Patient discussions
Patients should be encouraged to participate in a drug treatment program and abstain from opioids and other potential drugs of abuse (e.g., alcohol, cocaine, amphetamines). It is therefore important that the patient minimizes cues linked to the drug-using experience (e.g., people, places, and paraphernalia) and exposure to drugs.
Patients can benefit from 12-step-oriented groups such as Narcotics Anonymous. Narcotics Anonymous Opens in new window
Public health issues (e.g., preventing diversion, ensuring safe storage and security of medication, preventing overdoses) are considered when determining a patient’s eligibility for take-homes.[63]
In some parts of the world (including the US and UK), heroin may also contain highly potent synthetic opioids such as fentanyl or carfentanil, which even in small amounts can cause severe or even fatal toxicity.[192] Heroin users should be made aware of the risks of heroin "cut" with potent synthetic opioids such as fentanyl and that there is no "safe" amount of adulterated heroin that can be used. There is emerging evidence that, for heroin users, the combination of heroin plus gabapentin or pregabalin increases the risk of acute overdose death through either reversal of tolerance or the combined effect of the drugs to cause respiratory depression.[193] Carisoprodol and gabapentin can worsen respiratory depression in those co-using opioids and have been associated with increased risk of opioid overdose and death.[194][195]
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