Opiate Substitute Treatment (OST) has been used and studied for many years to help people who are dependent on heroin.

Research has shown that treatment will help you:

  • Stop using heroin
  • Stop injecting
  • Stop committing crime to get money for drugs
  • Have more stable relationships with friends and family

Coming off Heroin needs commitment and life changes that will take time and effort. Prescribing is part of the recovery process and allows you to stabilise your life and plan for the future.

Prescribed medication is:

  • Regular, free and legal
  • Long-acting and needs only to be taken once-a-day
  • A safer drug to be dependent on than heroin

Switching from heroin to a prescription allows you to access counselling, medical care, education and training, and to get the best out of your recovery programme.

Methadone (Phyesptone)

In most cases, your first prescription will increase your dose of methadone over a few days until you reach a dose that is right for you. You will need to consume your methadone under supervision of the pharmacist each day until the prescriber feels you are stable on your prescription. You will then be able to take your medication away from the chemist.

Missing a dose, especially at the start of treatment, means that it will take you longer to reach a stable state. As methadone is long-acting you may miss one or even two doses but if you miss three or more your tolerance will be much less than usual and you may overdose on a dose that previously would not have had any bad effect at all. If you miss three or more doses your pharmacist will cancel your prescription and contact your key worker. For your safety, you may have to wait to see a prescriber to begin your medication again.

Common side-effects are constipation, nausea and vomiting.

High doses of methadone can cause abnormalities in heart rate. This can be associated with fainting, collapse and in some cases sudden death. It is really important that you tell us if you or a member of your family has experienced heart problems. We may ask that you have a heart trace which we will arrange for you if necessary.

Some other medications can also affect heart rate so if you are prescribed other medications please make sure you tell us. The most common types of medication that cause these problems are psychiatric medications and those use for treatment of infections. Again, we may well ask you to have a heart trace to make sure everything is ok.

Buprenorphine

Buprenorphine is more strongly attracted to the opiate receptors in the brain than heroin or methadone. It sticks very tightly to these receptors for a long time and can be taken just once daily (or even every other day). Taking other opiates will have little or no effect because the receptors can be blocked, depending on your dose.

You must wait at least eight hours after taking heroin and 24 hours after taking methadone (until you have significant withdrawal symptoms) before you take your first dose. Other opiates will be “kicked off” the receptors and cause immediate withdrawal symptoms. The symptoms will resolve in a few hours.

The tablets must be allowed to dissolve under the tongue. If you swallow or chew the tablets most of the buprenorphine is destroyed and will not get into your blood stream.

Common side-effects of buprenorphine are headaches and insomnia.

Acamprosate

Acamprosate, also known by its brand name Campral, is a medication used to help people maintain abstinence from alcohol. We aim to start someone on Acamprosate as soon as possible after stopping drinking. It acts on the brain to reduce the desire to drink alcohol so cravings may be reduced. It is always best used alongside counselling or other addiction related support such as AA or SMART recovery.

Speak to your key worker if you would like further information.

Disulfiram

Disulfiram, also known as Antabuse is a medication used to block an enzyme that is involved in metabolising alcohol intake. Disulfiram produces very unpleasant side effects when combined with alcohol in the body. It is used in chronic alcoholism and it can keep people from drinking due to the unpleasant side effects that occur if they do drink alcohol whilst taking Disulfiram.

Disulfiram is not a cure for addiction but can be effective when used alongside counselling, psychotherapy and other addiction related support such as AA or SMART recovery.
Before being prescribed any medication to help treat alcohol misuse you'll have a full medical assessment which will include blood tests.

Speak to your key worker if you would like further information.

Naltrexone

Naltrexone can be used to prevent relapse into heroin and/or alcohol use. It works by blocking the opioid receptors in the body which stops the effects of heroin and alcohol. It is most effective when used together with counselling.
If naltrexone is recommended, you should be made aware that it will also stop painkillers that contain opioids, such as morphine and codeine, from working.

A course of naltrexone can last up to six months although it may sometimes be longer.

Speak to your key worker if you would like further information.

Diazepam

Diazepam is a benzodiazepine which is considered a minor tranquilliser. Diazepam has many uses. It can be used to reduce symptoms of anxiety and insomnia, as well as to help people come off alcohol. Diazepam should only be prescribed and taken as a short course.

It is used to help reduce withdrawal symptoms from alcohol. It relieves anxiety and tension and can prevent fits. It controls the withdrawal symptoms until the body is free of alcohol and has settled down. This usually takes three to seven days from the time you stop drinking. As Diazepam can be addictive it should be prescribed with caution. The alcohol detoxifications at home and in the in-patient unit are often done with Diazepam.

Speak to your key worker if you would like further information.

For more information visit www.choiceandmedication.org/sabp where you will find lots of helpful and practical information about your medicines.

Call our Pharmacy Medicines Information Helpline on 01737 281 033 Monday-Friday 9am-5pm

Driving and the DVLA

All opiates can make you drowsy and slow down your reaction time. This happens especially:

  • In the first few weeks of treatment
  • When the dose is increased
  • If you use alcohol and sedatives on top

If you hold a current driving license and intend to drive, you must inform the DVLA that you are being prescribed OST. Your license may be revoked and you will be asked to re-apply when you have been substance free for at least six months.

Changes to the drug driving law came into place on 2nd March 2015 to make it easier for the police to catch and convict drug drivers.

It is now an offence to drive with certain drugs above a specified level in your blood - just as it is with drink driving. Sixteen legal and illegal drugs are covered by the law, including cannabis, cocaine, ecstasy and ketamine. The limits for all illegal drugs are extremely low – taking even a very small amount of an illegal drug could put you over the limit.

The new offence will work alongside the existing offence of driving whilst impaired through drink or drugs. For more information visit think.direct.gov.uk/drug-driving .

Safe storage of medication

Children must be kept safe from all medications; even a very small amount could kill them.

Please take these simple steps to store your medication safely:

  • Put your medication out of sight as soon as you get home. Keep it out of sight and out of reach – a high locked cupboard is best or high up in a locked wardrobe.
  • If you don’t have a lockable cupboard or wardrobe, we advise you to fit a lock or buy a lockable box to keep your medication in at home.
  • If you don’t have somewhere to lock away your medication, make sure it is kept somewhere high up where it can’t be seen or reached by climbing.
  • Make sure your pharmacist gives you your methadone in a bottle with a child-resistant cap. These caps can save lives and help keep your methadone safe, but remember that they can be opened even by small children.
  • Never store your methadone in a different container than the one provided – doing so can increase the risk it may be mistaken for something else.

If you suspect that a child or other person has taken some of your medication you should telephone 999 immediately.