BOOST (Optimising Opioid Substitution Treatment) is an evidence-based approach designed to enhance the effectiveness of Medication-Assisted Treatment (MAT) for opioid dependence. It focuses on individualised treatment plans, patient engagement, dose optimisation, and psychosocial support to improve outcomes and retention in care.
📌 What is BOOST?
BOOST is a structured framework used to ensure that opioid substitution therapy (OST) is tailored to the needs of each patient. It aims to:
- ✅ Ensure patients receive the right medication and dosage.
- ✅ Improve retention in treatment and reduce drop-out rates.
- ✅ Promote psychosocial interventions alongside MAT.
- ✅ Reduce illicit opioid use and associated harms.
- ✅ Support patients towards long-term recovery and stability.
💊 Key Components of BOOST
BOOST focuses on several key areas to maximise the benefits of opioid substitution treatment:
| Component | Description |
|---|---|
| Optimised Dosing | Ensuring that patients receive an effective dose to prevent withdrawal and cravings while minimising risks. |
| Medication Choice | Personalising treatment using methadone, buprenorphine (Subutex, Espranor, Buvidal), or Naltrexone based on patient needs. |
| Retention Strategies | Engaging patients through motivational interventions, flexible dosing, and harm reduction support. |
| Psychosocial Support | Integrating counselling, peer support, and mental health care alongside MAT. |
| Regular Reviews | Monitoring progress through structured treatment reviews and adjusting care plans as needed. |
🟢 Who Can Benefit from BOOST?
BOOST is designed for individuals receiving opioid substitution treatment, including:
- ✔ Patients struggling with adherence to MAT.
- ✔ Individuals at risk of dropping out of treatment.
- ✔ Patients requiring dose adjustments or medication changes.
- ✔ Those needing additional psychosocial support.
- ✔ People transitioning between MAT options (e.g., from methadone to Buvidal).
⚖️ Medication Optimisation in BOOST
BOOST ensures that patients receive the most appropriate MAT based on individual needs. Key considerations include:
| Medication | Best For |
|---|---|
| Methadone | Patients requiring high-dose stabilisation, long-acting relief from cravings. |
| Buprenorphine (Subutex, Espranor) | Patients preferring a partial agonist with a lower overdose risk. |
| Buvidal (Long-acting Buprenorphine) | Patients who struggle with daily adherence or supervised consumption. |
| Naltrexone | Patients who have completed detox and seek an opioid-free recovery. |
🔄 Transitioning Between MAT Options
BOOST supports safe transitions between different MAT options to ensure continuity of care and minimise withdrawal risks:
| From | To | Considerations |
|---|---|---|
| Methadone | Buprenorphine | Requires a gradual reduction of methadone before initiating buprenorphine to avoid precipitated withdrawal. |
| Buprenorphine | Buvidal | Can be transitioned directly, ensuring equivalent dose coverage. |
| Methadone | Naltrexone | Requires full opioid detox (typically 7–10 days opioid-free) before starting. |
📢 Retention & Engagement Strategies
- 📌 Offering flexible prescribing options (weekly or monthly Buvidal injections).
- 📌 Using motivational interviewing to explore treatment goals.
- 📌 Addressing barriers to adherence (e.g., stigma, pharmacy supervision).
- 📌 Providing peer mentoring and lived experience support.
⚠️ Overdose Prevention & Risk Management
BOOST incorporates harm reduction to prevent overdose and promote safer opioid use:
- ✅ Naloxone provision for all MAT patients.
- ✅ Screening for polysubstance use (alcohol, benzodiazepines, synthetic opioids).
- ✅ Education on tolerance loss after MAT discontinuation.
📢 Signs of Overdose & Emergency Response
Recognising an opioid overdose early can save lives. Signs include:
- Slow or stopped breathing.
- Pale, blue, or cold skin.
- Pinpoint pupils.
- Unconsciousness or non-responsiveness.
Emergency response: Call 999, administer Naloxone (if available), place the person in the recovery position, and monitor until help arrives.