Our case studies show examples of when the MAT standards have been implemented. They are from work from across drug and alcohol services, pharmacies and the third sector.
Reducing harm in communities, Take Home Naloxone
Situation
The Changing Lives Report in 2022 recommended that all community pharmacies within Scotland should be able to supply Take Home Naloxone (THN) which reverses the effects of opioid overdose to the following groups of people:
- People who use opioid drugs like morphine or heroin,
- Families of people who use opioid drugs,
- Anyone likely to witness an opioid overdose.
- This is to help reduce drug deaths and associated harms across Scotland.
Community pharmacies are an essential community-based resource. As discussed in the HIS MAT Standards Pharmacy impact report, they are a key point of access and engagement for individuals who also access drug and alcohol treatment. To support the availability and accessibility of take home naloxone, pharmacy staff should receive training in:
- Overdose awareness,
- Provision of THN.
From 30 October 2023, the Scottish Government and Community Pharmacy Scotland agreed to implement emergency access to supplies of naloxone across Scotland. This was a first step in the aim to have emergency holding and supply of take home naloxone in all community pharmacies.
Challenges faced in relation to the supply of take home naloxone across community pharmacies in Scotland include:
- Gaining appropriate funding,
- Engagement from pharmacy contractors and their staff,
- Finding time and capacity to train staff,
- Implementing an operational IT system to process claims.
This meant NHS Fife saw low levels of uptake of the take home naloxone programme. NHS Fife therefore deployed a senior pharmacy technician for substance use and other pharmacy staff to improve uptake of take home naloxone. Their aim was to:
- Ensure all pharmacies have Naloxone available for emergency use
- Ensure staff are proficient in the use of naloxone
- Increase the number of pharmacies that were able to supply take home naloxone.
These roles were funded by the Fife Alcohol and Drug Partnership.
Approach
They identified a key first step to improve engagement. This was undertaken in two phases:
- Phase one: Hosting an online seminar for pharmacy teams
- Phase two: Unannounced drop-in visits to the pharmacies to discuss the benefits and process of the take home naloxone programme.
The unannounced visits had the greatest impact and immediately led to an increase in registrations.
oxone, the senior technician emailed pharmacies monthly. Giving details of activity for that month, figures for what pharmacies were most active, as well as any upcoming milestones.
Impact
Increase in active participation in the programme since changes to increase engagement were introduced in March 2024. In total NHS Fife have trained 300 staff members across 50 community pharmacies and statutory addiction services. This has meant that from April to October 2024, community pharmacies have distributed over 167 naloxone kits within Fife. Compared to 54 kits for the whole of the previous year.
Within community pharmacies that have received training, as of November 2024 there have been three recorded instances of staff intervening in overdose occurrences within the vicinity of the pharmacy.
Next Steps
The success in engagement and availability of take home naloxone supports the community-based responses in reducing harm. To maximise the impact that this has, there is an opportunity to expand the training and provision of naloxone for emergency response into GP practices and other community-based health services.
Lastly, there is a need to ensure sustainable funding for this programme and wider harm reduction to help reduce Fife’s drug related deaths and in the long run, the aim should be to ensure take-home naloxone is available from as many locations as possible across Scotland.
Buchanhaven Pharmacy
Situation
This case study describes how Buchanhaven’s team of pharmacy staff have developed a holistic package of services to ensure that people who use substances are provided with accessible services focused on their needs. They aim to take a stigma-free approach to offer people effective, accessible, and person-centred care for as long as they need.
Buchanhaven is located on the edge of Peterhead. This is the largest town in Aberdeenshire with a population of approximately 19,000 people. The population they serve consists of a wide demographic. Ranging from the most affluent to the most deprived socio-economic backgrounds.
The pharmacy acts as a one-stop place for:
- Prescribing,
- Signposting and onward referrals,
- Administration,
- Supply of treatment for substance use and other health conditions.
Background
When Buchanhaven Pharmacy was first purchased by its current owners 18 years ago, they supported only four people seeking medication assisted treatment services. During the COVID-19 pandemic they were managing up to 100 opioid agonist prescription collections. They currently have approximately 40 people actively accessing services including:
- Substance use prescribing clinic,
- Injecting equipment provision,
- Wound and skin infection management,
- Administration of long-acting injectable Buprenorphine and take-home Naloxone.
Patients also have access to Pharmacy First services for managing common ailments.
Approach
Staff Training
The pharmacy has regular monthly training sessions on current topics, including:
- Supply of take home naloxone,
- Emergency use of Naloxone to reverse overdose,
- Motivational interviewing,
- Needle exchange.
Culture
All pharmacy staff deliver services in a way that avoids stigma. They are respectful of people’s right to confidentiality.
The pharmacy prides itself on treating all patients, regardless of their reasons for visiting the pharmacy, with the highest standard of care.
Environment
The pharmacy has two entrances, providing a choice of access. Patients can use either the main entrance or a secure side door.
People who use substances prefer to use the side entrance as they benefit from a more discreet way of accessing services.
Impact
Within the pharmacy, staff treat all patients consistently with dignity and respect. This creates a welcoming environment, resulting in most substance-use clients in the area using their services. This respect is mutual and helps to build a strong therapeutic relationship between staff and patients. It also helps to get and retain substance use patients in treatment. Evidence presented in the Scottish Drugs Death Taskforce’s Changing Lives report shows this is the safest approach in terms of reducing drug-related harms.
Local Tips
- Involve the whole team in delivering services and planning training by getting suggestions from all staff members,
- Get feedback from all sources including pharmacy staff, and other health and social care staff,
- Take the time to ask your patients ‘What matters to you?’
- Do not underestimate the impact of social issues, such as financial stressors.
Get in touch
Please send us an email at his.alcoholanddrugs@nhs.scot if you:
- have a question about our programme or resources
- would like to speak to a member of our team about our work