ABSTRACT
This chapter presents a case of a 30-year-old man who is brought to the emergency department by his girlfriend in an unresponsive state. She says that he has been an intravenous heroin addict for the past 5 years but is certain that he never shares needles and has had regular negative tests for HIV. In the past he has made several unsuccessful attempts to quit heroin, the last one being as recent as a week ago. He is in a hypotonic hyporeflexic coma but there are no focal neurological signs. There is no verbal response though he groans in response to pain. The step-wise goals of treatment guide the patient through harm minimization strategies up to the complete cessation of the addictive behavior. These include reduce injecting; reduce street drug use; practice maintenance therapy (MT) with heroin substitutes methadone or buprenorphine; reduce substitute prescribing; and abstain.
