When we discuss the barriers to accessing OST medications , most often it ’ s the barriers of making it to the clinic , through the clinic ’ s hoops , or the pharmacy . Money , transit , and the stigma associated with walking through the doors of a drug service or being spotted on supervised consumption all come to mind . Much less commonly spoken about are the ways in which modern global supply chain dynamics can produce shortages . These impact a great many things in our lives , but unlike most – and even most other medicines – OST medications are subjected to the sort of regulations that make overcoming shortages significantly more challenging . Supply chains are likely to be disrupted more and more regularly as a result of things like climate change-related extreme weather events , and while many of us will find workarounds to these disruptions as part of our new ‘ normal ’, what happens when we ’ re powerless to do so ?
Anna is a Release service user who was recently impacted by a medication shortage that meant her prescribed methadone tablets became unavailable . She was originally prescribed injectable methadone , but transitioned to tablets as that was deemed safer by her prescriber . When the tablet shortages impacted her , her service swapped her back to injectables but reduced her dose
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significantly from what would have been the equivalent dose to her tablets , citing overdose risk as the reason . This is despite the fact that leaving Anna suddenly under-dosed would increase the odds she would resort to the illicit market after a long time away from it – increasing her overdose risk .
In this case , to stay well , Anna supplemented her dose with some leftover oral methadone so that she could get through the Christmas period with her family . Sadly , this has caused her to worry about whether the service would ever reinstate her earlier dosage or if they would punish her for ‘ topping up ’.
Unfortunately , Anna ’ s situation is not unique . As a result of medication shortages , Release has been contacted by a number of people – some of whom had been stable on their medication for years only to be thrown into a state of sudden uncertainty and put onto regimens they were unhappy with or even properly consulted about . In other cases , people have contacted us because their service simply would not get involved promptly to help resolve their medication shortage through the provision of an alternative script , leaving them sick and in distress .
The systems of medication manufacturing and distribution to pharmacies are not straightforward to understand or navigate . Pharmacies order medications via different wholesalers who have rules for
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ordering and distribution – such as not stocking or supplying medicines within a set number of months of their expiry date . Getting information from wholesalers on whether they still have stock of different medicines is often impossible for normal citizens trying to solve their own shortages . This is also true for advocates at Release , who are not privy to intel from wholesalers and have to work with allied professionals in the drugs sector to find solutions for people whose medication is unavailable .
For every person contacting us , and who we were able to support , how many didn ’ t have Release ’ s number , or an allied key worker , or a kind pharmacist fighting their corner ? Even in cases such as Anna ’ s – where people have self-advocated but been offered subpar treatment plans as a result – how many are left more vulnerable after each supply disruption ?
It ' s not an answerable question . We don ’ t know how many people are prescribed various different forms of OST , as there ’ s no breakdown of prescription type in NDTMS and there ’ s no public entity keeping track for us to make FOI requests to . This means it ’ s hard to strategise much beyond the firefighting we do already .
Ultimately , we need a system overhaul which rejects the current allowance for OST patients to be treated as second class citizens , especially OST patients who do not fit the mould and require less common
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OST medications are subjected to the sort of regulations that make overcoming shortages significantly more challenging .
forms of OST medication to live well . Services should offer and protect medicine choice and not view shortages as an opportunity to permanently alter the treatment plan of a patient . We also need services and systems to become more responsive to patients , in an environment where disruptions are becoming more commonplace and the illicit market evermore dangerous . Finally , for people who commission services , we ask : what mechanisms are you incorporating to make services accountable to service users ? These mechanisms must suit people actively on OST in all their diversity ( by which we mean diversity of medications , of class , of race and ability status , and of gender and sexuality ) and not prioritise those people working towards abstinence alone .
Shayla Schlossenberg is head of drugs services at Release
Riley Johnson is drugs support advisor and NSP specialist at Release
Mary Long / iStock
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