Community pharmacy the silent member of the AOD team

1
Community pharmacy the silent member of the AOD
team

• Pauline Clarke
• Tina Goodman
• Peter Muhleisen
• Suzi Nielsen

2
Goal of the workshop

• Given the majority of pharmacotherapy clients are
  dispensed in community pharmacy, and the majority
  of pharmacists are not specialist AOD
  professionals, how can community pharmacy be
  better integrated with AOD to achieve better
  client outcomes?

3
Opioid Substitution Treatment (OST) in Victoria

• 10 735 on methadone or buprenorphine
• 10 200 dosed in community pharmacy
• 1996 community methadone evaluation 4000
  treatment places
• Specialist Pharmacotherapy Clinics
• Dose about 200 clients
• Referral for more complex/ high need clients

4
Community methadone and buprenorphine

• 95 of methadone and buprenorphine is dispensed
  in community pharmacy in Victoria
• 63 of all contacts with clients in the service
  system review were with community pharmacists
• How many pharmacists attend conferences like this?

5
Advantages of community pharmacy OST

• Accessibility- number and locality of providers
  (gt400)
• Less waiting for treatment, depending on areas
• More choice of providers
• Limits congregation of clients
• Embedded in generalist health setting
• Less stigma for premises
• Personalised treatment
• No government funding
• advantage for government

6
Disadvantages of community pharmacy OST

• Not specialists
• Not trained to deal with difficult presentations
• Potential inconsistency
• Potential client stigma
• Separation from rest of treatment team
• Private businesses
• Potential effect on other clientele
• Client funded

7
Recent research Suzi Nielsen

• 282 Meth/Bup pharmacies participated in mail out
  survey (76 response)
• Buprenorphine diversion was identified as a key
  issue
• 12 pharmacies indicated as a result they would no
  longer offer buprenorphine, others seemed
  disillusioned
• Need more support for pharmacies around key
  issues
• Could utilise pharmacist to educate clients about
  harms associated with bup injection

8
Sequelae of Bup injection
Picture SHARPS Frankston
9
Community pharmacists

• Appreciate
• Support with difficult clients
• Communication
• Involvement in treatment plan
• Dislike
• Being the defacto case manager
• Being ignored
• Being stuck with difficult clients

10
The OST treatment team
Client Prescriber Pharmacist
Counsellor/ Case mgr
11
A good treatment team will

• Talk
• Think
• Care
• Look out for
• Clients best interest
• Potential problems
• Have a treatment plan

12
Treatment plan is for

• the team - which includes, and is for, the
  client.
•  
• each member of the treatment team.
• communication, which ensures that safe and
  supportive treatment is provided to the client.
•  

13
Treatment plan includes

• .details of treatment and of an agreed response
  to certain situations, eg
•     details of medication schedule ..
•      takeaway doses available/not available if
  ..
•      response to intoxication
•     response to mental health concerns ..
•     response to behavioural problems .
• and should include Client consent

14
Treatment plan includes

• Client Fred SMITH
• 1 Smith Rd,Smithville Ph .
• Prescribing doctor Dr Mary BROWN
• 3 Brown Rd, Browntown Ph
• Dispensing pharmacy East West Pharmacy
• Bill BLOGGS
• Railway Av,Railtown Ph
• Specialist agency 1 Central Alcohol and Drug
  Service
• Case manager
• Tom JONES Ph ...
• Other  eg Mental Health Service doctor and case
  manager

15
Case example - 1

• 34yo woman, in first pregnancy, using diverted
  buprenorphine daily heroin 2 times/week
• Commenced OST with SPS, community pharmacy, RWH
  womens AD service
• Episode of concern pharmacists response
• Team response .

16
Case example - 2

• 46yo man, client of SPS
• long history of polydrug use, schizophrenia,
  chronic pain, gambling relship problems,
  impulsive behaviour
• On methadone episodic instability, seeking meds
  from GPs
• Pharmacists response .
• Team response .