FDS Insight Magazine Nov - Dec 2022

43 has been linked to readmission to hospital, overdose, and death. However, clinicians are often concerned about prescribing substitute opioids because they are unsure of the safe dose for individuals. National guidelines recommend that NHS trusts have local policies to ensure the timely prescription of substitute opioids in hospital. Before this study, there had been no comprehensive review of these policies. The national Omitted and Delayed Medicines Tool is used locally to create lists of critical medicines. Medicines are considered critical if people are in danger when the drug is not given on time (delayed) or at all (omitted). The lists determine which drugs are stocked by individual hospitals. This study examined whether policies in England delay or prevent the prescription of substitute opioids. It also examined how substitute drugs were classified in The Omitted and Delayed Medicines Tool. What’s new? The research team used the Freedom of Information Act to request local policies on the management of opioid withdrawal. They approached 135 trusts in England; most (86) provided relevant policies (101 in total). 1 in 3 trusts (33%) responded without a relevant policy (mostly because they had no policy in place). More than 1 in 4 (28%) policies were overdue a review. The researchers analysed the policies’ content and compared them with national guidelines. They described 5 common barriers to the provision of substitute drugs. 1. Continuing community prescriptions in hospital All hospital policies required confirmation of community prescriptions (in line with national guidelines) but few described how to do this other than by contacting community services, which might not be available on evenings and weekends. Only one policy included patient verification as an option; some explicitly stated that patients were not trustworthy. Some stated that no substitute opioids should be provided if verification was not possible; others suggested, regardless of confirmation, that substitute opioids could be started at a lower dose and gradually increased. 2. Starting new prescriptions in hospital Most hospital policies said people could be started on substitute opioids (in line with national guidelines), but some provided no practical details on how to do so; a few prohibited it. Some advised treating withdrawal symptoms with different drugs (such as anti- sickness medications).