Drug Deaths Taskforce considers pharmacy resilience during COVID-19

The Scottish Drug Deaths Taskforce has made a number of recommendations to the Minister for Public Health, Sport and Wellbeing relating to the COVID-19 outbreak.

The aims of these objectives are to reduce harms and deaths amongst people who use drugs during the COVID-19 pandemic.

The following are the key issues and recommendations from the Drug Death Taskforce to the Minister for Public Health, Sport and Wellbeing to mitigate harms from COVID-19-related service disruption and decline in the context of the existing drug-related deaths crisis.

Write to Health Boards and Health and Social Care Partnerships

There is a need to highlight the importance of maintaining service-level provision of drug and alcohol services during the COVID-19 outbreak and to plan for additional capacity to these services on the basis of public health surveillance.

Protect harm reduction and treatment staff from redeployment

This is to ensure workforce capacity for injecting equipment provision (IEP), opioid substitution therapy (OST) and take-home naloxone (THN) delivery and ensure non-fatal overdose follow-up pathways are maintained. These services add value to necessary COVID-19 response measures as well as mitigate unintended consequences, and so prevent additional burden on the NHS.

Pharmacy resilience

Preparation of alternative systems of delivery should pharmacy provision be further depleted e.g. central stocks of OST medicines; skeleton staff to provide OST & IEP despite being closed to the general public; expansion of outreach networks and delivery vehicles.
Identify pharmacies with high patient numbers receiving OST for site-specific contingency plans to be developed.
Ensure that all health boards include OST dispensing and IEP provision as essential pharmacy services to be maintained as core elements of the emergency response
Support pharmacies with volunteers to help manage queues.

Consider people who use drugs (PWUD) as a priority group

This would ensure they receive COVID-19 testing, in particular those who are homeless/in prison/prisoners on release etc.
Extend inclusion criteria for Scottish Government national helpline (0800 111 4000) for vulnerable people to include PWUD.

Levels of supervision of OST

Ensure a rights-based approach is taken towards this and prioritise OST as an essential medicine.
Provide risk assessment of the most vulnerable to ensure safety and that emerging needs are met at times when individuals need to self-isolate, or are at increased risk and subject to shielding guidelines due to underlying health conditions.
Provide safe storage boxes for storage of medicines and take home doses.
Ensure ongoing availability of oral toxicology testing to those considered most at risk (e.g. those with unstable drug use or child protection issues) to enable accurate risk assessment around supervision and dispensing arrangements.
Establish home delivery outreach networks – using a mixture of redeployed staff from other services, third sector and volunteers.
Investigate use of long acting depot injection OST preparations given its ability to aid initiatives such as self-isolation/quarantine.

Provision of Naloxone

Maximise naloxone distribution through all channels, including on release from prison and through families, with the possibility of using third sector organisations and recovery communities.
Make allowance for other relevant organisations to hold or distribute naloxone during this pandemic, even if only for a specific timescale.
Request that all ‘first responders’ to drug overdoses (emergency services) are naloxone trained.

Prioritise outreach

Identifying those not in treatment, noting the increased harm this population already experience and the likely disruption to supply of drugs.
Initiate same day access to OST alongside provision of THN supply.
Maintain therapeutic support through phone and text, particularly for those receiving OST unsupervised and those in self-isolation. This can be done through the ‘NHSNearMe’ technology which the majority of GP practices now have installed.
Make additional resources available for local organisations to provide service users with the means to maintain communication, e.g. mobile phones with credit/data packages to ensure users can still receive a consistent level of support.
Support the use of volunteers for phoning PWUD as a daily point of contact – keeping people connected.
Support the use of volunteers for pharmacy deliveries for OST and injecting equipment provision (IEP)

Local formularies

This should be reviewed as a matter of urgency to ensure they contain the range of licensed, approved OST medicines (methadone, buprenorphine in its various forms, including injectable long-acting preparations) so that there is equity of provision and choice for patients and prescribers.

Drug Testing

Laboratory facilities e.g. for oral fluid testing and oral toxicology testing needs to be maintained to ensure treatment is optimal.

Homeless population who have substance problems

Accommodation and prioritisation of rough sleepers to enable safe social distancing measures and self-isolation amongst this population, accompanied by proactive testing for COVID-19 to allow appropriate measures to be put in place and ‘cohorting’ of accommodation to be considered.
Ensure a range of in-reach services including OST and THN supply in hostels and requisitioned sites such as hotels.

Prisoner Throughcare

Ensure adequate throughcare provision is available to prisoners on liberation including: access to GP (information about the ‘Access to Healthcare – GP Registration Cards’ for vulnerable people accessing GPs available here – Access to Healthcare) and continuity of OST provision.
Provision of naloxone for all prisoners with a history of substance use on liberation, and their families (exploring the distribution of intra-nasal naloxone might also be an option) is essential.

Public Health Surveillance

There is a need for public health surveillance and the need for real-time information and data should be prioritised. This includes information on the impact of COVID-19 on drug-related deaths, but also the impact on illicit drug supplies and levels of quality. This will better enable Health Boards, ADPs and service providers to provide a suitable response.