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

Standard 3 Assertive Outreach and Anticipatory Care

All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT.

If a person is thought to be at high risk because of their drug use, then workers from substance use services will contact the person and offer support including MAT.

Rationale

Severe drug-related health harms include premature death and significant physical or mental health conditions. The type of substance used, the route of administration (such as injection) and the health of the person all have an impact on the risk of overdose and drug-related death. The combination of heroin, or other opioids, with depressants such as alcohol or benzodiazepines, contribute to particularly increased risks. In the case of people who use opioids, disruption or discontinuity of care and treatment increases the risk of harm. In certain situations, such as following detoxification, release from custody or discharge from treatment drug-free (planned and unplanned), tolerance to opioids is greatly reduced and as a result people are at increased risk of overdosing if they resume use. The risk of experiencing drug-related health harms is compounded by the presence of social and financial risk factors. The objective of this standard is to proactively identify people who are at high risk of severe drug-related harm, and to prevent the harms by rapidly providing that individual with support for engagement or re-engagement with holistic care including MAT.

Criteria

3.1 Each service within the drug treatment system should have a documented procedure to identify and follow-up people at high risk of severe drug-related harm, including death. This includes those who may have left residential, justice and inpatient settings, as well as those who have stopped attending treatment services and people who have just experienced a near-fatal overdose. The multiagency response should:

a) include at a minimum the SAS, emergency departments, primary care, public health, community pharmacy, secondary care (acute and psychiatric inpatient services), housing providers, Police Scotland and specialist drug, alcohol and mental health services;

b) ensure that engagement with a person is timely, respectful, age-appropriate and recognises the persons needs and choices;

c) take place within 24 hours (maximum 72 hours) of notification. Contact should take place in community settings, this could include at the persons own home, to maximise accessibility and address barriers presented by stigma;

d) include a comprehensive assessment of risk based on the available information and including the person and their family member or nominated person(s). Care provided should be tailored to the individual, documented and actioned as appropriate. Action may include rapid initiation of MAT where appropriate.

3.2 All service providers should have clear information governance structures in place to facilitate the timely sharing of information about people at high-risk, with partners who can take responsibility for follow-up. Governance must ensure that:

a) information sharing is compliant with relevant legislation and reflects Caldicott principles;

b) where people enter the pathway as a result of opt-out consent arrangements the information sharing agreements have the necessary detail to accommodate this. Requirements include the provision of information to the person on how their personal information is being used, triage of the appropriateness of entry into the pathway and provision of a means by which a person can opt-out of the pathway.

3.3 Service providers within the local partnership should have trained practitioners that are competent to carry out effective assertive outreach work in line with the requirements set out above.

3.4 All service providers should have a documented process in place to enable staff to access appropriate and timely expertise for child protection or adult protection.