Janie Sheridan

Prescribing injectable and oral methadone to opiate addicts: results from the 1995 national postal survey of community pharmacies in England and Wales.

Abstract Objective: To establish the extent of prescribing injectable and oral methadone to opiate addicts and the practice characteristics and dispensing arrangements attached to these prescriptions. Design: National survey of 25% random sample of community (high street) pharmacies through postal questionnaire, with four mailings. Setting: England and Wales. Subjects: 1 in 4 sample of all 10 616 community pharmacies, stratified by family health services authority. Main outcome measures: Data were collected on each prescription for controlled drugs currently being dispensed by pharmacies to misusers, describing the drug, form, dose, source (general practice or hospital; and NHS or private), and numbers of dispensing pick ups a week. Results: Methadone was the opiate most commonly dispensed to misusers (96.0% of 3846 opiate prescriptions). 79.6% of methadone prescriptions were for the oral liquid form, 11.0% for tablet, and 9.3% for injectable ampoules. More than one third of all methadone prescriptions were for weekly or fortnightly pick up, with a further third being for daily pick up. Tablets and ampoules were even less likely to be dispensed on a daily basis. Private prescriptions were significantly more likely than NHS ones to be for tablets or ampoules, to be for substantially higher daily doses, and to be collected on a weekly or fortnightly basis. Conclusions: The distinctively British practice of prescribing injectable methadone was found to be widespread and, contrary to guidance, to be as prevalent in non-specialist as specialist settings. In view of the frequent crushing and injecting of methadone tablets, clearer more authoritative guidance is needed on the contexts in which injectable methadone (tablets as well as ampoules) should be prescribed and on the responsibilities for monitoring and supervision which should be attached. Key messages Tablets and ampoules make up one fifth of methadone prescriptions Arrangements already exist for daily dispensing of methadone to patients, but many prescribers (particularly general practitioners and private doctors) prescribe large amounts with long intervals between pick ups As well as ampoules, methadone tablets (when crushed) may be injected; clearer guidance is needed on the clinical criteria for prescribing injectable methadone Daily dispensing arrangements are insufficiently used, and guidelines for pre- scribers on dispensing arrangements need to be reviewed

Role of community pharmacies in relation to HIV prevention and drug misuse: findings from the 1995 national survey in England and Wales

Abstract Objectives: To establish activity levels of community (high street) pharmacies in the provision of HIV prevention services to drug misusers and to compare these findings with the levels identified in 1988. Design: Self completion questionnaire (four mailings) to a random 1 in 4 sample of all community pharmacies, stratified by family health services authority. Setting: England and Wales. Subjects: Data provided by pharmacist in charge of the dispensary, on service provision at the pharmacy. Main outcome measures: Quantitative reports of current activity levels for (a) dispensing of controlled drugs to drug misusers, (b) sale of needles and syringes, (c) needle and syringe exchange. Results: 74.8% response rate (1984/2654). In 1995, 50.1% (992/1980) of pharmacies were dispensing controlled drugs (mostly methadone), compared with 23.0% (562/2457) in 1988; 34.5% (677/1962) of pharmacies were selling injecting equipment, compared with 28.0% (676/2434) in 1988; 18.9% (366/1937) were providing a needle exchange service, compared with 3.0% (65/2415) in 1988. Conclusion: Activity levels increased substantially across all three service areas. Increased activity included greater individual activity as well as higher proportions of pharmacies participating. The network of community pharmacies represents an underused point of contact for this Health of the Nation target population. Key messages Many communities pharmacies have a role in providing HIV prevention services for injecting drug misusers—such as dispensing controlled drugs on prescription, selling injecting equipment, and operating needle exchange schemes Since 1988 the proportion of pharmacies dispensing prescribed controlled drugs has dou- bled, and the proportion taking part in needle exchange schemes has increased sixfold A large reservoir of untapped potential still exists among community pharmacists The community pharmacist has a high level of contact with often “hard to reach” drug misusers; the potential for maximising such contacts should be explored

Effect of government recommendations on methadone prescribing in south east England : comparison of 1995 and 1997 surveys

On instruction from the Minister of Health, the Department of Health in England convened a task force on the effectiveness of treatment services for drug misusers, and widely distributed its recommendations in 1996.1 Methadone constituted 96% of all opiate prescriptions dispensed to drug misusers. 2 3 The task force specifically recommended that ( a ) methadone tablets should no longer be prescribed for the treatment of drug misuse; ( b ) daily dispensing should be used to prevent diversion of drugs; and ( c ) the optimal dosage for methadone maintenance treatment was probably between 50 mg and 100 g daily.1nnMuch of the drug problem of England and Wales is concentrated in London, 4 5 with 23% of all methadone prescriptions in the area being from the Thames regions.3 We report the extent to which changes in line with the three recommendations of the task …

