Coronavirus guidance issued for providers and commissioners

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New guidance for commissioners and treatment providers during the COVID-19 outbreak has been issued by Public Health England (PHE) and the Department for Health and Social Care (DHDC).

While services don’t need to close they should be taking steps to ‘keep face-to-face contacts between staff and service users to a minimum’ and minimising use of biological drug testing, it says. 

naloxone kit
Provision of harm reduction measures and take-home naloxone, should be increased where possible

Given the pressure the on NHS and other services it will ‘mostly be necessary to defer drug detoxes, especially inpatient’, the guidance states, as well as scaling back testing for hep C. Provision of harm reduction measures such as NSP and take-home naloxone, however, should be increased where possible, while arrangements for prescribing and dispensing will need to change to take account of social distancing, pharmacy closures and staff unavailability. 

Providers, commissioners and pharmacies should be as ‘flexible as possible, within the legal framework, to support the safe delivery of OST’, it states. Services should be transferring ‘most, if not all’ patients from supervised consumption to take-home doses, and providing them with up to two weeks’ worth of take-home supply where possible. Anyone advised to self-isolate asked to nominate someone to collect medicines on their behalf. 

Services should also be increasing the amount of stock held by NSPs, allowing people to take more equipment or ‘providing packs with more equipment in them’, it says, as well as increasing outreach and peer-to-peer supply ‘with appropriate social distancing’. The ‘usual expectations’ on services for monitoring, reporting, performance management and contract re-tendering, meanwhile, should be scaled back to focus on delivery.

Service users should be told not to turn up without an appointment, and staff should contact them before their appointments to check if they’ve developed symptoms. Providers should also liaise with local hospitals to ‘ensure they are aware the symptoms of COVID-19 may be confused with withdrawal symptoms in a dependent drug or alcohol user’, the guidance adds. ‘It is important that anyone taken to hospital and showing symptoms that could be either alcohol or drug withdrawal or COVID-19 is managed as if they have COVID-19, unless and until the results of testing show otherwise.’

New ways of working during the outbreak, such as contacting service users by phone or video call, may also ‘bring to light new information about a service user’s home life’, it says. ‘If staff discover a service user is living with children, or see that a service user with children is now struggling to cope, they should consider whether the family would benefit from further support from their local Early Help service, community food banks and other resources.’ Staff should also be monitoring safeguarding issues, and note that referrals to children’s social care services may be appropriate in cases where children are having to take on ‘inappropriate caring roles’. 

Providers should also be monitoring reports of adulterated or unusually strong drugs or any unexpected effects, the document stresses. ‘If usual drug supply routes are affected, there is a risk that alternative substances will be sourced and sold. Cases should be reported to drug.alerts@phe.gov.uk.’

COVID-19: guidance for commissioners and providers of services for people who use drugs or alcohol at www.gov.uk