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Letters to the Editor
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Community pharmacy
Methadone maintenance treatment is a life-saver
From Mr M. Bennett, FRPharmS
The correspondence around drug addiction in recent editions of The
Pharmaceutical Journal has demonstrated a wide divergence in attitudes and knowledge.
Let us get this clear: the evidence is that methadone maintenance treatment,
when undertaken correctly, is extremely effective and a life saver.
The suggestion that success is only measured by the number of patients
that “give up” is simplistic. I cannot recall many patients
that “give up” treatment for hypertension, diabetes or asthma,
but it does not stop us treating them.
Opiate addiction is a chronic relapsing condition. Treatment with adequate
maintenance doses of methadone or buprenorphine is effective. Community
pharmacists have a vitally important role in monitoring the patient’s
condition and in the provision of supervised consumption which gives
prescribers the confidence to prescribe high doses in the knowledge that
the methadone will not be diverted.
In Sheffield we have had great success, which is reflected in the number
of patients now in employment and in a 70 per cent drop in criminal behaviour
of those under treatment. The effect on their families and friends is
equally dramatic.
I would ask community pharmacists to research the evidence, then to approach
their drug action team for additional funding to cover the cost of extra
staff and the creation of private areas that will enable them to deliver
this important service efficiently.
The community pharmacist is uniquely placed to provide one of the most
effective interventions available and to provide it in the heart of the
community. I have every sympathy with those that might argue for improvement
in premises, better training or the need for additional staff to cope
with the workload. I have little sympathy for those that consider dealing
with controlled drugs is “too much trouble”, that possible
mistakes in writing prescriptions by prescribers is a good reason not
to provide the service and those that group all under treatment as “drug
addicts” rather than considering each as an individual patient
requiring treatment.
This is a funded role that allows community pharmacists to develop their
practice with daily contact with a group of patients desperately in need
of health care. Do not reject it because of one or two problems. Sort
out the problems and provide the service!
Martin Bennett
Sheffield
A harm reduction exercise
From Mr P. J. Goddard, MRPharmS
Michael Hutchison (PJ, 6 March, p280) wants to stop needle exchange
services in community pharmacies. Let us remember that needle exchange
schemes are intended as harm reduction exercises. They reduce the spread
of AIDS and hepatitis within the drug misusing community and so limit
their spread to non-misusers (which includes us).
Phil Goddard
Hopton-on-Sea,
Norfolk
The natural place to advance public health
From Mr S. S. Kalsi, MRPharmS
I have followed the recent spate of letters on drug misusers and needles
exchange with some interest. It concerns me that at a time when pharmacy
is trying to get a foothold into “enhanced services”, some
of our colleagues are advocating throwing away what we already have.
Michael Hutchison’s letter in particular strikes a jarring note
(PJ, 6 March, p280).
Pharmacy is the natural place to advance public health, and needle exchange
is the finest example of this. The guiding principles of the service
are harm reduction and health promotion. Within our scheme we provide
sterile injection grade citric acid given the clinical detriment of using
lemon juice or cooking citric acid instead. At our latest training evening
for participating pharmacists and their staff, they were made acquainted
with the activities of drug misusers including “cooking” the
drug and injection sites. We did not do this to assist clients in their
activity but so that staff better understand the purpose of the service
when giving advice and also to safeguard our own people through good
practice and safety-first precautions.
Understanding the nature of the problem allows you to deal with the client
with greater knowledge and dispense sound advice, be it good injecting
practice or referral to the treatment agencies.
Surinder Singh Kalsi
Barking,
Essex
Create business plans to support new services
From Mr G. McCague, MRPharmS
I work daily with earnest, hard working pharmacists who are often inspired
by news features such as your “Smoking cessation” news
feature (PJ, 6 March, p286). Their enthusiasm then takes a battering when they
try to take things forward at their local primary care organisation,
which typically will ask for a justifiable business case.
Essentially pharmacists have (or can get) the skills to deliver new clinical
services, but usually lack the commercial acumen to create a business
case for it in the first instance. Conversely PCOs have the skills to
appraise business cases but, as lay managers, they lack the skills and
time to innovate and create pharmaceutical and clinical service models.
My role for the local pharmaceutical committee involves creating business
plans to support the introduction of such new services. The success of
the role has been remarkable because primary care trusts are now being
presented with business plans rather than wish-lists.
Gareth McCague
Cossington, Leicestershire
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Pharmaceutical Journal