Medication Assisted Treatment- Opioid Substitution Therapy Supervision and instalment dispensing

Service specification (what it is, how it works)

Medication Assisted Treatment (MAT) – Opioid Substitution Therapy (OST) is a structured clinical approach for treating opioid dependence. It combines pharmacological treatment (using prescribed opioid substitutes like methadone or buprenorphine) with psychosocial support to help individuals stabilise and recover from opioid misuse.

What is “Supervision and Instalment Dispensing”?

These terms refer to how the medication is provided and monitored:

1. Supervised Consumption
   • The patient takes their prescribed dose under direct observation, usually in a community pharmacy or clinic.
   • Purpose:
     • Prevents diversion (selling or sharing medication).
     • Ensures correct dosing and reduces overdose risk.
     • Allows pharmacists to check for signs of intoxication or missed doses and report concerns to prescribers.
   • Commonly required at the start of treatment or for higher-risk patients. Over time, if stable, patients may earn take-home doses.
2. Instalment Dispensing
   • Instead of giving a full prescription at once, the medication is dispensed in small, scheduled amounts (daily or several times per week).
   • This reduces the risk of misuse and supports regular contact for monitoring and safeguarding.
   • Prescribers decide instalment intervals after a risk assessment, considering factors like stability, housing, and safeguarding concerns. [communityp…cot.nhs.uk], [cpe.org.uk], [pharmacies…valley.com]

How Does OST Work?

Pharmacological Element:
Replace illicit opioids (e.g., heroin) with a long-acting opioid (methadone or buprenorphine). This:

• Reduces withdrawal symptoms and cravings.

• Stabilises the patient’s life and reduces injecting-related harms.
• Lowers risk of blood-borne virus transmission and overdose. [gov.uk]

Psychosocial Element:
Counselling and recovery support to address underlying issues (mental health, housing, employment).

Supervision Benefits:

• Frequent contact with healthcare professionals.
• Opportunity for wellbeing checks and safeguarding.
• Early detection of missed doses or illicit drug use. [cpe.org.uk]

 In short:
Supervision and instalment dispensing are safety measures within OST to ensure medication is taken correctly, prevent diversion, and provide ongoing support. Over time, as patients demonstrate stability, supervision may be reduced, and take-home doses allowed.

Resources

NHS Highland has specific resources and guidance for Medication Assisted Treatment (MAT), including Opioid Substitution Therapy (OST) with supervised consumption and instalment dispensing. Here are the key resources:

NHS Highland MAT Guidance

• Medication Assisted Treatment (MAT) Guidelines – NHS Highland
  This is the main clinical guide for delivering MAT in Highland. It covers prescribing methadone and buprenorphine, supervision protocols, and adherence to Scottish MAT Standards.
  View NHS Highland MAT Guidelines [rightdecis…cot.nhs.uk]
• Substance Misuse Guidelines – NHS Highland
  Includes detailed protocols for opioid dependence treatment and links to related guidance.
  Access Substance Misuse Guidelines [rightdecis…cot.nhs.uk]

MAT Standards Implementation in Highland

• Highland Alcohol and Drugs Partnership (HADP) – MAT Standards
  Explains the 10 MAT Standards and Highland’s commitment to same-day access, informed choice, harm reduction, and trauma-informed care.
  Visit HADP MAT Standards Page [highland-adp.org.uk]
• NHS Highland MAT Standards Implementation Plan
  Details actions for meeting MAT standards locally, including governance and test-of-change projects for same-day prescribing.
  Download Implementation Plan (PDF) [nhshighlan…cot.nhs.uk]

Key Points in NHS Highland Guidance

• Medications available: Methadone (oral solution) and Buprenorphine (tablets, film, depot injection).
• Supervised Consumption: Required initially or for high-risk patients; usually in community pharmacies.
• Instalment Dispensing: Prescriptions split into daily or short intervals to reduce diversion and overdose risk.
• Integrated Care: MAT is part of a wider recovery package including psychosocial support. [rightdecis…cot.nhs.uk]

Useful documents (claim forms etc)

NHS Highland provides several official documents that are very useful for MAT and OST processes. Here are the most relevant ones:

1. NHS Highland MAT Guidelines

• Covers prescribing methadone and buprenorphine, supervision protocols, instalment dispensing, and adherence to Scottish MAT Standards.
• Link: Medication Assisted Treatment Guidelines – NHS Highland

2. Substance Misuse Clinical Guidelines

• Includes opioid dependence treatment, risk assessment, and pharmacy supervision requirements.
• Link: Substance Misuse Guidelines – NHS Highland

3. MAT Standards Implementation Plan

• NHS Highland’s roadmap for meeting the 10 MAT Standards, including same-day prescribing and pharmacy engagement.
• Link: Download PDF

4. Highland Alcohol and Drugs Partnership (HADP) MAT Standards

• Explains the standards and local delivery approach.
• Link: HADP MAT Standards

These documents include:

• Clinical protocols for OST prescribing.
• Supervised consumption and instalment dispensing guidance.
• Governance and implementation plans for MAT standards.