A working group of pharmacists and pharmacy technicians in Scotland says meaningful policy reform is needed that improves access to treatment for people with drug dependency, strengthens recovery pathways and embeds community pharmacy as a core clinical partner. Their comments come as the Scottish Conservative party publishes an update on their plans for a Right to Recovery, saying funding for drug consumption rooms should be redirected to rehabilitation beds, and there should be mandatory reassessment of any person on methadone for two years

The Scottish Conservatives’ paper says:

‘To improve prevention, we would ensure community pharmacies are given the support they need to better engage in early intervention and provide proactive referrals to support services with drug users who frequent their locations’.

The Right to Recovery policy paper also says Scottish ministers must direct NHS boards to include mandatory reassessment in medication-assisted treatment standards (MATS) to limit prescribing of methadone in the cases where there is no evidence of progress.

The paper says anybody caught for a second time with Class A or B drugs in their possession for personal use should automatically be given the advice and treatment they need to get off drugs.

Pharmacists say arbitrary thresholds for reassessment could do more harm than good as recovery, for people seeking to come off opioid drugs, rarely follows a straightforward path.

The Scottish Pharmacy Alliance, a policy group within the membership organisation Pharmacy in Practice, agrees pharmacy should be at the centre of supporting people with addictions but, as part of that, pharmacists and their teams should have the clinical freedom to make individualised decisions about their patients.

Chair of the Scottish Pharmacy Alliance, Dr Sarah Donaldson, says that a renewed focus on reducing harm to individuals, families, and communities affected by drugs is welcome. She cautions, however, that politicians should avoid closing the door on any evidence‑based measures that could improve outcomes.

"Scotland needs a coherent, whole system response grounded in clinical science and compassion to reduce harm and restore hope to communities affected by drugs and alcohol.

“We agree that pharmacy as a profession must be more fully involved in the design and delivery of services, particularly in early intervention, harm reduction, and ongoing pharmacotherapy.

“However, we believe that policy development in this space must be guided by robust clinical evidence and an understanding of the complex nature of substance use disorders. Opioid dependence is recognised internationally as a chronic, relapsing condition requiring long-term, individualised management."¹

In a statement, the Scottish Pharmacy Alliance says international and UK guidance emphasises the need for a complementary mix of harm reduction, pharmaceutical care such as prescribing methadone, psychosocial interventions and access to recovery-oriented services^2,3 – with none of these excluded.

Dr Donaldson says the pharmacy profession has a role that goes far beyond delivering MATS, supplying naloxone and offering injecting equipment – and they must be supported and trusted to tailor their advice, treatment and referral decisions to the needs of the person in front of them:

“Decisions about medicines such as methadone or buprenorphine, including long-acting injectable buprenorphine, should remain clinically individualised and rooted in shared decision-making between the patient and a multidisciplinary team.

“Evidence consistently demonstrates that opioid agonist treatment, including methadone maintenance, reduces illicit opioid use, overdose risk, transmission of blood-borne viruses, and mortality.^4,5

“Time-limited or arbitrary thresholds for reassessment risk undermining therapeutic stability if not clinically indicated.”

 

References

1. Volkow ND, Koob GF, McLellan AT. Neurobiologic advances from the brain disease model of addiction. N Engl J Med. 2016;374:363–371
2. Scottish Government. Medication Assisted Treatment (MAT) Standards: access, choice, support. Edinburgh: Scottish Government; 2021.
3. UK Department of Health and Social Care. From harm to hope: a 10-year drugs plan to cut crime and save lives. London: DHSC; 2021.
4. Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis. BMJ. 2017;357:j1550.
5. World Health Organization. Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Geneva: WHO; 2009.

 

Read more: Pharmacy’s road to stigma-free drug dependency care; Scots urged to show Yellow Card to meds side effects; Pharmacists urge leaders to act for the profession

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