I am a Consultant in substance misuse based in Cumbria. I work for Unity drug and alcohol recovery services which is part of Greater Manchester Mental Health NHS Foundation Trust. I am particularly interested in working collaboratively with other organisations to reduce drug related deaths and to improve care of patients presenting acutely with alcohol related problems.
Use of antipsychotics in patients who died within a community substance misuse service
Identify whether antipsychotic medication use in patients who have died whilst in treatment with substance misuse service align with NICE guidelines for mental health disorders and UK guidelines for the management of drug misuse and dependence.
Review of case notes of patients to assess rationale for use of antipsychotic medication. A review took place of the relevant case notes of both the substance misuse service and the local mental health service.
Community substance misuse service in Carlisle
Patients who died between 01/04/16 and 01/04/17 who had attended for treatment for substance misuse problems.
Demographic information, details about antipsychotic medication, rationale for initial use of antipsychotic medication, antidepressant medication and opioid replacement treatment were recorded for patients using Excel Software. Data was summarised using Excel tools.
Findings and conclusions
Eighteen patients were identified using the specified criteria. Sixteen out of eighteen had relevant information available. Six out of sixteen (37.5%) were prescribed antipsychotics. The reasons for prescribing included: treatment for drug induced psychosis (1); mood stabilisation (1); emotional instability (1) and PTSD (2). It was unclear for one person why antipsychotic medication was given. Six patients prescribed an antipsychotic were also prescribed methadone. Three of these were prescribed the sedating antidepressant mirtazapine. Substance misuse services need to be aware antipsychotics are commonly used in patients at high risk of premature deaths. General adult psychiatry services need to carefully consider the rationale for antipsychotic treatment in this cohort.