Substance Misuse

Substance (Mis)Use Services

These services are provided as part of the holistic support that the NHS, social services and third sector offer for people with substance use issues, which may include the use of opioids, stimulants, prescription medications, alcohol and more. The detail of which medications are used in treatment and what support is delivered varies by Health Board.

The core of these services is the provision of support to patients in recovery, along with dispensing and/or supervision of substitution therapies.

Opioid Substitution Treatment

The following guidance is intended to support pharmacists and staff involved in dispensing and supply of Opioid Substitution Treatment (OST) to patients.

Community Pharmacy Guidance for the Provision of Substance Misuse Services (updated August 2018)

The above document contains Information Sharing Forms which can be used to communicate any health and wellbeing issues with prescribers via email or alternatively, they can be printed off and used in paper form. Arrangements for communication should be made based on local requirements and preferences. Quick links to the forms are below:

The PCR system may also be used for recording interventions, issues or discussions which may be used to feed back to prescribers or addiction workers and collate a record to support patient care in the pharmacy.

If you need to order further supplies of purple installment forms, you can do so using this Stores Order form.

OST – Missed Doses ("3 Day Rule")

It is of vital importance that the prescriber of any patient who misses 3 consecutive days of opioid substitution treatment is informed as soon as possible. There are a number of reasons for this stipulation:

There is a risk that the patient may have lost tolerance to the drug and the usual dose may cause overdose.

There is a risk that the patient has come to some sort of harm. Community Pharmacies are an important point of contact for many patients prescribed OST.

There is a risk that the patient has moved to another area and their OST has been prescribed elsewhere.

Scotland is currently in the midst of a drug related deaths crisis and community pharmacy can play a vital role in tackling this issue, particularly through ensuring effective communication between services.

If a patient fails to present to the community pharmacy for 3 consecutive days for OST treatment, please contact the prescriber or local substance misuse service. Alternatively, please notify the NHS Lothian Lead Pharmacist for Substance Misuse and Prison Services: paul.maguiness@nhslothian.scot.nhs.uk.

OST – Supervision during COVID-19

As the pandemic moves to its latter stages, there is an expectation that community pharmacies will be able to start moving back to delivering a full supervision service for existing OST patients, as well as being able to find extra capacity for new OST prescriptions where this can be safely accommodated.

Although no formal guidance on supervising safely is currently available, please see here for a list of top tips and things to think about in relation to your own pharmacy regarding:

Reintroduction of supervision
Supervising safely to minimise transmission risk

Other Harm Reduction Services

Injecting Equipment Provision (IEP) Pharmacies

The following list of community pharmacies and support hubs provide clean injecting equipment and take back used equipment for safe disposal. Doing so is an important harm reduction measure and can support patients not yet in treatment to access services by providing encouragement and signposting when necessary.

