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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Station brief
Format. Communication station, approximately 7–10 minutes after reading. You are the psychiatry/addiction registrar. Examiner may play patient and/or sister. [3]
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 when already withdrawing. Teach take-home naloxone. Negotiate against unsafe rapid home detox. Check understanding. [1][3][4]
References5ShowHide
- [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
- [3]American Society of Addiction Medicine The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update J Addict Med, 2020.PMID 32511106
- [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