When and how to use supervised consumption Sample Clauses

When and how to use supervised consumption. Supervision of consumption by an appropriate professional provides the best guarantee that a medicine is being taken as directed. Since the advent of supervised consumption, the number of drug-related deaths involving methadone has reduced, during a period when more methadone is being prescribed, providing indirect evidence that supervising the consumption of medication may reduce diversion. Other guidance, such as the ACMD report on drug-related deaths (ACMD, 2000), the NICE technology appraisal on methadone and buprenorphine (NICE, 2007a) and the 1999 Clinical Guidelines (UK health departments, 1999) have described recommended practice for supervised consumption in slightly different ways. For the 2007 Clinical Guidelines the working group agreed the following recommendations. In most cases, new patients being prescribed methadone or buprenorphine should be required to take their daily doses under the direct supervision of a professional for a period of time that may be around three months, subject to assessment of patients’ compliance and individual circumstances. There may be variation in practice across the UK and a range of durations of supervised consumption is likely to be seen for different patients, ranging from just a couple of weeks in highly compliant patients to much longer in patients who fail to respond to conventional treatment. The clinical need for supervised consumption should be reviewed regularly and the decision on when to relax the requirement for supervised consumption is one for the individual clinician. Long-term, daily supervised consumption would probably not be appropriate for a patient in regular, full-time work where supervision would be a clear barrier to engagement in treatment. When a patient restarts methadone or buprenorphine after a break, or receives a significant increase in the methadone dose, daily dispensing – ideally with supervised consumption – should be reinstated for a period of time agreed in local guidelines and protocols. In patients whose treatment is failing, a period in supervised consumption can improve observation of progress and increase interventions to improve outcomes. A good example is to enable daily breathalyser readings or monitoring of other indicators of alcohol intoxication in patients who are drinking heavily while taking methadone (see section 6.4). Supervised consumption may have a role in contingency management. Relaxation of supervision can be regarded as an incentive if progress, such...
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