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

Standard 1 Same Day Access

All people accessing services have the option to start MAT from the same day of presentation.

This means that instead of waiting for days, weeks or months to get on a medication like methadone or buprenorphine, a person with opioid dependence can have the choice to begin medication on the day they ask for help.

Rationale

The Drug Misuse and Dependence: UK Guidelines on Clinical Management (2017) (Orange Guidelines) recommend that services should avoid unnecessary steps in the assessment process, particularly to reduce the risk of harm for people who need to stabilise on opioid substitution therapy. It is possible to make a diagnosis of dependence by establishing sufficient information for a prescribing decision to be made at the first appointment (2017; p37). Clinical information needed to start MAT should be obtained without adding delay as this places the person at risk of dropping out of treatment (2017; p94). Further evidence suggests that rapid access to MAT meets the needs of highly vulnerable groups, such as people experiencing homelessness, and that it reduces heroin use, HIV and hepatitis C virus (HCV) risk, injection-related and all-cause mortality and criminal charges.

Criteria

Each NHS Board should:

1.1 have a written standard operating procedure that offers 'no barrier' access to MAT;

1.2 have prescribing clinical guidelines that enable practitioners, including non-medical prescribers, to safely initiate same day prescribing as clinically appropriate;

1.3 provide practitioners that are competent to confirm dependence and to safely initiate same day prescribing. Practitioners should be available in accessible community locations, prison and custody suites for a minimum of five days a week;

1.4 have policies stating that MAT is not contingent on uptake of other interventions or abstinence from other drugs.

Each ADP, HSCP and NHS Board should:

1.5 have documented pathways that offer people a range of referral options for MAT including self-referral and drop-in services. Pathways should ensure the offer of person centred care that has been developed with the person in partnership with the multiagency team, and their family member or nominated person(s) where applicable;

1.6 have documented evidence through care planning and scheduled reviews demonstrating that peoples' views have been sought, documented and acted on;

1.7 have a documented system in place that ensures people are informed of independent advocacy and that their family member or nominated person(s) can be included from the start in care planning;

1.8 have a process in place to periodically audit and review their services against relevant guidance and standards, including the MAT standards;

1.9 have clear governance in place to ensure that people, including their family member or nominated person(s), feel able to provide feedback, including complaints, on care planning and treatment, through informal or formal channels;

1.10 ensure that staff have regular supervision and training to remain competent to deliver MAT.