How 56 community pharmacies helped to eradicate hepatitis C

 

In response to the following article:

 

“Community pharmacy key to hepatitis C eradication in Tayside”

 

Dear PIP Editor,

 

56 community pharmacies across three Scottish Health Boards from Tayside, Grampian, Greater Glasgow and Clyde, took part in the evaluation of a community pharmacy pathway.

 

The community pharmacies invited people attending their pharmacies and who were prescribed opioid substitution therapy to take a test for Hepatitis C, Hepatitis B and HIV.

 

The pharmacists diagnosed on-going Hepatitis C infection using a PCR test and reviewed of a panel of blood tests including liver function tests. They performed a liver fibrosis risk assessment test (FiB-4) from these test results and determined whether the patients could start treatment.

 

Prescriptions for the direct-acting antiviral medicines were either written by independent pharmacist prescribers or provided using a Patient Group Direction. The pharmacies then administered the treatment each day alongside the patient’s methadone or buprenorphine prescription.

 

Our evaluation of the views and perspectives of the staff taking part showed that they thought the opportunity to provide this care was a valuable addition to the range of services they offer. Pharmacists appreciated the opportunity to provide a wider range of clinical services and to help the patients attending their pharmacy practice to a greater extent.

 

The studies that evaluated this pathway showed that approximately twice as many people accepted the offer of a test from a pharmacy than from other services. And these patients were approximately twice as likely to achieve a cure for their hepatitis C infection than from other standard routes of care.

 

Our evaluation showed that the long-term trusting relationship with pharmacy staff, the local situation of the pharmacy within a community and the on-going reason to attend the pharmacy were key factors in this success. Patients did not need to find the money for bus fares or navigate their way around an unfamiliar hospital.

 

As a consultant in public health pharmacy, my role is to maximise the value that we achieve from the pharmacy and medicines resource.

 

Working with Professor Dillon’s Liver Group at Dundee University has created a range of opportunities for our work to showcase the health gain that can be achieved by investing in pharmacies and empowering pharmacists to deliver clinical services. My role was as Principal Investigator for the SuperDOT-C study that was led from NHS Tayside and to work closely with community pharmacy colleagues responsible for delivering this care.

 

NHS Tayside has a reputation for innovation and for pioneering new ways of caring for its population. The hepatitis C work has demonstrated that strong clinical leadership and multidisciplinary working, harnessing the contribution of the wider team, can provide world-beating outcomes.

 

Community pharmacies are present in each community and provide an accessible point of care for local people. We have shown that by utilising the community pharmacy resource, many of the barriers that prevent some of our most vulnerable groups accessing effective healthcare can be reduced.

 

Further reading.

 

Can community pharmacists treat hepatitis C virus?

 

Clinical effectiveness of pharmacist-led versus conventionally delivered antiviral treatment for hepatitis C virus in patients receiving opioid substitution therapy: a pragmatic, cluster-randomised trial.

 

Yours etc.

 

Dr Andrew Radley

 

Consultant in Public Health Pharmacy

 

 

 

What can Scotland learn from British Columbia’s approach to overdose deaths?

 

Part of the answer to mounting drugs-related deaths in Scotland lies in grassroots charities, community groups and experts with lived experience taking a lead role, a Canadian substance use researcher says.

 

Professor Bernie Pauly of the Canadian Institute for Substance Use Research was in Scotland last week to speak at a Dundee harm reduction event organised by the Scottish Drugs Forum.

 

In Vancouver, the setting up of unsanctioned ‘pop up’ overdose prevention sites to save lives in the face of a rising tide of overdose deaths led to the provincial government backing these sites across the province, Professor Pauly, who is also a nurse at the University of Victoria School of Nursing, tells healthandcare.scot.

 

Her comments come amid an ongoing standoff over a safe consumption room in Glasgow. The Home Office refuses to allow such a facility, which campaigners, local politicians and the Scottish Government say has been proven to “save lives”.

 

British Columbia is home to just over five million people, compared to just under five and a half million for Scotland.

 

Like Scotland, it has also struggled with drugs. In 2015, overdoses became the highest cause of unnatural deaths, outstripping suicides and traffic accidents.

 

Fatalities have remained stubbornly high, with more than 1,500 people losing their lives in 2018 and, for the first time in recent history, life expectancy is falling.

 

In Scotland, 934 drug-related deaths were recorded in 2017.

 

Professor Pauly explains how, in light of long processes for federal approval of drug consumption rooms, activists and campaigners moved to provide an “essential health service” themselves.

 

“There were people, particularly in Vancouver, who started by setting up unsanctioned sites – often called pop-ups, because they were in tents. One of the ones in Vancouver was basically a tent in an alleyway where people could be observed and Naloxone administered immediately in the event of an overdose.

 

“People knew there were evidence based-interventions that would save lives – so why weren’t we doing that?”

 

Following the declaration of a public health emergency in 2016, the provincial government sanctioned overdose prevention sites – a move opposition politicians in Scotland have been calling for.

