Explain methadone, buprenorphine, COWS, and naloxone — CASC communication station

Open. Name time; ask top fears (control, stigma, “liquid handcuffs,” baby/family concerns if raised). [3]

Explain withdrawal. “Your body has adapted to opioids. When they drop, you get flu-like sickness, craving, and restlessness. We score this with a checklist called COWS — your score shows moderate withdrawal, which is actually the right window to start buprenorphine safely.” [5]

Explain OAT. “Medicines like buprenorphine or methadone stabilise receptors, cut craving and street use, and people who stay on treatment are less likely to die than people who stop treatment.” Keep statistics light but accurate.[2][3]

Buprenorphine plan. “We start with a small under-the-tongue dose (about 2–4 mg), check how you feel in an hour or two, and build up — often toward about 8 mg on day one if you tolerate it, then a daily dose that stops withdrawal and craving (often 8–24 mg). We wait until you are already withdrawing so the medicine does not knock other opioids off the receptor too fast.” Link to clinic.[1][3]

Methadone contrast. Full agonist, daily supervised dosing early, very effective, needs careful slow start because it builds up; heart-rhythm checks in some people. Can revisit choice later. [3]

Naloxone. Train both on recognising slow breathing and using take-home naloxone; always call emergency services. [4]

Sister’s detox plan. Acknowledge love and fear; explain high relapse and overdose risk when tolerance falls after detox without treatment. Offer support without colluding in unsafe care. [2]

Close. Summarise plan, written info, crisis contacts, early review, teach-back. [3]