Managing unwell or symptomatic clients - suggestions
- provide maintenance opioid medication promptly
- reassure that this medication will be continued
- no need to reduce medication if mild to moderately unwell
- contact pharmacy to confirm last dose and date
- contact me early so I can plan for extended home dosing
- if parenteral opioids are required then allowing for clients tolerance to opioids and need for extra to cover pain or distress is essential.
Unwell clients on opioid treatment will obviously be managed in much the same medical manner as non-opioid patients.
However it is vital that my patients have their opioid medication continued. Without it they will face an involuntary opioid withdrawal which will make the management of any other medical condition difficult.
Symptoms of opioid withdrawal include runny nose, sneezing, hot and cold flushes, sweating, vomiting and diarrhoea to name a few. Agitation, anxiety and panic attacks are common. Restless legs and the uncontrollable need to roll around or pace makes bed rest impossible to endure.
To avoid this my clients need prompt access to their medications at the same dose and time structure that they are used to. Provision of medication will not only prevent withdrawal but it will alleviate a great deal of anticipation anxiety that the fear of withdrawal induces. If a patient is to be admitted to hospital, delays in medication will almost certainly provoke distress and concern.
This doesn't normally need to be stated, but a non-judgemental and empathetic approach will go a long way to reassuring my clients - as sadly it is not often the case. People can delay presenting for medical help because of this, often with tragic outcomes. A relaxed non-defensive patient will go a long way to alleviating an already frightening scenario and producing best outcomes.
Maintenance opioids such as Methadone and Suboxone are not respiratory depressant in tolerant clients as such. People on long-term opioids have normal respiratory rates and drive and for mild to moderately unwell patients they do not in general require a reduction in dose. Reinforcing the need to avoid other sedating medications when unwell is wise - self medicating is best avoided except with the usual recommended OTC preparations.
I would prefer to be notified as soon as possible if one of my clients is unwell. But please contact the pharmacy where the person normally doses to confirm last date and dose of medication. I can confirm the dose on the prescription but this may be a dynamic dose that changes and I cannot confirm last date of actual dose, so please contact the pharmacy in the first instance.
If a patient is to be kept on home isolation then as soon as I know I will be able to arrange dispensing from the pharmacy and delivery of mediation to the person's home or picked up by a trusted individual.
In these exceptional circumstances we must do what is best for the patient as well as the community. I can make the individual risk assessment based on my knowledge of the client.
If the clients is seriously unwell then the decision to stop medication and transfer to parenteral opioids may be required. Please bear in mind the clients tolerance and the need for baseline opioids merely in order to stay out of withdrawal - additional opioids will be required to treat pain or respiratory distress.
Please phone 0468 869 873 and that answering service can put you through to my direct work number. Alternatively SMS that number and I can call you back. Or you can email email@example.com
I am not based in my office at the moment, but will be available every day to discuss and manage clients