Pharmacists are to be allowed to give out methadone, buprenorphine and other medicines containing controlled substances such as opioids or barbiturates without a prescription during the COVID-19 pandemic. The home secretary wrote to the Advisory Council on the Misuse of Drugs (ACMD) earlier this month asking them to urgently review emergency measures that would ‘ensure patients continue to have access to medicines, build resilience and help relieve pressure elsewhere in the health system caused by COVID-19’, the government states.
The proposed measures, which were developed by the Department of Health and Social Care (DHSC) and the Home Office, are to enable registered pharmacies to supply controlled drugs without a prescription where patients have been receiving the medicines as part of ongoing treatment, allow them to vary the frequency of dispensing for an instalment prescription, and extend the Serious Shortage Protocols (SSPs) to include controlled drugs in Schedules 2, 3 and 4 (Part I) of the Misuse of Drugs Regulations 2001.
The government has assured the ACMD that the measures will only relate to NHS services and that controlled drugs would only be supplied by registered pharmacies regulated by the General Pharmaceutical Council and at the pharmacists’ ‘professional discretion’. Cases where there is ‘insufficient information available to dispense safely’ would be referred back to the original prescribing service. The National Crime Agency (NCA), National Police Chiefs Council (NPCC) and HM Prison and Probation Service have been consulted and view the risks of diversion as ‘outweighed by the need to continue to supply medicines to those in need’.
The ACMD is ‘generally supportive’ of the measures, says the reply from its chair Dr Owen Bowden-Jones, given the exceptional circumstances and the potential risk of discontinuity of supply. ‘However, pharmacists will require additional support and guidance, as they will be working outside of the scope of their usual practice,’ the letter states. The ACMD has recommended that national-level guidance be issued in consultation with the relevant royal colleges and professional bodies, and notes that the measure ‘would be associated with a greater risk of misuse and diversion’ for patient groups requiring OST or opioid pain medicines.
‘Patients with substance misuse issues might attempt to place pressure on a pharmacist to dispense in accordance with this measure, or might visit a range of pharmacists in an attempt to locate and exploit weaknesses in any of their practices in order to be supplied with medicines against best practice,’ the letter states. Risk assessments by pharmacists will need to be documented and recorded, the prescribing service notified and ‘rigorous’ ID checks carried out, it stresses.
People will need to be able to safely store medicines in locked boxes and have access to take-home naloxone, the document adds, as well as be able to maintain regular contact with the professionals responsible for their prescriptions. ‘Pharmacists will also need to be supported by the original prescribing service to minimise the risks associated with this measure, which include the possible increase in risk of drug-related death,’ it states, and stresses the importance of ensuring that the measures ‘do not extend any longer than is necessary’.