An analysis of initial service transformation in response to the COVID-19 pandemic in two inner-city substance misuse services

Abstract

Background: The COVID-19 pandemic presents challenges to substance misuse services. Patients face a higher risk of infection and transmission to others. Services were required to reconfigure quickly in response to the government lockdown. These changes had to be completed before national guidance was published. Method: To examine the strategy and operational delivery of two London boroughs and measure how convergent they were with national guidelines. Referral data were analyzed and compared to a similar time frame pre-COVID-19. Results: Both services adopted similar strategies and pace of change. Longer supplies of opiate substitution therapy (OST) were prescribed, with less restrictive arrangements for collection. There was an increase in opiate assessments and a reduction in alcohol assessments. There was no overall increase in mortality. There was minor deviation from national guidance when it was initially published. Conclusions: The services were well equipped to respond to the rapid changes demanded during early lockdown. Reduced restrictions in OST may not be associated with negative service or patient outcomes. The move to remote consultations and home working are likely to have value in substance misuse services after the pandemic. The long-term impact of lockdown presents uncertainties in terms of clinical safety and requires evaluation.

Patients’ perceptions of self-administered dosing to opioid agonist treatment and other changes during the COVID-19 pandemic: a qualitative study

“…They concluded that patients living in rural communities also quickly adapted to changing treatment policy 28 and a further benefit to longer-interval prescribing of OAT facilitates engagement in alternative activities, including employment for the individual. This study's findings also align with a study of prescribing services in two north London Boroughs 29 and a global systematic review of 25 studies published in 2020 (mostly in the USA) on the adaptation of OAT and allied services to pandemic restrictions. 30 In this review, the most common innovation was the offer of telephone or online services, and longer interval prescribing of medication.…”

Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review

“…Multiple programs in the U.S., Canada, India, Spain, Italy and England instituted longer take-home policies for dispensed opioid agonist medications (Peavy et al [ 43 ], MacKinnon et al [ 44 ], Basu et al [ 45 ], Trujols et al [ 46 ], Vecchio et al [ 32 ] and Hazan et al [ 47 ]). This strategy was facilitated by relaxed regulations and recommendations limiting the prescription of take-home medications, especially around methadone, and a shift in emphasis by regulators on safety and access rather than preventing diversion.…”

Remote harm reduction services are key solutions to reduce the impact of COVID-19-like crises on people who use drugs: evidence from two independent structures in France and in the USA

“…A larger study on how COVID-19 related restrictions quantitatively impacted the activities of home-delivery services would be of interest to broaden our conclusions and show that those types of approaches must be developed in other countries because (i) they compliment classical HR services and (ii) they are key structures to face big-event crisis that will likely occur in the future. Nevertheless, it is important to note that remote HR structures cannot be only considered as take-home medications [ 27 , 28 ]. Indeed, first there is no need of medical prescription to access paraphernalia whereas it can be the case for some take-home medications.…”