Do not feel pressurised to prescribe

Only prescribe when the assessment, examination and investigations have been completed and indicate that an inpatient prescription is appropriate.

Patients may take 24-36 hours to develop symptoms and signs of withdrawal, therefore may not require a dose within the first hours of admission unless they are pregnant.

Telephone the community prescriber and contact the community pharmacy to inform them of the patient’s hospitalisation. It is important to contact the pharmacy to confirm when the last was dose consumed, and to ensure that the patient regularly obtains their prescribed dose (supervised/unsupervised) as prescribing records cannot confirm collection from the pharmacy and tolerance may be lost if doses are missed. Once the information has been confirmed and their clinical assessment is satisfactory, continue the patient’s usual dose of medication assisted treatment (MAT).

If the patient’s MAT is unsupervised, confirm with the patient that they are indeed consuming the full prescribed dose as they may be non-compliant and therefore will be intolerant of the full dose. If they have not been taking their full prescribed dose, consider reducing the dose appropriately or contacting Drug Liaison Nurses for advice.

Out of hours, such as Bank Holidays, weekends and evenings, contact may not be possible with DLNs or community pharmacies to confirm whether a dose was last administered. In this instance, refer to section 4 on managing patients who are dependent but not currently receiving treatment.

Caution - If in doubt, withhold opioid substitution therapy (OST) and treat symptoms of withdrawal until OST dose can be confirmed.