To all Community Pharmacies dispensing Methadone/Buprenorphine to OST patients

Dear Colleagues,

Please find below some clarification regarding dispensing Opioid Substitution Treatment to patients during the COVID-19 pandemic. 

Take-away doses

GPs/clinics may undertake a risk assessment in terms of suitability for increased take-away doses in order to reduce footfall and client exposure balanced with safety risks in this vulnerable client group. It is important that the direction of the patient’s GP is sought before changing any of the instructions on the prescription, in particular relating to take-away doses. 

Take-away doses may be required for patients in isolation due to suspected or confirmed COVID-19 infection. Pharmacists should dispense the doses as instructed and a healthcare professional such as a nurse may pick up and deliver the dose and supervise administration. A suitable family member may also be considered for collection of take away doses but this will be clearly communicated by the GP/clinic and take-away doses should not be given on request by the patient/family member/friend without checking with the GP. Safe storage should be emphasised as per standard practice. 

Please refer to the PSI Guidance on Methadone dispensing which outlines

“Pharmacists should be aware that manufacturer’s bottles contain an overage and ‘take-away’ doses of methadone should never be supplied in these bottles or other glass bottles. They should be packed in unbreakable plastic bottles, fitted with a child resistant cap. For certain patients, e.g. those whose dose has recently changed, individual doses are the safer option. If patients are provided with a bottle containing several doses, a measure should be given.” 

Pharmacy closure

In the event of pharmacy closure please contact your local Liaison Pharmacist (Addiction Services) to arrange for the transfer of patients to an alternative pharmacy. It may be prudent to discuss plans for moving clients to another local pharmacy prior to the event happening. 

GP Closure

We are linking in closely with our GP colleagues regarding this and should a GP practice close it is likely that the clients will be transferred back into their local HSE Addiction clinic for prescribing. 

Virtual consultation

The HSE Addiction Service is looking into the possibility of Virtual consultation between healthcare professionals and clients using communication platforms on HSE phones. This may offer psychological support to clients in self-isolation and also may be useful in ascertaining suitability for OST doses. 

Pharmacy Needle Exchange clients

PNEX pharmacies are in the unique position in that they may meet vulnerable clients who are not linked in with any service and may be able to provide the opportunity for education on good hygiene/cough etiquette using the information posters available. Should a client complain of possible symptoms of COVID 19 they should be asked to contact their GP or the HSE LIVE HElPLINE 1850241850. The www.hpsc.ie website has a number of algorithms including the approach to be taken in the general healthcare setting.

https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/algorithms/COVID-19%20Risk%20Assessment%20Primary%20Care%20v6.0.pdf 

As advised by the PSI in their Novel coronavirus communication there may be times where professional judgement will be required in the event of exceptional circumstances arising. Please consider phoning your liaison pharmacist for assistance if required on a case by case basis. The Addiction Services are in regular contact with the relevant authorities such as the Department of Health, the PSI and the PCRS so any requirements for relaxation in legislation will be assessed by these and communicated to you.

https://www.thepsi.ie/tns/news/latest-news/20-03-12/Novel_Coronavirus_COVID-19_%E2%80%93_Joint_communication_to_pharmacists_pharmacy_owners_and_staff_from_the_PSI_President_and_Registrar.aspx 

We would like to extend our sincere thanks for all your hard work and help at this time and we very much appreciate the efforts being made to continue to provide a safe OST dispensing service.

Kind regards,

Liaison Pharmacists (HSE Addiction pharmacists)