1. Developing role of community pharmacy in responding to the needs of people with drug problems David Thomson Lead Pharmacist Community Pharmacy Development & Governance

2. Once upon a time….. …..in olden days Methadone on GP10 - unsupervised Voluntary ban on prescribing Area Pharmaceutical Committee Supervised consumption on 13 sites Support provided –Education & training –Guidelines –Specialist Pharmacist in Substance Misuse

3. Once upon a time….. Not universally accepted Poor understanding & awareness –Providers & clients Attitudinal issues Negative press coverage Extensive PR & marketing efforts Supporting communities

4. Why Community Pharmacies? Builds on existing model of supply Ease of access Extensive network - well distributed 312 prior to April 2014 74% located in deprived areas Open over extended hours & weekends Access to highly trained healthcare staff Responsive to needs of local population

5. Developments along the way…. Premises fit for purpose –Private areas & consulting rooms –NHS contribution to costs Injecting Equipment Providers –From 8 in 1999 to 58 currently –Electronic recording of transactions –Supply drug paraphernalia Citric acid, filters, cookers, water for injection, etc One Hit Kits –Naloxone

6. Developments along the way…. Methadone pumps Automated dispensing e.g. MethaMeasure ® Satellite pharmacy –Manage capacity issues in G5 Independent prescribing Buprenorphine Community Addiction Teams Shared Care

7. Current model – Glasgow style Opioid Substitution Therapy –275 (94%) of 293 contracted for OST –~ 9000 attend regularly for OST –With ~ 1000 for buprenorphine (Suboxone) –Average of 31 per pharmacy (1 – 120) –Majority supervised - over 5/6 days Take home weekends –Referral links to Specialist Services, CAT’s etc Disulfiram –98 pharmacies in supervision pilot –~130 patients at any given time

8. Current model – Glasgow style Injecting Equipment Providers –1 million needles supplied from 58 pharmacies & 10 other outlets in 2013 –Busiest IEP pharmacy in Europe in GGC –Safe disposal 7 days/week Naloxone –77 pharmacies (47 are IEPs) –192 pharmacists & staff trained –586 kits issued by CPs (16%) as at Aug 14

9. Future Direction Influence of ‘Prescription for Excellence’ –Patient centred care –Services more geared to needs of the patient Hepatitis C –Sofosbuvir treatment from 13 Oct 2014 –Testing in IEP pharmacies from Jan 15