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‘Shortage of methadone tablets could jeopardise patients’ treatment’

Martindale: Physeptone tablets will be back on the market by the end of August
Martindale: Physeptone tablets will be back on the market by the end of August

The current shortage of Physeptone tablets could jeopardise vulnerable methadone patients’ treatment, a pharmacist prescriber has warned.

Martindale, the sole UK manufacturer of Physeptone tablets – which are sometimes used off-license for the treatment of opioid addiction* – informed the Department of Health and Social Care (DH) last week that due to manufacturing issues, the tablets would not be available until November.

Jonathan Smith, pharmacist at Mayberry Pharmacy in Newport, Wales, said the short-notice alert of the supply issues has created “an enormous problem” for his branch and several methadone patients.

“We now must find a way of bringing these patients into the clinic, explaining the situation and producing new prescriptions at very short notice,” he said.

“These are one of the most vulnerable set of patients that we deal with, [who] often don’t cope with change, especially at such short notice,” Mr Smith said.

The change will “create a lot of anxiety for them” and may result in non-adherence to treatment, he claimed.

Manufacturer responds

Speaking to C+D yesterday (August 6), Paul Concannon, UK commercial director at Ethypharm, which owns Martindale, said the November date is the “worst-case scenario” and in fact the manufacturer is hoping Physeptone tablets will be available by the end of August.

To help deal with the current shortages, Martindale has manufactured unlicensed methadone 5mg capsules, which pharmacists can order from it directly, Mr Concannon explained.

The capsules cost £5.12 for a pack of 50 and are a short-term solution until the Physeptone tablets are back in stock, he added.

Other formulations available

The DH pointed out that supplies of alternative methadone preparations are available and advised affected patients to discuss these options with their doctor.

National Institute for health and Care Excellence (Nice) guidelines recommend oral methadone as a maintenance therapy in the treatment of opioid dependence. However, this “does not specify between its use in tablet or solution form”, Nice told C+D.

Geoff Mascall, a registered mental health nurse and independent non-medical prescriber at UK Addiction Treatment Centres, told C+D there are no UK guidelines for transferring patients from one formulation to another.

“Methadone liquid is the preferred formulation for community substance misuse clinics in the UK, as it is less likely to be diverted to illicit supply chains and [consumption] is easier to supervise in a community pharmacy,” he explained.

However, prescribing tablets instead of the liquid preparation has “historically been the preference for individuals who may be travelling where liquids are restricted by volume”, and a shortage could “restrict the individual from travelling”, Mr Mascall added.

*This article was updated to clarify that Physeptone tablets are licensed for moderate to severe pain.

Will the Physeptone shortage affect your patients?

A LOCUM, Community pharmacist

If you read PSNC guidance on CD private prescriptions, 'private prescribers should be referred to their primary care organisation (e.g. local NHS England team) if they require a private prescriber identification number, (six digits) which is fine if you are a medical prescriber ,but what if you are a non medical prescriber , they have tried every organisation, and not managed to get one ?

Tired Manager, Community pharmacist

Why would anyone use unlicensed capsules when there is licensed liquid form available? I was also under the impression,certainly amongst our local drugs clinics, that the tablets are no longer recommended to be prescribed.

Ranjeev Patel, Non Pharmacist Branch Manager

Strange that you posted this comment. I think all pharmacists know that liquid is the preferred form, unless your patient is having to fly somewhere, where they inevitably have to switch to tablets for their trip as liquids cannot be taken onto planes over 100ml. To be honest it's actually commendable that Martindale has been able to supply these capsules so quickly and for such a decent price.

A LOCUM, Community pharmacist

it is the word 'code' which is ambigious , medical and non medical prescibers have an individual  prescriber number, is this number the 'code' they want on the form ? 

No, if you are trying to obtain CDs you'd be providing the "pharmacy's NHS account number".  The "individual prescriber code" is only used if the person requisitioning is a prescriber.

You'd then need to put the NHS provider code in the boxes underneath, which is the ODS code.

Hope that helps

A LOCUM, Community pharmacist

To make matters even worse , the change in cd requistions, makes it near impossible to transfer them from a nearby pharmacy who will never use them  , i don't know anyone who has managed to get an 'individual prescriber code', has anyone done this and where did they get it from ? (i tried everywhere , nhs england , cd accountable officer , LPC , CCG,  for guidance and had no luck )

For the main pharmacy I work at, the superintendent/owner had the pharmacy NHS account number. We wouldn't have an individual prescriber code, unless you are a prescriber of course. If they don't know or are not available I think the NHSBSA can help, they know if the pharmacy is allowed to submit FP10CDF forms so should have details (I've not called them myself though so not sure how accurate this info is, but worth a try).

Ben Merriman, Community pharmacist

Private code is for the pharmacy, not the pharmacist. Individuals not prescribing it don't need their own code. Haven't updated this for a while but should still be good to use:

Type in your NHS ODS code and it'll confirm your pharmacy details and give you your private CD ODS code. Message/Tweet me @blmerriman if you've any issues

A LOCUM, Community pharmacist

for medical or non medical prescribers then is the required ' individual prescriber code' wrt requisitions the same as their gmc/ nmc/ gphc number and if they write a private prescription on a FP10PCD, then is the required 6 digit 'prescriber identification number' their gmc/nmc/gphc number ? If so why don't they just put on these forms 'your professionl registration  number and ODS code for the pharmacy instead of 'pharmacy's NHS account number' ?Talk about making a simple form difficult ?

GMC number is 7 digits and isn't needed on the form or FP10PCDs.

Individual prescriber code is a 6 digit code assigned by the NHS (appears next to their name on green scripts). This needs to be on the form and is needed on FP10PCDs. The practice code is also 6 digits (appears on tokens next to the prescribers name), but usually has a letter at the beginning and would also need to go on the requisition form.

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