Psych CASC / OSCE · Addiction psychiatry — public health and systems
Explain harm reduction and naloxone to a sceptical family — CASC communication station
MRCPsych/FRANZCP-style communication station: explain harm reduction, NSP, OAT mortality rationale, take-home naloxone teaching, and negotiate against unsafe detox-only pressure without colluding with stigma.
On this page & tools
Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. Examiner may play mother and/or patient. [1]
Candidate instructions. Explain harm reduction in plain language. Teach take-home naloxone use. Explain why needle exchange does not equal “encouraging drugs.” Discuss medication treatment and why a 7-day detox-only plan is high risk after overdose. Negotiate a collaborative safety plan. Check understanding. [2][3]
Candidate scenario
He survived opioid overdose yesterday. Partner/family used naloxone successfully once before. He injects, sometimes shares when desperate, and is HCV Ab status unknown to the family. Mother is frightened and angry. You recommend: take-home naloxone training for both, sterile equipment access, and offer of buprenorphine or methadone with clinic follow-up. [2][3]
Marking domains
- Empathy with mother’s fear without colluding in stigma
- Clear plain-language definition of harm reduction
- Accurate naloxone teach-back (when, how, call emergency services)
- NSP rationale (HIV/HCV risk reduction) without lecturing
- OAT mortality/retention framing vs detox-only risk
- Shared plan and teach-back [1][2][3][4]
Reveal assessor key
Open. Name role and time; ask mother and patient top concerns (fear of death vs fear of “encouraging use”). Validate that her fear comes from love.[1]
Define harm reduction. “We use every tool that keeps him alive and healthier even if he is not ready to stop completely today — clean equipment, a reversing medicine for overdose, and treatment medicines if he wants them. Stopping can still be a goal; we do not make him earn basic safety first.” [1]
Naloxone teaching. Slow or no breathing, unresponsive; call emergency services; give the kit dose (nasal spray or injection as supplied); recovery position; stay; may need repeat doses. Evidence supports community programmes reducing overdose deaths.[2]
NSP. “Shared needles spread HIV and hepatitis. Clean equipment cuts that risk — it is infection control, like sterile procedure in hospital, not a reward for using.” [5]
OAT vs 7-day detox. “Medicines like buprenorphine or methadone reduce craving and, for many people, the chance of dying. After detox, tolerance drops and a usual street dose can kill. Leaving treatment is a dangerous window.” Use Sordo-style lay framing without drowning in statistics.[3]
Stigma check. Avoid words like “junkie” or “dirty”; frame addiction as a treatable health condition (Volkow).[4]
Close. Summarise written plan: THN kit, NSP location, OAT appointment, crisis numbers, HCV testing offer; teach-back from mother on naloxone steps.[1][2]
References
- [1]Hawk M, et al. Harm reduction principles for healthcare settings Harm Reduct J, 2017.PMID 29065896
- [2]McDonald R, Strang J Are take-home naloxone programmes effective? Addiction, 2016.PMID 27028542
- [3]Sordo L, et al. Mortality risk during and after opioid substitution treatment BMJ, 2017.PMID 28446428
- [4]Volkow ND Stigma and the Toll of Addiction N Engl J Med, 2020.PMID 32242351
- [5]Aspinall EJ, et al. Needle and syringe programmes and HIV transmission Int J Epidemiol, 2014.PMID 24374889