Opioid Substitution Treatment (OST) and Instalment/supervised dispensing
OST is well-established in the treatment of opioid use. The medication used includes methadone, buprenorphine (sublingual and oro-lyophilisate) and Buvidal (long acting injectable buprenorphine).
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)
Dispensing intervals (including supervised dispensing) are decided by the prescriber after a risk assessment, and aim to reduce harm to the patient from their prescribed medication, to support stability of patients and allow for regular monitoring, to ensure safe custody and storage of medications and to reduce diversion of controlled medication. Regular contact also provides an opportunity for community pharmacy teams to deliver valuable relational care and interventions which may reduce harm.
OST – Missed Doses (“3 Day Rule”)
It is of essential that in the case of any patients missing 3 consecutive days of opioid substitution treatment the prescriber/substance use service is informed as soon as possible. There are a number of reasons for this stipulation:
- Patients who disengage from treatment are at a high risk of harm.
- 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 moved to another area and their OST has been prescribed elsewhere.
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.
Pharmacy closures
There is a high risk of harm to patients who disengage from or who are unable to access their treatment.
In the event of a pharmacy closure, it is important that the care of patients receiving OST via installment dispensing is considered and prioritised. Each pharmacy should ensure that this is included in their Business Continuity Plan, and that staff are familiar with this. This is in addition to the established closure process: Closure Alert Process – NHS Lothian
It is good practice to record contact details for patients receiving OST so that they may be contacted in the case of a closure. This should be done at the first presentation and updated/reviewed regularly (minimum of every six months). It may be appropriate to record the contact details of a patient representative for use in the case that the patient is not contactable.
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Last updated 10/6/25 BC, JN & EBR