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Pharmacy pilots 'game changing' buprenorphine injection

Shaheen Bhatia of P&S Chemists in Essex is the lead pharmacist working on the pilot
Shaheen Bhatia of P&S Chemists in Essex is the lead pharmacist working on the pilot

Essex pharmacy P&S Chemist is the first in the UK to trial a "game changing" long-acting buprenorphine depot injection in place of daily medication for opioid dependence.

Trialling in-pharmacy administration of Buvidal began in May 2019, with the aim of reducing the need for daily supervised buprenorphine treatment.

Buvidal is an opioid partial agonist/antagonist and the first long-acting medication approved in the EU for the treatment of opioid dependence in patients who are also receiving medical, social and psychological support. It must be administered by a healthcare professional.

According to manufacturer Camurus, the injection can be administered weekly or monthly for the treatment of opioid dependence in adults and young people aged 16 years and over.

Currently, either oral methadone or buprenorphine tablets are typically prescribed to patients with opioid use disorders, and these must be administered daily and under supervision for the first three months of treatment, according to National Institute for health and Care Excellence (Nice) guidelines.

Shaheen Bhatia, pharmacy manager at P&S Chemist, is administering the Buvidal injection along with trained locum pharmacists, she told C+D last month.

As well as improving outcomes for patients, the injection model can free up pharmacists’ time, as they only have to supervise buprenorphine patients weekly, Ms Bhatia said.

“We do see it as a game changer for supervised treatment,” she added.

How the pilot works

Under the pilot scheme, patients referred from the local drug and alcohol team have a consultation with their doctor. If they agree to be changed from buprenorphine tablets to the injection, an appointment is booked with P&S Chemist.

Ms Bhatia worked with her local clinical commissioning group, local public health team, drug and alcohol charity WDP and Camurus to create a standard operating procedure for the pharmacy.

“We had no model as such to work on, except some Nice guidance, recognising [Buvidal] can be used for substitution treatment,” Ms Bhatia explained. “We also looked at some successful pilots in America and Australia.”

Positive feedback

Although the pilot is still in its early stages, Ms Bhatia said she has received “really good feedback” from patients.

As the injection is administered weekly, it is suitable for patients who find coming into a pharmacy daily “inconvenient”, and reduces the risk of overdoses or “children accidentally ingesting” buprenorphine tablets that have been taken home, she explained.

The injection may also be useful “in a prison setting”, she suggested, as well as for people who are “erratic” and struggle to pick up prescription medication regularly.

Missing out on daily supervision funding

Although this will mean losing out on daily supervision funding, Ms Bhatia stressed that the model “won’t get rid of supervision altogether”, as “new clients will always need that early stage of supervision”.

The pilot is expected to continue for at least one year, and Ms Bhatia said she has already had pharmacists and prescribers from Leeds and Jersey interested in seeing how the model works in practice.

P&S Chemist will also look to trial the service with methadone patients “at a later stage”, she explained.

Would you like to trial buprenorphine injections in your pharmacy?

Ranjeev Patel, Non Pharmacist Branch Manager

It is highly commendable to the pharmacists involved to be taking part in this, addicts are an extremely vulnerable part of the customer base, and deserve the best care that can be offered. Every addict you serve is someone's son or daughter, they are still real people, hard times can hit so fast that it can make your head spin.

I just hope this service expands and that the government sees the value in it and assigns the correct remuneration for providing such a service, but something tells me that they will start to expect this for nothing.

C A, Community pharmacist

What's the remuneration for providing this service? It requires more training and liability, so on par with the £28 for an MUR?

Not that I'm looking for funding to replace them or anything...

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