Opioid use disorder

Patients should be encouraged to participate in a drug treatment programme and abstain from opioids and other potential drugs of misuse (e.g., alcohol, cocaine, amfetamines). Therefore, it is important that the patient minimises cues linked to the drug-using experience (e.g., people, places, and paraphernalia) and exposure to drugs.

Advise patients newly taking methadone for opioid use disorder to avoid driving or operating heavy machinery until their dose is stabilised.[69]Substance Abuse and Mental Health Services Administration. TIP 63: medications for opioid use disorder. Jul 2021 [internet publication]. https://library.samhsa.gov Warn patients that stopping drug treatment and returning to opioid use increases overdose risk, especially after naltrexone, due to lost tolerance. Patients on methadone or buprenorphine should avoid alcohol, benzodiazepines, and other sedatives.[69]Substance Abuse and Mental Health Services Administration. TIP 63: medications for opioid use disorder. Jul 2021 [internet publication]. https://library.samhsa.gov

Patients can benefit from 12-step-oriented groups such as Narcotics Anonymous, preferably within a group supportive of pharmacotherapy. UK Narcotics Anonymous Opens in new window[69]Substance Abuse and Mental Health Services Administration. TIP 63: medications for opioid use disorder. Jul 2021 [internet publication]. https://library.samhsa.gov ​ For patients and their family members and others in their recovery support network, instructions on recognising and responding to an overdose is recommended, in combination with information on naloxone use.[69]Substance Abuse and Mental Health Services Administration. TIP 63: medications for opioid use disorder. Jul 2021 [internet publication]. https://library.samhsa.gov

Public health issues (e.g., preventing diversion, ensuring safe storage and security of drug treatments, preventing overdoses) are considered when determining a patient’s eligibility for take-homes. Inform patients that accidental ingestion of opioid agonists can be fatal for opioid-naïve individuals, particularly children. Patients should keep take-home methadone in a locked container out of the reach of children.[69]Substance Abuse and Mental Health Services Administration. TIP 63: medications for opioid use disorder. Jul 2021 [internet publication]. https://library.samhsa.gov ​​

Advise patients to report pregnancy if this occurs. Pregnant women treated with methadone or buprenorphine have better outcomes than pregnant women not in treatment who continue to use illicit opioids. For pregnant women receiving opioid agonist treatment, offer guidance to help reduce the risk or severity of neonatal abstinence syndrome (NAS). Key recommendations include avoiding smoking and benzodiazepines, discussing breastfeeding with obstetric care providers, and preparing for NAS care by meeting with paediatric staff. After birth, practices like rooming-in, skin-to-skin contact, low lighting, and minimal stimulation can help soothe the baby and lessen NAS symptoms.[69]Substance Abuse and Mental Health Services Administration. TIP 63: medications for opioid use disorder. Jul 2021 [internet publication]. https://library.samhsa.gov