Clinical guidelines and procedures for the use of methadone in the maintenance treatment of opioid dependence

4.5 Continued high risk drug use

Page last updated: August 2003

(see also 4.9 Polydrug use)

Continued high risk drug use is evidenced by:

  • Frequent presentations when intoxicated;
  • Overdoses;
  • Chaotic drug using behaviour;
  • Deteriorating medical or mental states due to drug use.
Continued drug use can affect patient stability and treatment progress and place the patient at risk of:
  • Relationship, social and employment problems;
  • Contracting infectious diseases;
  • Involvement in crime.
Attempts to stabilise such patients should include:
  • Review of:
    • Psychosocial interventions and supports;
    • Precipitants to continued drug use;
    • The risks of combining methadone with other drug use against the benefits of continued treatment:
      • If the patient's safety is not at risk from ongoing drug use it will generally be in the patient's interest to persist with treatment.
      • If the risks of combining methadone with other drug use outweigh the benefits to the patient of MMT arrange the patient's gradual withdrawal from methadone.
    • Medication regimes.
      • Increases in methadone dose may be helpful if this is considered safe by the prescriber.