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| Supervised
Consumption |
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| Since the opening
of the Drug Service clients have always self administered
their own medication; the large majority of prescriptions
are posted or delivered to local pharmacies. The medication
is dispensed and consumed by the client at home. Local Pharmacists
have been an important partner in the provision of this community
based drug treatment system. |
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Although this system
benefits the vast majority of clients, a small minority need
more careful supervision of their medication consumption.
A scheme has therefore been devised, based
on others already in operation, |
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| Between April and December 2001, 210 clients
have accessed the scheme, a total of 5945 observations. |
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and
placed once again in local
pharmacies. Medication is dispensed to certain client
groups daily, under the supervision of the pharmacist,
at approximately the same time each day. Client confidentiality
and dignity is ensured by the provision of a segregated
area in the pharmacy. Following government recommendations
and advice from the Clinical Guidelines all new clients
entering treatment are placed on supervised consumption
for a minimum of two weeks.
There may be exceptions, for example full time work
but this is rare. Clients using the scheme include:
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- All new clients entering treatment.
- Those who have recently left
prison or rehabilitation centres.
- New clients who feel they need
large initial doses of medication.
- Vulnerable clients who may
have their medication stolen, etc.
- Clients who present as increasingly
chaotic or problematical.
- Clients whose health and welfare
give cause for concern.
- Clients who have a history
of accidental overdose.
- Those who request the service,
eg. a planned daily detox regime.
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| Clients can be referred
on to the scheme by pharmacists themselves, although
the final decision is the team leaders. Pharmacists
see clients 3 or 4 times a week and can often notice
whether a particular client is not doing too well. The
scheme is not used as a punitive measure, or as a sanction
for inappropriate behaviour. Clients are placed on the
scheme to add stability to their drug treatment. We
would normally expect a client to be on the scheme for
a period of 2 - 6 weeks. During this period they would
be reviewed |
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| weekly by the key
worker to monitor progress. It has also made it much easier
to safely set the required dose for those clients who are
asking for a large initial dose. Once some measure of stability
is reported then clients go back to the more normal 'take
home' dose. Clients who have already been on large doses for
some time with the worker expressing some concern that not
all is being consumed properly can also be placed on the scheme
as a safeguard against leakage onto the streets. |
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