Routines for the administration of Subutex in Stockholm

Link to Stockholm´s open medical care receptions:

Subutex administration is handled by the teams of S:t Erik, hospital depatrment 110 at Danderyd hospital and by hospital department M48 at Huddinge University hospital. At the hospital departments the patients can be in overnight or be day care patients.
Subutex administration is also handled at Mariaberoendecentrum AB, for information on this, please contact Mariaberoendecentrum AB.

Letter of referral for administration is written by the Chief physician at Beroendecentrum or a doctor delegated by the Section manager.

The referral is issued in two copies, one for the Administration team/hospital department and one for the Inquiry unit of the Methadone conference. A special referral form should be used. At the Inquiry unit the registration of the patient and the validation of the patient´s journal and treatment plan is taken care of. The Inquiry unit then follows the care process, that is date of entry, date of discharge, use of other narcotics, and so on.

The criteria at this date is at least one year of documented compulsive opiate use. Further, that a treatment with Subutex is considered necessary to achieve success in treatment and that Subutex is a part of the treatment plan.

All contacts and questions regarding patients, waiting time and so on is referred to the Inquiry unit. This means that doctors and other staff at the Treatment units should refer inquiries to the Inquiry unit.

The decision of prolonged detox with Subutex is taken by Chief medical officer at the Treatment unit.

The decision of the administration of Subutex as a continued maintenance treatment is taken by the Doctor responsible for the patient at the Treatment unit in consultation with the Subutex activity´s Chief physician group consisting of all doctors in the Subutex activity and the Chief medical officer at the Methadone activity. This group is meeting at least once a week and they can also firmly establish the decisions of the group on telephone, alternatively in retrospect.

The decision of Subutex adjustment cannot be taken without a referral and the treatment plan being firmly established within the Open medical care, also including the Social services.

In the cases where the patients do not have a current contact with the Social services it is up to the local Open medical care reception to consider if such a contact should be established. Alternatively, the matter can be dealt with by the Methadone conference, where agents from the Social services are represented.

If there is any hesitation regarding referral or decision on treatment the question is delegated to the Chief of the Inquiry unit/Section manager of the Methadone activity, and matters there can also be dealt with by the Methadone conference or by the Discharge group of the Methadone activity.

The same apply to any hesitation regarding discharge, which normally is decided by General chief medical officer or by the Section manager. These matters can be referred to the Discharge group of the Methadone activity and passed on to the Methadone conference. Inquiries of discharge is made to the Inquiry unit.