FDS Insight Magazine Nov - Dec 2022

44 Most policies required patients to display withdrawal symptoms (sweating, tremor) before substitute drugs could be given, and did not consider the psychological impact of withdrawal. 3. Continuing prescriptions after discharge National guidelines state that this group should be encouraged to start or continue with substitute opioids in the community. In line with this, most policies said community drug treatment services should be told when someone is discharged to allow them to continue treatment. However, some policies contained no information on how treatment could be continued. Take home doses were limited when patients were discharged on weekends or bank holidays; one policy explicitly stated patients would need to refer themselves if they wished to continue with substitute opioids. 4. Extra tests and input National guidelines state that urine tests to confirm recent drug use can be used but are not essential. However, many policies required these test results before substitute opioids could be prescribed, and local labs could take hours or sometimes days to give results (unlike rapid point of care tests). Some policies required input from specialist drug teams before substitute opioids could be prescribed. 5. Stigmatising attitudes Many policies were mistrustful of patients. A few advised clinicians watch people urinate to confirm they weren’t providing someone else’s urine for drug tests. Some policies said that people should not be allowed to leave the ward; one stated that people with a previous addiction may have ‘unreasonably high expectations’ of pain relief. Policies often used negative language such as ‘user’, ‘abuser’, or ‘addict’, and said that staff should have ‘a degree of suspicion’. A few policies required patients to sign a contract governing their behaviour when they were admitted; if broken, this could lead to their treatment being stopped. The study also looked at the Omitted and Delayed Medicines Tool. Unlike opioids for pain management, the tool did not consider substitute opioids (to prevent withdrawal) to be critical if delayed or omitted. Why is this important? This was the first comprehensive review of hospital policies in England on the management of opioid withdrawal. It found wide differences in policies in different areas of the country. No policy said people with lived experience had been involved in its development. Many policies created barriers to prompt provision of substitute opioids. When people are admitted at night or at weekends, many community drug treatment services can’t be contacted to