independant pharmacy

[student]

Hi

I've applied for a pre-reg position at an independent pharmacy. I know the pharmacy deals with a majority of drug abuser patients.
What I would like to know is what I should be looking out for any particular important questions I may need to ask at interview.



Many Thanks



Student

[Shop Designer]

Ask what provisions are made for security and integrity of dispensing supplies of Methadone, Mmmmm,,,,, sugar free anyone or do you want original blend,,,, (sorry being flippant) I am sure a lot of the questions will be visibly answered re methameasure pump secure area etc, but it may be of value to understand if Subutex and Nx are done.
As you are aware the interaction times with Subutex are markedly longer than methadone and then with needle exchange a very high degree of unpredictablity occurs from patients.

It may also be of value to hint at how this dependancy regime affects script volumes as it is my direct experience that many Pharmacists see (or have seen) these programs as excellent ways to increase revenue then find script volumes decline sharply but visibly as many do not wish to be associated with the place that "junkies" go. not my opinion neccessarily just observations of real life thinking.

[johnep]

Believe the 'Wicker Pharmacy' is a model on how to deal with addicts. Was an article in the PJ.
johnep

[admin]

I have started and run a needle exchange scheme with a lot of drug users. I'd just add that I would ask you questions: -

1. What is your attitude to drug users?
2. Why do you think people become addicted to drugs?
3. Is the object always to make them quit drug use, or harm minimisation?
4. What health problems do this group of people often suffer with?
5. How can we help to reduce these health problems discussed in Q4

Hope this helps

[shan]

Not being sercastic but, ..... how much do we get paid by NHS for providing these services A LOTTTTTT. Sometimes, I feel we are the possibly the highest paid and well respected Bar Tenders (not my thought.....was once told by a locum during my pre-reg as a joke) His reasoning was he has been working in a pharmacy for the last 10 years as a locum and sharp 9.30am Mr. X comes in to have his dose of Methadone 60ml, which has never changed. Do we see this as a stable dose ?? or are we anyway helping him come out of the wrong habit he got in to for whatever reason ??? or was the locum right in saying the joke ??? Introspectively I think it's a mix of all but all these points mentioned by Admin will go in fumes or rather dissappear within no time the moment NHS stops paying for these services. Honestly how many can stand up and say they would provide this service for the betterment of these people even if they don't get paid ????????

Shan

[shan]

I have started and run a needle exchange scheme with a lot of drug users. I'd just add that I would ask you questions: -

1. What is your attitude to drug users? Same as for any other customer/ patient seeking pharmacy service
2. Why do you think people become addicted to drugs?Why should we think, when we are not allowed to either ask these questions or offer any advice without the person himself requesting for an advice. It is against law to ask them. All we need to do for a needle exchange is fill in those coloured forms with anonymous data where the person collecting can answer whatever he feels. ex. Name: P.R. Age: 35. What drugs do you take?: all of them. Has he/she returned used bins: No. Reason: forgot, will bring next time. .... Does any of this make any sense ???? there is no way we can even justify that the information given by the person is correct ad there is no way this data helps in anyway of reduction in drug abuse
3. Is the object always to make them quit drug use, or harm minimisation? Harm minimisation to whom??? Poor counter assistant has to stand there and fill the form herself so that she doesn't contract any disease from the person with so many open bleeding needle wounds, smelling awful. What about the needles that are thrown in a park or alleyway or on the streets, that can come in contact with any young ones ???
4. What health problems do this group of people often suffer with? Will it make this person get a job by knowing this ??? As if he is going to counsel the patient on his health. How many pharmacists really care or even ever seriously discuss this with their regular meth/needle exchange people. All we do is get them out of the pharmacy as quickly as possible and make necessary entries so we save our *** and get paid for it. End of the story.
5. How can we help to reduce these health problems discussed in Q4Answered in Q4

Hope this helps

Just some thoughts

[weeneldo]

