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Covid-19 Primary Care Resources

Opioid dependence – management in homeless populations

Guidance on symptomatic relief of opiate withdrawal

This information is sourced from the Homeless Drug and Alcohol Service (HDAS) and Dr Dana Beale:

As part of the Pan-London response to homeless patients being placed in emergency hotel accommodation, Homeless Drug and Alcohol Service (HDAS) was formed and provides simple guidance on common substance misuse issues seen in homeless populations

Key message – opioid withdrawal IS NOT life-threatening; opioid toxicity IS life-threatening

If you can neither safely prescribe continuation of opioid substitution therapy (OST) nor safely prescribe initiation of OST, consider prescribing for symptomatic relief of opiate withdrawal:

  • Diarrhoea: loperamide 4mg PO stat and 2mg PO after each loose stool (normal dose 6-8mg daily; maximum 16mg per 24h)
  • Nausea: metoclopramide 10mg PO TDS PRN or prochlorperazine 5mg PO TDS PRN
  • Stomach cramps: mebeverine 135mg PO TDS
  • Agitation and insomnia: diazepam 5-10mg PO TDS or zopiclone 7.5mg PO PRN
  • Headache/pain: paracetamol 1g PO QDS PRN