Psych CASC / OSCE · Addiction psychiatry — substance use disorders
Explain methadone, buprenorphine, COWS, and naloxone — CASC communication station
MRCPsych/FRANZCP-style communication station: explain withdrawal staging, OAT rationale, precipitated withdrawal timing, methadone vs buprenorphine, and naloxone training against unsafe detox pressure.
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Candidate brief
Format. Communication station. You are the psychiatry or addiction registrar. The examiner may play the patient, her sister, or both.
Candidate instructions. Explain opioid withdrawal and why medication treatment is recommended after overdose. Describe COWS in plain language. Compare methadone and buprenorphine. Explain why buprenorphine is started only once she is clearly withdrawing. Teach naloxone use. Negotiate against unsafe rapid home detox. Check understanding.
References8ShowHide
- [1]D'Onofrio G, O'Connor PG, Pantalon MV, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial JAMA, 2015.PMID 25919527
- [2]Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and after opioid substitution treatment BMJ, 2017.PMID 28446428
- [4]Boyer EW Management of opioid analgesic overdose N Engl J Med, 2012.PMID 22784117
- [5]Wesson DR, Ling W The Clinical Opiate Withdrawal Scale (COWS) J Psychoactive Drugs, 2003.PMID 12924748
- [6]National Institute for Health and Care Excellence Drug misuse in over 16s: opioid detoxification (CG52) NICE clinical guideline CG52, 2007.Source
- [7]US National Library of Medicine DailyMed METHADONE HYDROCHLORIDE TABLET [AMERICAN HEALTH PACKAGING] DailyMed, 2026.Source
- [8]US National Library of Medicine DailyMed SUBOXONE (BUPRENORPHINE HYDROCHLORIDE, NALOXONE HYDROCHLORIDE) FILM, SOLUBLE [INDIVIOR INC.] DailyMed, 2026.Source
- [9]US National Library of Medicine DailyMed NALOXONE HYDROCHLORIDE INJECTION [DR. REDDY'S LABORATORIES, INC.] DailyMed, 2026.Source