I believe the reason for those questions was to investigate your attitudes towards and understanding of those patients that have substance misuse issues. Unfortunately during my time in pharmacy I have mainly just seen ignorance, nastiness and bitterness towards this group and a total lack of understanding. Bear in mind that they are people with feelings who are often in a state they never wanted to be in, having become dependent through using drugs to make the days go by easier for whatever reason. These are people who have grown up in a different world to ourselves. It may have been a world of abuse, it may have been a world without any hope or promise, it may have been a world of mental health struggles, but to judge them on their drug problem is to judge them on how they responded to what they have faced in their life. Most importantly, can you guarantee that if you had lived their life, you wouldn't have ended up down the same road? Chances are you don't even know the first thing about why they ended up on drugs, so how/why should we judge them on it? And its perfectly understandable that we only learn what patients feel ready and able to tell us. Some (especially the women) will have some pretty traumatic stories to tell and I really don't want to probe around that. We seem to expect so much more of them than other patients, but in all honesty, how many non-methadone patients frequently miss out on their medication, how many other patients have conditions that result from what they put into their own body (COPD, hyperlipidaemia, asbestosis, lung cancer, throat cancer, liver failure etc), how many other patients have poor personal hygeine and how many other patients are annoying or unpleasant? Methadone patients are just as much members of our society as anyone else, like it or not, and so we have a responsibility to protect their health just like any other member of our society. And if giving them methadone means they won't overdose, they can spend their days doing something other than stealing, scheming and finding smack, they won't get injecting site problems and they can achieve abstinence if that's the goal they want to achieve then we are doing our job. And if needle exchange means that blood borne viruses aren't spread through the IDU community and out to non-IDUs, that hospitals and paramedics aren't robbed for their equipment, that we don't have to later dress horrible abcesses, that we spend a little money on needles to save a fortune on anti-retrovirals and that we can get a little bit of education to the most chaotic of users (providing the pharmacy staff have a helpful attitude) then we are protecting some of society's most vulnerable members and thus society as a whole. Methadone patients aren't bad people, they're just people who have often suffered for a long time, please don't make them suffer anymore just to get the help they need.

[Shop Designer]

I believe the reason for those questions was to investigate your attitudes towards and understanding of those patients that have substance misuse issues. ,,,,,,,,,,

,,,,,Methadone patients aren't bad people, they're just people who have often suffered for a long time, please don't make them suffer anymore just to get the help they need.

What an insightful post, we must have met at some point as this feels very familiar

Your last sentence is very true to me also, in my travels I encounter addicts several it feels daily, I sense that they feel lesser people and are wary of interaction (some are not naturally but in the main) but a smile from me and a how are you crap weather type comment as I measure around them in seconds,,, literally seconds, has them disarmed and jovial. OK this is a shallow observation but they are people, victim to their own and societies weaknesses.
I am not a pharmacist but I never ever got the point of not weaning them off Methadone program's surely all it does is perpetuate the cycle with another equally hazardous drug?


Oh and as for Wicker, it is one of so many I know of in Newcastle London, Glasgow Edinburgh, all over to be frank that adapt and change to make patients feel more integrated but still safe.

[Tony Schofield]

I would be asking if you need Hep B vaccination before offering NEEDEX services in addition to what Elaine has said.

[Tony Schofield]

Mr. X comes in to have his dose of Methadone 60ml, which has never changed. Do we see this as a stable dose ?? or are we anyway helping him come out of the wrong habit he got in to for whatever reason ???

Shan

Average doses are between 60ml and 120ml and patients are regularly tested to see if they use illicit drugs as well, if they do the dose goes up so that they don't crave other drugs so yes this appears to be a stable dose.

The aim of treatment so far is not to get patients off their medication, it is to get them stable so that they can hopefully contribute to society rather than damage it with drug seeking behaviour. It has been very effective for many patients I know personally, one who has a responsible job including company BMW which allows him to take his family on holiday twice a year and service a £200k mortgage. He is currently on 50mg methadone daily.

The "recovery" agenda is looming and there is debate about whether a patient such as I have described can be deemed "recovered" (type 2 diabetics aren't expected to get off insulin but many could) or if they need to be drug free. If it is the latter we will get the same charade we currently have with smoking cessation where a patient is a "quitter" when they give up for 4 weeks. After that many just start smoking again, re-enter the treatment cycle and become another "success" for a commissioner somewhere to celebrate when they quit for another 4 weeks!