Dispensing Methadone Oral Solution against a Rx for SF

[razorbladekisses]

Last week (Fri.) we ran out of Methadone SF 1mg/1ml. The locum on duty gave ordinary Methadone instead. When my manager returned she was shocked that this had happened and didn't think it was allowed. She telephoned the NPA who said it was OK. She then telephoned someone else, not quite sure who, who said legally it was fine but ethically it wasn't.

Can anyone tell me for sure if it is/isn't allowed.

[Zoggite]

This is the only reference I could find, it's from the PSNC's "dispensing Resources" booklet, page 35:
"Sugar Free Medicines
The Code of Ethics states that 'Except in an
emergency, pharmacists must not substitute
any other product for a specifically named
product without the approval of the patient or
carer and the prescriber' and under the NHS
Terms of Service, a chemist is required to
supply the drugs ordered with reasonable
promptness.
The RPSGB have confirmed that when a
prescriber does not specify 'sugar free' and a
pharmacist supplies a sugar free medicine
then this would not be in breach of the Code
of Ethics.
However if a sugar free formulation has been
prescribed, then the pharmacist should supply
this, other than in exceptional circumstances.
The exception to this would be when a
Schedule 2 and 3 Controlled Drug has been
prescribed, as the Code of Ethics Service
Specification 19 (Services to Drug Misusers)
states that a pharmacist must not deviate from
the instructions given on the prescription and
sugar free/colour-free preparation must not be
dispensed unless specifically prescribed.Pharmacists should endorse the prescription
appropriately. The pharmacy will be
reimbursed based on the prescribed product
with the normal reimbursement rules applied."

Is that any help? it's probably one of those situations again where it's not illegal to supply non-SF methadone, but it's considered to be "best practice" to do so, rather than let the patient go without altogether? "Patient's best interest", etc...etc...

[admin]

I always thought that except in emergencies you should not exchange the two. The two registers won't add up will they - unless you make notes in them.

This is ok on the odd occasion, but not on a regular basis - I know you didn't say it happened more then once............

[razorbladekisses]

Thanks for finding that info. It does make a little more sense now.

[razorbladekisses]

The locum pharmacist on duty that day did telephone the superintendent pharmacist to ask a question about the register and he was made aware that the pharmacist was dispensing non-SF against a Rx for SF. He didn't say no, you shouldn't be doing that, so assumed it was OK.

It's never happened before. We always have SF Methadone in stock but on that particular day the AM order with Methadone on was not sent.

Hopefully it won't happen again.

[Jeff]

The locum pharmacist on duty that day did telephone the superintendent pharmacist to ask a question about the register and he was made aware that the pharmacist was dispensing non-SF against a Rx for SF. He didn't say no, you shouldn't be doing that, so assumed it was OK.

It's never happened before. We always have SF Methadone in stock but on that particular day the AM order with Methadone on was not sent.

Hopefully it won't happen again.

The only thing I might have done differently to your locum would have been to report the incident to both the prescribers and the NPSA.

Jeff

[Titch]

It is advised by the RPSGB that the two are not substituted for each other.

PJ Online | Law and ethics | Substitution of colourless and/or sugar-free methadone mixture

I think the rationale behind it is that the prescriber must specify the form for a CD script and "mixture" & "SF mixture" are classed as two different forms.

Pedantic - maybe..?

[Jeff]

It is advised by the RPSGB that the two are not substituted for each other.

PJ Online | Law and ethics | Substitution of colourless and/or sugar-free methadone mixture

I think the rationale behind it is that the prescriber must specify the form for a CD script and "mixture" & "SF mixture" are classed as two different forms.

Pedantic - maybe..?

As said many times before - if you want a reason not to do something - ask the RPSGB - if want want a reason to do something ask the NPA.

The RPSGB and the NTA orange book (the guidelines for addiction treatment) can't even agree on what constitutes a properly written CD script.

Jeff

[paco]

Whilst in an emergency you do have the discretion to supply regular or SF. Remember addicts do prefer SF as it is easier to inject.

[DavidS]

Whilst in an emergency you do have the discretion to supply regular or SF. Remember addicts do prefer SF as it is easier to inject.

Don't you have the option to contact the prescriber - or the caseworker, more likely - and tell them the difficulty, and ask them what they suggest? I bet they will authorise you to give plain mixture, and to write on the script "or with sugar if that's all available."

I do hope that doesn't upset anyone