Explain opioid agonist treatment and naloxone — CASC communication station

Open. Name time; ask patient and mother top concerns (control, stigma, “addiction to methadone”). [3]

Explain OUD. “This is a medical brain-and-behaviour condition where opioids take priority despite harm — not a simple willpower gap. After overdose, the risk of dying remains high if we only send him home.” [1]

Explain OAT. “Medications like buprenorphine or methadone stabilise receptors, cut craving and illicit use, and people on treatment are less likely to die than people who stop treatment.” Use lay mortality framing from retention evidence without drowning in statistics.[2]

Buprenorphine plan. “We start when he is already withdrawing so the medicine does not knock other opioids off the receptor too fast — that sudden jump is precipitated withdrawal. Typical start is a small under-the-tongue dose (e.g. 2–4 mg), then build up, aiming for a daily dose that stops withdrawal and craving (often 8–24 mg).” Link to follow-up clinic.[3][4]

Methadone contrast. Full agonist, daily supervised dosing early, very effective, needs careful slow start because it accumulates; cardiac monitoring in some patients. Choice can be revisited. [3]

Naloxone. Train both on recognising slow breathing and using take-home naloxone; call emergency services. [3]

Five-day detox. Acknowledge wish for quick fix; explain high relapse and overdose risk when tolerance falls. Offer supports for the relationship crisis without abandoning MOUD. [2]

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