Harm reduction — structured clinical viva

This is a post-overdose systems and ethics viva, not a simple detox request. She has just survived a life-threatening opioid overdose; partner-administered naloxone was appropriate first aid. She is now in withdrawal — a high-craving, high-relapse state — and has lost OAT continuity, a period when mortality risk rises (Sordo). Framing sterile equipment or naloxone as “enabling” misreads the evidence: take-home naloxone programmes reduce overdose mortality, and NSP associates with reduced HIV transmission.^[1][2][3]

Acute priorities. Medical observation for re-sedation (especially if long-acting opioids or fentanyl possible); manage withdrawal supportively; offer same-episode restart of OAT (buprenorphine if adequate withdrawal and local protocol allow; or methadone re-induction low and slow — not automatic return to a prior high dose after gap); supply take-home naloxone and train her and her partner; facilitate NSP access; arrange HCV RNA and antiviral pathway; assess stimulant co-use, suicide risk, housing, children/safeguarding.^[1][2][5]

Detox only. A short detox without maintenance and without overdose prevention is not the safer moral high ground when tolerance is falling — counsel mortality data and shared decision-making.^[2]

Staff stigma conversation. Use Volkow’s framing: stigma delays care and increases the toll of addiction. Person-first language; reject “dirty urine” culture; explain that retaining people in care is the clinical goal. Hawk: accountability without termination.^[4][5]