SERVICES
POWER TO THE PEOPLE?
I n early 2020 the global pandemic had a significant effect on the wider NHS but also community drug and alcohol treatment services, forcing services to rapidly change how they delivered care as well as prescribing practice( see table, p19). In community drug and alcohol treatment services the need to protect the public and staff by minimising contact during lockdowns meant the unprecedented rapid risk review of every person on opioid substitution treatment( OST), as well as reducing pharmacy collection frequency or supervision for the majority.
The outcome of this rapid change in prescribing practice, and the inability for prescribers to have OST supervision as a safety net, was increased anxiety – namely the very real concern
We need a long overdue exploration of power dynamics in community drug and alcohol treatment services, say Deanne Burch and Dr Georges Petitjean
that many people might overdose and the expectation of a large number of opioid-related deaths.
PRESCRIBING PRACTICE Prescribers rely on the Drug misuse and dependence: UK guidelines on clinical management(‘ orange guidelines’) for reassurance that their prescribing practice follows a consensus of safety and an evidence base. A part of this guidance relates to OST collection frequency and supervision by a pharmacist, which during the earlier period of the COVID-19 pandemic was required to be adapted by prescribers across the country.
Following the pandemic, Inclusion( part of Midlands Partnership University NHS Foundation Trust) conducted an evaluation study – 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 – to explore the period of time from the first national lockdown to post-pandemic. The study had one question in mind – what was it like being a prescriber in community drug and alcohol services during the pandemic?
Among the findings of this study was that prescribers were initially fearful of the impact of the prescribing changes but some later perceived benefits. All had concerns about the potential for increased overdoses or deaths, and many had fears around the legality of their own prescribing practice. While national data from methadone related deaths is available and
WHAT ARE POWER DYNAMICS?
Within an organisational context, power dynamics relate to how power is experienced or used by individuals or organisations. Power can be used to influence or hold authority over others but can also be distributed and negotiated, and might be fluid. Within community drug and alcohol services this can be seen as the relationship between the person accessing the service and the prescriber, or even the way the service itself is designed. Factors associated with distrust or stigma can also influence how power is exerted.
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18 • DRINK AND DRUGS NEWS • APRIL 2025 WWW. DRINKANDDRUGSNEWS. COM