Methadone

[Linnear]

Can anyone out there explain to me the rationale of picking up Mon, Weds Friday but consume the day on the premises?

Are they trustworthy on Tues, Thurs, Sat and Sunday but not on Mon, Weds and Friday?

[Steve G]

And why, when just about every pharmacy is open on Saturday, do so many prescriptions specify collect Saturday and Sunday dose on Friday?

[Zoggite]

"My" shop was recently fitted with one of those posh "consultation rooms". Lovely it is, and nice and cool, especially in this heatwave we're having. Only problem is, to get to it, I still have to cross the shop floor past all the other customers, juggling with methadone tumblers and rinsing water... Discreet or what?!?

[Steve G]

I had a script on friday (15/9) for methadone, 36ml daily, dispense 252ml on 14/9 for a patient I know fairly well. What to do? Could I find the appropriate section in the MEP? No. So I phoned my former pre-reg tutor, who said that he had reduced the amount accordingly plenty of times in the past, so that was what I did (he also happens to be the professional services manager for the group I work for). I've now found the section in the MEP where it says about CD scripts being dispensed only in accordance with the prescribers directions (so I take this to read that I shouldn't have dispensed it).

What would others have done?

[admin]

I had a script on friday (15/9) for methadone, 36ml daily, dispense 252ml on 14/9 for a patient I know fairly well. What to do? Could I find the appropriate section in the MEP? No. So I phoned my former pre-reg tutor, who said that he had reduced the amount accordingly plenty of times in the past, so that was what I did (he also happens to be the professional services manager for the group I work for). I've now found the section in the MEP where it says about CD scripts being dispensed only in accordance with the prescribers directions (so I take this to read that I shouldn't have dispensed it).

What would others have done?

Steve

There was a Statt Comm case not too long ago where the pharmacist did exactly that. You are not supposed to take away one dose, and give the rest, unless the script says so. I tried to find it on the PJ web site but haven't - maybe someone else remembers it?

As I remember, the judge gave him only a reprimand, but said he was lucky.

I would have not given it, unless it said so on the script. I know that is a ridiculous thing to do, but I still think that's what you have to do. Some Dr's practices are getting stamps so you can dispense it if they miss the actual day, but if that's not on it I don't supply.

I must add that I personally think this is a ridiculous state of affairs. I have worked at places where somebody is getting their life back on track, at work, and paying for their scripts. To have to refuse to supply the rest of this persons methadone, if they are at work late etc and find the shop shut that night so therefore come the next day is just silly.

I am still more scared of the society then the patient, or the correct thing to do I'm sorry to say.

[Jeff]

I had a script on friday (15/9) for methadone, 36ml daily, dispense 252ml on 14/9 for a patient I know fairly well. What to do? Could I find the appropriate section in the MEP? No. So I phoned my former pre-reg tutor, who said that he had reduced the amount accordingly plenty of times in the past, so that was what I did (he also happens to be the professional services manager for the group I work for). I've now found the section in the MEP where it says about CD scripts being dispensed only in accordance with the prescribers directions (so I take this to read that I shouldn't have dispensed it).

What would others have done?

http://www.pjonline.com/Editorial/20...tatcomm.html#1

Stat comm took no action

"Giving the committee’s determination on 27 April, the chairman (Lord Fraser of Carmyllie, QC) said that if on 17 December 2004 Mr Bhaiji had dispensed 420ml of methadone, there could have been no complaint. However, what he did was to dispense a day later only 360ml of methadone, which might appear to be common sense when the expectation was that 60ml would be consumed daily.

The chairman said: “Instalment prescriptions, as this was, fall into a rather special category and, as we understand the law at the relevant time, … he should have declined altogether to provide any dispensing against that prescription for instalments if it was presented later than 17 December 2004. … That appears to us to be a startling absurdity and the government guidance now accords precisely with what Mr Bhaiji did, namely, that if the instalment prescription was presented a day later, he should cut out that missing day and otherwise dispense the prescription. That would appear to us to be not only common sense but it must be in the public interest.

