News

IoW pharmacies offer sharps disposal for diabetic patients
More money to fight drug misuse
NHS web plan excludes pharmacists
Cannabis Bill fails
NHS R&D budget up 6.6 pc
Most condom purchasers choose pharmacies
Manufacturers miss BSE (TSE) deadline
PAGB website aims to be first choice for advice
Americans mix their medicines
MSPs call for prescription charge freeze
Deadly medicines warning issued by World Health Organisation
Clinical trials directive planned
SGM call overtaken by new appointment

IoW pharmacies offer sharps disposal for diabetic patients

Pharmacies in the Isle of Wight are now able to provide a disposal service for used sharps and needles from diabetic patients.

Mr Noel Staunton (prescribing manager, Isle of Wight health authority) told The Journal on February 5 that diabetic patients would be issued with five-litre sharps bins. When these were full they could be returned to a community pharmacy. They would then be disposed of along with the pharmacy's other clinical waste by Pharmawaste Ltd. The service was being provided at marginal additional cost on top of the existing waste medicines service. The pharmacies received a payment of £100 a year for taking part. Mr Staunton said the service was proving popular and the main problem at present was getting enough bins.

Isle of Wight health authority had agreed a joint budget with the island's social services department to pay for monitored dosage systems for use by patients in the community. Protocols had been drawn up to assess which patients should receive the service and who was the most appropriate professional to decide that the service was necessary. A budget of £6,000, shared 60:40 between the health authority and social services, had been allocated for the first year.

Last year, Isle of Wight health authority provoked controversy by its decision to stop payments to pharmacy contractors for visiting nursing and residential homes and to appoint its own pharmacist to make the visits (PJ, March 11, 2000, p392).

Mr Staunton said that since Mr Paul Gerram had been appointed to the post he had undertaken a number of medication reviews. As a result, the amount of medication being prescribed for nursing home patients had fallen by 48 per cent.

Mr Gerram had also established at one nursing home a scheme to provide non-prescription medicines, such as analgesics and lactulose, to be used on an as necessary basis from bulk prescriptions.

Mr Gerram trained staff at the home on which patients should receive such medicines and when. The home was then provided with stock bottles on bulk prescription. Mr Staunton said that the service was expected to be revenue neutral for community pharmacies as there was an additional bulk prescription dispensing fee.

In the Drug Tariff, bulk prescriptions are defined as prescriptions for two or more patients at an institution with at least 20 residents and with one GP responsible for at least 10 of them. They can only be for non-prescription only medicines or dressings which are prescribable on the National Health Service.

More money to fight drug misuse

Pharmacists are to get special training in drug misuse in order to increase their skills and expertise.

The training is to be paid for from an extra £25m announced by the Department of Health on February 12 for drug misuse services.

Around 8,000 health professionals, including pharmacists, nurses and GPs are to benefit from the training.

Almost half of the £25m has been allocated directly to health authorities for use in the provision of treatment services and the reduction of deaths attributable to the diversion to the streets of prescribed medicines, such as methadone, and sharing needles.

The money is to be spent on more methadone supervision and needle exchange schemes and drug awareness training for medical practitioners and nurses. In addition, more drug counsellors and drugs and mental health workers will be recruited and trained. The aim is to expand the provision of drug treatment services and to get more drug abusers into treatment.

Ms Gisela Stuart (Minister for Health) said on February 12: "There are up to 200,000 problem drug misusers in the United Kingdom, of whom no more than half are in contact with treatment services."

NHS web plan excludes pharmacists

Pharmacists are excluded from plans to give all National Health Service clinical staff internet and intranet access to online information services by the end of next year.

Plans for the launch of electronic health records and online services were announced by the Secretary of State for Health (Mr Alan Milburn) on February 4.

A Department of Health spokesman told The Journal on February 6 that a reference to "all NHS clinical staff" meant doctors, nurses and specialists, but not to managers, porters and cleaners. He confirmed that pharmacists were also excluded.

Electronic health records (EHRs) will hold summarised key data about patients, such as name, address, NHS number, GP and contact details, previous treatments, ongoing conditions, current medication, allergies and the date of any next appointments.

The Government says that EHRs will be securely protected, created with patient consent and that changes will only be made by authorised staff.

As the initiative is rolled out, up to 5m people are expected to have an EHR by 2003, rising to around 25m by 2004 and to every person in the country by March, 2005.

