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Dispensing Methadone Oral Solution against a Rx for SF

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  • Dispensing Methadone Oral Solution against a Rx for SF

    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.

  • #2
    Re: Dispensing Methadone Oral Solution against a Rx for SF

    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...
    Ze genuine Article, present & perfect!

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    • #3
      Re: Dispensing Methadone Oral Solution against a Rx for SF

      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............
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      • #4
        Re: Dispensing Methadone Oral Solution against a Rx for SF

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

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        • #5
          Re: Dispensing Methadone Oral Solution against a Rx for SF

          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.

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          • #6
            Re: Dispensing Methadone Oral Solution against a Rx for SF

            Originally posted by razorbladekisses View Post
            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

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            • #7
              Re: Dispensing Methadone Oral Solution against a Rx for SF

              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..?
              Titch

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              • #8
                Re: Dispensing Methadone Oral Solution against a Rx for SF

                Originally posted by Titch View Post
                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

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                • #9
                  Re: Dispensing Methadone Oral Solution against a Rx for SF

                  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.

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                  • #10
                    Re: Dispensing Methadone Oral Solution against a Rx for SF

                    Originally posted by paco View Post
                    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
                    ....just my opinion

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                    • #11
                      Re: Dispensing Methadone Oral Solution against a Rx for SF

                      Oh! yesterday we ran out of ordinary methadone and in the end had to top up with a few mls of sugar free. Had one addict wanting 420mls, he agreed to come in after the pm delivery. Noticed several bottles of OD martindale brand in the cupd. Surely this could have been 'worked off' with physeptone over a period before it went OD.

                      Oh Bliss, working in addict free branch on Monday.
                      johnep

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                      • #12
                        Re: Dispensing Methadone Oral Solution against a Rx for SF

                        how do we register this supply? i think under both SF and normal methadone registeries? and probably leave a note at the end of the page to record what was done.
                        [COLOR=Olive]xxxx They tried to break my back, but i survived. whatever doesn't kill you, will only makes you stronger xxxx
                        [/COLOR]

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                        • #13
                          Re: Dispensing Methadone Oral Solution against a Rx for SF

                          I've also "heard", haven't research the topic properly but, sugar free methadone should not be dispensed for or in place of sugared methadone, for "non-supervised" methadone addicts, one of the reasons is that sugarfree methadone is injectable and has more potential for abuse.

                          anyone else heard of this?
                          [URL="http://www.pharmacyknowledge.co.uk"]www.pharmacyknowledge.co.uk[/URL] A guide for preregistration students [URL="http://www.pharmacyknowledge.co.uk"]Pharmacy Exam[/URL]

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                          • #14
                            Re: Dispensing Methadone Oral Solution against a Rx for SF

                            Originally posted by gamhulcol View Post
                            I've also "heard", haven't research the topic properly but, sugar free methadone should not be dispensed for or in place of sugared methadone, for "non-supervised" methadone addicts, one of the reasons is that sugarfree methadone is injectable and has more potential for abuse.

                            anyone else heard of this?
                            Yes, and its true as far as I'm aware, at least the addicts seem to believe it and they'll inject almost anything, poor loves.

                            Originally posted by Ray View Post
                            how do we register this supply? i think under both SF and normal methadone registeries? and probably leave a note at the end of the page to record what was done.
                            Well, that sounds the best way to me. But doesn't the whole business just pointout what a vital job Dame Janet and the RBSGB have done in making sure that no patients are inadvertantly wiped out by an incorrect register entry [missing an ironic smiley here].
                            ....just my opinion

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                            • #15
                              Re: Dispensing Methadone Oral Solution against a Rx for SF

                              Sugar...now you can't sleep at nights because you dispensed.....SUGAR??

                              Please..Please explain the problem here..I was unaware sugar is so strictly controlled. The addicts claim sugared meth rots their teeth..their teeth were rotten anyway.

                              Dispensed methadone is seldom injected.. it is sold on.
                              Last edited by Fleegle; 6, July 2008, 12:02 AM.
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                              http://youtube.com/watch?v=rnT7nYbCSvM

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