Medication Assisted Treatment (MAT) standards: access, choice, support

Introduction

Scotland has a high level of drug-related deaths. The annual figure for 2019 increased from the previous year by 6 % to 1,264 and this is the highest number recorded for the sixth year in a row. The Drug Deaths Taskforce was set up in September 2019 and prioritised the introduction of standards for Medication Assisted Treatment (MAT) to help reduce deaths, and other harms, and to promote recovery. The standards provide a framework to ensure that MAT is sufficiently safe, effective, acceptable, accessible and person centered to enable people to benefit from treatment for as long as they need.

There is good evidence that the health of individuals with opioid dependence is safeguarded while in substitution treatment. Evidence also indicates that it is important to consider medication choice and that optimum dose for an individual is critical to achieving positive outcomes. Evidence shows elevated mortality risks during the first four weeks of starting treatment and the first four weeks after leaving treatment. This demonstrates that these are critical intervention points to support people in MAT and to prevent drug-related deaths. A holistic approach, designed and tailored to the health and social needs of individuals, will improve the effectiveness of interventions, help increase motivation, prevent drop-out and improve the experience of people using services.

The most recent analysis of the circumstances of people who had a drug-related death in Scotland uses data from 2015/2016 and this shows that over half (52%) of the individuals who died lived in the 20% most deprived neighbourhoods in Scotland. These deaths are symptomatic of marginalisation and inequitable social conditions. This highlights the need to prioritise people most at risk and to offer intensive treatment and support to tackle this inequality. In 2018 NHS Information Services Scotland (now Public Health Scotland) estimated that in 2012/13, only 35% of people with problematic opioid or benzodiazepine use were in a structured treatment service.

The Scottish Government's drug and alcohol treatment strategy Rights, Respect & Recovery (RRR) was published in 2018 and sets out a clear policy to deliver evidence based interventions through a public health approach. In March 2021, the Minister for Drugs Policy made a commitment to the Scottish Parliament to ensure that the evidence-based MAT standards recommended by the Drug Deaths Task Force are 'fully embedded across the country by April 2022'. At the request of Ministers, a MAT programme of work has been set out to ensure the sustained scale up of implementation.

The standards are in line with the vision for NHS Scotland that by 2025 anyone providing health and social care will take a realistic medicine approach. This approach puts people at the center of decisions made about their care and how it is delivered. Implementation of the MAT standards is a rights-based approach and follows the principles of the Scottish Government Health & Social Care Standards: my support, my life, dignity and respect, compassion, inclusion and support to wellbeing.

The standards are evidence based. They were developed through extensive consultation with multiagency partners that deliver care, and, with the individuals, families and communities with experience of problematic drug use. Please see the interim report published March 2021 for full details.

The aim and scope of the standards

The MAT standards define what is needed for the consistent delivery of safe and accessible drug treatment and support in Scotland.

The standards apply to all services and organisations responsible for the delivery of care in a recovery orientated system.

The purpose of the standards is to improve access and retention in MAT, enable people to make an informed choice about care, include family members or nominated person(s) wherever appropriate, and to strengthen accountability and leadership so that the necessary governance and resource is in place to implement them effectively.

Format of the standards

Each standard comprises

• A statement with a plain English explanation of what this means.
• A rationale explaining why the standard is important.
• A list of criteria describing what needs to be in place to implement the standard.

Terminology

Wherever possible, we have incorporated generic terminology which can be applied across all settings. The term 'person' or 'people' is used to refer to the person experiencing MAT treatment and support. We have used the term 'provider' to refer to the relevant organisation, team or practitioner that is offering components of MAT. Where necessary, we refer to specific providers such as General Practitioners (GPs). The word 'service' refers to a particular team that is delivering MAT e.g. a city centre harm reduction team or a locality team within a Local Authority area.