Transcript Module 5
training manual Module 5 Special patient groups training manual Introduction • Worldwide, the majority of people in substitute treatment are men between 25-40 • Even they do not form a homogeneous group • In addition, there are groups with specific needs • And specific settings training manual Women • Often women with severe dependence do not menstruate. It is important that they understand that this does not necessarily mean that they do not ovulate training manual Pregnant women • ST improves outcome regarding pregnancy, childbirth and infant development: • Better overall general health of women • Better (access to) antenatal care • Physiological changes (accelerated metabolism) in third trimester requires higher dosage • Detoxification not to be encouraged • Breast-feeding encouraged (when HIVnegative) • Psycho-social care recommended training manual Parents with young children • Needs of children are paramount • Care of children to be included in treatment plan • Case management training manual Young people • ST not recommended under 16, because they do not fit the general criteria of: • Long-term dependence • Significant tolerance • Level of problematic use • Buprenorphine more indicated • Sometimes need for parental consent training manual People with HIV/AIDS • ST can: • Reduce risk behaviours which could further damage the immune system • Reduce stress • Improve general health • Retention in treatment can allow for early diagnosis and HIV treatment • Liaison with specialist care • Interaction of medications training manual People with hepatitis • Vaccination for hepatitis B for all patients without antibodies • Hepatitis C prevalent and serious • Dose of substitute drug may need to be reviewed (liver function) • Specialised referral • Health education regarding risk behaviour training manual People with mental health problems • 30% of patients have mental health problems, including anxiety and depression • 25% risk of self harm and suicide • 10% severe mental disorders requiring collaboration with mental health specialists • Note age- or HIV-related dementia training manual Multiple drug users • Assess use of all substances • Open relationship and discussion • Risk reduction: • • • • • Increase dose and possibly other medication Frequency of collection Supervised consumption Realistic treatment goals Suspension? training manual Quick metabolisers • Some patient demonstrate longer or shorter half life times • They require significantly lower or higher dosages • Most can be treated relying on clinical factors • Testing blood levels can be helpful • Various drugs or conditions can alter substitute drug metabolism training manual Minority ethnic groups • Barriers to treatment, education and prevention: • • • • • • lack of cultural sensitivity distrust of confidentiality communication problems - language lack of awareness of services stigma failure to target minority ethnic drug users training manual People in prison • Treatment should be available to start and/or continue in order to • improve health • reduce risk behaviour • reduce relapse upon release • Need to continue afterwards when returned to the community training manual People in hospital • • • • Recognise dependence Assessment Liaison with drug treatment Continue treatment (no detoxification) training manual People who travel • Continuity of care • Make people think about referral • standard letter • Communication between prescribers • Who is responsible, the regular doctor or the one who takes over? • Collaboration between cities and countries • www.home.muenster.net/-indro/ • www.euromethwork.org training manual People with chronic pain • A complex, difficult-to-treat condition • Can persist following prolonged tissue or nerve injury • Opiates and opioid based medications like morphine and methadone are used to relieve patients with chronic pain • The guiding principles: • to maintain methadone treatment • to use short-acting narcotics administered at higher doses • as often as necessary, preferably on a fixed schedule • supplemental analgesic medication, except that opiate antagonists must be avoided. training manual The aging patient • Patients in maintenance treatment are getting older • Geriatric illnesses such as cardiac and pulmonary complaints and other signs of aging (menopause) should be taken into consideration training manual Quick metabolisers • Some patient demonstrate longer or shorter half life times • They require significantly lower or higher dosages • Most can be treated relying on clinical factors • Testing blood levels can be helpful • Various drugs or conditions can alter substitute drug metabolism training manual Conclusions • • • • Different patients have different needs Assessment of needs Addressing them Liaison with specialist services