Service specification
Opioid Substitution Therapy (OST) is a treatment for people who are dependent on opioids such as heroin or prescription opioids. It involves replacing an illicit or high‑risk opioid with a safer, prescribed substitute—most commonly methadone or buprenorphine—alongside psychosocial support.
The OST service in NHS Highland closely encompasses the Medication Assisted Treatment (MAT) standards. Click the link for more information.
What is “Supervision and Instalment Dispensing”?
These terms refer to how the medication is provided and monitored:
- 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.
- 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.
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.
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.
Community Pharmacies can claim for OST services using the monthly claim form.
They can claim for the number of patients for Buprenorphine, Methadone and Buvidal. Currently, the fee for this is £70 per patient.
This fee is totalled and paid to the pharmacy contractor on submission of the monthly claim form.
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.