What are the criteria for referring a patient with opioid misuse to specialist addiction services?

Referral to specialist addiction services for a patient with opioid misuse should be considered when:

• The patient has expressed an informed choice to become abstinent and requires detoxification or maintenance treatment beyond primary care capabilities.
• There are complex needs including comorbid physical or mental health problems that require integrated specialist management.
• The patient demonstrates poor response to standard care interventions or has complex psychosocial needs requiring enhanced care.
• There are safeguarding concerns involving children, young people, vulnerable or at-risk adults that need multiagency involvement.
• The patient requires comprehensive assessment and development of a treatment plan integrating pharmacological and psychosocial treatments.
• There is a need for specialist support to reduce risks such as safer drug use, access to sterile equipment, immunization against bloodborne viruses, and overdose prevention.
• The patient is in a setting where specialist services are more appropriate, such as prison or inpatient/residential care, or has relapsed after previous treatment.

Referral should be made using a shared decision-making approach, respecting the patient’s goals, motivation, and preferences, and ensuring continuity of care and engagement with services.

Immunization advice and risk reduction strategies should be part of the specialist service offer.

Overall, referral is indicated when the complexity, risk, or treatment needs exceed the scope of primary care management and require multidisciplinary specialist input.

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