The Pharmacist September/October 2018 - Page 26

YOUR PHARMACY Tips for running a supervised consumption service orraine Maden, lead clinical pharmacist for the mental health, drug and alcohol charity Addaction, is passionate about the role of community pharmacy in substance misuse. ‘Pharmacists have so much to off er and are the healthcare professionals who have most contact and potential impact with substance misuse service clients,’ she says. But she believes that in general, more could be done to help pharmacists better understand substance misuse services. ‘The more we can do to educate, the greater the benefi t to all involved,’ she says. Her work involves supporting substance misuse services, including supervised L 26 | The Pharmacist | September/October 2018 consumption services, from setting them up to dealing with ongoing day-to-day clinical queries. Supervised consumption services are commissioned by public health departments, local councils or via agencies such as Addaction. Assessing the situation Ms Maden explains that when a client is referred to this service, they should initially have a detailed assessment with an assigned recovery worker who will then give them ongoing support with the psychosocial element of their recovery and may need to assist with longer term support, such as addressing housing needs or employment training. Clients then see a prescriber to discuss initiation on prescribed treatment if this is indicated. She says one of the aims of this service is to provide an ‘extra layer of safety for new clients’, who are starting prescriptions to replace heroin and other opioids, using substances such as methadone or buprenorphine. Initial transfer to oral substitution therapy (OST), for example, ‘has the potential risk of respiratory depression, which can be fatal if titration isn’t undertaken safely’, she says. Pharmacists should be trained to monitor for signs of concern and toxicity, she advises. ‘If any dose is missed during the titration period or the person is intoxicated, a prescriber must be consulted.’ Looking out for the ‘danger zone’ After initial stabilisation, tolerance can rapidly be lost and ‘we can enter the danger zone again after three missed doses,’ she says. So even if a client has been stable and collecting for some time, if they miss over a bank holiday Monday, then restart on the Tuesday on the usual dose this ‘could lead to overdose’, she says. Another service aim is to minimise misuse by both increasing adherence and reducing the likelihood of supplies leaking into the illicit market, Ms Maden explains. Clients may be re-referred for supervised consumption if, say, collections are erratic, there is concern that the prescribed drug is being diverted or used inappropriately, there are safeguarding concerns or the client shows a continued and unstable pattern of misuse. Knowing your role in supervised consumption Anna Ruthven, national healthcare development manager for commissioned services at LloydsPharmacy’s parent company Celesio, says most service specifi cations require pharmacists to supervise the consumption, but some may allow other trained members of the pharmacy team to deliver the service. ‘In this case, the