Giving Up the Guidelines

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

Anxiety · Coronavirus disease 2019 (COVID-19 · Disease · Family medicine · Medical emergency · Mental health · Pandemic · Psychiatry · Psychosocial · Qualitative research · Social isolation · COVID-19 and Mental Health · Medicine · Migration, Health and Trauma · Nursing · Opioid Use Disorder Treatment

• Responding to the opioid crisis in North America and beyond

  Open Access•Keith Humphreys, Chelsea L Shover et al.•The Lancet•2022

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• Understanding and learning from rural drug service adaptations to opioid substitution therapy during the Covid-19 pandemic

  Open Access•Jenny Scott, Hannah Family et al.•Frontiers in Public Health•2023

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• Reorganization of Substance Use Treatment and Harm Reduction Services During the Covid-19 Pandemic

  Open Access•Seyed Ramin Radfar, Cornelis A J De Jong et al.•Frontiers in Psychiatry•2021

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• Should I Stay or Should I Go? A Qualitative Exploration of Stigma and Other Factors Influencing Opioid Agonist Treatment Journeys

  Open Access•Vicky Carlisle, Olivia M Maynard et al.•International Journal of…•2023

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• The impact of Covid-19 on access to harm reduction, substance use treatment and recovery services in Scotland

  Open Access•Joe Schofield, Joshua Dumbrell et al.•BMC Public Health•2022

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• Living Under Coronavirus and Injecting Drugs in Bristol (Lucid-B)

  Open Access•Joanna M Kesten, Adam Holland et al.•International Journal of Drug…•2021

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• A qualitative study exploring the impact of the Covid-19 pandemic on People Who Inject Drugs (PWID) and drug service provision in the UK

  Open Access•Tom May, Jo Dawes et al.•International Journal of Drug…•2022

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• Covid just kind of opened a can of whoop-ass”

  Open Access•Stephanie M N Glegg, Stephanie Glegg et al.•International Journal of Drug…•2022

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• Methadone and buprenorphine-related deaths among people prescribed and not prescribed Opioid Agonist Therapy during the Covid-19 pandemic in England

  Open Access•D Aldabergenov, Laura Reynolds et al.•International Journal of Drug…•2022

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• You'll come in and dose even in a global pandemic”

  Open Access•Anne Conway, Carla Treloar et al.•International Journal of Drug…•2023

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