Introduction

Infectious diseases
NHS Lothian

This guideline relates to the management of patients who have a history of problematic drug use and have presented to hospital principally for reasons other than drug use.

Substance users can be a particularly challenging group of patients; however, it is unfair to assume that this is applicable to all patients.

Opioids (e.g. heroin) and benzodiazepines are the substances most frequently associated with problematic drug use in Lothian, therefore feature prominently in this guidance. Cocaine and certain new psychoactive substances are being used more often and guidance on these particular substances is included on pages 12-14. Primary problematic alcohol use is not covered within this guideline, with the exception of co-dependent users (heroin +/- benzodiazepines + alcohol). The guideline also advises on the management of individuals who usually receive opiate substitution medication in primary care (e.g. methadone or buprenorphine) who are admitted to an acute NHS Lothian hospital.

This guideline also introduces and formalises the role of the Drug Liaison Service within Lothian, providing advice on when and how to contact the team for support. Contact details and information regarding each of the Substance Use Service sites is provided in section Useful phone numbers and contacts during working hours.

This document is intended as guidance only and cannot be comprehensive. Patients with complex needs and challenging behaviour should be discussed on a case-by-case basis with appropriately experienced staff. This guidance should be read in conjunction with the information and the Inpatient substance misuse pathway.

The guideline development team would like to express thanks to NHS Greater Glasgow and Clyde for allowing use of their local guidelines as a basis for this document.

Principles of management

Engaging and retaining patients in treatment is a priority of the Scottish Government strategy to reduce problematic drug use. Admission to an acute hospital often provides access to care for this chaotic patient group. Rather than seeing acute admission as an opportunity to promote drug abstinence, which may lead to loss of tolerance and treatment failure, the principles of acute management are stabilisation and enrolment of the patient into specialist services.

There is an increasing body of evidence that concurrent treatment of substance misuse can improve compliance, retention and success of a patient’s other medical and surgical regimes.

 

Pregnancy

In pregnancy, there are increased risks associated with opiate withdrawal. Urgent advice must be sought from local Substance Use Service staff within the PrePare Team. See Useful phone numbers and contacts during working hours for further contact details.

Drug Liaison Service

The Drug Liaison Service is a nurse led, community-based resource to facilitate acute service delivery and provide care to drug users who are at high risk of harm. The service provides an essential link between acute and community services, ensuring continuity of care and seamless transition between care settings.

The service assesses patients who have dependent, erratic and/or hazardous drug use, some of whom have not had previous engagement with community treatment services.

The main objectives of the service include:

  • early access to Medication Assisted Treatment (MAT),
  • retention in treatment to avoid early or self-discharge
  • and to identify current and new cases of Blood Borne Viruses.

The role of the Drug Liaison Nurse focuses on:

  • improving patient experience and outcomes,
  • commencing MAT in line with Scottish MAT Standards (www.matstandards.co.uk) where appropriate
  • and facilitating discharge planning, while supporting the patient throughout the process.

 

Editorial Information

Last reviewed: 30/06/2023

Next review date: 30/06/2026

Author(s): Linda J Smith, Rakhee Vasishta, Joanna Renée.

Version: 1.1

Approved By: NHS Lothian Drugs and Therapeutics Committee

Reviewer name(s): Linda Smith, Rakhee Vasishta, Joanna Renée.