Expert group on opioid replacements
Independent group recommends improvements to drug treatment services.
An independent group, commissioned by the Scottish Government to gather evidence on opioid replacement therapies (ORT) for people with drug problems, has today published its recommendations.
The Scottish Drugs Strategy Delivery Commission, chaired by Dr Brian Kidd, was asked by the Chief Medical Officer, Dr Harry Burns, to review current evidence on the use of methadone and other opioid replacements, and make recommendations aimed at ensuring that where ORT is used, it is being used as effectively as possible. It also looked at access to other treatments.
It concluded that ORT, in particular methadone, is supported by a strong evidence base, that local services are largely providing it in accordance with national guidance and its use should continue in Scotland. However, it also concluded that ORT must be one of a full range of treatment options across the country ranging from community to residential rehabilitation, and services should become more aspirational in relation to supporting individuals’ recovery.
Other key recommendations include:
- Consideration should be given to how to better address the link between health inequalities and problem substance use
- Fit for purpose, local information systems should be in place and be able to identify people on ORT and demonstrate their progress towards recovery
- A national specification for pharmacy services for drug users should be developed to ensure high quality provision, supported by a nationally agreed guideline for supervised, self- administration of ORT
- Discussions should take place on how substance misuse treatment can best be provided through GPs and community pharmacists, with action to reduce variations in practice
- The arrangements for reimbursing pharmacists for methadone prescriptions should be reviewed to ensure they provide best value for the public purse, while also meeting individuals’ needs
- Care providers should publish plans to ensure they can demonstrate that individuals are making progress towards recovery and all their staff should be trained in care that is geared towards recovery
- The Scottish Government should reconsider how to facilitate effective local partnerships. In particular the role of Alcohol and Drug Partnerships should be reviewed and clear improvement measures developed and monitored.
Dr Kidd said:
“This review aimed to be as inclusive as possible and to incorporate the breadth of opinions on how drug problems should be addressed. We have concluded that ORT with methadone is an effective treatment and must remain a significant element of the treatment options available for those struggling with opiate dependency in Scotland. However, ORT must be one of a comprehensive range of treatment options in every area. It must be delivered to the highest quality standards and services delivering treatment must become more aspirational regarding the possibility of recovery.
“The review also identified a range of areas in which progress is required. These included: the need for improvements in terms of the accountability of Alcohol and Drug Partnerships and their information systems, as well as a broader range of issues such as the effect of stigma on this vulnerable population and the need to explore how generic services – such as GPs and community pharmacists - can play a broader role in reducing drug related harm in our communities. I hope our findings will provide the basis on which the Scottish Government and local care providers can work to improve drug treatment and enable more people to go on to lead a life free of drug-related problems.”
Scotland’s Chief Medical Officer, Dr Harry Burns, said:
“Opioid replacement therapies, including methadone have had a beneficial effect in preventing the spread of viruses among drug users. However, they often simply switch one form of drug use for another, albeit a safer one. That’s why we need to find more ways of helping people access a range of treatments and support, tailored to their needs and their aspirations for sustained recovery. This review will help ensure that the right approaches and interventions are in place, while also making recommendations to further improve the quality of care across the country.
“I want to thank the group for their detailed consideration of these complex issues. The review and its evidence is a positive platform on which we can work with professionals in this challenging area to help more people into recovery and create stronger, healthier communities, free from the damaging impact of drug addiction.”
Minister for Community Safety, Roseanna Cunningham, said:
“I am grateful for the considerable work undertaken by the group to produce this report, which underlines the importance of methadone treatment but also makes clear the need to improve access to other treatments and support. Just as we have made great strides to cut waiting times for drug treatment, we now need to continue to improve the quality and range of the support and treatment available, and the systems in place for monitoring how well all areas are performing on this.
“At a time when drug misuse among the general population and young people is declining, we also need to take account of how we better address the needs of the ageing cohort of drug users in this country, who face a range of problems alongside their drug issues. Given these challenges and the range of the recommendations in the report, we intend to hold a series of high level planning meetings with those working in this field, as well as politicians from Scotland’s main parties, to agree the best way forward, with a view to the Scottish Government making a formal response to this report in November.”
The report is available from: http://www.scotland.gov.uk/deliveringrecovery