CD: installment prescriptions

Question 1

Define harm reduction

Answer 1

Reduce adverse effects of drug misuse until misuser has decided/able to stop misusing the drug

Question 2

What are the principles of harm reduction?

Answer 2

• Misuse of drugs is accepted but not approved
• User treated as normal human
• Need not necessarily lead to longer term goal of ridding world of drug misuse

Question 3

Which drugs are used for harm reduction?

Answer 3

• Methadone

- Buprenorphine

Question 4

When is needed when entering harm reduction treatment?

Answer 4

• Complete history

- Prescribing is then tailored to individual requirements

Question 5

Which prescription is used for instalment prescribing to treat addiction?

Answer 5

FP10MDA

Question 6

What is the maximum days of supply of schedule 2 CD, buprenorphine and diazepam when treating addiction?

Answer 6

14 days supply

Question 7

Can doctors prescribe cocaine, diamorphine or dipipanone when treating addiction?

Answer 7

Yes if they have license from Home Office

Question 8

What are the prescription requirements for a FP10MDA?

Answer 8

• Same legal requirements as CD
• Installment direction: amount of med per installment + interval btw each installment
• Approved wording
• Marked w/ each date of dispensing
• If start date is not specified then dispensing must start 28 days from date

Question 9

Methadone

Answer 9

• Metabolised slowly
• Lipophilic
• Half life: 22hrs
• Given once a day
• Available: liquid, tablets and injection

Question 10

Buprenorphine (subtex)

Answer 10

• Opioid partial agonist
• Less sedating than methadone
• Used as substitution therapy for patients w/ moderate opioid dependence
• Takes 10 mins to dissolve

Question 11

Who is responsible for any adverse effects that may occur when crushing a buprenorphine sublingual tablet, the manufacturer or the pharmacist?

Answer 11

Pharmacist

Question 12

When a third party collects a CD for a patient being treated for drug addiction, is it a legal requirement or good practice to be presented a letter of authorisation from the patient?

Answer 12

Good practice - letter retained in pharmacy

Question 13

If a patient is being treated for a drug addiction, how many times does a pharmacist need to see the patient, and is this a legal requirement or good practice?

Answer 13

• Once a week

- Good practice

Question 14

What does wording approved by the Home Office provide pharmacists?

Answer 14

Degree of protection against consequences of supplying against strictly unlawful prescriptions

Question 15

What are the 5 statements approved by Home Office?

Answer 15

• Please dispense instalments due on pharmacy closed days on a prior suitable day
• If an instalment’s collection day has been missed, please still dispense the amount due for any remaining day(s) of that instalment
• Consult the prescriber if three or more consecutive days of a prescription have been missed
• Supervise consumption on collection days
• Dispense daily doses in separate containers

Question 16

What happens when a patient misses a dose?

Answer 16

• Misses daily dose: prescriber should be informed

- Misses 3 consecutive daily doses: prescription stopped + patient reassessed (titrated up to optimum dose)

Question 17

Is dispensing daily doses a legal requirement or good practice?

Answer 17

Good practice (safer)