Treating Substance Misuse in Pharmacies The Sheffield Experience

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Treating Substance Misuse in Pharmacies The
Sheffield Experience

• Martin Bennett - February 2007
• National Conference Choosing Health Through
  Pharmacy Implementation

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Background 1

• Martin Bennett
• qualified 1970
• MD of Associated Chemists (Wicker) Ltd
• Sheffield
• Industrial city with areas of deprivation
• 600,000 population
• 113 Community Pharmacies (including 5 recently
  opened 100 Hour pharmacies!)

Sheffield
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Wicker Pharmacy home!
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Background 2

• Associated Chemists (Wicker) Ltd
• Formed in 1951 - owned by a consortium of 45
  local independent pharmacists.
• Aims
• To provide an extended hours pharmacy
• To act as a centre of excellence and to be at
  the forefront of pharmacy development

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Background 3.

• Currently 28 pharmacist shareholders
• MD since 1973
• Also Secretary of Sheffield Local Pharmaceutical
  Committee until this year.
• Development of a Hub and Spoke method of
  support from the central late night pharmacy for
  peripheral pharmacies over the years
• Stock, oxygen , trusses, mobility products,
  research, extemporaneous dispensing, palliative
  care

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Treating Drug Users in Sheffield in 1998

• Long waiting lists for treatment for drug
  addiction.
• Approximately 250 people being treated
• High level of drug deaths 38
• High level of crime related to drug use.
• Reluctance of majority of GPs to prescribe
• Reluctance of majority of community pharmacists
  to become involved only around 6 pharmacies
  providing a service.

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Treating Drug Users in Sheffield in 2006

• Short waiting lists for treatment - pharmacists
  able to directly refer patients to clinics.
• Approximately 1600 patients being treated
• Drug deaths reduced by over 50 despite 6 times
  the volume of methadone being dispensed.
• Reduction in crime related to drug use (by 70).
• Over 1000 patients being prescribed by primary
  care GPs
• 78 community pharmacies providing a supervised
  consumption service.

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How was this achieved?

• From the pharmacy perspective
• Need to give prescribers the confidence to
  prescribe clinically effective doses of
  methadone safely - pharmacy supervised
  consumption service linked to feedback was
  developed.
• There was also a need to nurture the pharmacy
  based needle exchange scheme which had been
  introduced in the late 80s and then allowed to
  whither.

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Co-ordinated Pharmacy Services for Drug Users
(CPSDU) 1.

• Health Authority requested expressions of
  interest / tender to devise a service to include.
  
• Fixed budget
• Need for staff training
• Service to be co-ordinated across the city
  involving many of the previously reluctant
  pharmacists.
• Associated Chemists (Wicker) Ltd was awarded the
  contract with myself as co-ordinator.

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CPSDU - 2

• How did we do it?
• Shared Care Concept
• Initial stabilisation at the central pharmacy
• When stable place with a local pharmacy
• Agreement to take back the patient should there
  be any problems.
• Help with unacceptable behaviour devised a
  red/yellow card scheme
• Provision of feed back forms, wallets , leaflets.
• Prompt adequate payment
• Scheme to cover ALL patients being treated not
  just supervised.
• Regular meetings to provide training for ALL
  pharmacy staff
• Joint meeting with Sheffield GPs treating Drug
  Addiction
• Monthly newsletter At the Sharp End
• Central support from myself and staff at the
  Wicker Pharmacy

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CPSDU - 3

• Funding increased from around 60k in first year
  to almost 300k this year as part of an SLA
• Treating over 1600 patients (including around 25
  taking Subutex)
• Regular meetings with DAAT
• Member of Shared Care Monitoring Group
• Daily conversations with prescribers
• A central resource for pharmacists to contact.

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CPSDU - 4

• Provision of grants towards
• Private consultation areas
• CCTV / recording
• Increase CD storage
• Training - Royal College of General Practitioners
  Certificate in the Management of Drug Misuse Part
  2 - Two pharmacists (including myself) have
  completed this and a third has just commenced.

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CPSDU - 5

• Current situation in Sheffield
• 1600 patients in treatment with methadone and
  subutex all with feedback to prescribers
• 60 are receiving medication supervised
  providing major benefits in retention in
  treatment.
• 1500 people use the pharmacy based needle
  exchange scheme resulting in around 3,000
  transaction per month.
• A service is available 365 days per year and
  until 10pm (8pm Sundays)
• Minor Ailments Scheme applies.
• Emergency Hormonal Contraception applies

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Improved facilities separate entrance to drug
treatment area
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Privacy
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Harm minimisation messages
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Dedicated Drug Treatment Area
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Future Roles

• Patient focused
• Support encouragement during daily contact
• Prescribing supplementary / independent
• Diagnostic testing
• Counselling
• Provision of information training to patients
• Support to prescribers
• Support to other pharmacies.
• Supervised injecting rooms
• Depends on adequate funding from all sources

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The future prescribing and testing?
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The future patient focused?
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Any questions?
Martin Bennett, Associated Chemists (Wicker)
Ltd, Wicker Pharmacy, 55-67 Wicker, Sheffield S3
8HT Tel [phone] For more info see
http//www.wicker.co.uk/pharmacy/drug.htm
or www.sheffieldlpc.co.uk Email
martin_at_wicker.co.uk