Substance use - treatment target: letter from Minister for Drugs Policy

Annex B

Opioid Substitute Therapy Treatment Service Capacity Target Information Pack

Background

In January 2021 the First Minister announced a new national mission to reduce drug-related deaths and harms. A key part of this mission is to increase the number of people who are in treatment for harmful drug use.

Evidence tells us that opioid substitution therapy (OST) is a protective factor against drug-related deaths and harms^[1]. There is also evidence to suggest that too many people at risk of a drug-related death are not accessing the treatment they need. For example in 2016only 55% of individuals who died from a drug-related death were in contact with drug treatment services in the six months prior to death^[2]. Our most recent prevalence estimates suggest there are around 57,000 peoplewith problem drug use in Scotland and our treatment baseline work suggests only around 29,500 are in community-based OST treatment.

Ensuring that everyone who uses drugs can get treatment when they need it is central to the implementation of the MAT standards. The standards reinforce a rights based approach for people who use drugs and the treatment they should expect, regardless of their circumstances or where they are.

This target aims to increase the number of people in protective OST treatment and reduce the number of people who experience drug-related harms and death.

The National Target

By 2024 there will be at least 32,000 people in community based OST treatment in Scotland. This target is based on analysis of prescribing data conducted by Public Health Scotland which estimates that an average of around 29,500 people in Scotland were in community based OST treatment during the 2020/21 financial year. The target equates to an increase of approximately 2,500 (9%) in the number of individuals in OST treatment.

Further detail on how the baseline number of individuals in the community who are prescribed OST has been calculated can be found in the 'Treatment For Drug Misuse' area of the SCotPHO website: https://www.scotpho.org.uk/behaviour/drugs/data/treatment-for-drug-misuse

We will expand and stretch the target to include all people with problem drug and alcohol use from 2024.

Local Targets

This target will be applied equitably across all Integration Authority areas in Scotland. The national target represents an increase in the number of individuals on OST of around 9% and this flat percentage increase has been applied across all Integration Authorities in Scotland. It is recognised that the target will present different challenges, and require different approaches, in different areas. Rural and remote areas, for example, may face challenges in terms of geographic exclusion and service delivery while more populous urban areas will naturally face a higher challenge in numerical terms.

People in Prison

People in prison prescribed OST are not in the scope of the target for 2024. A needs assessment of prisons is currently being progressed and the report is due for publication in Spring 2022. Alongside this further work is needed to carry out data linkage to follow people through prison and consideration will be given to expanding the target to cover people in OST treatment in prisons from 2024 at the latest.

How will the National and Local Targets be measured?

The target will be measured using management information from the Prescribing Information System (PIS). The baseline for the target has been established using the estimated minimum number of people prescribed OST in Scotland during in the financial year 2020/21. This data covers all individuals prescribed OST whether within specialist drug treatment settings or within primary care. The figures are based on the number of unique Community Health Index (CHI) numbers captured from named community prescriptions for relevant medications at any time in a financial year. As data is sourced directly from the Prescribing Information System there is no requirement for treatment services to collect additional information to measure progress against this target.

Although in some areas CHI capture remains below the agreed threshold of reliability for individual-level analysis (usually only reported when CHI completeness is above 85-90%), due to the public interest in OST prescribing, these statistics are published as management information. IJBs will need to work with NHS Board prescribing leads to ensure the quality of prescribing data reflects the numbers of people prescribed OST in Scotland. .

Further detail can be found in the treatment for drug misuse area of the ScotPHO website: https://www.scotpho.org.uk/behaviour/drugs/data/treatment-for-drug-misuse

What are the reporting arrangements?

Allowing time for data extraction, quality assurance, analysis and consultation, production time for each report will be approximately four to five months. The OST patient estimates from the Prescribing Information System will be updated to include figures for financial year 2021/22 in August 2022 and annually thereafter.

Performance against this target will be published by PHS in line with the following timetable:

2022/2023	Report
Quarter 1 (April - June)	September 2022
Quarter 2 (July - September)	December 2022
Quarter 3 (October - December)	March 2023
Quarter 4 (January - March)	June 2023

All reports are based on paid prescription data from the Prescribing Information System. Data extracts are generated three months after the end of the relevant time period. This reflects the length of time taken to process requests for the reimbursement of community prescriptions.

Due to their experimental nature these data will initially be released as management information to stakeholders including IAs, ADPs, Health Boards and Scottish Government. The production time for this information will be approximately four months. Therefore, information for 2022/23 Quarter 1 is expected to be available in September 2022.

Quality assurance arrangements

Prior to each of these publications, PHS will consult with NHS Board prescribing leads, providing early access for quality assurance in relation to data sourced from the Prescribing Information System and enabling PHS to gather and validate their patient count data.

Balancing indicators

While the proposed target relates to increasing the number in treatment, feedback from the consultation process highlighted the need for the target to be contextualised within broader indictors which will reflect quality alongside the quantity focus of the target.

Themes

The purpose of these indicators is to provide top level indications of how treatment is being delivered and provide a balance with the focus on quantity of the target. Therefore it is naturally broad-brush and will focus on one or two indicators against four key themes.

The key themes which have been identified as necessary to contextualise the target are

• Access
• Retention
• Availability of Services
• Treatment Completeness

These indicators are top level and will complement rather than replace more detailed indicators being developed to assist with strategic planning of services and reporting against the MAT standards.

It is also intended that these indicators will complement each other, so while there may be potential to show progress against any one indicator this may be offset by other indicators to demonstrate the broader impact on the system. For example the measure of new entrants into treatment for the access indicator is complemented by the retention indicator to identify whether multiple discharges or cycling in and out of treatment are underlying issues.

Buvidal

Baseline data used to develop the target relies on individual patient CHI numbers to provide a patient count. It is recognised that some long-acting buprenorphine treatments administered in community settings are prescribed via hospital stock order prescribing systems and do not include patient details. It is estimated that there may be a small number of cases where a person on OST may be omitted from the OST patient estimate figures used for the target baseline because the only relevant medication the individual received in a specific financial year was long-acting buprenorphine dispensed via this mechanism. PHS are aiming to publish information on the numbers of people prescribed long-acting buprenorphine later in 2022 and this will be incorporated into the monitoring and reporting of progress towards meeting the treatment target.

Further Information

Any queries should be directed to alcoholanddrugsupport@gov.scot