Standard 2 Choice
All people are supported to make an informed choice on what medication to use for MAT and the appropriate dose.
People will decide which medication they would like to be prescribed and the most suitable dose options after a discussion with their worker about the effects and side-effects. People will be able to change their decision as circumstances change. There should also be a discussion about dispensing arrangements and this should be reviewed regularly.
The Orange Guidelines recommend 60-120mg of methadone or 12-16mg of sublingual buprenorphine as optimal therapeutic doses. The guidance recognises that maintenance on these doses can contribute to longer term recovery and abstinence from illicit opioids, and can maintain opioid tolerance which may in turn reduce the risk of overdose. However, more recent research suggests that prescribing needs to take account of a person's perception of dose efficacy. Trujols and colleagues (2019) have identified that a person's perception of dose adequacy is influenced not just by the pharmacological effects of MAT, but also by their satisfaction with the care they receive. In this study, especially important factors were respect for autonomy and choice, the skills, behaviours and attitudes of providers, as well as the impact of stigma. Person centred care-planning that focuses on personal goals, with services working in genuine partnership with people, will result in more effective care and a better experience for people using services.
Each NHS Board should:
2.1 have documented guidelines to ensure that methadone and long and short-acting buprenorphine formulations are equally available in local formularies and dispensing locations;
2.2 where applicable, have a home office license to allow injectable buprenorphine to be stored on NHS premises. NHS boards that do not have a Home Office licence should have standard operating procedures for named patient prescribing;
2.3 have prescribing guidelines available for each substitute prescribing option. These guidelines should take into account peoples' treatment goals, enable people to be aware of medication and dose options, and allow them to move from one medication to another.
Each ADP and HSCP and NHS Board should:
2.4 ensure that appropriate information is provided, in a written and/or verbal format, to enable people to make an informed choice;
2.5 have a documented system in place that ensures people are informed of independent advocacy services to empower them to access their rights and enable informed decision making;
2.6 have a process in place for regular review of a person's care plan. The frequency and format of reviews should be agreed between the person and provider;
2.7 have documented guidance that ensures family members or nominated person(s) can be included from the start in care planning for individuals who choose this form of support;
2.8 have clear governance in place to ensure that people, including family members or nominated person(s) feel able to provide feedback, including complaints, on care planning and treatment, through informal or formal channels;
2.9 have a process in place to periodically audit and review their services against relevant guidance and standards, including the MAT standards.
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