Clinical assessment prior to detoxification

NICE have provided guidance concerning the clinical assessment of patients who are to undertake opioid detoxification:

• Clinical assessment
  • assess to establish the presence and severity of opioid dependence, as well as misuse of and/or dependence on other substances, including alcohol, benzodiazepines and stimulants. As part of the assessment, healthcare professionals should:
    • use urinalysis to aid identification of the use of opioids and other substances; consideration may also be given to other near-patient testing methods such as oral fluid and/or breath testing
    • assess signs of opioid withdrawal where present
    • take a history of drug and alcohol misuse and any treatment
      • include a history of previous attempts at detoxification, for these problems
    • review current and previous physical and mental health problems (including respective treatments for these)
    • consider the risks of self-harm, loss of opioid tolerance and the misuse of drugs or alcohol as a response to opioid withdrawal symptoms
    • consider the person's current social and personal circumstances, including employment and financial status, living arrangements, social support and criminal activity
    • consider the impact of drug misuse on family members and any dependants
    • develop strategies to reduce the risk of relapse, taking into account the person's support network o if opioid dependence or tolerance is uncertain, healthcare professionals should, in addition to near-patient testing, use confirmatory laboratory tests. This is particularly important when:
      • a young person first presents for opioid detoxification
      • a near-patient test result is inconsistent with clinical assessment
      • complex patterns of drug misuse are suspected
    • for women who are opioid dependent during pregnancy, detoxification should only be undertaken with caution

Reference:

1. Prescribers' Journal (2000); 40 (2): 67-76.
2. NICE (July 2007).Drug misuse - Opioid detoxification.