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Heroin Addiction and Related Clinical Problems: 2017, 19, N1 (pages: 55 - 62)

Towards Best Practice: Trends in the Management of Opioid Analgesic Dependence. Meeting Report.

Alam F., D'Agnone O., Bremner D., Tuckey G., Abbasi Y., and Littlewood R.

Summary: Background: Opioid analgesic dependence (OAD) may be a consequence of treatment for pain, or result from consumption of illegally acquired or diverted analgesic drugs, possibly related to underlying mental health problems such as anxiety. Affected populations and clinical management are different from street heroin dependence. Relevant evidence and guidelines review does not clearly define best practice in OAD decision-making. An expert-led approach integrated real world experience from clinical practice to define decision-making paradigm for OAD. This was presented to a symposium of experts at the 2016 meeting of EUROPAD. Meeting report: For OAD, treatment assessment often includes management of pain and potentially, other mental health problems such as anxiety or affective disorders. Treatment selection considers a broad set of interventions and outcomes/service user aims (for example: individual and society goals, work, social etc.). Other factors including minimising the risks of overdose, harm to children from inadvertent consumption of prescribed medications in the domestic setting, or potential for service users to participate in criminal behaviour may be important. Experience indicates that the integrated team approach with psychosocial interventions promotes success. An integrated medical treatment plan with options combining prescribed medicines indicated for dependence, other therapies, psychosocial interventions is described for OAD management. Options for treatment selection include: reduce current opioid analgesic medication, initiate medication assisted treatment, stop opioid analgesic medication in managed withdrawal. Success from clinical experience informs care choices for different types of people with OAD. This decision-making tool is a useful start in defining best practice in OAD care. Conclusion: Symposium participants concluded that the management algorithm was useful and that suggested planning in its treatment choice section were useful.