Kieran Nichol

I recommend that consideration be given to devising specific guidance directed towards those providing drug misuse treatment within a residential setting such as Castle Craig where it is likely that the process of titration and stabilisation will be rapid.

I recommend that all nursing staff recruited in Castle Craig Hospital to care for drug detoxification patients should undergo a learning needs analysis and either:- (i) have sufficient, current experience in caring for drug detoxification patients as to be fully familiar with the nature and extent of the industry standard guidance found in the Orange Book and be aware of the nature and side effects of methadone; the halflife cumulative effect of treatment with methadone in the first few days of treatment with the drug; the withdrawal symptoms associated with opiate withdrawal; the intoxication symptoms associated with opiates; the nature, use and administration of opiate antidotes such as naloxone; the cumulative respiratory depressing effects of drugs such as methadone and benzodiazepines when taken in conjunction with one another; and the withdrawal symptoms associated with benzodiazepines; or (ii) have sufficient training provided by the hospital to bring any such nurse up to the level of awareness set out above before that nurse is allowed to operate autonomously within the hospital.

I recommend that only those with appropriate medical qualification or other relevant and current accreditation should be allowed to prescribe methadone or upwardly alter any existing prescription.

I recommend that no prescription for methadone be written by anyone in Castle Craig Hospital prior to there having been definite signs of opiate withdrawal observed and recorded by the prescription writer.

I recommend that only after stabilisation has been achieved and recorded should there be any prescription for methadone written in association with any detoxification care plan.

I recommend that, without prejudice to the right and duty of a nurse to withhold medication if considered appropriate to do so and to apply reduced doses within a specific dose reduction regime, the responsibility, within Castle Craig Hospital, for altering any prescribed dose of methadone should remain, at all times, with those qualified to prescribe that drug.

I recommend that no locum GP should be employed by Castle Craig Hospital to perform duties unless that GP has current and relevant qualification or accreditation and experience in the field of drug addiction and detoxification and full familiarity with any and all drugs that may be used in the hospital in connection with such purpose including opiate antidotes.