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Guidelines on the management of people who inject drugs in Lothian hospitals (2023)
Symptomatic relief in opiate withdrawal

Update your RDS mobile app to v4.7.2 to download toolkits even when website is down.

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. You will see that each toolkit has a small QR code icon in the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively update to the latest release - RDS app version 4.7.1 - to see this improvement.

Updating to this latest version of the RDS app is also strongly recommended to get the full benefits of the new resilience arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Symptomatic relief in opiate withdrawal

Infectious diseases

Below are some of the symptoms commonly experienced during opiate withdrawal and prescribing suggestions (see BNF for further information).

Nausea and vomiting	Metoclopramide	ORAL or IM injection: 10mg, 8 hourly, up to a maximum of 30mg in 24 hours. See BNF for dosing advice if body weight <60kg
Pain	Ibuprofen	ORAL: 400mg, 4 - 6 hourly, up to a maximum of 2.4g in 24 hours
Diarrhoea	Loperamide	ORAL: 2mg as required, up to a maximum of 16mg in 24 hours
Stomach cramps	Hyoscine butylbromide (Buscopan®)	ORAL: 20mg as required, 6-8 hourly, up to a maximum of 80mg in 24 hours
Sleep difficulties	Consider zopiclone for short term use rather than a benzodiazepine	ORAL: 3.75mg - 7.5mg once daily at night

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

Approved By: NHS Lothian Drugs and Therapeutics Committee

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