Steve Taylor Addiction to medicines: commissioning services after the health reforms 28 February 2013 COMMISSIONING TREATMENT FOR DEPENDENCE ON PRESCRIBED AND OVER THE- COUNTER MEDICINES

Some parameters Commissioners Brief Advisory

Contents of the guide Whats 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 Whats right? Whats wrong? Whats missing

Whats 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 systems 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?