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

2. 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

3. 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

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

5. 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.

6. 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

7. 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

8. 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

9. 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.’’

10. 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.

11. 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

12. 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

13. 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

14. 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.

15. 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

16. 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

17. 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