Treatment for drug addiction: how do patients in rural areas cope in lockdown?

There are encouraging signs that people in treatment for drug addiction can manage their medication when they are entrusted with a substantial quantity of opiate substitutes and told to take it in small daily doses. This finding comes from an ‘early insight’ report from the University of Bath.

Before Covid-19, it was the norm for a patient to be dispensed a daily dose of opiate substitutes such as methadone, and this was often taken under the supervision of a pharmacist. However, treatment protocols have been turned on their head during the pandemic, with the majority of patients taking home with enough medication to last a week or two. This change was introduced to minimise contact between patients and pharmacists, and to keep people safely at home.

The research team, which is being led by Dr Jenny Scott from the Department of Pharmacy and Pharmacology, set out to explore the impact of these new prescribing habits on people living in rural South West England. Through telephone interviews, participants share their experiences of drug use and services during the pandemic. This research is a collaboration between Bath, the University of Bristol and Turning Point.

Dr Scott said:

“There was a big concern when people in drug treatment were first given quantities of supplies to cover up to two weeks. Drug-related deaths are higher than they’ve ever been (In 2019, 2,160 drug poisoning deaths in the UK involved opiates) and no one knew whether people would manage to take their take-home treatment as prescribed.

“Everyone we interviewed so far has been grateful for the take-away regime and they’ve all managed well. Some have changed the time of day when they take their medication, others have split the dose to suit themselves. All have reported managing to cope and not taking more than the prescribed dose.”

Even before the disruption of Covid-19, researchers were keen to discover how people in drug treatment might respond to the interval being stretched between opiate substitutes prescriptions, however the stakes were too high for this idea to be investigated.

Dr Scott added:

“There was a belief that tightly controlling opiate substitutes reduced overdosing, but though there was little evidence to support this, it would have been totally unethical to experiment in a controlled way. Then wholesale overnight we had to switch to a new practice because of the pandemic.”

To date, six people have been interviewed for the Bath study. Dr Scott is planning to recruit a further 24 before the study ends in March. Those interviewed to date say less frequent trips to the pharmacy have brought cost-saving benefits, with less being spent on transport.

Fewer visits has also helped patients avoid some of the stigmatisation associated with drug addiction.

The NHS would also stand to benefit from more patients managing their own medication for a week or two at a time, allowing pharmacists to focus their supervision on those who are most vulnerable and in need of intensive support.

However, Dr Scott is quick to point out the downsides of patients making less frequent visits to their local pharmacy:

“Some people – for instance, those with unstable use of multiple substances – might be at higher risk of overdosing if they are given a lot of take-away medication,” she said. “Long term, it would be great to pinpoint people and situations that need strict controls over their dispensing regimes and identify those that don’t, so they can be given more freedom.”

Loneliness was another problem for patients interviewed for the study:

“The pandemic means drug-treatment services have gone largely to telephone appointments, and though most people seemed reasonably happy with this and welcomed not having to spend on travel – which is difficult in rural areas – some have felt isolated and lonely, and their mental health has suffered.

“So we need to think holistically about the services that are offered, bearing in mind that isolation and related mental-health issues are all risk factors for addiction.”

The project What C-OST? The Impact of the Covid-19 pandemic on people who receive opioid substitution therapy is supported by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West)and NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol. The group’s interim report (PDF) is published this week.

Dr Joanne Kesten, Senior Research Associate at NIHR ARC West and HPRU BSE, said:

“It is great to collaborate with Dr Jenny Scott at the University of Bath on this project. I’ve done a lot of work with people who inject drugs in the Bristol area, so it was important that we extended our research to the rural community who often get overlooked. I am pleased that so far we found that largely the changes to prescribing were well received by this community. This is much needed evidence to understand how best to support people receiving opiate substitutes now and in the future.”

Dr Scott is also collaborating on a second study relating to drug use during Covid-19. For the Lucid-B project, researchers are examining data on drug-related deaths during Covid to see how this relates to frequency of collection of medications. This research is being led by the University of Bristol.