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

Please do not assume if a patient becomes unusually drowsy they have taken illicit substances. There may be an underlying medical reason that requires further investigation and monitoring.

Patients may exhibit symptoms of drug intoxication when in hospital due to ongoing illicit drug use on the ward or within hospital premises. If the patient appears overly sedated, it may be appropriate to withhold MAT/dihydrocodeine until symptoms resolve. It would also be appropriate to obtain an oral fluid toxicology test.

Patients who have received naloxone prior to admission may be at increased risk of overdose as naloxone is shorter acting than many opioids. Patients who have been given naloxone should have opioids withheld and be monitored for a minimum of 6 hours. TOXBASE (www.toxbase.org) should be used to guide management for all patients with opioid toxicity.