Transcript Commissioning guide - National Treatment Agency for Substance

COMMISSIONING TREATMENT
FOR DEPENDENCE ON
PRESCRIBED AND OVER THECOUNTER MEDICINES
Steve Taylor
Addiction to medicines:
commissioning services after the
health reforms
28 February 2013
Some parameters
 Commissioners
 Brief
 Advisory
Contents of the guide
 What’s the issue?
 What medicines and who is using them?
 Understanding local need
 Prisons and secure environments
 Responding to need
 References and further reading
 Appendices:
 Some medicines liable to misuse and dependence
 Needs assessment checklist
 What’s right? What’s wrong? What’s missing
What’s the issue
 2010 drug strategy: “dependence on all drugs, including
prescription and over-the-counter medicines”
 Local responses to drug misuse and dependence are expected
to include those needed to respond to dependence and other
problems with medicines
 JSNA support pack for commissioners:
 “Are innovative responses in place or being developed to prevent,
identify and treat evidenced and emerging need in relation to addiction
to prescribed and over-the-counter medicines?”
 And suggests that prescription and over-the-counter medicines
are included in wider considerations of:
 Waiting times
 The treatment system’s ability to respond rapidly and effectively to
changing patterns of substance misuse.
What medicines and who is using them?
 What medicines?
 Benzodiazepines and z-drugs
 Opioid and some other pain medicines
 Stimulants
 Other over-the-counter medicines.
 Populations using them:
 as a supplement or alternative to illicit drugs, or as a
commodity to sell
 to cope with symptoms
 inadvertently dependent: involuntary or iatrogenic
 Anything missing?
Understanding local need 1 – data sources
 NHS prescription data
 JSNA support pack for strategic partners
 NDTMS quarterly (or Green) reports
 Other local sources: ATM and primary-care services
 Any others?
Understanding local need 2 – other information
 Controlled drugs accountable officers
 Not New Medicine Service and Medicines Use Reviews
 What else?
Secure environments
 Similar medicines and reasons for use
 May be more insomnia, anxiety and pain
 Misuse or currency
 Limited access to over-the-counter medicines
 Existing and new guidance
 Other issues? Other environments?
Responding to local need 1 – who and where?
 Primary care first port of call
 Specialist responses to:
 support and advise GPs
 provide responses to patients who cannot be treated in
primary care.
 Specialist services need to reflect:
 knowledge and expertise needed to treat patients
 where and when services are best provided
 Dedicated or integrated or both?
 Any other issues?
Responding to local need 2 – how?
 Primary care practices as part of regular patient care (NHS
CB-commissioned
 More specialised responses:
 commissioned as part of drug and alcohol treatment
 enhanced primary care?
 provider of integrated drug and alcohol services
 dedicated, voluntary sector ATM group/service
 Sources of support for voluntary sector responses
 Any other issues?
References and appendices
 References and further reading
 Medicines liable to misuse and dependence
 Needs assessment checklist
 Anything else?