The recovery agenda – a pharmacy perspective Theresa Fryer MRPharmS Community Pharmacist Leamington Spa

Why pharmacies ? Large number of locations One of the most accessible healthcare services Pharmacist can be consulted confidentially No appointment system No need to register Relatively anonymous Able to signpost toward range of support depending on where individual is in their recovery journey

What do Pharmacists do ? Medicines are the most common health intervention that patients receive from the NHS; Pharmacists are the medicines experts; Pharmacists are committed to quality; Pharmacists can enhance patient outcomes from medicines use and drive efficiency on costs

Harm Reduction Needle and Syringe Exchange Schemes Why Pharmacies ? Pharmacy services are easy , low threshold Open access User friendly

What are the benefits ? Distribution of new injecting equipment Written information on harm reduction eg safer injecting / overdose prevention Signposting to specialist services for vaccinations and drug treatment Ensure safe disposal of used injecting equipment Address other health needs and advise on where to access those services Building a rapport with clients Referral into treatment Sexual health services , alcohol services , dental care , GP services general health promotion advice.

Supervised consumption Access to treatment in a pharmacy is voluntary -patients right to choose but not all pharmacies will provide. No legal requirement to supervise – pharmacies will be signed up to SLA Signed Patient agreement to consent to supervision- may also include information sharing

Supervised consumption Ensures compliance with agreed treatment plan Improves effectiveness of prescribing Responsive to individuals progress Dispensing in specified instalments Ensures each supervised dose is correctly administered to the patient for whom it was intended – take away doses for when the pharmacy is closed. Correct wording –Home Office

The prescription Cannot be dispensed if : Does not fully comply with legal requirements Dispensing and supply can be refused if : The pharmacist believes the Rx is not genuine or for the person named on the Rx -If the pharmacist believes the prescriber has made a clinical error , or the Rx is clinically inappropriate - the patient or anyone with them behaves or threatens to behave violently , or commits or threatens to commit any criminal offence in the pharmacy

For bank holidays when unsure which days the pharmacy is closed:- Instalments due on days when the pharmacy is closed should be dispensed on the day immediately prior to closure.’’

If you want to ensure that the patient is not supplied with their dose if they have missed collecting for three days Instalment prescriptions covering more than one day should be collected on the specified day. If this collection is missed, the remainder of the instalment (i.e. the total amount less the instalments for the days missed) may continue to be supplied in the specified instalments at the stated intervals, provided no more than three days are missed.

If you want methadone to be measured in individual bottles for the patient (otherwise patient will be supplied with multiple take home doses in a single container) Dispense daily doses in separate containers and in advance

Supervised consumption Enables pharmacist to monitor patient response to treatment –signs of overdose -change of dose eg titration -patient intoxication - Missed doses -consider withholding treatment in interest of patient safety - liase with keyworker/prescriber

Outcomes of supervised consumption Builds a relationship with patient Improves retention in drug treatment Improves drug treatment delivery and completion Reduced risk to local communities of -overuse or underuse of medicines -diversion of prescribed medicines onto illicit drugs market -accidental exposure to dispensed medicines

First steps Notification by prescriber / keyworker to pharmacy Medicines will be prepared in advance and paperwork completed ahead of presentation Client may present with prescription themselves Client (now patient ) will be introduced to the pharmacy team They will be informed of pharmacy opening hours and any restrictions on pick up times.

Patient is given information about their medicine –PIL , advice on what to expect Written information given if wanted. Advice on precipitated withdrawal- buprenorphine Advice on methadone dosing – why we start low & increase up Coping with adverse effects – insomnia Symptomatic relief explained

Dose is given to patient for self administration together with a glass of water Patient is engaged in conversation When dose is taken patient is free to leave Other services we offer are a NHS Stop Smoking Service Sexual Health Services

summary Community pharmacy is already present at the heart of local communities Pharmacists not only have a role in supporting recovery in the community but also in helping people to stay alive and healthy until they are ready to recover