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Reducing harm and promoting recovery: a report on methadone treatment for substance misuse in Scotland: SACDM Methadone Project Group

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Appendix 2 - SACDM Methadone project group - terms of reference

SCOTTISH ADVISORY COMMITTEE ON DRUG MISUSE: PLACE OF METHADONE IN DRUG TREATMENT PROJECT GROUP

TERMS OF REFERENCE AND PROJECT OUTLINE

Background

1. In May this year the First Minister announced a review of the place of methadone in drug treatment. We are committed to taking this forward within a timescale specified by Ministers. There are three main themes to the review: Scoping the Issue; Reviewing Current Practice and Improving Current Practice. Work on some of these themes has already started.

2. We are "Scoping the Issue" by summarising the effects of international evidence on the effects of methadone for Ministers and collating information held by NHS Boards on the level and circumstances of methadone use in Scotland. Information from Boards includes the number of people receiving methadone treatment for drug misuse, the number of those on a daily supervised consumption regime and the number of those who receive methadone who have children under the age of 16 living with them all or part of the time. This work is nearing completion.

3. We are "Reviewing Current Practice" by gathering information from Boards about their own arrangements for monitoring the implementation of current UK national and any local clinical guidelines. On our behalf, the Scottish Drugs Forum is gathering views from service users and carers through focus groups, and from a wider selection of stakeholders through open meetings and a postal questionnaire. A report on this work is expected in late November. Scotland is represented on the UK-wide review group established to update the UK clinical guidelines which should finish work next summer.

4. There is already a large amount of ongoing work aimed at "Improving Current Practice". Professional training funded by the Executive is being delivered by the Royal College of General Practitioners. National Quality Standards for Substance Misuse Services were published in September 2006. The Scottish Drug Misuse Database is being expanded.

5. The review is not about deciding whether or not methadone should be used to treat drug addiction. It is about building a picture of methadone use in Scotland from a variety of perspectives, indicating for Ministers where improvements should and could be made. It is important to stress that Ministers wish to be made aware of current practice.

6. This SACDM working group will form part of the review, by capturing the views of clinicians and other practitioners involved in treating people receiving methadone.

Remit

7. This project group would aim to:

  • summarise current experience of methadone treatment across Scotland from the perspective of those who prescribe methadone and/or those who supply additional support to clients;
  • summarise what additional support is currently provided to people receiving methadone treatment in different locations; and
  • identify examples of good practice.

Scope and methodology

8. As this forms part of the review of methadone in drug treatment requested by the First Minister, the group should focus exclusively on the substitute prescribing of methadone. While comparisons would be interesting, the prescribing of other substitute drugs such as buprenorphine is outwith the remit of this work.

9. The project group will draw on their own experience and those of colleagues in their professional and other networks to build a picture of current activity and practice in Scotland, to describe both the benefits and the limitations of current methadone treatment. The group will need to consider how they wish to gather this information [by survey/questionnaire or other means.] The group will also need to consider whether there should be a focus on particular factors, such as dosage levels and supervised or take home doses.

10. While a definitive study of practice across Scotland could take many months, the purpose of this group is to provide Ministers with the most realistic 'snapshot' possible, while taking account of the fact that current practice of any treatment regime is by nature a dynamic process.

Key outputs

11. The key outputs of this project group will be as follows:

  • A briefing paper for Ministers describing what support is available to those currently accessing methadone treatment and people's experiences of providing this support.
  • Practical recommendations for how service commissioners and service providers can improve that support.