Following the relaxations to the way in which opiate substitute treatment has been subscribed and delivered during the Covid-19 pandemic, as a sector we now have a challenge:
How do we incorporate the lessons learned from the changes to supervised dispensary during the pandemic? And, can we move towards a fully risk based, individualised dispensing system?
Dr Emily Finch, Clinical Director of Addictions at the South London and Maudsley NHS Foundation, and Vice Chair of NHS APA, explains how supervising dispensing has changed during the pandemic:
“Supervised dispensing was stopped because of an urgent clinical need to protect service users and pharmacists during Covid-19. This required very difficult clinical decisions and to take some clinical risks. However, it has been an interesting natural experiment and there is a lot of learning that we can take from the experience”.
Addiction treatment services and primary health services are now faced with a challenge. Dr Finch describes the significance of this critical period as a time to reflect about the future of supervised dispensing:
“There are certainly benefits of allowing unsupervised dispensing to continue. However, I think it's important to go back to basics and think about why we developed supervised dispensing in the first place. We have it because we had high levels of deaths in people using diverted methadone from prescriptions. Yet we have seen many benefits from stopping it [supervised dispensing] - our service users generally like it, they feel more empowered, stigma is removed and they are given an opportunity to control their own substance use rather than having it controlled for them through a rather paternalistic system of supervised dispensing”.
“Supervised dispensing was stopped because of an urgent clinical need to protect service users and pharmacists during Covid-19."
“I think the challenge it gives us is that we finally have the ability to develop a genuinely nuanced risk based system that individualises supervised dispensing for the individual service user. We can take away rules about the compulsory supervision - which many services have, and replace it with a dynamic risk assessment for an individual which finds the best way to treat an individual and their specific needs”.
In conclusion, we have a huge task ahead of us to try and navigate the best way to relax the current supervised dispensing system and the impact of Covid-19. The benefit of things remaining unchanged is that it allows for a system that gives service users the responsibility for their care. However, we need to ensure that it would not be detrimental to the lives of service users, or other people using drugs in the system. As Dr Finch concludes:
“The task of a truly individualised system is a big challenge to us. We know one size won’t fit all. I think we have to avoid ideologies, think pragmatically about what is going to benefit the most people. We need to ensure that we have staff with the right skills to do that”.