 

Overdose prevention sites are small-scale, “welcoming and friendly” spaces typically staffed by harm reduction workers, including staff with lived experience of drug use.

 

As well as expanding access to overdose prevention, they created “a space that was safe, where people felt like they wouldn’t be judged, with opportunities to develop trust and facilitate opportunities to access other services.”

 

In Canada, larger drug consumption spaces – of the kind proposed for Glasgow – have a broader range of staff, including nurses and counsellors. But while British Columbia is held up as an exemplar when it comes to harm reduction policy, Professor Pauly says a comprehensive response is critical.

 

Alongside overdose prevention sites, there was rapid scale-up of the provincial Take Home Naloxone Program and Opioid Substitution Therapy – but, she argues, more is needed. While no deaths occurred at supervised consumption or overdose prevention sites, British Columbia still saw 104 suspected overdose deaths in March.

 

Ultimately, these spaces are still “emergency measures,” Professor Pauly says. The ‘real prevention’ is ensuring a safe supply.

 

One idea being proposed in Canada’s western-most province is ‘compassion clubs’, in which members would be able to access a safe source of heroin.

 

It’s hoped this would undermine the illegal market, reduce poisonings and overdose deaths caused by impurities.

 

Asked what lessons Scotland could draw from the Canadian experience, Professor Pauly says:

 

“One is engaging people with experience right from the start because so many innovations are driven by them. The establishment of safe consumption sites…were really led by people with expertise and lived experience.”

 

Ultimately, she returns to the issue of supply, which is “something that should be addressed from the start.”

 

“You can scale up things like overdose prevention,” Professor Pauly says, “but you really have to address the fact there is an unsafe supply and really focus on changing policy to ensure a safe supply – that’s the real prevention.”

 

This story was supplied as part of our partnership with healthandcare.scot. 

Drug users need compassion, not custody

Westminster committee hears voices of Scots with experience of addiction during an inquiry into problem drug use.

 

The current approach of criminalising people who use drugs is making the problem worse and needs to be drastically overhauled, an influential committee of MPs has been told by Scots with personal experience of addiction.

 

Westminster’s Scottish Affairs Committee is investigating problem drug use in Scotland, including whether the Scottish Parliament needs more powers to deal with rising drugs deaths. Drug-related deaths are at the highest level on record in Scotland, outstripping England and many European countries.

 

Meanwhile, the Scottish Government and the Home Office are locked in a standoff over whether to allow a safe injecting facility in Glasgow. Supporters say the facilities, which are used in Canada, are proven to save lives but the UK Government has refused to change the law to allow such a move.

 

At an evidence session held last week, witnesses said prison sentences were harming, not helping, people who use drugs.

 

Hannah Snow, a 26-year old from Aberdeen who grappled with misuse and addiction for 13 years and who has been abstinent for the past 18 months, said:

 

“I experienced custodial prison sentences for supply of a controlled substance, so selling drugs, and possession of drugs, is not a deterrent — for me, anyway; I can only speak for myself.”

 

She continued: “What benefits are you getting from sending a known drug user into prison to do a drug sentence, who will get released to do the same thing? Enforce an order that has to put them through a recovery-based programme, instead of putting them into a criminal procedure programme where the cycle just starts again.”

 

“…A third of criminals who are released from prison are in addiction or have had addiction problems since they went into prison,” she added. “What hope do they have if they are just released?”

 

Elsewhere in the session witnesses told MPs their time in prison had been introduced them to more harmful substances such as heroin.

 

Also giving evidence was 45-year old Scott Ferguson, who called for possession of drugs for personal use to be decriminalised along the same lines of Portugal and Canada, and the money released from the justice system diverted into treatment and recovery programmes.

 

He went on to suggest a compassionate response was key, telling the panel of MPs the “first bit of empathy” he received from a support worker had given him hope he could recover:

 

“My “[criminal justice worker] was doing a lot of linked casework with my community alcohol and drug services worker, so they were singing off the same hymn sheet and knew what stage I was at.

 

“That was the first bit of compassion and empathy…I felt worthless because that was where my direction had taken me.

 

“I was in and out of homeless accommodation and I just couldn’t get it until I got shown that compassion and empathy, and I got that sense of belief in myself for the first time that I could maybe change.”

 

This story was supplied as part of our partnership with healthandcare.scot. 

Innovative pharmacy technician tackles opioid crisis

Alyssa Stanlake

 

Alyssa Stanlake is a Canadian pharmacy technician who works as an operations manager in a community pharmacy in Whistler. Alyssa works for Pier Health, a community pharmacy which specialises in supporting people who have an addiction and mental health problems.

 

She was awarded the honour of Canadian Pharmacy Technician of the Year 2018 after being nominated by her employer.

 

In the relatively short time that Alyssa has worked for them as operations manager, she has introduced a scheme whereby patients and residents can access naloxone kits free of charge. She has also instigated training so that everyone who has a kit knows how to use it.

 

Alyssa explained to me how she has saved many lives and educated a community as a consequence of this project.

 

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