Misuse of Drugs Act 4

Question 0

Dependance is…

Answer 0

A cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance takes on a much higher priority for a given individual than other behaviours that once had greater value. A central descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take psychoactive drugs, alcohol, or tobacco. There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals.

Question 1

Main prescribed pharmacological treatment for addiction: (4)

Answer 1

Opiate substitution
Opiate withdrawal symptom relief
Alcohol treatments
Tobacco substitution

Question 2

Main opiate substitutions. (3)

Answer 2

Methadone
Buprenorphine (eg. Subutex)
Diamorphine

Question 3

Proscribed treatment for addiction is also assisted by other interventions:

Answer 3

Psychological support and interventions, eg. CBT.
Behavioural change
Lifestyle change
Social change

Question 4

Other roles of the pharmacist in the lives of drug dependent patients.

Answer 4

Needle exchange (and harm reduction advice - signposting to treatment)
Support in treatment - daily contact.
Involvement in shared care with prescribers, care workers.
OTC advice - does this affect urine tests?
General lifestyle advice
Minor allotment schemes
Naloxone supply (counters effect of opioids OD)
Hep B vaccinations
Hep C and HIV screening
Prescribing

Question 5

How does opiate substitution therapy (OST) work. Common example?

Answer 5

Methadone or buprenorphine replacing heroin.
Longer t1/2, once daily dose.
Maintain adequate dose has best outcomes. Role for detox of patient but they need to be ready and use no pharmacological interventions to maximise outcome.

FORCED DETOXIFICATION DOES NOT WORK.

Question 6

How does instalment prescribing and supervised consumption help society?

Answer 6

Prevents leachate of drugs into black market and accidental overdose (eg. Teenager finding drug and taking it)

Question 7

How long are patients supervised for?

Answer 7

Three months recommended but not a legal requirement, use your judgment.

Question 8

What is the primary aim or OST?

Answer 8

Retention in treatment… Keep patient coming back.

This facilitates other outcomes.

Question 9

Who can prescribe CDs to drug dependant people? For treatment of organic disease. Eg. Broken leg, cancer etc.

Answer 9

And prescriber can prescribe CDs for organic disease treatment (eg. Broken leg)

Question 10

Dr require adding to the DH list to prescribe ….. (3) …. For addiction treatment

Answer 10

Diamorphine, cocaine, dipipanone.

Question 11

Any doctor can prescribe … (2) for the management of dependance without the need for a licence?

Answer 11

Methadone and buprenorphine.

Question 12

Can pharmacist and nurse independent prescribers prescribe CDs for addiction?

Answer 12

Yes - except for diamorphine, cocaine and dipipanone ( they cannot get onto the DH list to prescribe these).

Question 13

What script do we write instalments for drug dependance on?

Answer 13

Can prescribe to treat dependance on FP10 but instalments must be on FP10MDA (blue) or you won’t get paid.

Question 14

What CDs for the treatment of addiction can be prescribed in instalments? (2)

Answer 14

Buprenorphine and diazepam.

Other drugs are still on FP10MDA but not in instalments.

Question 15

Maximum number of days supply on FP10MDA?

Answer 15

14

Question 16

With instalment dispensing how many dispensing fees are you paid?

Answer 16

One for each instalment.

Question 17

When supplying dry powder ampules what can you also provide and claim for from NHS even if it’s not on the script?

Answer 17

Water for injection.

Should automatically provide!

Question 18

Are ‘repeat’ Rxs allowed for CDs?

Answer 18

No. Not schedule 2&3.

Question 19

To prescribe in instalments what paper do we use?

Answer 19

FP10PCD or FP10MDA for schedule 2&3

Normal paper for 4&5

Question 20

How does the 28 day rule for CDs work with instalments?

Answer 20

Must dispense first instalment with one 28 days.

There is no legal requirement for the start date of instalments to be specified but if it is there you must comply with it.

Question 21

If the name of the pharmacy is stated on the Rx can you dispense it elsewhere?

Answer 21

Yes. It’s not illegal. But you. Should probably check with le doctor.

Question 22

What information do you need for instalments?

Answer 22

Quantity of each instalment and interval between them.
You also need the dose, even if it’s the same.

‘90mls to be taken once a day, dispense 90mls daily’

Question 23

What is written on Rx to cover bank holidays?

Answer 23

Dispense 180ml on Saturday to cover Sunday’
SAFE BET: ‘Instalments due on days when pharmacy is closed should be dispensed on the day immediately prior to closure’

‘Cover when closed’ is not technically acceptable.

Question 24

Is it a legal requirement for the total number of instalments to be stated?

Answer 24

No

Question 25

If collection is missed mark blue form with...

Answer 25

ND. (Not dispenced)

Question 26

Item level fee is paid to pharmacist for dispensing for what drug?

Answer 26

Methadone | £4.p5 per Rx. No need to claim for it.

Question 27

Supervised consumption is paid by the

Answer 27

PCT

Question 28

For a CD Rx pharmacists get paid

Answer 28

Ingredient cost Professional fee CD fee for schedules 2&3 Container allowance per instalment

Question 29

How many doses can be missed before you have to stop giving the patient the medication?

Answer 29

If 3 or more opiate doses in a row are missed there may be loss of tolerance to prescribed dose. You should not dispense any more medication before referring to the prescriber for guidance. Five or more missed doses may require complete re-titration of the dose.

Question 30

If a dose is missed what can you give

Answer 30

The remained of the instalments but not the missed dose. Providing correct wording is present. 'Instalment prescriptions covering more than one day should be collected on the specified day; if this collection is missed the remainder of the instalment (i.e. the instalment les the amount prescribed for the day(s) missed) may be supplied’

Question 31

Supervised consumption is recommended for...

Answer 31

Three months. But this is not a legal requirement. Generally used at the discretion of the prescriber.

Question 32

Problems with the supervised consumption service?

Answer 32

Patients may find it degrading humiliating and a barrier to treatment. Always respect privacy and offer a private consultation room.

Question 33

If supervised consumption is written on the Rx you should... | Do you need the Rx amended?

Answer 33

Supervise or if not possible consult prescriber before supply. You would not need to amend the Rx but you should document the reason. Eg. Patient in police custody. Consider the implications of not supplying - illicit drug use and associated risks to health and crime.

Question 34

Take away doses recommended after three months. Who can collect?

Answer 34

Patient or representative (should ID or be known to you - generally introduced by patient). Recommended but not legally required to have a written note on collection. Make it a group rule in the pharmacy ;)

Question 35

Pharmacists can provide what equipment used in the preparation of illicit drugs? (5)

Answer 35

``` Swabs Cookers (preparation vessels) Citric acid (acids are used to convert bases into soluble forms) Ascorbic acid Filters ```

Question 36

Why do pharmacists supply equipment?

Answer 36

Reduce the risk of blood born virus transmission. Eg. HIV and hepatitis C

Question 37

Who can supply sterile water? | Max volume?

Answer 37

If pharmacist is engaged in lawful drug treatment (eg. Needle exchange scheme) can supply strike water. Max 2ml. If not in scheme pharmacist can only supply WFI from Rx or PGD. Not OTC. CANNOT MAKE A PROFIT!

Question 38

Base decisions on clinical need, legal requirements, code of ethics, confidentiality, harm reduction and common sense. Do not be afraid. If in doubt, seek advice from GPhC Professional Standards Department or PSNC or NPA if member

Answer 38

.