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  • Auckland Methadone Service

    Community Pharmacy Methadone Dispensing Manual

    CADS Auckland • www.cads.org.nz

    http://www.cads.org.nz

  • Waitemata CADS District Health Board Auckland Methadone Service

    Community Pharmacy Manual

    Classification: 058.003.07.000 Issued by: AMS Governance Team Issue Date: August 2009 RP : 36 mths Authorised by: CADS Regional Manager

    & Service Clinical Director

    AMS Community Pharmacy Manual Page 1 of 44

    Contact details – AMS and CADS units

    Note: Please do not provide individual staff phone numbers to clients.

    Pitman House, 50 Carrington Road, Pt Chevalier Opening Hours: Mon-Fri 8.30am-5.00pm

    Phone Fax

    AMS Pharmacy (Mon-Fri 10.00am-1.00pm) (09) 815 5830 ext 5006 (09) 815 5840

    AMS Liaison Pharmacist (09) 815 5830 ext 5120 or 5006

    (09) 815 5840

    AMS Reception (Medical Officers, manager & other staff)

    (09) 815 5841 (09) 815 5850

    Clinical Nurse Specialist & GP Liaison Issues (09) 845 7518 021 784 266

    (09) 815 5850

    AMS Duty (09) 815 5830 ext 5012 (09) 815 5850 After hours (evenings, weekends & public holidays)

    AMS Pharmacy (9.00am-12 midday Sat, Sun & Public Holidays)

    (09) 815 5830 ext 5006 (09) 815 5840

    On-Call Medical Officers and information re methadone dose etc. is available by phoning:

    (09) 815 5830 ext 5100 (09) 815 5839

    (09) 815 5848

    Community Alcohol & Drug Services (CADS) – Auckland

    Opening Hours: Mon-Fri 8.30am-5.00pm.

    Phone Fax

    CADS Call Centre (09) 845 1818 (09) 845 1845

    CADS Central 409 New North Road, Kingsland

    (09) 845 1800 (09) 845 1845

    CADS North 14 Como Street, Takapuna

    (09) 488 2701 (09) 488 2703

    CADS West 1st Floor, 1 Trading Place, Henderson

    (09) 837 9400 (09) 837 9494

    CADS South Building 4, 17 Lambie Drive, Manukau City

    (09) 263 2000 (09) 263 2011

    CADS website www.cads.org.nz

  • Waitemata CADS District Health Board Auckland Methadone Service

    Community Pharmacy Manual

    Classification: 058.003.07.000 Issued by: AMS Governance Team Issue Date: August 2009 RP : 36 mths Authorised by: CADS Regional Manager

    & Service Clinical Director

    AMS Community Pharmacy Manual Page 3 of 44

    Overview

    This document This manual has been written by Community Alcohol & Drug Services

    (CADS) – Auckland, and contains information and guidelines for community pharmacists trained to dispense opioid substitution medication. This document will assist in the provision of a quality professional service that ensures safe and consistent dispensing of opioid substitution medication throughout the Auckland region.

    Review This document was reviewed by AMS pharmacists, clinical governance

    team and selected community pharmacists. Reviews: v1: March 1999 v2: June 2000 v3: May 2005 v4: August 2009

    Acknowledge– ments

    AMS would like to acknowledge the individuals and groups who have been involved in this review. Special thanks to Maree Jensen and Don Bensemann, community pharmacists, whose expertise, comments, opinion and feedback has been invaluable.

    Changes This manual has been revised to replace the 2005 version. A more user-

    friendly order or format, updated service overview, added sections (e.g. E- scripting, split dosing, flexible consumption), updated forms, and change in terminology e.g. Opioid Substitution Treatment (OST), are just some of the major changes.

    Contents Please see over page for the table of contents.

  • CADS Waitemata Auckland Methadone Service District Health Board

    Community Pharmacy Manual

    Classification: 058.003.07.000 Issued by: AMS Governance Team Issue Date: August 2009 RP : 36 mths Authorised by: CADS Regional Manager

    & Service Clinical Director

    Page 4 of 44 AMS Community Pharmacy Manual

    Contents Service overview...................................................................................................8 About AMS............................................................................................................8 AMS Philosophy ....................................................................................................8 A harm reduction approach....................................................................................9 Client retention.......................................................................................................9 AMS treatment programme components .............................................................10 Phases of Treatment .............................................................................................11 Roles and responsibilities ..................................................................................11 AMS responsibility to community pharmacy ......................................................11 Community pharmacy responsibilities to AMS and clients.................................12 Instructions for new staff pharmacists/ locums....................................................12 Administration and dispensing .........................................................................13 Summary ..............................................................................................................13 General .................................................................................................................13 Controlled drug prescription forms......................................................................14 E-Scripting ...........................................................................................................15 Administered or dispensed dose...........................................................................15 Methadone Formulation .......................................................................................15 Buprenorphine Formulation .................................................................................16 Dose Measurement...............................................................................................16 Consumed doses...................................................................................................16 Takeaway doses ...................................................................................................16 Collecting doses on behalf of a client ..................................................................17 Recording entries in the Controlled Drug register ...............................................17 Administration errors in the pharmacy ................................................................18

    Management of Common Clinical Issues .............................................................19 Stabilisation / Restabilisation............................................................................19 Stabilisation / Restabilisation...............................................................................19 Maintenance .........................................................................................................19 Takeaway doses ...................................................................................................20 Clinical monitoring by a pharmacist................................................................21 Summary ..............................................................................................................21 Indicators of stability ...........................................................................................22 Indicators of instability ........................................................................................22 Client non-attendance (DNA) or Missed doses................................................22 Non-attendance (DNA) or Missed doses .............................................................22 Intoxicated clients ..............................................................................................23 Intoxicated clients ................................................................................................23 Management of threatening and abusive behaviour.......................................23 Management of threatening and abusive behaviour.............................................23 Detection of diversion ........................................................................................24 Detection of diversion..........................................................................................24 Some methods used to attempt diversion of medication......................................24

  • Waitemata CADS District Health Board Auckland Methadone Service

    Community Pharmacy Manual

    Classification: 058.003.07.000 Issued by: AMS Governance Team Issue Date: August 2009 RP : 36 mths Authorised by: CADS Regional Manager

    & Service Clinical Director

    AMS Community Pharmacy Manual Page 5 of 44

    Replacement doses .............................................................................................25 Replacement of doses...........................................................................................25 Lost, leaked or stolen doses .................................................................................25 Vomited dose .......................................................................................................26 Flexible consumption days ...............................

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