The chairman said that the committee had concluded that Mr Bhaiji’s approach was so in accord with both common sense and what is now to be the legal requirement that there should be no further action."

So stop covering your ass and start looking after patients.

Jeff

[admin]

Jeff

I am not just covering my arse. Ok the pharmacist didn't get anything, but he will have had this hanging over his head for over a year!

He added: “Mr Bhaiji is fortunate that the law has moved in the direction in which he sensibly acted; it was, however, a brave decision. He might have been wrong and he could have suffered grave consequences. Pharmacists would be far better advised to communicate to the Society their concerns and invite the Society to advance their concerns. I can only say that that would appear to us to be the correct way forward.

I have phoned the society on this, and have been told by the ethics/law or whatever it department that I should not dispense it, unless it says I can do so on the script.

I also phoned my friend tonight who runs the 150+ methadone/needle ex shop and he agrees with me.

Sorry mate, but I have to protect this patient first. I can't help anyone if I'm struck off.

I find the "start looking after patients" a bit insulting Jeff. You know, as I have previously written about, I started up and ran a needle exchange scheme in a very dodgy part of town. I ran a first class service to those people, and had over 600 clients within six months. I even managed to keep the other (previously very worried) store holders happy.

I also kept the company happy, as they had their £10,000 back after only ten months, when they had expected a return after around three years. I used to have drug workers in there helping clients, family planning people, you name it. They were in my store giving advice directly to the people who wanted it and needed it most, in a private room at the back of the store. Crime in the area even went down and I was on local TV.

NONE of these things, or past history, or any good/great deeds you have previously done, will count for squat if they want to make an example of you. I know a lawyer (pharmacist too) who told me that over the years they had tried to analyse the verdicts the statt comm give out. He said there was no correlation to be found, and called it a roll of the dice. He said he honestly believed it could be done on the grounds of how they got out of bed that day.

Until dispensing methadone in this way is confirmed 100% by the society, then my advice is don't do it. My friend with all the addicts agrees with me that it is a sad state of affairs, especially when you know the person is really trying to get off drugs. He said he's even considered saying they had run out of methadone the previous day, make a CD entry stating they came to the store but no methadone was there, and then entering the rest of the weeks worth. He's decided against it, for obvious reasons.

He also told me about two local GP's who completely refuse to add to the script that the person can take the rest away. He says if you ring them because a client is trying to collect the rest of his prescription the next day, they tell you to tell the patient to come back next week. He's told me he has pointed out to these GP's that these people cannot last a week without methadone, and will almost certainly start robbing etc. This would probably end up with people being hurt (physically or emotionally) and the patient losing their job. They still refuse to give permission for the rest to be dispensed. So do you then go against the prescribers wishes? Where is their duty of care in an example like this? Why are some Dr's getting stamps/writing on scripts that the balance can be given if it's not picked up on the first dispensing day if it doesn't matter?

Sorry, but it's sailing too close to the wind for me.

[Jeff]

I find the "start looking after patients" a bit insulting Jeff.

My apologies - no insult intented - it was meant to be encouragement.

Jeff

[admin]

My apologies - no insult intented - it was meant to be encouragement.

Jeff

Ok I forgive you.

[admin]

I'd just like to add to the statt comm debate that I know of a case, and the outcome of which makes me wonder if "it's not what you know, but who".

A guy I know has been before it twice. He owned two pharmacies, and was known in the area for buying out of date drugs from other pharmacies, and re-packaging them. He had his "special" room upstairs, and the staff that are left there (he's since sold up) tell me horrendous things went on.

The last time he went before the committee, it was again for this kind of thing - re-using returned drugs, using out of date stock, removing used by dates and batch numbers - things of that nature. The 2nd time he got another reprimand, and the only comments reported in the PJ that stick in my mind was that he had a good set of references.

One of my pharmacist friends tells me somebody has just been struck off for doing just about the same thing, and this was their first visit to the Statt Comm, not their second.

It makes you wonder.