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patients who were not homeless, but who are equally vulnerable. HRT provided an open access clinic for same-day prescribing of opioid substitution therapy OST. Together with EAP, 50 patients were engaged into opioid substitution therapy OST treatment during the pandemic through low threshold, same-day prescribing. The majority are still in treatment.
The HRT provided the hotels with specialist harm reduction nurses to deliver point-of-care testing for blood borne viruses, wound care, clean injection equipment provision and naloxone training and distribution. They also provided nurses for assertive outreach, emergency home visits, and Non-Fatal Overdose (NFOs) follow ups, finding high-risk patients and inviting them for treatment. HRT also conducted weekly Community Inclusion Health Huddles. This weekly huddle by teleconference was attended by assertive outreach staff, community police, public health representatives, prison representatives, EAP, hospital drug liaison nurses, community pharmacy, and many others. This initiative allowed those working across the city to come together and was a valuable source of co-ordinated support during the pandemic.
Virtual, online and telephone counselling were all provided by third sector agencies such as The Salvation Army, Simpson House, ELCA, Crew and many more. They also provided peer support with peer navigators, psychosocial online groups and online activity groups. To help patients access this, smart phones were distributed free of charge. Naloxone training and distribution were available for the first time from a non- clinical setting by The Salvation Army at Niddry Street.
The contribution of community pharmacy Community pharmacy played a vital role in the response to the pandemic for patients within substance misuse. What everyone quickly realised, is that community pharmacies really are the central core of substance misuse services. After all, it is the community pharmacists and their teams who see the patients on a face-to-face basis, often daily, for both welfare checks and medication dispensing provision.
Community pharmacies remained open during the pandemic and
ensured patients had access to medication throughout the pandemic. The substance misuse pharmacy service is traditionally reliant on regular contact, with many patients receiving daily dispensing services, often supervised, six days a week from their community pharmacy. Therefore, at the onset of the pandemic, in which we were all trying to reduce footfall and limit face to face contact to supress the virus, it was clear that community pharmacies and substance misuse teams would have to take significant steps to ensure that both themselves, their staff and their patients remained as safe as possible while continuing to deliver this essential service.
To do this, pharmacies worked closely with the Substance Misuse Prescribing teams, GPs, nurses, and third sector partners. It was partnership working at its best.
To supress the virus, a reduction in the frequency of pharmacy attendance coupled with a reduction in supervision services where possible, whilst keeping patients safe, was needed. Substance Misuse prescribers risk assessed each individual patient, and where possible reduced their frequency of pharmacy attendance and supervision. All of this was carried out very much on a case-by- case individual basis, taking into account the patients mental health and domestic situation, and was done in conjunction with the community pharmacies. To support patients who had reduced contact, prescribers and third sector partners such as Change Grow Live and the Salvation Army made virtual contact (telephone and zoom meetings) and door step visits to patients who were vulnerable. Naloxone was also made more widely available to patients. Supervision services that were still essential were made ‘contactless’ with guidance being issued to support this contactless supervision, such as medication cups being placed down at a distance with the patient then self- serving and self disposing into clinical waste bins.
One significant problem that we did face was when a significant number of patients had to shield or self isolate during COVID-19 - we were faced with the question of how to get their methadone to them. Many of these patients are homeless, or with reduced social structures, and
The whole experience has clearly shown the contribution that community pharmacy has made during this crisis. There was simply no one else to do the work. Community pharmacists were key to keeping substance misuse patients safe so I’d like to pay huge ‘kudos’ to community pharmacists
therefore often have no trusted friends or family to pick up their medication for them on their behalf. It was a significant challenge to get methadone to them on a large scale.
Community pharmacy didn’t have the capacity to deliver to every substance misuse patient, and neither did the prescribing teams, and so, in Edinburgh, we mobilised the ‘OST Delivery Service’, which was provided by the third sector Turning Point and Change Grow Live.
After picking up prescriptions from the pharmacy, experienced representatives from Turning Point and Change Grow Live would then drop off patients opiate substitute therapy – usually methadone – with clean needles, and kits of the life - saving overdose reversal drug naloxone to the patient’s door. Some visits were daily, especially in cases where an individual was deemed to be an overdose risk or in need of regular supervision, while others were delivered every few days in an attempt to ease pressure on services. This was not just a delivery service, quality patient interventions and safety checks were carried out on doorsteps with patients and many patients stated that they found this contact a lifeline. It also eased considerable pressure for the community pharmacies. All deliveries were conducted in line with COVID guidelines and with personal
protection equipment (PPE), social distancing and hygiene measures, and third sector teams received training prior to the service starting.
I have to say that this whole response across substance misuse services was such a massive team effort. It was incredible. This was such a fabulous new partnership and showed a way of collaborative working that had never really been done before. There is no doubt that this very integrated, multi-layered approach across all services proved to be successful- patients were kept safe and essential services continued to be delivered. As we move forward to test, trace, isolate, – there may be more people affected and so the third sector will be vitally important.
The whole experience has clearly shown the contribution that community pharmacy has made during this crisis. There was simply no one else to do the work. Community pharmacists were key to keeping substance misuse patients safe so I’d like to pay huge ‘kudos’ to community pharmacists – not only in Lothian, but across Scotland, where similar responses where mounted. They kept their doors open and managed the change and the general situation brilliantly. Their continuity of service certainly helped to keep their communities in general and their substance misuse patients in particular, safe. We are all indebted to them.
SCOTTISH PHARMACIST - 11
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