6. Controlled Drugs-Instalments PDF

Preview

Summary

mph209 law lectures...

Description

Controlled Drugs - Instalment prescriptions Addiction A person is regarded to be addicted to a drug if ' she/he as a result of repeated administration, became so dependent on a drug that she/he has an overpowering desire for the administration of it to be continued' - physical dependence, psychological dependence or tolerance. What can be prescribed to treat addiction?   

Blue FP10MDA prescription form - used for instalment prescribing by drug treatment centres and GPs in England Schedule 2 CD - maximum of 14 days can be supplied, buprenorphine and diazepam prescribed for addiction No doctor can administer/authorise the supply of cocaine, diamorphine or dipipanone (or its salts) to an addicted person - UNLESS it is for the treatment of organic injury or disease, or licensed by the secretary of state

FP10MDA prescription requirements The prescription follow the same legal requirements for any CD prescription but must ALSO include an 'instalment direction':  

Amount of medicine per instalment Interval between each instalment

Rx must also include:    

Instalment amount and dose are specified separately on Rx - legal requirement Marked with each date of dispensing If a start date is specified - it must be complied with and instalment directions must run from that date Certain approved wording - not a legal requirement

Methadone It is metabolised slowly and is quite lipophillic therefore has a half life of ~22 hours.   

Given ONCE daily Available forms: Liquid, Tablet and Injection Care needed with liquid form:  Methadone oral solution 1mg/mL  Methadone oral solution sugar free 1mg/mL  Methadone linctus 2mg/5mL  Methadone oral concentrate10mg/mL  Methadone oral concentrate 20mg/mL

Buprenorohine (Subutex®) It is an opioid partial agonist - can be used as substitution therapy for moderate opioid dependence patients but for patients with high dose opioid dependence it can be used to precipitate withdrawal. 

'Patients who have not undergone opioid withdrawal, buprenorphine should be given at least 4 hourse after the last use of opioid or when signs of withdrawal appear. In patients receiving

methadone, the dose of methadone should be reduced to maximum 30mg daily before starting buprenorphine'- BNF Crushing Subutex® Why crushing might be needed: 

Pharmacists are sometimes required to supervise Subutex administration to prevent the patient from selling unused products to other drug misusers It has a long dissolution time (up to 10 minutes) - has implications for patient and the supervising pharmacist Crushing the tablet is outside the manufacturers marketing authority as it will make the product unlicensed - therefore pharmacist may assume it is appropriate to crush it themselves ensuring they are covered by their indemnity insurance to do so.

 

RPS guidance of crushing buprenorphine:    

Pharmacist needs to be satisfied it is in the best interest of the patient as there is a potential for products bioavailability to be distorted The prescriber and patient should agree to crushing the tablets before administration The patient should be informed of the risks and benefits of crushing Any crushing of buprenorphine should be for the benefit of the patient, rather than the convenience of the pharmacist

Supervising Subutex®      

Remove any chewing gum/sweets from mouth and dispose in a waste bin Give a drink of water - speeds up the dissolution process Tablets are crushed with pestle and mortar- if the prescriber requests this Tablets/crushed tablets are poured into a measure Patient is expected to tip the medication under the tongue without touching them Patient is expected to sit down (supervised) until the medication has dissolved

Collection by a person's representative  

Good practise - to obtain a letter of authorisation from the patient on every occasion that the representative collects the medicine and the letter should be retained in the pharmacy The prescription does not need to state that the medication can be collected by a third party

Paid prescriptions  

Patient should pay for each item they receive if they are not exempt from NHS prescription charges For FP10MDA prescriptions - only ONE charge is paid per drug ordered (not for each instalment collected)

Missed dose by patient  



If a patient misses a dose - prescriber should be aware of this If a patient misses 3 consecutive doses - the prescription is generally stopped and patient is reassessed - the patient generally needs to be titrated back up to their 'optimum' dose as there will be a change in tolerance for it If a patient misses a dose and turns up on another day - approved wording on Rx allows for a supply

Home Office says:   



Missed doses for supervised consumption: The amount prescribed can be supplied the following day, but the dose missed cannot be supplied Missed doses for unsupervised consumption: The amount prescribed can be supplied the following day, but the dose missed cannot be supplied If no more than 3 days have been missed: The amount prescribed can be supplied the following day, but the doses missed cannot be supplied provided that no more that 3 days are missed If the pharmacy is closed: Instalments due should be dispensed on the day immediately prior to closure

Dispensing in daily dose bottle   

Some patients collect for more than one day's dose at a time - dose separated in bottles NHS National Treatment Agency for Substance Misuse - Patient safety issue (overdosing/underdosing) To prevent any other risks - some patients have been known to use baby's bottles to measure doses (if residual is left in bottle it can kill the baby-as little as 5mL)

Practice guidance        

A contract should be made between the patient and the pharmacy An identification (e.g. photo) should be obtained of patient Clients should be treated with courtesy and respect All the quantities should be double checked Daily doses should be prepared in advance to prevent delays when the patient arrives If the dose is supervised, ensure the patient drinks and swallows the dose Pharmacy cannot deviate from the instruction given on Rx Sugar-free/colour-free products have more potential for abuse than syrup based and coloured products - must not be dispensed unless specifically prescribed...