clinical assessment prior to detoxification
Last reviewed 01/2018
NICE have provided guidance concerning the clinical assessment of patients who are to undertake opioid detoxification:
- Clinical assessment
- assess
to establish the presence and severity of opioid dependence, as well as misuse
of and/or dependence on other substances, including alcohol, benzodiazepines and
stimulants. As part of the assessment, healthcare professionals should:
- use urinalysis to aid identification of the use of opioids and other substances; consideration may also be given to other near-patient testing methods such as oral fluid and/or breath testing
- assess signs of opioid withdrawal where present
- take
a history of drug and alcohol misuse and any treatment
- include a history of previous attempts at detoxification, for these problems
- review current and previous physical and mental health problems (including respective treatments for these)
- consider the risks of self-harm, loss of opioid tolerance and the misuse of drugs or alcohol as a response to opioid withdrawal symptoms
- consider the person's current social and personal circumstances, including employment and financial status, living arrangements, social support and criminal activity
- consider the impact of drug misuse on family members and any dependants
- develop strategies to reduce the risk of relapse, taking
into account the person's support network o if opioid dependence or tolerance
is uncertain, healthcare professionals should, in addition to near-patient testing,
use confirmatory laboratory tests. This is particularly important when:
- a young person first presents for opioid detoxification
- a near-patient test result is inconsistent with clinical assessment
- complex patterns of drug misuse are suspected
- for women who are opioid dependent during pregnancy, detoxification should only be undertaken with caution
- assess
to establish the presence and severity of opioid dependence, as well as misuse
of and/or dependence on other substances, including alcohol, benzodiazepines and
stimulants. As part of the assessment, healthcare professionals should:
Reference:
- Prescribers' Journal (2000); 40 (2): 67-76.
- NICE (July 2007).Drug misuse - Opioid detoxification.