Australasian Chapter of Addiction Medicine
The Australasian Chapter of Addiction Medicine (AChAM) is a Chapter of the Royal Australasian College of Physicians (RACP) Adult Internal Medicine Division that connects and represents Addiction Medicine Fellows and trainees in Australia and New Zealand. AChAM advances the study of addiction medicine in Australia and New Zealand through training, research and collaboration with health professionals and organisations. The Chapter provides training and continuing professional development to ensure excellence in skills, expertise, and ethical standards. AChAM advocates on behalf of its members and acts as an authoritative body for consultation in addiction medicine to ensure quality care for individuals with addiction disorders.
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Do not undertake elective withdrawal management in the absence of a post-withdrawal treatment plan agreed with the patient that addresses their substance use and related health issues.
Do not undertake elective withdrawal management in the absence of a post-withdrawal treatment plan agreed with the patient that addresses their substance use and related health issues.
The main aims of withdrawal management are to provide the means for safe withdrawal from a drug of dependence, including alcohol, and to link the patient to relevant ongoing treatment for their Substance Use Disorder (SUD) and health and social conditions. Evidence shows that withdrawal management results in better outcomes, including reduced readmission rates, when a structured post-withdrawal treatment plan is formulated in collaboration with the patient.
Supporting evidence
Gowing, L, Ali, R, Dunlop, A, Farrell, M, & Lintzeris, N. National Guidelines for Medication-Assisted Treatment of Opioid Dependence. National Drug Strategy. Commonwealth of Australia; 2014; ISBN: 978-1-74241-945-9.
Haber PS, Lintzeris N, Proude E, Lopatko O. Treatment of Alcohol Problems. Australian Commonwealth Department of Health and Aged Care: Canberra; 2010.
Lubman, D, Manning, V, Best, D, Berends, L., Mugavin, J, Lloyd, B, Lam, T, Garfield, J, Buykx, P, Matthews, S, Larner, A, Gao, C., Allsop, S, Room, R.). A study of patient pathways in alcohol and other drug treatment. Turning Point: Fitzroy; 2014.
How this list was made
Through the RACP Evolve program, the Chapter Committee of the Australasian Chapter of Addiction developed a draft Evolve Top-5 Recommendations of low-value practices and interventions that pertain to the specialty. After several rounds of internal consultations and revisions, the list of recommendations was subject to an extensive review process that involved key College societies with an interest or professional engagement with addiction medicine.
The list was then consulted with other medical colleges including through Choosing Wisely Australia. The recommendations were also reviewed by the College’s Aboriginal and Torres Strait Islander Health Committee to ensure that the list adequately reflects the health needs of Indigenous Australians with substance use disorders.
Feedback received in the consultations led to further fine tuning of the list, which was then finalised and approved by the AChAM President and President-Elect.
Related recommendations
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1
Do not undertake elective withdrawal management in the absence of a post-withdrawal treatment plan agreed with the patient that addresses their substance use and related health issues.
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2
Do not prescribe pharmacotherapies as stand-alone treatment for Substance Use Disorders (SUD) but rather as part of a broader treatment plan that identifies goals of treatment, incorporates psychosocial interventions and identifies how outcomes will be monitored
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3
Do not deprescribe or stop opioid treatment in a patient with concurrent chronic pain and opioid dependence without considering the impact on morbidity and mortality from discontinuation of opioid medications
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4
While managing patients with Substance Use Disorder (SUD), exercise caution in the use of treatment approaches that are not supported by current evidence or involve unlicensed therapeutic products.
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5
Use a 'universal precautions' approach for all psychoactive medications that have known potential or liability for abuse including opioids, benzodiazepines, antipsychotic medications, gabapentinoids, cannabinoids and psychostimulants.