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Treatment of opioid overdose 498 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Opioid dependence Prescribing for opioid dependence The treatment of opioid dependence is a rapidly changing and dynamic field. A decade or so ago, maintenance treatm...

Opioid substitution treatment (OST) 500 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Opioid substitution treatment (OST) The mainstay of pharmacological management of opioid dependence is OST. OST can be prescribed for detoxification, that is, ...

Methadone 504 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 In rare cases, patients may be allergic to methadone or buprenorphine or to some of the constituents within the formulations. Methadone Initiation in all settings ■ ■Do not prescribe/di...

Buprenorphine 506 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Methadone overdose In the event of methadone overdose, naloxone should be administered as described in the section on opioid overdose earlier in this chapter. Methadone and risk of ...

Alternative oral opioid preparations

Injectable diamorphine 514 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Alternative oral opioid preparations Oral methadone and buprenorphine continue to be the mainstay of treatment.8 Other oral options such as slow-­release oral morphine (SRO...

Prescribing psychotropic medications in patients with opiate dependence Addictions and substance misuse CHAPTER 4 Prescribing psychotropic medications in patients with opiate dependence General psychiatrists often see and treat patients with addictions and psy...

Opioid detoxification and reduction regimens

Opioid withdrawal in a community setting 516 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Opioid detoxification and reduction regimens Opioid maintenance can be continued for a few weeks to almost indefinitely, depending on clinical need. Some ...

Opioid withdrawal in a specialist addiction in-patient setting

Naltrexone in relapse prevention Addictions and substance misuse CHAPTER 4 Opioid withdrawal in a specialist addiction in-­patient setting Methadone Patients should have a starting dose assessment of methadone over 48 hours by a ­specialist in-­patient team. T...

Pain control in patients on OST 518 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 The minimum recommended interval between stopping the opioid and starting ­naltrexone depends on the opioid used, duration of use and the amount taken as a last do...

References 520 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 References Scott G, et  al. Patients’ perceptions of self-­administered dosing to opioid agonist treatment and other changes during the COVID-­19 ­pandemic: a qualitative study. BMJ O...

Nicotine and smoking cessation

Nicotine replacement therapy (NRT) Addictions and substance misuse CHAPTER 4 Nicotine and smoking cessation Tobacco smoking is the leading preventable cause of illness and premature death ­worldwide. Smoking cessation interventions are clinically and cost effe...

Varenicline 524 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Clinical effectiveness A Cochrane review of NRT suggests combination NRT (i.e. two formulations such as a patch and an oral/nasal product) is associated with higher long-­term abstine...

Cytisine 526 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 4 Preparations and dose People who smoke should set a target stopping date between 1 and 2 weeks after starting varenicline treatment. Those who are not willing or able to set a target dat...

Bupropion