Opioid Substitution Therapy (OST) implicated deaths and prescribing: evidence review

4. Proposal for further work

The data presented in this paper outline some of the key trends in OST prescribing and the implications for drug-related deaths. It also outlines the complexities and challenges of understanding the impact of changes in prescribing practice. Public Health Scotland will take forward a further programme of work as more data becomes available to better understand and learn from the experiences of 2020. This work will comprise two elements: further research, and improving prescribing through the MAT Standards.

4.1 Further analysis

Work is already underway to further inform and evaluate changes in prescribing practice. Initial findings have been presented to the Drug Deaths Taskforce and with Alcohol and Drug Partnerships, and further consultation is being undertaken with prescribing leads to help identify further routes of enquiry. Key questions that warrant further exploration include: whether those who had an OST implicated death had prescriptions or obtained it illicitly; how regional variation in OST implicated deaths relates to changes in prescribing practice; and, importantly, whether changes in prescribing practice present learning opportunities.

PHS will design a programme of work that will include analysis of existing datasets as they become available, and exploration of the potential for data linkage to further examine these questions. Consideration will also be given to the potential for further qualitative data to understand the experience of service users. Pandemic related changes to prescribing and dispensing also occurred in England and a number of other international settings. PHS will review the available published and grey literature to identify relevant themes for consideration in the Scottish context.

4.2 Improving prescribing through the Medication Assisted Treatment Standards

PHS proposes to use the learning about changes to systems, process and practices to deliver outputs that support safe and effective prescribing within the wider context of the MAT Standards. In particular they further develop resources and systems which support the implementation of MAT Standards, and focus on methadone and buprenorphine prescribing in the context of a recovery-oriented system of care.

PHS intends to continue the co-production approach already adopted as part of the MAT Standards development work. This approach necessitates the participation of key stakeholders, building on the learning generated as part of the implementation of the MAT Standards one to five, as well as the additional actions described in 4.1.^[27] The intended objectives of this further work are to:

I. Co-produce a definition of the key dimensions of quality prescribing in a recovery oriented system of care;

II. Develop an indicator set that can be used at a local level or at a national level to assess prescribing quality;

III. Influence changes in the system, processes and protocols that support quality prescribing within the context of a recovery oriented system of care.