FDS Insight Magazine Nov - Dec 2022

42 N EWS FROM O VERSEAS United Kingdom M ANY HOSPITAL POLICIES CREATE BARRIERS TO GOOD MANAGEMENT OF OPIOID WITHDRAWAL People who are dependent on opioids (such as heroin) should be prescribed substitutes (methadone or buprenorphine) when they are in hospital. This treatment helps prevent withdrawal symptoms (including sweating, muscle spasms and agitation). A review found that many hospital policies delay access to substitute opioids. A lack of access to these substitutes may increase the risk of people discharging themselves early to obtain opioids in the community. This in turn may lead to worse illness and increased risk of death, the researchers say. This study looked at NHS hospital policies on the management of opioid withdrawal. It found wide variation in policies but many created delays in access to substitute opioids. For example, some policies required lab tests to demonstrate recent use (which could take many hours) or input from specialist drug teams before prescribing. Some lacked clear guidance for doctors on how to start prescribing opioid substitutes or how to continue community prescriptions. The study also looked at the UK’s Omitted and Delayed Medicines Tool, which informs hospitals’ lists of critical medicines. The tool did not consider opioid substitutes to be high risk if delayed or omitted, which was amended. The tool has since been withdrawn. Building on this review, new policies to overcome barriers to the provision of opioid substitutes will be trialled at University College London Hospital from November 2022. What’s the issue? In 2016/17, more than 250,000 people in the UK were estimated to have used heroin or other illegal opioids. People who are dependent may receive substitute opioids from GPs or community drug treatment services. This treatment prevents withdrawal symptoms and can reduce people’s reliance on street opioids. When people who use opioids go into hospital, national guidelines recommend that substitute opioids are started or continued to prevent withdrawal and allow people to receive treatment. A lack of substitute treatment, fear of withdrawal symptoms or the negative attitudes of healthcare professionals may prompt patients to discharge themselves early, against medical advice. Early discharge