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Letters to the Editor
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Community pharmacy
Dispensing methadone poses some problems
From Mr D. C. Satterthwaite, MRPharmS
I am compelled to write and voice my support for J.
S. Bowman’s
point of view regarding the dispensing of methadone (PJ, 14 February,
p184) having been surprised by the quantity
of letters printed opposing his position. Of the pharmacists I know (who have expressed an opinion)
I would say that two-thirds of them agree with him.
As a professional, I feel obliged to treat addicts with the same degree
of respect I give to all other patients, and I do just that. Indeed,
I have grown to quite like some of them as individuals since they are
often more polite, friendly and patient than other customers — so
I come to this argument with a foot in both camps.
However, after 10 years in community pharmacy, I have found that it is
usually the new methadone patients who seem to be the most jumpy or threatening
and can cause members of staff some concern as they eye the dispensary
while drinking their daily dose. Quite often, though, the ones that appear
least desirable soon seem to stop coming for one reason or another. Those
that stay the course normally mellow. Some do actually manage to reduce
their dose to an absolute minimum and even stop altogether, in which
case the system has worked.
But running the system from a community pharmacy does pose some problems.
On more than one occasion I have received a new prescription due to start
either that day or the next only to find an error which should by law
preclude me from dispensing methadone to the addict. At times like those
I would suggest that a special clinic with a doctor on site would be
much more suitable than a pharmacy, since errors could be corrected immediately.
Less problematic, but far more common, is the feeling of urgency created
when an addict appears for his or her daily supervised dose. I feel under
pressure to stop dispensing the prescriptions of those who are waiting
and go and see to the addict, who thereby jumps the queue. It depends
on the temperament of the addict as to whether you are happy to let them
wait until it is their turn or whether this poses a threat to your shelf
stock or your customers’ peace of mind. I feel annoyed when I have
to let addicts jump the queue since other members of the public have
been displaced for no good reason.
David Satterthwaite
Washington, Tyne and Wear
Education and love is the solution
From Miss M. L. Anderson, MRPharmS
The letter by J. S. Bowman (PJ, 14 February, p184) certainly generated
some valuable and thoughtful discussion. Two points worth considering
in conclusion are as follows:
· The methadone programme is a harm minimisation programme. In an ideal
world patients would gradually reduce their dose and finally come off
the programme. However the reality is that this happens rarely and many
patients continue to use heroin on the side. In over 10 years of dosing
methadone and Subutex I have only ever known of two patients that have
given them up. All of this is most disheartening for pharmacists and
their staff. However, our role is not to judge, but to assist in the
health care strategy. This feeling, though, of despondency for what is
the unfortunate reality of the current methadone programme may explain
some of Mr Bowman’s frustration.
· As a community we must address why heroin addiction begins in the first
place. The two key issues, I believe, are education and love. If people
understood the extent to which heroin addiction can destroy their body,
their hopes and their potential for living a normal life, they would
never touch it. And, if people are filled with a sense of self-worth,
hope and have high self-esteem enabling them to make wise choices, are
self-confident and, most importantly, feel loved they would never touch
heroin.
This is where the health and social policy must be aimed. Without these
key elements being addressed, the methadone programme is merely a bandaid.
I suspect Mr Bowman is a perfectionist, a benefit inherent to a high
achiever, but a limitation in being part of a solution without definitive
success.
I acknowledge and feel Mr Bowman’s frustration, but all of us have
a responsibility in building the foundation of a healthier community
(in every guise of the word healthy). The current methadone programme — and
those who are honest will admit it is not the success it was originally
hoped to be — is a part of that foundation.
Melissa Anderson
Glasgow
Stop needle exchange services
From Mr M. B. Hutchison, MRPharmS
I agree wholeheartedly with J.
S. Bowman’s letter (PJ, l4 February,
p184) regarding drug misusers. The pharmacy of which I am manager offers
both a methadone and a needle exchange service. I have never been a supporter
of either and am getting more and more disillusioned with them daily.
Since working as a locum in pharmacies in the Aberdeen and Dundee areas,
with upwards of 60 daily methadone patients, I have only seen two or
three customers come off methadone. I therefore believe that there is
a big problem with this service — it does not work.
As for the needle exchange service, not only are we expected to dispose
of dirty needles and give out clean ones, the local drug worker visited
the pharmacy last week to hand in some sachets of citric acid and cooking
pots. He then told us how to use the cooking pots so that we could help
addicts get the right concoction with which to inject themselves. What
next? I am waiting for the day when we are asked to make our shop toilets
available for shooting up, maybe pharmacists should take part in a course
on how to inject an addict and then we could do it for them to save them
from damaging their veins. I do not believe that many of us decide to
go to university, study hard for four years and train to become pharmacists
so that we can aid drug addicts to inject heroin.
I am of the opinion that everybody should get a second chance and therefore
there has to be some service to enable addicts to come off the drug.
It is blatantly obvious to every pharmacist and doctor I have ever spoken
to that the current methadone programme does not work and the needle
exchange service has nothing to do with coming off the drug. I think
a centralised clinic service should be made available for methadone dispensing
and consumption and the needle exchange service should be stopped altogether.
I, for one, have certainly had enough of aiding and abetting the criminal
activity of addicts.
Michael Hutchison
Alloa, Clackmannanshire
In my defence ...
From Mr J. S. Bowman, MRPharmS
In reply to the responses published to my
letter (PJ, 14 February, p184)
concerning drug dependency dispensing in community pharmacies, I am grateful
for those received — it is interesting to see other people’s
opinions on this matter. Sadly, my opinions have not been changed.
I do not have a problem with any other patient group, possibly because
I have never been threatened to be stabbed when dealing with any other
patient group. This happened to me recently when dealing with a methadone
client and provoked my initial letter.
In most cases I enjoy providing pharmacy services to the community, whether
it be Controlled Drugs to a terminally ill patient or antibiotics to
a child, but I do not find anything rewarding in supplying methadone
to addicts.
When I first started seeing methadone prescriptions some years ago, the
majority of clients were given a specific reducing course with the aim
of weaning them gradually off drugs. However, this did not seem to work
long term and I ended up seeing the same clients starting the course
again some time later.
Now all I see is clients on long-term, high-dose methadone treatment
with no end in sight and no thought of rehabilitating them back into
society. All this appears to do is prevent them from resorting to crime
to fund their illegal use of illicit drugs.
Perhaps part of the problem is that there appears to be no single treatment
regimen and the interaction between prescriber, client and pharmacist
varies wildly from region to region. If all addicts were dealt with in
the same manner, ideally in a clinic environment, then such problems
would possibly be lessened and picked up sooner.
However, I can see why methadone should be provided to help these patients,
if nothing else but for the reduction in crime it may produce. In my
view, a clinic environment that is properly funded and resourced is by
far the better option. From some of the comments that have been made
in response to my initial letter it seems there are several pharmacists
who enjoy serving these patients — they and others of a similar
view would be ideally suited to offering their services in running such
clinics.
J. S. Bowman
Washington, Tyne and Wear
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