may not have the needed space, could be a negative experience for the addict, lack of control can be irritating for patient, can be viewed of as lack of trust, also it is costly!!