Giving Up the Guidelines: A Qualitative Evaluation of Disrupted Prescribing of Opioid Substitution Therapy in a Rural UK County During and Following the COVID-19 Pandemic

Tim Lewington (), Deanne Burch and Georges Petitjean
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Tim Lewington: Research & Innovation Department, Midlands Partnership University NHS Foundation Trust, St. George’s Hospital, Stafford ST16 3AG, UK
Deanne Burch: Inclusion, Midlands Partnership University NHS Foundation Trust, St. George’s Hospital, Stafford ST16 3AG, UK
Georges Petitjean: Inclusion, Midlands Partnership University NHS Foundation Trust, St. George’s Hospital, Stafford ST16 3AG, UK

IJERPH, 2024, vol. 21, issue 12, 1-17

Abstract: The COVID-19 pandemic had wide impacts and repercussions for the NHS in the UK beyond the acute medical sector. This qualitative study evaluates the experience of medical (4) and non-medical prescribers (7) plus other staff (2 recovery workers; 2 community pharmacists) involved in opioid substitution therapy (OST) in a southern English county during and following the COVID-19 pandemic. Remote contact and a shift to predominantly weekly OST pick-up were anxiety-producing for clinicians, especially during the first lockdown. Widespread negative consequences were anticipated, such as a rise in fatal overdoses, which largely failed to materialise. Some diversion of medication was noted as were negative mental health consequences of enforced social isolation. Following a hiatus, psychosocial therapies transitioned to fully digital and subsequently hybrid delivery before returning to in-person group work towards the close of the pandemic. Changing power dynamics between clinicians and those accessing OST services were reported particularly around the re-introduction of daily supervised consumption and associated surveillance. Implications for future OST service delivery and national clinical guidance are suggested by way of conclusions.

Keywords: qualitative; medical and non-medical prescribing; opioid substitution therapy; daily supervised consumption; COVID-19 pandemic; psychosocial therapy; telemedicine (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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