Prescribed treatments for opiate use

If you use opiates such as heroin, morphine or codeine regularly you may feel unwell when you try to stop or use less, we call this withdrawal symptoms. You may also need more opiates to have the same effect (tolerance) and you may have strong urges to use opiates (craving). We can help to stop craving and withdrawal symptoms by prescribing medicines such as buprenorphine and methadone, these are opiates that stay in your system much longer than heroin and other opiates so you only have to take them once a day to stop cravings and withdrawal symptoms. You can either stay on these treatments (maintain) or reduce off (detox).

You can refer yourself to DDARS or someone can do this for you with your permission, and we will offer you an appointment. At this appointment staff will ask about your substance use, your work, family and housing situation, your physical and mental health and you will be asked to provide a sample of urine or saliva. We will arrange for you to speak with medical or other prescribing staff to talk through prescribing choices. If you need to start on methadone or buprenorphine we will arrange this, and you will be given a keyworker who will meet with you regularly to provide support.

We will explain how to avoid overdose and train you to use naloxone which can temporarily reverse the effects of opiates like heroin and methadone and help keep someone alive until an ambulance arrives. We will offer you testing for HIV, Hepatitis C and Hepatitis B, help you get you in contact with treatment services if needed, and explain how to get sterile injecting equipment. It’s a good idea to link up with the voluntary sector to support your recovery and we will ask you to meet with them.

Keeping a record of your substance use in diaries can help you understand your use and the situations that lead to using, it is useful to talk them through with your keyworker so you can work together to change your substance use. If you find writing difficult your keyworker can show you how to complete diaries using marks. If you don’t complete the diaries we can still start you on prescribed treatment and change your dose.

Urine and oral fluid samples let us know what substances are in your system, as we need to make sure you have been using heroin or other opiates before your first dose. If you don’t use opiates regularly your body may not be able to tolerate the first dose and we could cause you to overdose. Once you have started on prescribed treatment let us know if treatment has helped you stop or reduce your substance use (samples can also help us with this) as we can increase the dose to help you make changes to your substance use.

When you start on buprenorphine or methadone the pharmacist will watch you taking your dose to help keep you safe, this is called supervised dispensing or supervised consumption. As you are increasing your dose the pharmacist can check the effect this is having on you for your safety, also if you are using substances the pharmacist can check it is safe for you to take your medicine that day. Sometimes this can also help keep your treatment safe from other people using it. Once you are stable in treatment you can collect your treatment each day and take it home, and if you stay stable you can collect it three times a week or less frequently.

It’s very important to take your treatment every day for it to work but we understand sometimes it’s not possible. If you miss three doses or more as you can’t make it to the pharmacy or the pharmacist can’t give you doses as you are under the influence, they won’t be able to give you another dose. You may have lost tolerance to your medicine and Government guidelines to keep you safe mean the pharmacist has to do this, and they will ask you to go to Constitution House to check it is safe to give you another dose that day.

We understand it is difficult to stop using substances. If you are using heroin or other opiates on top of prescribed methadone or buprenorphine we will ask you to increase your dose to help you stop using, if this doesn’t help we will speak to you about other treatment options. Using substances like gabapentin, pregabalin, alcohol and valium with prescribed treatment is very dangerous and may cause you to overdose. If you are using these substances with methadone and we are worried about your safety we will talk to you about other treatment options.

We understand sometimes it’s not possible to get to appointments and we are keen to keep you on treatment. However, methadone and buprenorphine are controlled drugs so we need to monitor our prescribing and see you regularly to keep you safe. We run clinics from lots of places across the city and also in evenings to make it easier to get to appointments and can ask your community pharmacist to remind you. If you are still unable to attend appointments we may ask your pharmacist to delay dispensing until after your appointment to remind you to attend.

Yes, if you go to prison let them know what treatment you are on so they contact us and we can tell them what you are prescribed, so they can continue your treatment. Then the prison will let us know the date you will be released and we can arrange for your treatment to continue at your community pharmacy after you are released. Sometimes people are released from court at short notice without us knowing, if this happens it’s important to come to Constitution House as soon as possible so we can arrange for your treatment to continue.

If you go into custody and they continue treatment, they should let your community pharmacist know you haven’t missed any doses so treatment can continue once you are released. If you missed doses in custody your pharmacist may ask you to come to Constitution House to check it is safe for you to have another dose that day.

Yes, it’s important you are able to go on holiday. We can transfer your prescription to another pharmacy in the UK whilst you are on holiday, but we need enough time to get a prescription there so let us know as soon as possible. If you are stable in treatment we can give you methadone or buprenorphine to take with you on holiday in the UK or abroad, but please give us enough time to arrange this. Please bring in details of your holiday so there is no mix up over dates.

Yes, when you feel ready we can arrange for your dose to reduce regularly by the amount you want until you are off treatment, this usually takes about twelve weeks. This can be done at your local pharmacy supported by your keyworker and our community programme, or you can go into Murray Royal Hospital for a two week buprenorphine detox supported by their therapeutic programme. Once you are off buprenorphine or methadone your keyworker can explain about treatment with naltrexone to help you stay off heroin and other opiates. It’s a good idea to link up with self help groups such as Narcotics Anonymous or SMART recovery, and the voluntary sector to help your recovery. If you start using heroin again your overdose risk will be increased as you won’t be used to heroin so let us know as soon as possible so we can talk you about treatment choices to help you stay safe.

For more information about treatment please click the links below to read our patient information leaflets about buprenorphine and methadone.