Drug misuse and community pharmacy

Part 1: Background. Opiate Addiction and the British System: Looking Back on the Twentieth Century and Trying to see its Shape in the Future. Drug Misuse and the Community Pharmacist: a Historical Overview. Part 2: Surveying the Situation. Reviewing the Situation - Pharmacists and Drug Misuse Services in England and Wales. Drug Misuse and Community Pharmacy in Scotland. Drug Misuse in Northern Ireland: the Role of the Community Pharmacist. Drug Users and Pharmacists: the Client Perspective. Part 3: Working with Drug Users. The History and Operation of Pharmacy Needle Exchanges. New Approaches to Dispensing Controlled Drugs: Supervised Consumption. Providing Health Care for Drug Users. Misuse Over-the-Counter Products. Part 4: Practical Matters - Training, Support and Shared Care. Legal and Ethical Considerations for Community Pharmacists. Training and Support for Pharmacists. Professional Conflicts for the Front-Line Community Pharmacist. Shared Care at the Primary and Secondary Interface: The Role of GPs and Specialist Drug Services. Part 5: The Way Forward. The Way Forward - Greater Specialism or More Generalism?

Can I help you? A qualitative study of pharmacist and pharmacy assistant views on the role of pharmacy assistants in New Zealand

Objectivesu2002 To begin to explore the role of PAs more fully in a New Zealand context, through semi‐structured interviews with PAs and pharmacists.

The role of the community pharmacist in drug abuse: a comparison of service provision between Northern Ireland and England/Wales

Aim: The aim of the present research was to establish the current extent of pharmacists contact with illicit drug users in Northern Ireland, their willingness to provide services for this group and to compare the findings with data from a 1995 national survey of community pharmacies in England and Wales. Method:The questionnaire developed by the National Addiction Centre for research in England/Wales was used to collect data. It was mailed on two occasions (March and April 1999) together with a covering letter and a prepaid return envelope to all community pharmacies in Northern Ireland (n=507). A final reminder letter was included in the local wholesalers medical delivery for the attention of the pharmacist in May 1999.Main Outcome measure: The extent to which Northern Ireland pharmacists had contact with and provided services to illicit drug users compared to pharmacists in England/Wales.Results: A response rate of 67.5% was achieved. Respondents in Northern Ireland were providing fewer services to drug users than those in England/Wales. Respondents reported dispensing methadone for the treatment of addiction/misuse to only 9 patients, while only 17 pharmacists had been asked to sell injecting equipment in the previous week and no pharmacist was participating in a needle exchange scheme. However, most respondents indicated their willingness to provide such services. Barriers towards the provision of services were, however, highlighted e.g. the need for training and the establishment of support systems. Conclusion: Pharmacists in Northern Ireland are in a position to contribute to the policy agenda in Northern Ireland for drug misuse, prevention, treatment and harm minimisation ‐ roles which the survey indicates they are willing to embrace. However, training programmes, support systems and adequate remuneration packages must be established before they will be in a position to participate fully.

Late responders and non‐responders to a postal survey questionnaire: analysis of potential further response and non‐response bias

The purpose of this study was to evaluate the effect of further mailshots on response rates to a postal survey, and to determine the extent of non‐responder bias. A questionnaire on services to drug misusers was mailed to a random sample of one in four community pharmacies in England and Wales (2,654), stratified by family health services authority, followed by three further mailshots to non‐responders. The remaining non‐responders were contacted by telephone and asked to participate in a brief telephone interview. The addition of the fourth mailshot increased the response rate by only 4.8 per cent overall. Responses to key variables (demographics, participation in service provision) were not significantly different when comparing response to mailshots 1–3 with the fourth mailshot. Responses to the telephone survey succeeded in increasing the overall response rate to 98.4 per cent. These postal non‐responders (ie, those responding to the telephone survey) were significantly different from those who responded to the postal survey in the extent of their service involvement, with postal responders being more involved in dispensing Controlled Drugs than telephone responders (50.1 per cent and 39.2 per cent, respectively) and provision of needle exchange (18.9 per cent and 9.6 per cent, respectively).

Prevalence and predictors of medicine saving and future prescription medicine sharing: findings from a New Zealand online survey

To assess the prevalence of and factors predicting future prescription medicine sharing behaviours among adults in New Zealand (NZ). The prevalence and predictors of having leftover medicines at home and the relationship between medicine storing and sharing practices were also explored.

Analysis of the information and support needs generated by a community pharmacy‐based methadone treatment programme

Background — Methadone treatment has been provided in Ireland since 1998 under the methadone protocol scheme. Two liaison pharmacists were employed by the Eastern Health Board to interface between pharmacists dispensing methadone in primary and tertiary care.