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Clinical Guidelines for Opioid Substitution Treatment (OST)

Author: HSE; ICGP; College of Psychiatrists; the Pharmaceutical Society

Publication Year: 2016



Chapter 1: Guiding principles of Opioid Substitution Treatment (OST)
Chapter 2: Rehabilitation and psychosocial components of OST
Chapter 3: Principles and key operational stages of pharmacological interventions for OST
Chapter 4: Assessment of dependence and management of OST
Chapter 5: Drug testing
Chapter 6: OST and associated health considerations
Chapter 7: Specific treatment situations and populations
Appendix 1: Clinical Governance
Appendix 2: Initial Assessment Template
Appendix 3: Care plan templates
Appendix 4: Sample Methadone Prescription Form
Appendix 5: Recommendations re appropriate patient cohort for buprenorphine/naloxone
Appendix 6: Pharmacy Transfer Form
Appendix 7: National Waiting List Information Sheet
Appendix 8: Central Treatment List Entry Form
Appendix 9: Drug to drug interactions with methadone
Appendix 10: Drugs that may help symptoms in the end phase of detoxification
Appendix 11: Different Matrices for Drug Testing, adapted from TAP 32
Appendix 12: Approximate Durations of Detectability of Selected Drugs in Urine/Oral Fluid
Appendix 13: Guiding principles for working with clients with Co-occurring Conditions (COD)
Appendix 14: Roles and responsibilities of Mental Health and Addiction Services under Children First National Guidelines
Appendix 15: Summary Tables of Vaccinations for Hepatitis A and B


The Guidelines are based on the principles that people who use drugs have the same entitlement as other patients to the services provided by the HSE. Service users have a right to be heard, listened to and taken seriously and should be consulted and involved in all matters and decisions that may affect their lives. The Guidelines have been developed in order to outline evidence-based care to standardise and improve the quality and safety of care to the patient.

The main illicit opioid used in Europe is heroin, which may be smoked, snorted, or injected. A range of other synthetic opioids are also illicitly available, such as Oxynorm/Oxycontin, codeine, fentanyl, methadone, and buprenorphine. In 2011, eleven European countries reported that 10% or more of their first-time opioid clients entering specialised treatment were using opioids other than heroin.

In Ireland, Opioid Substitution Treatment (OST) refers to the provision of both methadone and buprenorphine/ buprenorphine-naloxone.

Format Download
Keywords methadone treatment, Opioid, drugs, drug addiction treatment, drug addiction, opiates addiction
Publisher HSE
Pages 113
Email:, Tel: 01 6763705, Fax: 01 6765850