The UK government has updated its COVID-19 guidance to commissioners and addiction treatment services. Managing change is central to addiction treatment, so the sector knows (more than most) how difficult change can be.
The update relates to England, with different guidance available for Scotland, Wales and Northern Ireland.
The guidance summarises what to do now that lock-down is beginning to ease. People who use drugs are vulnerable to catching, transmitting, and becoming unwell from COVID-19. In the past year, treatment services have balanced protecting vulnerable people from COVID-19 whilst providing as much support as possible. As lock-down measures lift, this balance will change. Services will be able to offer more contact and increased services, but this must still be balanced against the risks of COVID-19.
Time to review, and increase, provision
First, the guidance says to review your plans. As the situation changes, review – and keep reviewing. The emphasis of any review, however, should be on how to re-introduce treatments that were previously scaled back. The guidance particularly cites reintroducing testing and treatment for blood borne viruses, detoxification services and supervised consumption.
The guidance also notes that services should re-introduce harm reduction measures where they have been reduced. This includes provision of vaping products and NRT to help people quit smoking as well as needle exchange services, naloxone provision, thiamine and advice on reduced drinking.
Face-to-face, telephone and digital contact
There are more balancing challenges. Face-to-face contact should still be kept to a minimum, but not at the cost of delivering services that have to be delivered in person. Such contact, however, should be avoided if it is ‘unsafe’ or ‘unnecessary’. If groups absolutely must be held in person, there is a 15-participant limit. People attending those groups must also comply with social distancing throughout. The guidance notes that this applies to official groups run by businesses, charities or public health bodies. Groups must not occur in private homes.
Telephone and online contact should be maintained where people do not plan to attend services in person. The guidance notes that online groups and counselling remain a good option for many.
Risk assess and review (again)
Much of the guidance relies on service managers assessing and balancing risks. There is a link to government guidance on carrying out risk assessments.
As with the rest of the population, staff and service users are advised to reduce the risks from COVID-19 by following national guidance. Everyone should wash their hands for 20 seconds on entry to a service. Sanitation gels should be available throughout. Surfaces washed. Hands, face, space, fresh air. You probably know this part fairly well by now.
Staff should be provided with PPE where appropriate. Services also need to keep a record of staff schedules for 21 days to help with test and trace services. COVID-19 symptomatic staff should be sent home.
Alongside the reviews and risk assessments, services are urged to make contingency plans for medicine supply problems, illicit drug supply interruptions, increased demand for services, poor health of vulnerable people, non-compliance with social distancing. The list goes on. This is still a complex and changing situation.
As service managers, organisations and commissioners work through these reviews, risk assessments and contingencies, the guidance concedes that regular monitoring requirements can continue to be scaled back allowing services to focus on delivery.
Prescribing
Another review – this time about prescribing arrangements. These will have changed in the past year according to staffing, pharmacist availability and other considerations. All these factors are likely to have changed recently or are likely to change in the near future.
The guidance outlines steps to ensure that medication is provided in a safe and manageable way. This includes assessing the feasibility of supervised consumption plans, considering a range of safe alternatives and offering take-home naloxone.
Safeguarding
All safeguarding considerations should be reviewed in light of potentially diminished, and changing support networks available to children, vulnerable adults and people who use drugs. Such assessments should be made with the safeguarding team.
The challenges to addiction services continue, and although there are opportunities to reduced lock-down measures, the continual changes can be challenging to services, staff and to people who use drugs. Even where those changes are generally positive ones. This guidance will go some way to helping services navigate these changes.
The full guidance can be found here.
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