Managing Drug Dependence in the Community: Spectrum’s proposal in response to the COVID-19 outbreak

In response to the current Coronavirus pandemic (COVID-19), Spectrum Community Health CIC is proposing changes to the way our service users access opioid replacement therapy (methadone/buprenorphine) across our substance misuse services.

In order to limit face-to-face contact and adhere to Government guidelines on social distancing, we propose that service users collect their medication weekly rather than receiving daily prescriptions. We believe that this change will safeguard both our staff and our most vulnerable service users and is necessary because:

  • Many service users affected by long-term drug dependence are in fragile health and may have underlying conditions which put them at greater risk from COVID-19. A small number of our service users are ‘very high risk’ and may be self-isolating. Weekly collections remove the need for clients to attend clinic every day and this reduces their risk of contracting the virus
  • Weekly prescriptions are still frequent enough to provide patients with regular support in managing their medication safely. This protects service users from key risks, including potential overdose or medication diversion
  • Spectrum relies heavily on NHS pharmacies to supply medication and these are facing growing pressure as a result of COVID-19. Rising demand for prescriptions and low staffing levels all create challenges for the NHS – moving to weekly prescriptions will reduce this burden and ensure our patients can access the medication they need
  • The prescription of controlled drugs must be authorised by a Spectrum prescriber. This process becomes harder to manage when there is great demand for daily prescriptions, particularly if changes need to be authorised (for example, if a service user begins self-isolating). Spectrum is managing increasing numbers of prescription changes as a result of self-isolating – weekly prescriptions will alleviate this pressure.

Best Practice

Across the North, we know that substance misuse providers are adopting similar measures in order to keep patients safe. For example, Change Grow Live (CGL) is offering fortnightly opioid replacement prescriptions, whilst ASPIRE in South Yorkshire has moved to weekly prescribing

How we will manage risks

We have planned to manage any potential clinical risks, including:

  • Risk of drugs mismanagement / accidental overdose. This is possible, however, prescribed opioid substitution therapy is shown to reduce drugs overdose. People usually overdose due to use of multiple illicit drugs and alcohol. We will be reinforcing harm reduction advice and providing Naloxone.
  • Risk of medication diversion. There is a possibility of an increase in illicit Methadone/Buprenorphine supply due to medication diversion. However, most long-term service users rely on their medication and are not likely to divert. We will manage this risk through education around drug safety and management

Keeping our patients informed

Spectrum prioritises harm prevention in substance misuse and we routinely discuss safe storage of medications, overdose risks and drug safety with our service users. We will be informing them of the changes outlined in this proposal, and:

  • We will be providing service users with an information leaflet explaining the reasons for these changes, as well as online support and advice
  • We will continue to provide community naloxone and will maximise our existing provision of safe storage boxes so that medication can be kept safely
  • Spectrum staff will be providing telephone support and our bases will remain open for urgent care and (limited) face-to-face contact where necessary. We will continue to accept new referrals

Spectrum will also provide additional support for those who require complex care or are vulnerable due to other circumstances (e.g. in the case of homeless patients who cannot store medication safely). We will work closely with Team Leaders and Key Workers to identify these patients and work with them on a 1:1 basis.

For more information about the changes we’re proposing, please contact:

Dr. Helen Chidlow 07873 500 112

Andy Pearson 07802 875801