Psych CASC / OSCE · Addiction psychiatry — substance use disorders
Explain opioid agonist treatment and naloxone — CASC communication station
MRCPsych/FRANZCP-style communication station: explain why medication is offered after overdose, buprenorphine induction timing, methadone versus buprenorphine, take-home naloxone, and negotiate against a rapid detox.
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Study tools
Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
A 29-year-old man with severe heroin use disorder is offered buprenorphine–naloxone after an overdose. He fears 'replacing one addiction with another,' asks about methadone vs buprenorphine, and his mother wants him detoxed in 5 days.
Candidate brief
Format. Communication station. You are the psychiatry or addiction registrar. The examiner may play the patient, his mother, or both.
Candidate instructions. Explain why medication treatment is offered after an overdose. Compare methadone and buprenorphine in plain language. Explain why buprenorphine is started only once he is clearly withdrawing. Teach naloxone use. Explain why a five-day detox is risky. Check understanding and agree a plan.
References7ShowHide
- [1]Larochelle MR, Bernson D, Land T, et al. Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study. Annals of internal medicine, 2018.PMID 29913516
- [2]Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies BMJ, 2017.PMID 28446428
- [3]US National Library of Medicine DailyMed SUBOXONE (BUPRENORPHINE HYDROCHLORIDE, NALOXONE HYDROCHLORIDE) FILM, SOLUBLE [INDIVIOR INC.] DailyMed, 2026.Source
- [4]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
- [5]US National Library of Medicine DailyMed METHADONE HYDROCHLORIDE TABLET [AMERICAN HEALTH PACKAGING] DailyMed, 2026.Source
- [6]National Institute for Health and Care Excellence Drug misuse in over 16s: opioid detoxification (CG52) NICE clinical guideline CG52, 2007.Source
- [7]Mattick RP, Breen C, Kimber J, Davoli M Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence Cochrane Database Syst Rev, 2014.PMID 24500948