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Methadone child deaths prompt call for pharmacist and GP training

Substance misuse charity Adfam is calling for co-ordinated national action to better safeguard the children of those on opioid substitution treatments

Pharmacists must learn not to stigmatise methadone-using parents and should help to prevent children from accidentally taking the drug, substance misuse charity Adfam has said.

Children were at risk of ingesting their parent's methadone due to insufficient safeguards and pharmacists needed to be trained to spot these symptoms and explain the risks to patients, the charity said in a report published last week (April 29).

Although supervised consumption was advised when there were concerns about safe storage or risks to children, parents on opioid substitution treatments (OST) often felt ashamed to consume their methadone with their children in a pharmacy due to a lack of privacy, the charity claimed.

Parents complained of a lack of privacy when consuming their methadone in a pharmacy, Adfam's report found

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A 2007 study of methadone users in Staffordshire and Shropshire had shown that patients wanted pharmacists to receive training to combat their stigma towards methadone users, the charity said. It was important healthcare professionals were supportive of users that were parents and did not alienate them, it said.

More than 60,000 people caring for children received prescriptions for OST in the UK, Adfam said. There were 20 serious case reviews by local safeguarding children boards into the ingestion of drug addiction medications between 2003 and 2013, 15 of which involved a death involving methadone, Adfam said.

In order to minimise these risks, healthcare professionals must understand the dangers methadone posed to children and other "opioid naive" people, the charity stressed.

It referred to a 2005 study which revealed that 21 per cent of OST users who received information on safe storage of their methadone had received it from a pharmacist, compared to 42 per cent who were advised by a methadone clinic and 27 per cent who spoke to a local drug agency, the charity said.

The same study had shown that prescribing pharmacists were not as good as drug workers at understanding and addressing how medicines should be safeguarded at home. These pharmacists perceived speaking to patients as "risky" and preferred to give "non-confrontational" written information instead, the charity said.

But clinicians should use their first appointment with a patient to emphasise the importance of keeping their methadone safely stored in a locked box, it said.

"Professionals must understand this rationale, and be able to transmit the message to clients in a clear but sensitive way. This can be supported by clear literature and information in drug agencies and pharmacies," it added.

When dispensing methadone, do you give advice on safe storage as a matter of course or do you leave this to the prescribing doctor/clinic?
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Amal England, Public Relations

How pathetic an attempt by Adfam to stigmatise and use pharmacists as a scapegoat. What informed nonsense. Adfam please get on with your job what ever that maybe and let me get on with my job.

Dale Peacock, Dispensing assistant

The thing is if the patient is saying that they feel ashamed of taking the methadone supervised with their children present so thefore they may get an unsupervised consumption then surely it is down to the parent to keep it out of reach and sight of children. Which is clearly stated on the label anyway.

Ahmed :-), Community pharmacist

Again it's us pharmacists who take the blame, our fault that a few parents under the influence of the strong opioid, methadone, have tragically ALLOWED their own child to ingest the potentially lethal drug....
Is that a legitimate reason for allowing your child to take a drug? That the pharmacist didn't tell me to keep it in a safe place?... Do supermarket checkout staff have to remind them to keep their bleach in a safe place? NO!!!!
If the charity is actually criticising pharmacy then shame on them.
If it's just the C&D making it sound like they are criticising pharmacists then shame on the C&D.
If it's just me incorrectly interpreting it as criticism then shame on me!

Mukesh Patel, Community pharmacist

We have been dispensing methadone to our clients for a long time now and some patients are sensible and do not have to mention about storage and administration ,while some patients have no clue about the dangers involved if taken by kids or other adults.
It is about time that all methadone clients should be supervised to avoid all these and see addiction numbers fall down ,cause i know some or many of these patients sell this quick fix to get a stronger fix

Calum Nelson, Locum pharmacist

Talking about "it's not my fault if this happens" isn't what's important. You might not be at fault if a kid dies, but you might have been able to do something to prevent it. If you only help your patients to a level that stops you from getting into trouble then you're a pharmacist for all the wrong reasons.

If your methadone patients won't listen to you or you don't think they'd be happy to discuss these things with you, maybe consider that it might be because of how you speak to them and how you act towards them.

Kevin Western, Community pharmacist

I do deal with methadone patients and am quite happy to discuss the risks with them though, as i say most are very aware already. I am not about to beat myself up about something over which I have no control, and even worse give someone else an opportunity to blame me for something for which they have responsibility. perhaps if we didnt facilitate their behaviour quite so much they might have to take more responsibility themselves

London Locum, Locum pharmacist

They have to take responsibility - it's always someone else's fault isn't it

Paul Miyagi, Information Technology

Oh Dear. Here we go again. Are these people for real.????

Gerry Diamond, Primary care pharmacist

As a pharmacist involved in methadone prescribing, safeguarding and safe storage are included in patients care planning and review stage. Also, it is a multisciplinary issue and responsibility and not a blame game.

Kevin Western, Community pharmacist

How are clinicians to blame for the deeds of patients who are parents - addicts are generally well aware of the risk of overdose and its consequences - what happens when they deliberately or accidentally allow their children to take their methadone is tragic but not the fault of the prescriber or the Pharmacist.

geoffrey gardener, Community pharmacist

Some addicts are doubtless good parents, and some doubtless are not. The first group will doubtless head good advice, and the latter will not regardless of whom has given it. Drug addiction continues to blight an ever increasing proportion of the population. What is needed is a multi agent approach to eradicate the problem not appease it. Entrusting poorly trained support staff to question and instruct hardened addicts is irresponsible, so yes let's get pharmacists more involved, I am sure we have all got plenty of free time .

London Locum, Locum pharmacist

How absolutely stupid. Let me get this straight, a charity needs to inform me that methadone is dangerous for children and that we should be aware of the risks. Ok. Thanks for the advice.

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