What can we learn from COVID-19 to improve opioid treatment? Expert providers respond

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

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.

A conceptual analysis of SBIRT implementation alongside the continuum of PrEP awareness: domains of fit and feasibility

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a supplementary intervention that can be incorporated into the Pre-Exposure Prophylaxis (PrEP) Care Continuum, complementing initiatives and endeavors focused on Human Immunodeficiency Virus (HIV) prevention in clinical care and community-based work. Referencing the Transtheoretical Model of Change and the PrEP Awareness Continuum, this conceptual analysis highlights how SBIRT amplifies ongoing HIV prevention initiatives and presents a distinct chance to address identified gaps. SBIRT's mechanisms show promise of fit and feasibility through (a) implementing universal Screening (S), (b) administering a Brief Intervention (BI) grounded in motivational interviewing aimed at assisting individuals in recognizing the significance of PrEP in their lives, (c) providing an affirming and supportive Referral to Treatment (RT) to access clinical PrEP care, and (d) employing client-centered and destigmatized approaches. SBIRT is uniquely positioned to help address the complex challenges facing PrEP awareness and initiation efforts. Adapting the SBIRT model to integrate and amplify HIV prevention efforts merits further examination.