Opioid Substitution Therapy

Opioid Substitution Therapy (OST) is the most common treatment for people with opioid dependence and has a substantial evidence base for effectiveness in achieving positive outcomes. The opioid maintenance prescribing options in Fife are methadone, buprenorphine and buprenorphine with naloxone. The aim of OST is to provide holistic pharmaceutical care for patients and to promote recovery by:

  • Providing person centred support to patients in terms of clinical care associated with the patient’s recovery care plan, monitoring and providing intervention when required.
  • Sharing appropriate information regularly with Fife wide treatment and recovery services, particularly NHS Fife Addiction Services in support of the patient’s recovery care plan.
  • Dispensing OST as prescribed and according to GPhC standards.
  • Provide pharmaceutical care (including supervision and dispensing of medication) and public health interventions to meet patient needs and refer or signpost to ensure access to further assessment and intervention from relevant health, social care and third sector services.
  • Promote patient safety and support appropriate harm minimisation strategies, contributing to a reduction in drug-related harms within our communities. This includes ensuring the availability of naloxone for emergency administration and signposting or referring patients to services able to provide Take Home Naloxone or through existing Take Home Naloxone community pharmacy SLA.

OST Patient Support

Patients who receive OST will have regular contact with their community pharmacy and the support that they receive is invaluable to aid them with their recovery. Community pharmacy teams will have strong relationships with their OST patients and, as such, will be able to identify any behaviour that is out of the ordinary. It is therefore vital for patient safety that community pharmacy teams raise any concerns with addiction services as soon as possible. Information that should be reported to addiction services includes, but is not limited to:

  • Patient misses any doses: When a patient misses any of their doses it should be reported to addiction services as soon as possible. If a patient misses three consecutive doses then all subsequent doses should be withheld until further guidance is given from addiction services. Tolerance can be lost quite quickly and the prescriber may wish to reassess the patient before continuing with their treatment.
  • Prescription issues: If there are any concerns relating to an OST prescription then this should be raised with addiction services so that the prescriber can be made aware.
  • Any other concerns:
    • If a patient appears intoxicated it may be appropriate to ask them to return after 3 to 4 hours or miss the dose and return first thing the following morning, provided nothing further is taken.
    • The patient tries to avoid supervision or does not consume the whole dose under supervision.
    • The health and wellbeing of the patient deteriorates.
    • The patient is abusive, threatening or caught shoplifting.

Regardless of how minor any cause for concern may seem, it is better to report this information to addiction services so that they can make an informed decision for that patient. The contact details for addiction services are:

Take Home Naloxone service

The Take Home Naloxone (THN) service allows community pharmacies to offer overdose awareness training and naloxone kits to people at risk of an opioid overdose. Patients who receive OST would be deemed at risk of an overdose so should be offered this service. Furthermore, if a patient was to experience an opiate overdose they will be unable to administer naloxone to themselves so it is encouraged to offer the THN service to someone in their network (i.e. friends or family members).