Release Date
Geography
Language of Resource
Full Text Available
Open Access / OK to Reproduce
Peer Reviewed
Objective
To develop a clinical guideline for opioid withdrawal management in acute National Health Service (NHS) hospital trusts to be tested and evaluated as part of the iHOST (Improving Hospital Opioid Substitution Therapy) research intervention.
Findings/Key points
The iHOST clinical guideline aims to remove procedural barriers to opioid withdrawal management for hospital inpatients.
Changes to the UCLH guideline included removal of mandatory urine drug testing prior to opioid substitution therapy (OST); increasing initial methadone titration dose; and provision for a higher day-one titration dose when specific safety criteria are met. Discharge planning to ensure continuity of community care and reduce risk of opioid overdose was emphasised, with allowance for bridging prescriptions of OST and naloxone provision on hospital discharge.
Design/methods
The University London College Hospital (UCLH) substance dependence guideline was used as a template, with key points of revision informed by evidence review, consultations with hospital staff and people with opioid dependence. A multidisciplinary working group deliberated evidence statements to develop recommendations. These were reviewed by an oversight committee comprising representatives from key stakeholder organisations. The team authored the guideline with iterative review by the oversight committee, key stakeholders and UCLH clinical governance committees.
