More detail on the recommendations
must be available from every community pharmacy for supply to people
who use drugs, family, healthcare professionals, and carers.
Naloxone should also be kept in first aid boxes for emergency use in
any clinical setting, and staff trained to use it, where people who
use drugs attend. Pharmacy teams in those locations must be among the
staff trained to use it.
recent study into take home naloxone programmes found that ownership
and carriage of the medicine were lower than desired.
3 Supplying patients, family, healthcare professionals, and carers
with take home naloxone and impressing upon them the importance of
carrying it is fundamental to success of the programme.
pharmacy teams are ideally placed to make these vital interventions.
The UK drug misuse and dependence guidelines state that ‘it is good
practice for the pharmacist to engage the patient in a discussion
regarding risk management to ensure all harm reduction options have
been addressed (such as overdose awareness and provision of naloxone
4 Every community pharmacy team should be able
to offer naloxone to anyone they believe to be at risk of an overdose
or to anyone who may witness an overdose. This should be offered as
part of a package of care which promotes not only the safe use of
naloxone but also the importance of carrying it and of naloxone being
in Scotland are currently able to distribute naloxone kits, with
89,543 supplied as of 31 December 2020. With the latest report from
the Scottish Drug Deaths Taskforce, published in June 2021,
concluding that almost 1,400 lives may have been saved by the kits in
based in other settings, e.g., specialist services, GP practices,
should also be engaging patients in conversations about harm
reduction. They should be offering education around naloxone and
ensuring patients have a supply.
guidelines also recommend that ‘opportunistic interventions (such
as hepatitis interventions, injecting equipment, and overdose and
naloxone training) can be crucial to maximise engagement in
potentially life-saving interventions.’ Community pharmacists are
the most accessible healthcare professional which makes these
interventions possible on a regular, sometimes daily, basis. This is
true for not only patients but also family members, friends and those
in the community.
can also be offered at times when patients are particularly
vulnerable to overdose, for example, during the initial stages of
treatment or upon release from prison or hospital. This
accessibility also makes community pharmacy ideally placed to hold a
stock of naloxone for use in the event of an emergency in the
immediate vicinity. However, we also believe that naloxone should be
included in the emergency boxes in any clinical setting where people
who use drugs may attend, and first aid staff trained to use it,
including pharmacy teams. Any increase in availability must be
communicated effectively with local communities.
teams in all settings should have the tools to prevent and identify
possible dependence on prescribed or over the counter medicines (OTC)
and carry out brief interventions where appropriate.
principles of brief interventions
6 could be applied to prescribed
or over the counter (OTC) medicines, allowing trained pharmacy staff
to engage patients in a non-confrontational way. Brief interventions
are a tool to motivate and support patients to think about their
medicine use and identify if a change may be required to reduce harm.
7 They can be a way to identify any additional needs and signpost
Drug misuse and dependence: UK guidelines on clinical management
8 make reference throughout to brief interventions and suggest they are
beneficial for young people, those at initial assessment of drug
misuse or where the person is perhaps not at the threshold of
requiring more structured help, which is often the case with
prescribed or OTC dependence. The guidelines also recognise the
invaluable resource that pharmacists can be in identifying problems,
harm reduction and the provision of brief interventions, particularly
for the ageing drug treatment population with complex comorbidities.
and pharmacy teams, are ideally placed to make an impact on patient
care through brief interventions. Interventions can take place in
any setting the patient may attend, do not require any formal
arrangements to be made and are quick, making them ideal for patients
presenting at a community pharmacy, general practice surgery,
custodial setting, or even when receiving their discharge medication
from hospital. Consideration should be given to targeting
interventions based on local trends to prevent problematic drug use
by vulnerable, young and minority groups
of brief interventions would ensure that every contact the pharmacy
team has counts. To achieve this, carefully developed tools will be
required with clear, distinct messages to educate and support
patients in a way that means these interventions are meaningful and
effective. Previous campaigns have used communication bundles
9 to ensure that safety messages are delivered specific to that
medicine every time it is dispensed/sold. This model, which would
work well with prescribed and OTC medicines susceptible to
dependence. The whole pharmacy team must be involved and trained to
deliver a consistent and professional message to patients, with aide
memoirs supplied to reinforce the message.
pharmacy teams should have a shared method of recording over the
counter medication purchases to help identify overuse or misuse, and
enable action to prevent harm.
of OTC products, particularly pain relief and sleeping aids, are
continuing to increase.
10 Pharmacists and pharmacy teams could
provide much needed interventions and education on the dependence
forming of some of these medicines
11. Public health campaigns
such as those mentioned below would be a starting point to get these
messages across but, with patients still able to make multiple
purchases from different community pharmacies with no way of this
being monitored or recorded, the risks of harm are still high.
Purchases of these products should not be incentivised in any way.
method of recording OTC sales of medicines liable to abuse or
dependence would help address this issue. Patients registering with
one pharmacy could facilitate this. The records would need to be
practical and accessible to others, where appropriate, and relate to
a particular patient. A shared patient record would enable this to
be done in a quick and unobtrusive manner, while recording what could
be valuable and potentially lifesaving information (see
expansion of the existing services , such as the new medication/high
risk medication services in community pharmacy, should include
medicines with a risk of dependence and misuse to encourage and
enable education to start at the point of prescribing and dispensing.
risk medicines are defined as medicines that have a high risk of
causing injury or harm if they are misused or used in error.
with a risk of misuse and dependence come under this definition. In
England in the year 2017 to 2018, one in four adults in England were
prescribed benzodiazepines, z-drugs, gabapentinoids, opioids for
chronic non-cancer pain, or antidepressants.
teams can use existing high risk medicine tools to identify harm or
deterioration in patients taking these medicines. They can intervene
to prevent harm and to structure a timely response if harm occurs.
of the current community pharmacy new medicine tool to include the
classes of medication with a risk of dependence would allow community
pharmacy teams to educate patients at the point of dispensing,
building on information provided during the consultation with the
prescriber (who may be a pharmacist or another professional). This
will encourage person centred, working with realistic expectations
from the outset, as well as patient awareness of the risks and
limitations of treatment. It also allows an opportunity for
discussion on non-pharmacological treatments which may be of benefit
and ensure a holistic approach to care.
pharmacies are ideally placed to host national targeted public health
campaigns around misuse and dependence on prescribed, illicit, and
over-the-counter medicines. Pharmacy teams in any setting can
highlight and reinforce these messages.
health is an intrinsic part of pharmacy practice. Pharmacists and
pharmacy teams, working in all settings, can support people with
dependence on medicines and/or drugs and prevent dependence from
happening by promoting public health messaging. Teams can educate
patients on the importance of adhering to maximum treatment times and
dosing, drug interactions, self-management and seeking help with
concerns about personal use.
campaigns to be successful all pharmacy team staff must be trained
and involved. Public health campaigns around smoking cessation have
been very successful in the past. Organisations enhance their impact
by working together and utilising visual aids, posters, leaflets, and
training. Trained staff can then engage patients and get the
important messages across.
Campaigns are needed to raise public awareness of a growing issue of
dependence on certain groups of medicines. It would also work well
in targeting those purchasing medication over the counter and online. There is also a role in educating the general public on drug
treatment options as a way to try to de-stigmatise seeking drug
15 As the most accessible healthcare professionals,
community pharmacy teams are ideally placed to deliver a campaign’s
key messages. These messages could be reinforced across healthcare
settings with posters, materials and linked to activity outside the
pharmacy. Pharmacy teams in all settings can also raise awareness of
risks while ensuring patients do not stop medication abruptly or