Patients who routinely use illicit drugs

From the patients perspective and in particular in those using intravenous drugs:

• They are more vulnerable to disease and injury
• They may be perceived as drug seeking, even when they have a genuine illness
• They are likely to suffer withdrawal symptoms if their opiate (or other drug) requirements are not met

Treatment

• Consider these patients as high risk of pathological disease or injury
• Do not label them as drug seeking, unless there is clear evidence of well-being (normal observations, normal examination)
• Use titrated IV opiates to address acute pain
• Continue methadone (e.g. 30 mg a day)
• Engage the help of the pain team