Guidance

Injectable opioid treatment: acknowledgements and appendices

Published 19 March 2021

Applies to England

Appendix 1: IOT expert advisory group terms of reference

This is the agreed terms of reference for the expert advisory group that was formed to develop this guidance.

Introduction

The following terms of reference outline the purpose, responsibilities and meeting structure for the Expert Advisory Group. The group has been set up to guide Public Health England (PHE) in the collation and development of guidance on supervised, prescribed injectable opioid treatment (variously known as injectable opioid treatment (IOT), heroin assisted treatment (HAT), supervised injectable heroin (SIH) and piloted in England in the Randomised Injectable Opiate Treatment Trial (RIOTT)).

Background and project objectives

PHE will collate existing UK and international evidence and guidance on the provision of injectable treatment, and build on the latest clinical guidelines and the earlier evidence on which the guidelines draw. PHE will use this evidence to provide guidance in 2019 to 2020 for commissioners and service providers considering setting up a supervised injectable service. The guidance will clarify clinical and operational aspects of the service.

PHE’s Alcohol, Drugs, Tobacco and Justice Division (Health Improvement Directorate) has established a project team to develop the guidance – the Expert Advisory Group’s role will be to inform and guide the team.

Within the scope of the guidance are:

• services offering opioid substitution treatment
• adults
• injectable opioids
• oral opioid substitution therapy (OST) medicines provided as take-home doses supplementary or alternative to injectable doses

Other UK countries are outside the scope. PHE only has a remit for England but the other countries’ governments will be invited to observe and contribute their experience, and to adapt or adopt the guidance for their own circumstances if helpful.

Outline of functions

Members of the advisory group will contribute to the success of the project by:

• informing the approach and providing support for the project as a whole
• ensuring advice is available on key issues
• assisting the development of PHE’s guidance, ensuring it is realistic and based on existing evidence and experience
• commenting on draft versions of guidance as requested
• advising on the quality, limitations and appropriate use of evidence
• highlighting relevant practice and implementation issues relevant to the guidance and signposting the project team to further information on such issues

Members can expect the project team to:

• give reasonable time to provide feedback
• alert them to potential risks and issues that could impact the project, as they arise

Meetings

Two meetings will be held over the course of the project, the first in September 2019 and the second in November 2019. A further meeting may be held if required. Meetings will be held in London. Secretariat will be provided by PHE. The agenda and meeting papers will normally be circulated a week before the meeting.

Review of terms of reference

The terms of reference will be agreed at the first meeting. Because this is a time-limited piece of work the terms of reference will not be formally reviewed but will be amended if required to adequately support the project, with the agreement of the group.

Confidentiality

Advisory group members are asked not to disclose any information shared in the meeting if they think it may have an impact on another member of the group or adversely affect the project. While the meetings are not confidential, frank discussion and the sharing of views will enhance the work. This may be inhibited if members feel comments will be publicly attributed to them out of context. At times there may be specific information shared that is confidential and not to be shared outside of the group and this will be made explicit.

Declarations of interest

Each member of the Expert Advisory Group will complete a declaration of interest form which will be registered with PHE and available to the public on request.

Membership

Members and other roles in relation to the group are listed below.

Members have been selected for their expertise and experience, and to represent a mix of sectors and professions. They are not expected to represent a constituency.

Expert Advisory Group membership and others

Members	Chair: Dr Michael Kelleher	Public Health England and South London and Maudsley NHS Foundation Trust
	Dr Prun Bijral	Change Grow Live (CGL) (psychiatry, third sector)
	Professor Eilish Gilvarry	Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (psychiatry, NHS)
	Roz Gittins	Humankind (pharmacy)
	Mark Harrison	Independent, former commissioner, Durham (commissioning)
	Professor Sir John Strang	King’s College London (academia)
	Rob van der Waal	South London and Maudsley NHS Foundation Trust (nursing)
Observers	Peter Burkinshaw	Public Health England (Alcohol, Drugs, Tobacco and Justice)
Secretariat	Craig Wright	Public Health England (Alcohol, Drugs, Tobacco and Justice)
	Steve Taylor	Public Health England (Alcohol, Drugs, Tobacco and Justice)
	Angie McCall	Public Health England (Alcohol, Drugs, Tobacco and Justice)

Appendix 2: The name of the treatment

In different places at different times this sort of treatment, and variations on it, has had different names, all with problems or omissions, including:

1. Injectable Opioid Treatment (IOT), which omits the prescribed, supervised nature of the treatment so could apply to take-home diamorphine.

2. Heroin Assisted Treatment (HAT), which also omits the prescribed, supervised nature of the treatment but further omits injectable, although in theory (and in practice in other countries) diamorphine is available as an oral treatment. It also omits other injectable opioids that can be used as treatment.

3. Supervised Injectable Heroin (SIH) includes the supervision but omits other injectable opioids that can be used. It also does not specify treatment so could be, and has been, mistakenly applied to illicit-drug consumption rooms (also called supervised injecting facilities), especially by referring to ‘heroin’ and not the pharmaceutical name of diamorphine.

So, a perfect name might be supervised prescribed injectable opioid treatment (SPIOT) but we decided against trying to introduce a new (and complicated) name.

Appendix 3: Acknowledgements

With thanks and acknowledgements to colleagues at South London and Maudsley NHS Foundation Trust and King’s College London whose ‘Clinical Guidelines and Operating Procedures for the Supervised IOT Clinic (AAU Annex)’ – themselves drawn from the guidelines and procedures for the Randomised Injectable Opiate Treatment Trial (RIOTT) – served as the basis for most of the operational and clinical guidance in this document.

PHE would like to thank members of the expert advisory group (terms of reference at Appendix 1) that supported the project. They were:

• Dr Michael Kelleher (chair)
• Dr Prun Bijral
• Professor Eilish Gilvarry
• Roz Gittins
• Mark Harrison
• Professor Sir John Strang
• Rob van der Waal

We would also like to thank Dr Carole Hunter for providing expert advice to the group, and Dr Tim Leighton for drafting content on recovery and injectable opioid treatment (IOT).

We would like to thank the following people for their time (sometimes at short notice) and for being hospitable and informative hosts during visits by project staff to UK and European IOT services:

• Dr Carole Hunter and her colleagues at Glasgow’s Enhanced Drug Treatment Service
• Daniel Ahmed at Middlesbrough Foundations
• Professor Ambros Uchtenhagen and his colleagues in Zurich
• Dr Helle Petersen and Lene Caspersen and their colleagues in Copenhagen