Overview

This information is for people using the addiction care or mental health liaison service at:

Guy's Hospital

St Thomas' Hospital

Royal Brompton Hospital

Harefield Hospital

Opioids are a group of strong medicines that relax the body and can help with pain. Examples include:

• codeine
• morphine
• the illegal drug heroin

There is a serious risk of addiction to opioids. You might get effects called withdrawal symptoms when you reduce the opioids that you take or stop using them.

This information explains what to expect if you have opioid withdrawal symptoms while in hospital. If you have any questions, please speak to a doctor or nurse caring for you.

About opioid withdrawal

If you use opioids for a long period, your body will adapt to their presence with time. There is a risk that you might become addicted to, or dependent on, the opioids.

When you reduce your opioids or stop using them, you might get withdrawal symptoms. These can include:

• flu-like symptoms, such as muscle aches, sweating and chills
• digestive problems, such as feeling sick (nausea), being sick (vomiting) and diarrhoea
• effects on your mood, such as anxiety, irritability and depression
• effects on your body, such as widened pupils (the openings in the centre of the eyes) and yawning
• increased heart rate and blood pressure

Opioid substitution therapy

We use medicines called methadone and buprenorphine for opioid substitution therapy. This treatment involves giving you replacement medicine to help you manage withdrawal symptoms when you come off opioids.

The replacement medicine can:

• reduce cravings
• ease the discomfort of withdrawal symptoms

Managing opioid withdrawal in hospital

During your hospital stay, your doctor, a specialist substance misuse nurse or both of them do an assessment. They:

• ask you about your health and social circumstances, including details of your past and current substance use
• do a physical health check, which includes monitoring your body temperature, pulse, breathing rate and blood pressure (these are called the vital signs)
• do a urine test to confirm which drugs you currently use
• work with you to make a safe care plan, which includes arrangements for continuing to have opioid substitution therapy in the community after your leave hospital

We only start prescribing medicine for opioid substitution therapy if we feel that this appropriate after your assessment.

Medicine dose for opioid substitution therapy

An overdose is when you take more than the prescribed or recommended amount (dose) of medicine.

If you have an overdose of methadone or buprenorphine while on opioid substitution therapy, this could lead to severe harm or even death. To protect your safety, we prescribe a low dose of medicine at first. It is important to be patient during this early stage of treatment.

You may notice a stronger effect of the medicine in the first few days, even without an increase in dosage. In some cases, it may take several weeks to find the most effective dose for you.

Dealing with withdrawal symptoms

While you adjust to the replacement medicine, you may get some withdrawal symptoms. Please tell us about any discomfort that you have. We may be able to prescribe extra medicines to support you during this time.

Our nurses regularly assess your withdrawal symptoms. This helps us to make sure that you get the right care and support throughout your treatment.

Keeping you safe

For your protection, hospital staff may decide to withhold your opioid substitution therapy if they are concerned about the risk of an overdose. Your safety is our priority and we are here to support you throughout your recovery.

Support and more information

We have an addiction care team and a mental health liaison team. They can:

• give you useful information about substance misuse issues
• help to manage your substance misuse care

You are welcome to ask your nurse or doctor to arrange a review by these teams at any time during your hospital stay.