	EDINBURGH IEPs
EH2	Boots, 48 Shandwick Place, Edinburgh EH2 4SA	0131 225 6757	Mon-Sat 9am-6pm
EH3	Spittal Street Centre, 22-24 Spittal Street, Edinburgh, EH3 9DU	0131 537 8300	Mon-Fri 9am-5pm, Sat open 24 hours
EH4	CGL North West Hub, Craigroyston Health Centre, 1B Pennywell Road, Edinburgh, EH4 4PH	0131 469 5044	Mon-Fri 8.30am-4.30pm
EH5	Lindsay & Gilmour, 228-230 Crewe Road North, Edinburgh, EH5 2NS	0131 552 4253	Mon-Fri 8.45am-6pm, Sat 8.45am-5.30pm
EH6	Turning Point/North East Hub, 5 Links Place, Edinburgh, EH6 7EZ	0131 554 7516	Mon-Fri 9am-5pm
EH6	Lindsay & Gilmour, 257a Leith Walk, Edinburgh, EH6 8NY	0131 554 6591	Mon-Fri 9am-6pm, Sat 9am-5.30pm
EH8	Newington Pharmacy, 46-50 Clerk Street, Edinburgh, EH8 9JB	0131 667 2368	Mon-Fri 8.30am-6.30pm, Sat 9am-6pm
EH11	M&D Green (formerly Mackinnon) Pharmacy, 291 Calder Road, Edinburgh, EH11 4RH	0131 455 7073	Mon-Fri 9am-5.30pm, Sat 9am-5pm
EH11	Omnicare, 1 Ardmillan Terrace, Edinburgh, EH11 2JN	0131 337 1604	Mon-Fri 9am-6pm, Sat 9am-12.30pm
EH11	Calder Pharmacy, 18 Calder Park, Edinburgh, EH11 4JN	0131 453 2674	Mon-Fri 9am-5.30pm, Sat 9am-1pm
EH14	CGL South West Hub, Westerhailes Health Living Centre, 30 Harvesters Way, Edinburgh, EH14 3JF	0131 453 9406	Mon-Fri 9.30am-5pm
EH16	Omnicare, 102 Walter Scott Avenue, Edinburgh, EH16 5RL	0131 664 2363	Mon-Fri 9am-6pm, Sat 9am-1pm
EH16	Lindsay & Gilmour, 58-60 Niddrie Mains Road, Edinburgh, EH16 4BG	0131 661 2662	Mon-Fri 9am-5.30pm, Sat 9am-1pm
EH17	CGL South East Hub, 13 Newtoft Street, Edinburgh, EH17 8RG	0131 661 5294	Mon-Thur 9.30am-4.30pm, Fri 9.30am-4pm
	MID AND EAST LOTHIAN IEPs
EH20	Rowlands Pharmacy, 55 Clerk Street, Loanhead, EH20 9RE	0131 440 0511	Mon-Fri 8.45am-6pm, Sat 9am-5pm
EH21	Mid and East Lothian Drugs, The Esk Centre, Ladywell Way, Musselburgh, EH21 6AB	07843 339958	Mon-Fri 9am-5pm
EH21	M&D Green Pharmacy, 165 High Street, Musselburgh, EH21 7DE	0131 665 2146	Mon-Fri 9am-6pm, Sat 9am-5pm
EH32	Bankton Pharmacy, Hawthorn Road, Prestonpans, EH32 9QW	01875 811280	Mon-Fri 9am-6pm, Sat 9am-1pm
EH41	Right Medicine, 20 High Street, Haddington, EH41 3ES	01620 822361	Mon-Sat 9am-5.30pm
	WEST LOTHIAN IEPs
EH47	Blackburn Pharmacy, Unit A The Mill Centre, 2 Sycamore Walk, Bathgate, EH47 7LH	01506 813720	Mon-Fri 8.30am-6pm, Sat 9am-5pm
EH48	Dunamis Pharmacy, 27 Elizabeth Drive, Boghall, Bathgate, EH48 1SJ	01506 653867	Mon-Fri 9am-6pm, Sat 9am-1pm
EH52	Omnicare Pharmacy, 23-25 West Main Street, Uphall, Broxburn, EH52 5DN	01506 857516	Mon-Fri 9am-6pm, Sat 9am-5pm
EH54	Omnicare Pharmacy, 6 Main Street, Livingston Village, Livingston, EH54 8DF	01506 411570	Mon-Fri 9am-6pm, Sat 9am-12.30pm
EH54	West Lothian Drug & Alcohol Service, Almondbank Centre, Shiel Walk, Livingston, EH54 5EH	01506 430225	Mon-Fri 8.30am-5pm, Sat 9am-12.30pm

Injection Equipment Provision Standard Operating Procedure (updated August 2014)
Injection Equipment Provision Service Specification & SLA - see Local Services (NHS Lothian) section
Injection Equipment Provision in Edinburgh and Lothians (updated December 2019)

Take Home Naloxone Service

Currently the following IEPs are participating in NHS Lothian’s new ‘Take Home Naloxone’ scheme, whereby patients and/or patients’ friends, carers or family members can receive training and supplies of naloxone to be used in emergency where an opioid overdose is suspected:

EH2	Boots, 46-48 Shandwick Place, Edinburgh, EH2 4SA	0131 225 6757	Mon-Sat 9am-6pm
EH5	Lindsay & Gilmour, 228-230 Crewe Road North, Edinburgh, EH5 2NS	0131 552 4253	Mon-Fri 8.45am-6pm, Sat 8.45am-5.30pm
EH6	Lindsay & Gilmour, 257a Leith Walk, Edinburgh, EH6 8NY	0131 554 6591	Mon-Fri 9am-6pm, Sat 9am-5.30pm
EH8	Newington Pharmacy, 46-48 Clerk Street, Edinburgh, EH8 9JB	0131 667 2368	Mon-Fri 8.30am-6.30pm, Sat 9am-6pm
EH11	Omnicare, 3 Ardmillan Terrace, Edinburgh, EH11 2JN	0131 337 1604	Mon-Fri 8.30am-6pm, Sat 9am-12.30pm
EH11	M&D Green (formerly Mackinnon) Pharmacy, 291 Calder Road, Edinburgh, EH11 4RH	0131 455 7073	Mon-Fri 9am-5.30pm, Sat 9am-5pm
EH14	Wester Hailes (formerly Lloyds) Pharmacy, 26 Wester Hailes Crescent Shopping Centre, Edinburgh, EH14 2SW	0131 442 3118	Mon-Fri 9am-6pm, Sat 9am-5.30pm
EH16	Omnicare, 102 Walter Scott Avenue, Edinburgh, EH16 5RL	0131 664 2363	Mon-Fri 9am-6pm, Sat 9am-1pm
EH16	Lindsay & Gilmour, 58-60 Niddrie Mains Road, Edinburgh, EH16 4BG	0131 661 2662	Mon-Fri 9am-5.30pm, Sat 9am-1pm
EH17	Lloyds Pharmacy, 2 Ferniehill Road, Edinburgh, EH17 7AB	0131 664 3295	Mon-Fri 9am-6pm, Sat 9am-1pm

Supplies of ‘Take Home Naloxone’ (THN) are recorded on NEO – please click here for instructions on how to do this.

