Improving hospital care for people who use drugs: deliberative process development of a clinical guideline for opioid withdrawal management

• DOI: 10.1186/s12954-024-01127-2
• Publication Date: 2024-11-18T01:45:20Z
• Authors: Marisha Wickremsinhe; Adam Holland; Jenny Scott; Rosalind Gittins; Michael Brown; Adrian ‘Bean’ Noctor; Dan Lewer; Vivian Hope; Niamh Eastwood; Magdalena Harris
• Keywords: Guideline

Management of opioid withdrawal in hospital settings is crucial to improve treatment completion and health outcomes among patients who use opioids, such as heroin. Evidence-based clinical guidelines can support responsive provision substitution therapy (OST). In England there no standardised application guidance for substance dependence management across National Health Service (NHS) Hospitals. A recent review NHS policies identified varying approaches managing procedural barriers timely medication. To develop a guideline acute trusts be tested evaluated part the iHOST (Improving Hospital Opioid Substitution Therapy) research intervention. We undertook deliberative development process. The University London College (UCLH) was used template, with key points revision informed by evidence review, consultations staff people dependence. multidisciplinary working group deliberated statements recommendations. These were reviewed an oversight committee comprising representatives from stakeholder organisations. team authored iterative committee, stakeholders UCLH governance committees. Deliberation focused on three domains: (1) identifying promptly continuing existing OST prescriptions; (2) initiating or re-titrating OST; (3) ensuring safety continuity care at discharge. Changes included removal mandatory urine drug testing prior increasing initial methadone titration dose; higher day-one dose when specific criteria are met. new schedule sublingual buprenorphine incorporated. Discharge planning ensure community reduce risk overdose emphasised, allowance bridging prescriptions naloxone aims remove inpatients. It intended implemented other hospitals, which could access discrepancies completion. ISRCTN47320412 https://doi.org/10.1186/ISRCTN47320412 .