Buprenorphine treatment

Transcription

1 South London and Maudsley NHS Foundation Trust Buprenorphine treatment Information for service users Page

2 Buprenorphine treatment What is buprenorphine? Buprenorphine (trade name Subutex ) is an opioid similar to heroin. It is prescribed by a doctor. If you take buprenorphine, you are unlikely to get withdrawal symptoms if you stop taking heroin (or the symptoms will be much less severe). It also helps to reduce craving for heroin. The drug most commonly prescribed as a replacement for heroin is methadone. However, buprenorphine is sometimes preferred as: you may feel more clear headed' with buprenorphine than with methadone you may have trouble using methadone it tends to be easier to come off (detox) buprenorphine than with methadone - some people take methadone long-term but switch to buprenorphine if they decide to detox it is safer than methadone if you take an overdose. If you take buprenorphine (or methadone) under supervision from us you are: more likely to be able to get away from the drug scene' likely to feel better in yourself more likely to get off drugs for good. Page 2

3 What happens during buprenorphine treatment? A nurse or drugs worker will assess you and will agree the next stage with you. This could be either: going back to your GP and specialist primary care team for an appointment - this is usually within a week an appointment for a fuller assessment with us. What is assessment? An assessment is a meeting that usually includes: taking details of your health and social situation taking details of your past and current drug taking, and whether you need buprenorphine or methadone a urine test to confirm the drugs you are taking finding out what you think you need now agreeing a care plan that sets out what you want to achieve discussing how information is shared and who with, with your consent talking about the dangers and effects of using heroin and alcohol on top talking to you about testing for hepatitis C and HIV hepatitis A and B, and immunisations for these, if you have been injecting information about safer injecting and the risks you may be facing. Page 3

4 Starting off with buprenorphine Buprenorphine is started after assessment when the results of your urine test are back. We give you your first dose based on how much heroin or methadone you use now. Taking buprenorphine Buprenorphine is a tablet that you put under your tongue. The tablet dissolves over 3-7 minutes and goes straight into your bloodstream (it doesn't work if you swallow it). You usually take it once a day. We will usually ask you to take it under the supervision of the pharmacist who dispenses it. This supervision may be relaxed if you are stable and taking regular doses after twelve weeks or so. You will then be able take a daily dose home, gradually picking it up from the chemist or pharmacy less often (if you are stable). You can talk about doses with your key worker if you are going away on holiday. What is suboxone? Suboxone is a tablet where the buprenorphine is combined with a small amount of a drug called naloxone. When it is injected the user will experience withdrawal symptoms. If it used properly it has the same effect as buprenorphine. Your key worker and doctor can discuss it with you. Page 4

5 The first dose When you take the first dose it is important that: if you are taking heroin, you take the first dose of buprenorphine at least eight hours after taking your last dose of heroin if you are taking methadone, you take the first dose of buprenorphine between 24 and 36 hours after your last dose of methadone. This is because, for buprenorphine to work well, you need to take it when your body has low levels of heroin or methadone. So, the aim is to take the first dose only when you feel some withdrawal symptoms starting. If you take it sooner, it can cause withdrawal symptoms to suddenly develop. Getting to the right dose The first dose may need to be increased if you still get some withdrawal symptoms. It may take up to a few weeks to get to the right dose that stops all symptoms. Try to accept that you may have some withdrawal symptoms during this time. You should not take any street drugs or much alcohol when you are taking buprenorphine. Maintenance and coming off Page 5

6 Are there any risks or side effects of taking buprenorphine? If you are addicted to or dependent on heroin you develop withdrawal symptoms within a day or so of the last dose so you need a regular dose to feel "normal". Withdrawal symptoms include sweating, feeling hot and cold, runny eyes and nose, yawning, being off food, stomach cramps, feeling sick or vomiting, diarrhoea, tremors, poor sleep, restlessness, general aches and pains, and just feeling awful. Withdrawal symptoms tend to ease and go within five days, but you may then have a persistent craving for heroin, remain tired, and have poor sleep for some time afterwards. Some people feel it difficult to manage the transition from illegal opiates or methadone to buprenorphine. If you are having any problems go back to your prescriber. You are more likely to succeed if you have support from your key worker, your family and friends, and maybe other self-help or voluntary groups in the area. Some prescribed medicines may interfere with buprenorphine, for example some antidepressants. Tell the doctor who prescribes the buprenorphine if you are taking any other medication. Most prescribed medications can be taken in the normal way. Other street drugs such as benzodiazepines ("benzos") and alcohol can affect buprenorphine. It is best not take any other drugs, and don't drink too much alcohol. We will ask you to give a urine sample from time to time. Care needs to be taken if you have severe kidney or liver disease. Overdose can be fatal if taken in combination wither other drugs (eg alcohol) that restrict breathing. Page 6

7 Driving If you use illegal drugs, or are prescribed methadone or buprenorphine, you must tell the Driver and Vehicle Licensing Authority (DVLA). They may take away your driving licence until you can show you are drug-free. If you do not tell the DVLA, we will assess your risk and may tell them that you are still using drugs. We will talk about this with you. Sometimes, people who only use prescribed methadone and buprenorphine may be able to keep their driving licences. Page 7

8 South London and Maudsley NHS Foundation Trust Options available If you d like a large print, audio, Braille or a translated version of this leaflet then please ask us. Useful contact details SLaM Switchboard: SLaM 24hr Information Line - Advice on how to access SLaM Services: Contact our Patient Advice and Liaison Service (PALS) for help, advice and information: T: W: E: pals@slam.nhs.uk Complaints If you are not happy about something but not sure if you want to make a formal complaint you can speak to a member of staff directly. Alternatively you can contact the PALS Office on freephone If you decide you want to make a formal complaint this can be done by contacting the Complaints Department: Complaints Department, Maudsley Hospital, Denmark Hill, London SE5 8AZ T: (020) /2499 E: complaints@slam.nhs.uk W: For the quickest way to plan your journey anywhere in greater London use journey planner: 00 (hrs) Date of Publication: Reference: 04/07/2011 lc Page