If you need to re-order naloxone supplies, please order these as usual from your wholesaler.

If you work in an IEP and wish to request extra training (for instance, for new staff members), please contact the Harm Reduction Services, Spittal Street Centre, Edinburgh:

Further information and training on naloxone for pharmacy staff can be found here:

http://www.naloxone.org.uk

http://www.prenoxadinjection.com/

Further useful THN documents:

ODnotme Poster (please print and display in pharmacy)
15 Point Checklist for teams delivering the THN service
NHS Lothian Take Home Naloxone Service Level Agreement
Action on Finding a Potential Overdose
Prenoxad Assembly and Administration Guide
SLA - see Local Services (NHS Lothian) section

Naloxone - Emergency Supply Service

In a continued effort to reduce drug deaths across Scotland, a new public service - a naloxone emergency supply service - is launching on 30th of October 2023.

Through this service, community pharmacies will hold a supply of Naloxone for administration in an emergency. This will support a significant increase in access to naloxone so that it can be used to reverse the effects of an opioid overdose. For the Scottish Government circular and service specification, FAQs and links to TURAS training, please visit the Community Pharmacy Scotland website here.

Substance Use Services

Substance Use Service	Address	Telephone Number
Services for Substance Misusers Adolescent Substance Use Service (ASUS) and Young People’s Substance Use Service (YPSUS)	City Chambers, Level 6, 249 High Street, Edinburgh, EH1 1YJ	Working Remotely: 07969 200984
Drug Treatment and Testing Order (DTTO)	29-31 Alva Street, Edinburgh, EH2 4PS	0131 225 7788
East Lothian Substance Misuse Service	The Esk Centre, Ladywell Way, Musselburgh, EH21 6AB	0131 446 4853
Lothians and Edinburgh Abstinence Programme (LEAP)	Woodlands House, Astley Ainslie Hospital, 74 Canaan Lane, Edinburgh, EH9 2TB	0131 446 4400
Midlothian Substance Misuse Service	11 St. Andrew Street, Dalkeith, EH22 1AL	0131 285 9600
North East Recovery Hub	5 Links Place, Edinburgh, EH6 7EZ	0131 554 7516
North West Recovery Hub	Craigroyston Health Clinic, 1b Pennywell Road, Edinburgh, EH4 4PH	0131 315 2121
PrePare (Pregnancy/Neonatal)	Wester Hailes Healthy Living Centre, 30 Harvesters Way, Edinburgh, EH14 3JF	0131 453 9208
Spittal Street Centre (Harm Reduction Services)	22-24 Spittal Street, Edinburgh, EH3 9DU	0131 537 8300
Regional Infectious Diseases Unit (RIDU)	Ward 41, Western General Hospital, Edinburgh, EH4 2XU	0131 537 2820
Ritson Clinic	Royal Edinburgh Hospital, 1st Floor, Andrew Duncan Building, Morningside Terrace, Edinburgh, EH10 5HF	0131 537 6444
South East Recovery Hub	Gracemount Medical Centre, 24 Gracemount Road Edinburgh, EH16 6RN	0131 672 9544
South West Recovery Hub	Wester Hailes Healthy Living Centre, 30 Harvesters Way, Edinburgh, EH14 3JF	0131 453 9448
West Lothian NHS Addictions Service	1st Floor, Civic Centre, Howden Road South, Livingston, EH54 6FF	01506 282 845
Alcohol Related Brain Damage Unit (ARBD)	Milestone House, 113 Oxgangs Road North, Edinburgh, EH14 1EB	0131 441 5778

Further NHS Lothian Contacts

Paul Maguiness (Lead Pharmacist for Substance Misuse and Prison Services)

paul.maguiness@nhslothian.scot.nhs.uk

Further Useful Contacts/Patient Support

Change Grow Live have a UK-wide list of support and advice services including helpline numbers for Narcotics Anonymous and Cocaine Anonymous
www.changegrowlive.org

Scottish Drug Services list contact information and details for over 200 agencies in Scotland who can help with drug treatment and care
www.scottishdrugservices.com

Turning Point Scotland offer confidential and effective support to those wishing to address their drug and alcohol use
https://www.turningpointscotland.com/alcohol-and-drugs/