Pilot studies are already under way to find the best way of allowing patients to access their EHR. Possible options include on-line access via NHS Direct and smart cards for use in information points in GP surgeries, hospitals and National Health Service walk-in centres. Patients will be allowed to see their summarised and up-to-date health records.

Cannabis Bill fails

A private member's Bill which sought to legalise the production, supply, possession and use of cannabis resin for medicinal purposes failed to achieve its Second Reading in the House of Commons on February 2. The Misuse of Drugs (Amendment) Bill, tabled by Mr Paul Flynn (Lab, Newport West) failed because House of Commons standing orders require a total of at least 40 votes to be cast for a decision to be made. Eight members voted for the Bill and four against it.

NHS R&D budget up 6.6 pc

The National Health Service research and development budget for the coming financial year will rise by 6.6 per cent to £479m.

The funding, announced by the Department of Health on February 7, includes more than £20m for new R&D to take forward the NHS modernisation plan, including research in cancer, coronary heart disease and mental health, and health technology assessments for the National Institute for Clinical Excellence. More than 80 per cent of the R&D budget is to go directly to the NHS to support research designed to improve health and health services. Some of the money will be used by the Department to pay for research to strengthen the knowledge base for health and social care.

In addition, a further £140m has been allocated to health authorities in England, bringing their total funding for 2001-02 to £37,217m, an average increase of 8.9 per cent.

Most condom purchasers choose pharmacies

Pharmacies are the first choice for people to obtain the most popular form of contraception — condoms.

The 2001 Durex Report, published on February 14 by SSL International, says that despite the increasing availability of condoms from other sources, buying them from pharmacies remains the preferred choice of 48 per cent of British people. The next most popular source, with just 20 per cent of purchasers, is supermarkets.

Condoms are the most popular form of contraception, being the first preference of 31 per cent of the sexually active population. Second place goes to oral contraceptives, at 22 per cent. One per cent of people claim that the diaphragm or emergency contraception is their preferred choice.

Commenting on the findings, Ms Sarah Rose (marketing director for Durex) said: "The pharmacist plays a vital role within the local community, supplying relevant and important information to people about sexual health."

She added that SSL was currently working on the development of resources to support pharmacists in giving advice on safer sex and condom provision.

The report shows that although 87 per cent of people know that condoms can help provide protection against HIV/AIDS, 72 per cent do not realise that they also offer protection against chlamydia, which is one of Britains commonest sexually transmitted infections.

Ms Rose said: "Sexually transmitted infections are a real threat to anyone who is not practising safer sex. We are working in conjunction with pharmacists to ensure that more people, including those who have gone into pharmacies to buy emergency contraception, have access to the relevant information regarding effective condom use."

Manufacturers miss BSE (TSE) deadline

A number of medicines manufacturers have failed to meet a Medicines Control Agency deadline for declaring compliance with transmissible spongiform encephalopathy (TSE) guidelines designed to prevent the spread of bovine spongiform encephalopathy (BSE) to humans.

The guidelines prohibit the use if materials of bovine origin derived from countries in which there are known cases of BSE.

Marketing authorisation holders were told on July 7, 2000, to provide tabulated details of all their products along with a signed declaration of compliance with the guidelines by December 1, 2000.

PAGB website aims to be first choice for advice

The Proprietary Association of Great Britain is to try to make its website (www.pagb.co.uk) the first place on the internet for British people to go for advice on self-care and self-medication.

That is one of six key targets announced by the PAGB at its members’ strategy meeting at the end of last year.

The other targets are:

to stimulate more POM-to-P moves, with an emphasis on new indications for the prevention and treatment of chronic illness
to make it easier for health professionals to recommend over-the-counter medicines
to get self-care into the National Health Service national plan
to start work on alternative methods of funding the treatment of minor ailments through health care systems
to achieve a favourable European regulatory framework for medicines, herbal products and food supplements

The association's over-riding objectives are to help people achieve greater self-reliance and to depend less on health professionals, and to build a regulatory framework that encourages the development of self-medication.

Americans mix their medicines

Most American adults (51 per cent) take at least two medicines every day. An American Society of Health-System Pharmacists survey of medicines use in the US found that 46 per cent took at least one prescription medicine, and 28 per cent take multiple prescription medicines, daily.

The use of prescription medicines was highest among older Americans, with those aged 65 years or over taking an average of four medicines each day.

Use of non-prescription medicines and herbal supplements was also high.

