From Dr Mohd Haniff lsmail:

Dear doctors, We welcome you as the part of the working compartment of Pusat Rawatan Dr Mahmud,
First of all working in this unique clinic is merely a new experience to all of you, therefore we don't
expect that you to handle this clinic as an addiction specialist or experienced councellor . Nevertheless
we willprovide you the basic guideline for your referral.

ROLE OF LQCUM DOCTORS

A) NEW PATIENTS
Historv taklne: (staff will assist you in tll-q historv takine)
.
\-' Try to take a very simple history taking of active substance being used; for example

Heroine

Duration : (since L8 years old until now)

,

Frequency : daily

Amount : 3 to 4 tubes per day

Method Chase

*lf the patient is taking EUE!.01g-iU-bS&-0gC ask the patient which substance he is interested to be treat.
(most of them is looking for methadone for heroine)

There will be very minimal physical examination that we expected you to proceed. BUT at least take the
Blood Pressure. Urine drug test for suspected Ketamitre / Syabu user @ if there is demand from family
members (staf will assist you on this)

On receiving new patlent, we can further categorized the patient into 2 categories.

1) Opiate addicts alone {patient who using/abusingie Heroine, Codeine, Candu, Doun Ketum,
Morphine (Pak Teh), ) these substance is being put under the opiate group.
The treatment is straight forward. Patient can be started with 5v Methadone 30me on the first
dav and the dosage may be titred up according to the patient's dernand up to 5ome to 60ms
within 2 weeks time.
. After prescription, kindly explain {the staf will assist you on this) the side effects of
methadone ie:
a) Drowsiness - to cope, patient need to be in active physical movements such as doing
housework, take a few walk or stretching.
b) Constipation - to cope , patient need to take a lot of plain water / fibres
c) Headache - patient can lowered their dosage into half or 2 divided dosage (bd dose) for
avam.nlo (rr h/Iol-herinno 1(mc hd
b) For the oral medication; after finishing the detox procedure below is the suggested oral
medicine that can be prescribed. {staff will help you on this)

ror Ketamine patient: for lweek

Tablet Remeron 30mg ON
Tablet CPZ (chlorpromazine 50mg od)
Tablet Artane 4mg bd
Tablet Amytriptylline 50mg ON

ror ffi[!!-patient:forlweek
Tablet Valdoxan 25mg od with LFT taken 2 weeks after taking this medication.
Tablet Remeron 30mg ON

For other s.ubstance {which is rare) ....kindly consult with dr Mahmud first.

NOTE :

All new non-opiate patient should be referred to Dr Mahmud on the nearest date of
appointment. Please ask siti the nearest appointment date with Dr Mahmud.

B) PRE EXISTING PATIENT

It is more simple task for the locum doctors on pre-existing patient as they only need to
continue the plan as mentioned in the patients' card'

1) For opiate Patient:

.Just renew the prescription which last every month. On dealing with the patient just
ernphasized in 2 things:
a) ComplY to the methadone Program
b) Keep the sufficient dose to avoid relapse'

2\ For non-oPiate Patient:

a) Continue the detox procedure if he/she is still in the schedule

b) Repeatthe detox procedure from the first phase if the urinetest stillpositive in the
involved drugs.
Renew prescripticn and just continue the old medication. lf any complaints
from the
c)
neiientc ir rst .oncult with Dr Mahmud.
pu$AT RAWATAN PAI{.r{R DR MAHMUD (CAWANGAN KLANG)

37.G JALAN ]'IARA 2C/KU I tsANDAR BARU KLANG BUKIT RAJA.

4I5IO KLANG SELANGOR,
03-334368s0, 03 -33 59 s321, 0 t2-66 1 81 7 7

The sche4ule belor.v is designeC to elaborate the intravenous administration endorsed by Dr Mahmud Mazlan (the
Addiction Medicile Consultant) to achieve the rnaximum success in the Subtance Abuse Recovery.

APPOINII4ENT.DATE

5 TIMES PER
WEEK

WEEK 2 3'TIMES PER

WEEK

3 TII\4ES PER
WEEK

3 TIMES PER
WEEK

WEEK 5 ONCE A WEEK

ONCE A WEEK

ONCE A WEEK

ONCE A WEEK

WEEK 9 DEPENDS ON
PROGRESS
PATIENT

Substance Abuse Recoven Schedgle

Note:

'l'he appointment
- The above schedule is a guideline lbr the administration olthe intravenous soiution.
date with the specialist rvill bc given b1'thc Mcdical Ofl'icer in - charge.
'l'he actual liequency and dosage of the intravenous
- This is a summar), for the minimum requirement o1'thc general therap)'.
solution are vary from the individuals - therefore: need the availablc ph1'sician advicc-
-Urine dipstick test rvill be a marker lirr thi' drug-tiee period. in casc ofthe relapse - the detoxification procedure may be
repeated according to the physician advice
 2) Non opiate user including : Ketamine/Syabu/Gum sniffing/Pills/etc

a) For non opiate user: locum doctor should encourage the patient to undergone the routine
detoxification procedure at least for 2 weeks time. The full schedule of this procedure is

availabie. (staff will assist you on this)

Below is the step-by-step detoxification procedure which should be done:

(staff will assist you on this). Staff Siti is well trained on this she will guide you the step-by-step
procedure, don't hesitate to ask her.

1) Set an lV line with L pint of normal saline I

2) Mlix the p-trovite 1 with p-trovite 2

(labelted as p-trovite 1 in one ampule 5mh and another one p-trovite 2
I

in one ampule 5m!). The mixture can be rnixed in a 10ml syringe with I

green 21G needle. I

3) lniect all the mixture (p-trovite 1 and 2)from the 10mt syringe into
the normal saline bottle.
i

4) Run the drip at approximately X. hour.

I

5) Add t ampule of iv valium (labelled as valiu m L0mgllml) into the

I

normal saline bottle. Some patient may need 2 ampute of iv Valium

{ie 20mg valium) but this need to be discuss with Dr Mahmud first.
I

6) Only for ketamine patient - additional 1 pint of Dextrose 5% alone I

run at I hour i

This routine detox procedure should be done according to below minimum frequency. Set the
appointment date with the help from staff.

3 tirnes / week * for the first week

2 tirnes,/week - for the second week
L time / week for 3'd, 5th, 7th week

xlf relapsed occurred - meaning the patient still taking the substance then the initial phase of detox
ch^, l-na ranarl-ad haclr