Harris M, Holland A, Lewer D, et al. BMC Med 2022;20:151. doi:10.1186/s12916-022-02351-y

The authors of this study contacted 135 NHS trusts and asked for their policies on substance dependence management. These trusts largely cover acute hospitals in England. They did a document analysis on these and they also reviewed an Omitted and Delayed Medicines Tool (ODMT) which is used to categorise risk based on the consequences if medications are missed.

In total, 86 (46%) trusts provided 101 policies. A further 44 trusts (33%) did respond but couldn’t provide any policies and 5 (4%) did not respond at all. The authors describe “procedural barriers to OST provision” and these manifested in a number of ways: policies were not necessarily in line with national guidelines; people admitted in the evenings, at night, or at weekends, often didn’t receive OST as the hospital staff were unable to confirm doses with community organisations. And, 42 out of 101 (42%) trusts “required or recommended” a urine drug test that was positive for the OST medication or opioids before prescribing. The authors also noted the use of stigmatising language in policy documents. The ODMT that was reviewed was found to categorise ‘drugs used in substance dependence’ as low risk if delayed and moderate risk if omitted completely.

Commentary:

This study manages to illuminate a dingy and unedifying corner of clinical care. The authors have, for the purposes of presenting their research, been as even-handed as one would expect but the findings speak plainly. It exposes, quite clearly, systemic discrimination and stigmatisation. There are many reasons why this study is important, not least the scandalous discharge against medical advice rates in people who used drugs, and it seeks to understand the current situation to then address the systemic barriers that people who use drugs face. While this study scrutinises hospital policies there are many lessons for community services to absorb. We need to find ways to work with hospitals and we can’t stand on the outside, oblivious to the consequences once a person passes through the hospital doors, or shrug helplessly after discharge. Many of us will have and continue to have conversations with ward staff and clinicians about managing OST and we should look to push further with these where possible.

Article taken from our latest Clinical Update, edited by Dr Euan Lawson (Editor of the British Journal of General Practice). To read the full Clinical Update please become a Premium CPD Member.

Articles featured in this Clinical Update:

• Long-acting depot buprenorphine in people who are homeless: Views and experiences.
• The characteristics of people who inject drugs in the United Kingdom: changes in age, duration, and incidence of injecting, 1980–2019, using evidence from repeated cross‐sectional surveys.
• Suicidal motivations among opioid overdose survivors: Replication and extension.
• The United Kingdom’s first unsanctioned overdose prevention site; A proof-of-concept evaluation.
• A double-blind randomised crossover trial of low-dose flumazenil for benzodiazepine withdrawal: A proof of concept.

If you would like to see more from Euan Lawson, he is starting a new free newsletter looking at addiction issues. More Information here.

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