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This paper illustrates the key role the nurse can play in reshaping and streamlining a service for more effective treatment. This is demonstrated using the example at the Islington Drugs Service in London, where external pressures initiated a re-design of the part of the service and its aim and objectives.This re-design was successful and it is noted that, while the team delivering the service was multi-disciplinary, nurses played a central role in the effective design and implementation that ultimately received positive feedback from the clients involved in the project.Good clinical knowledge and an ability to think creatively and practically are important skills for nurses in today's healthcare system. This paper hopefully illustrates that nurses are well placed to play an active role in re-designing services and should definitely be playing a central role in strategic service delivery.

Aims and MethodTo investigate non-adherence to substitute opioid treatment, using a cross-sectional study design, with 630 patients from three London community drug services. Adherence was measured as the number of doses collected from the pharmacy as a proportion of the total number of doses stipulated on the prescription during a 28-day period and was further investigated through laboratory urine drug screens.ResultsOverall, 30.5% (n= 191) of individuals failed to pick up at least one dose of medication from the pharmacy over 1 month, but only 1.6% (n= 10) missed 50% or more of their doses. Non-adherence was associated with supervised consumption, more frequent pick-up, shorter duration of treatment, younger age, a lower dose of methadone and a recent urinalysis result positive for opiates.Clinical ImplicationsTreatment services need to monitor levels of adherence to treatment and develop strategies to improve it so that treatment can be optimised effectively.