MSPs call for prescription charge freeze

Members of the Scottish Parliament are calling for a prescription charge freeze. A motion tabled by Ms Nicola Sturgeon (SNP, Glasgow) calls on the Scottish Executive to freeze prescription charges at their current level and to establish an independent working group to review the prescription charge system and to propose reforms within 12 months. The motion is supported by 11 other MSPs.

Deadly medicines warning issued by World Health Organisation

The World Health Organisation has warned of a dangerous increase in the incidence of substandard medicines, particularly in developing countries.

The warning, published in the latest issue of the Bulletin of the World Health Organization, is accompanied by a report that 33 small children in India died after being given cough syrup that contained diethylene glycol. Diethylene glycol is a sweet-tasting, highly toxic solvent used in motor vehicle antifreeze.

The WHO bulletin says that several hundred patients, many of them children, have died in the past 15 years after using medicines contaminated in this way.

In the latest case, 36 children under six years of age were admitted to two Delhi hospitals between April and June, 1998, with unexplained acute renal failure. All but three of them died. Most were under two years old and the youngest was just two months old. Health officials began an immediate investigation, but initially failed to establish the cause. It was only when they read about a similar outbreak in Haiti in 1995, in which 88 young people died, that they began to consider the contamination of medicines as a cause. Subsequent investigations, including analysis of medicines the children had taken, pointed to a locally manufactured expectorant as the culprit. The medicine was found to contain 17.5 per cent diethylene glycol.

In a similar outbreak in Bangladesh in 1990, manufacturers were suspected of having replaced propylene glycol with the cheaper, but potentially lethal diethylene glycol. More than 300 children were affected and 236 of them died.

Describing the Delhi outbreak, the WHO bulletin points out that India has legislation to prevent the manufacture and marketing of contaminated medicines.

"This contamination, as well as others previously reported, indicate that there are major problems in enforcing pharmaceutical legislation in developing countries," it says. "Contamination of or substitution in medicines of diethylene glycol has occurred in many countries, including Argentina, Bangladesh, Nigeria, Haiti, and India, and it has resulted in the loss of over 500 lives. Problems related to the enforcement of pharmaceutical legislation must be addressed to prevent the re-occurrence of such tragedies."

The WHO bulletin can be found on the internet at www.who.int/bulletin.

Clinical trials directive planned

The final shape of a proposed European directive on human clinical trials for medicines has now been agreed, following the acceptance of amendments from the European Parliament, by the Council of Ministers. MEPs have toned down the changes they wanted to the original proposed directive in a successful bid to get them accepted.

The changes MEPs successfully sought included

Principal investigator always to be a medical practitioner
Written, dated and signed consent to be required from subjects
Special protection for persons incapable of giving informed consent
Oral consent allowed in exceptional circumstances and in the presence of witnesses for an illiterate person
Informed consent of parents or a legal representative required where the subject is a child and the child to be properly informed, with a similar requirement for psychiatric patients
Prior interviews to be are carried out to make sure that subjects are properly informed
Risk/benefit judgments to be made by ethics committees

Previously, MEPs had wanted to prohibit clinical trials involving people who were incapable of giving written consent themselves.

They had also wanted recruitment of new subjects to trials suspended if any unexpected side effects arose. Other proposed amendments aimed to guarantee treatment and compensation in cases of injury or death arising from trials.

Information on the proposed directive can be found on the internet at europa.eu.int/scadplus/leg/en/lvb/l21165.htm.

SGM call overtaken by new appointment

Plans to call a special general meeting of the Royal Pharmaceutical Society over the appointment of a non-pharmacist editor of The Pharmaceutical Journal have been shelved.

Mr Peter Schofield, who e-mailed to the Society on February 5 information that he had gained the required level of support for a motion that the editor’s position should be held by a pharmacist, told The Journal on February 13 that the motion was no longer relevant as the decision to appoint a non-pharmacist had been ratified.

Following a meeting with the Society’s Secretary and Registrar (Miss Ann Lewis) on February 14, Mr Schofield is now consulting other pharmacists to decide the way forward. He believes there is still a desire for open discussion. The Society’s President (Mrs Christine Glover) and Miss Lewis hope this will be possible on the occasion, but not as part, of the AGM.

Miss Lewis told The Journal: "I welcome the opportunity to discuss concerns and I believe the chance to exchange information and views in an open forum would be a positive development."