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

Standard 4 Harm Reduction

All people are offered evidence-based harm reduction at the point of MAT delivery.

While a person is in treatment and prescribed medication, they are still able to access harm reduction services – for example, needles and syringes, BBV testing, injecting risk assessments, wound care and naloxone.

They would be able to receive these from a range of providers including their treatment service, and this would not affect their treatment or prescription.

Rationale

The Orange Guidelines recommend that regular appointments during MAT titration should provide opportunistic harm reduction assessment to maximise engagement in potentially life-saving interventions (p38). These include blood borne virus diagnosis and referral, injecting equipment provision, overdose and naloxone training, wound care and assessment of risks associated with injection and poly pharmacy. It is understood that patients may decide to continue to use illicit drugs (e.g. crack cocaine, benzodiazepines or heroin) whilst in treatment and everybody accessing a substance use service should be seen as at potentially high risk of harm from injecting or other non-prescription drug use. There are benefits of MAT (e.g. opportunities to participate in psychosocial interventions, general medical care, hepatitis B, C and HIV treatment, welfare benefits, housing and peer support) that accrue over time and which may be of greater importance to the patient than the cessation of illicit drugs.

Criteria

All service providers should:

4.1 have in place a process for assessing injecting-related risk and other associated drug related harms alongside the delivery of MAT, with staff being able to offer full harm reduction advice at every relevant opportunity, including advice on the type of drugs being used and any related topics;

4.2 have a procedure in place to offer hepatitis and HIV testing and hepatitis B and tetanus, flu and covid19 vaccination, using an opt-out approach with regular follow-up as per local protocols;

4.3 have an opt-out approach to the distribution of naloxone with all staff having a supply of naloxone for use in an emergency;

4.4 have staff members trained in assessing injection related wounds and complications. Wounds should be treated onsite wherever possible or referred to a specialist service for treatment;

4.5 have staff members trained in the provision of injecting equipment and this should be offered to all. This should not impact on treatment provision;

4. 6 have a process in place to be considerate of gender-sensitive injecting assessments or general discussions with clients;

4.7 information sharing protocols are in place to allow for shared record keeping between the multiagency team providing care including social care, housing, community pharmacy, GPs, Police Scotland, SAS, primary and secondary care and third sector providers.