Harm Reduction

Welcome to my blog…This month it’s all about harm reduction…

Last week, I attended a meeting of the South Tyneside drug related death
group - which I sit on as a representative of the LPC. The group consists of
representatives from all agencies involved in drug misuse in the area and
attempts to try and learn from these sad deaths to prevent future tragedies.

We had 3 cases to consider, quite a lot really considering we only usually
have 3 cases per year, and they were all very heartbreaking. Community
Pharmacy is well placed to help prevent drug related deaths by supervising
methadone and buprenorphine - supervision has been clearly identified
by NICE as a method for reducing drug related deaths. Logic dictates
that reduced collection of methadone (more supervision) equates to less
methadone in society, less chance it can be diverted, and consequently less
tragedy. In some areas of Scotland supervision is at the 98% level, which
is well above our own as an attempt to reduce diversion. Sadly in one of
the cases we looked at, Methadone overdose was the culprit, and the police
had stated that the patient’s house was “awash” with Methadone. The
case is complicated, and I’m not going to go into detail here as it would
be inappropriate, but I raised the issue of minimising the risk for patients
by more pharmacy supervision. Clearly there is a prescribing decision
to make allowing patients to take home methadone as an alternate to
supervision… One member of the group strongly agreed and said “it simply
isn’t appropriate for a substance misuser to complain about a daily walk to
a pharmacy in an attempt to take-home supplies, only to have him lazing
around in bed or playing on a computer – a brisk walk is therapeutic”

Another of the cases we reviewed involved the tragic death of a patient taking
his father’s medication to help him to sleep…Not much we can do here, but
I’m sure improved patient counselling, and reduced prescribing of potent
opiate drugs, would lead to less chance of such an appalling waste of life.

The final case involved an ex-addict being tempted by a dose he had used
frequently before, but which ended his life - as his tolerance had been
markedly reduced. Educating addicts who are weaning themselves off drugs
is essential to limit such events.

I left the meeting feeling really quite sad at the waste of life; but happy that
pharmacy is doing as much as it can to prevent other cases like this.