Naloxone, alcohol abuse, why drug deaths remain high and a role for community pharmacy

 

Graham Parsons is the Chief Pharmacist at Turning Point. He is a pharmacist with a wide range of experience in many aspects of pharmacy.

 

As a specialist in Substance Misuse he has worked at both local, regional and national level (through the Advisory Council on the Misuse of Drugs, National Institute of Health and Care Excellence and Turning Point) to deliver a wide range of initiatives and policies which have impacted on both substance misuse services and the lives of individuals affected by substance use disorders. This has included over six years as a prescriber within the Plymouth Specialist Addiction Service. During this time he has also developed an interest in Mental Health and Pain and the management of these conditions in this cohort of patients.


Graham has also delivered a number of training sessions covering a diverse range of topics from substance misuse to Controlled Drug legislation for a number of institutes including the University of Bath and the Royal College of General Practitioners and developed Post Graduate addiction courses for Medway University. He is an experienced public speaker who has presented at many events including the College of Mental Health Pharmacy International Conference and on local BBC radio. In the written media he has produced a number of articles on substance misuse and its treatment for the Pharmaceutical Journal.

 

We had a wide-ranging discussion about the issues of the day in the area of substance misuse.

 

  1. There has been a move towards the use of Buvidal slow-release injection. Have you got any thoughts on this move especially in light of the current pandemic?
  2. What is the future of substance misuse services delivered through community pharmacy?
  3. What is the role of naloxone in community pharmacy?
  4. How can community pharmacy support alcohol brief interventions?
  5. Why are drug deaths still so high?
  6. How is polypharmacy relevant to the area of polypharmacy?
  7. Has nudge theory got a role in tackling the alcohol crisis in this country?

 

 

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Monthly buprenorphine injections will reduce pharmacy contact

 

Wales will become the first part of the UK to make a new once-a-month injection for recovering heroin addicts routinely available.

 

The new service will replace daily oral medication services to support recovering addicts. The Government has said that this will relieve pressure on pharmacy and NHS services during the coronavirus pandemic.

 

The treatment is a clinically proven, long-lasting injection, which is given once a month. Former heroin users currently receiving a daily oral medication, normally through their community pharmacy, will be screened for their suitability for have the injection of slow-release buprenorphine.

 

The injection will reduce the amount of contact between individuals and frontline healthcare and pharmacy staff during the coronavirus pandemic, while still continuing to provide substance abuse treatment. It will also be available within prisons in Wales.

 

The Government has said that the new service will reduce pressure on already busy health services and will help to reduce the risk of the coronavirus from repeated daily visits to community pharmacies. It will also ensure those people who need to self-isolate do not need to break quarantine every day to receive daily medication.

 

An additional £10m has also been made available to help support people who are homeless or sleeping rough during the coronavirus pandemic.

 

The additional funding, together with the new long-lasting injection service, is aimed at helping former heroin users who are homeless to self-isolate and follow social distancing rules safely and access handwashing and other basic hygiene facilities.

 

Health Minister Vaughan Gething said:

 

“Former heroin users are at greater risk of contracting coronavirus because, as a result of their substance misuse, they have poorer immune systems and many will have underlying health conditions.

 

“People who sleep rough and who have substance use issues are even more likely to have respiratory conditions and other underlying health problems, which put them at very high risk.

 

“This new service will help to ensure people continue to receive support for their addiction and we continue to reduce the risk of spreading coronavirus.

 

“The staff in community pharmacies and our substance misuse services are doing an incredible job in very difficult circumstances. Reducing both their workload and the risk to their own health is vital.”

 

Housing and Local Government Minister Julie James said:

 

“Homelessness and substance misuse often go hand in hand. People experiencing both are particularly vulnerable during this difficult time.

 

“The introduction of this treatment, together with the additional funding we have provided to safely house and support those without a home, is an example of how we are working across government to protect those who need it most.

 

Dr Julia Lewis, a consultant addiction psychiatrist, Gwent Specialist Substance Misuse, said:

 

“Securing the support of the Welsh Government for this treatment will hugely reduce the pressures on both our services and community pharmacies, enabling us to focus our work on our most vulnerable service users, many of whom have complex needs, including mental health issues.”

 

 

This circular is being shared under the Open Government Copyright licence.

 

 

Drug-related deaths involving fentanyl on the increase

 

A recently published report by the Advisory Council on the Misuse of Drugs has warned of the pharmacology and toxic effects of fentanyl and related analogues. The report says that it can be concluded that fentanyl and fentanyl-analogues present a significant ongoing risk to UK public health.

 

Episodes of fentanyl toxicity and deaths in the UK have been sporadic and have not approached the very high numbers seen in North America.

 

However, rates of registered deaths involving fentanyls have recently increased and may be under-estimated because sufficiently detailed forensic analysis of drug causes is sometimes not carried out. Consequently, the role of a fentanyl in the death may not be recognised.

 

The public health risk associated with the misuse of fentanyl and its analogues relates to the high potency of these substances a report has highlighted. Compared to morphine, the amount of fentanyl required to produce the same analgesic effects is 50-100 times lower.

 

Fentanyl and its analogues are potent compounds that therefore carry a high risk of accidental overdose that may be fatal.

 

The report warns of the ongoing risk of fentanyls and other new synthetic opioids increasingly infiltrating the UK heroin market and increasing rates of drug-related deaths.

 

The report makes a number of recommendations including the following:

 

  • Research should be commissioned to study diversion and non-medical use of strong opioids to identify trends, drug products involved and populations at risk.
  • Government departments should conduct a full review of international drug strategy approaches to fentanyl markets, in particular, the North American experience, and consider interdiction controls that can be applied to the UK situation.
  • Toxicology analysis of samples of all deaths related to drug poisoning should include analysis for fentanyl and fentanyl analogues as nonsystematic screening hinders our capacity to understand trends in drug death.
  • Toxicology reports from all deaths related to drug poisoning should include a clear statement as to whether fentanyl and/or its analogues were included in the testing. This would enable meaningful monitoring of trends in fentanyl-associated deaths.
  • Research should be commissioned to monitor the local and national prevalence of fentanyl and fentanyl analogues in:
    • Drug seizures, including heroin preparations and counterfeit medicines.
    • Non-fatal episodes of heroin toxicity requiring hospital treatment.
  • Increased funding should be made available to the Defence, Science and Technology Laboratory Forensic Early Warning System (DSTL FEWS) programme to increase capacity to analyse un-adopted police and border force seizures.
  • Agencies with responsibilities relating to drugs of misuse should monitor the international situation and share available UK data. There should also be a comprehensive early warning system which has access to up to date consolidated UK-wide drug misuse data sets.
  • If materials are encountered in the UK or Europe that retain potency but fall outside the UK generic control on fentanyls, a small amendment to that generic control should be applied to address these.
  • Following a consultation with the research community the Home Office should expand the precursor controls to cover simple variants of ANPP, the immediate precursor to fentanyl (further details are included in this report).

 

You can read the full report below.

 

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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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