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Methadone-Ethical dilemma

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  • Methadone-Ethical dilemma

    Hi, just a quick question.

    Was working this morning, & our pharmacy closes at 1pm. Have always told our clients to make sure that they don't come too late to collect their methadone, and no later than 12:30. Two of the clients still hadn't come to collect their methadone at 1pm. As we were closing, their daily methadone was put back into the CD cabinet, and the keys in the safe, upstairs. My dispenser had already set the alarm for upstairs, and was just setting the alarm for the shop, for us to leave when one arrived knocking on the window.

    As it had gone 1pm, I just told him that we were closed, everything was locked away, and the alarms were set, I couldn't do anything. I was stood there outside the shop with the shutters coming down and him having a go at me, saying he'd have to go buy heroin now, and it would set him back, and that the other client was on her way, and that they'd been up the hospital all night etc.etc.

    Now I don't mind helping clients, and I try to be understanding. But I'd already told them once this week not to come in so late. And its not the first time they've arrived after we've closed.

    I just wanted to know what you all would have done. I feel a little bit guilty now that I hadn't gone back in & got their methadone.

    Sorry the post is a little long-winded!

  • #2
    Re: Methadone-Ethical dilemma

    Save your guilt. They entered an undertaking from the start and if they cant keep to it that's their lookout. I would be sceptical about any excuse especially if they have been late before and if they were at hospital they could have called. They'll know not to do it again.
    MUR

    Major Underestimation of Resources

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    • #3
      Re: Methadone-Ethical dilemma

      Originally posted by scarlet80 View Post
      I just wanted to know what you all would have done.
      Given them the address of a local needle exchange that would be open and also say that you will contact the DAT team on Monday and inform them that these clients have a problem picking up during your restricted opening hours on a Saturday morning and ask that future scripts be Monday to Friday.

      I try to keep contact numbers for addiction clients and then phone them an hour before closing time if they haven't already collected.

      Jeff

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      • #4
        Re: Methadone-Ethical dilemma

        The customer has the choice of whether to call during opening hours or not ! We are there to serve them, not nanny them ! If they choose to arrive late then go off to buy heroin it is their own choice not ours! They have to learn to take some responsibility for themselves!

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        • #5
          Re: Methadone-Ethical dilemma

          One would not mind making a few exceptions, but if it keeps happening like you're saying, then you can't keep closing five minutes late, next thing you know they might expect you to open 5 mins extra and and next thing you know they're turning up 10 mins late.
          We are the music makers, We are the dreamers of dreams and God damn we are that good

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          • #6
            Re: Methadone-Ethical dilemma

            I had a similar experience a few weeks ago. We were closing our shutters at 5.05pm (should have closed by 5pm) and someone came running up begging for her methadone. I wouldn't do it. I've had my long day from 9-5.. why should I stay back to measure out the methadone and supervise it?

            But then later I felt so bad thinking I might have turned the person back on drugs...

            could it come back to bite to say I didn't put patient care first?

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            • #7
              Re: Methadone-Ethical dilemma

              could it come back to bite to say I didn't put patient care first?
              Yes you did, by going about it the way you did, you made sure you would be refreshed and re-energise for the next day, so you could provide the best care you could.
              We are the music makers, We are the dreamers of dreams and God damn we are that good

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              • #8
                Re: Methadone-Ethical dilemma

                Originally posted by posey View Post
                could it come back to bite to say I didn't put patient care first?
                Here is another example, IMHO, where putting yourself first is in fact putting patients first. First of all, not all addicts are ready and suitable for methadone pickups: but those that are ready need some practice at keeping proper boundaries. This involves, amongst other things, working to set times and set protocols.

                I think its OK that you decide what the boundaries need to be, and are clear about them. Jeff's, for instance, are drawn differently to mine, I think! They can always go to another pharmacy if they don't like it.

                Secondly, if you bend or break the boundaries, then you are inviting aggressive and threatening behaviour. A number of people, when presented with someone who moves their own boundaries for whatever reason, will think that a bit of aggression will make you do it again. You are training them to be like that, if you like, if you bend your own boundaries.

                That's how I see it, anyway.
                Last edited by DavidS; 11, November 2008, 09:42 AM. Reason: obsessive correction of minor spelling mistake!
                ....just my opinion

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                • #9
                  Re: Methadone-Ethical dilemma

                  Originally posted by DavidS View Post
                  I think its OK that you decide what the boundaries need to be, and are clear about them. Jeff's, for instance, are drawn differently to mine, I think! They can always go to another pharmacy if they don't like it.
                  I think it depends in part on you patient group. I'm not dealing with 100 methadone clients a day (about a dozen at most)
                  Many are in shared cared rather than treated by the DAT team,

                  Secondly, if you bend or break the boundaries, then you are inviting aggressive and threatening behaviour. A number of people, when presented with someone who moves there own boundaries for whatever reason, will think that a bit of aggression will make you do it again. You are training them to be like that, if you like, if you bend your own boundaries.
                  I'll try to help with most requests - and I expect the clients to do the same.
                  There is an amount of flexibility. A request from me that clients come in early on Friday for whatever reason usually works.

                  Similarly if a client can't make it on Friday - I ask them to tell me ASAP so I can organise Thursday or Saturday pick-up.

                  I couldn't and wouldn't even try to make such a system work dealing with large numbers of clients.

                  Jeff

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