Common use of Intoxication Clause in Contracts

Intoxication. 15.1 Methadone and buprenorphine should not be dispensed in instances when the pharmacist considers the patient to be significantly intoxicated due to drug or alcohol use. When a patient presents in this manner the pharmacist should establish if this is a result of alcohol or drug use. 15.2 If significant intoxication due to alcohol or drugs is suspected, the pharmacist should telephone the prescribing service to seek advice from the care co- ordinator or prescriber before medication is dispensed. 15.3 In instances when the patient presents as significantly intoxicated and the care co-ordinator or prescriber cannot be contacted then the following courses of action will be taken: • If the patient presents as significantly intoxicated at the end of a working day after the prescribing agency is closed, the pharmacist must withhold the patient’s daily dose and ensure that the matter is discussed with the care co-ordinator or prescriber the following working morning. (Pharmacists handing over to locums / other pharmacists must ensure that the matter is communicated and that the pharmacist is able to deal with the matter on their behalf). The patient should be given an explanation as to why their dose is being withheld and if possible, advice given regarding the risks of overdose. • If the patient presents as significantly intoxicated on a Saturday or a long bank holiday period when the prescribing agency is closed, the pharmacist should decline to dispense the patient’s medication and ask them to return for their medication later in the day when the patient’s suitability to have their medication can be re-assessed. The pharmacist should explain to the patient that if they are still intoxicated when they return, both their daily dose, and any take home/Sunday dose will be withheld and if possible, give advice regarding the risks of overdose. Regardless of the outcome, the pharmacist must ensure that the prescribing agency is contacted and informed at the beginning of the next working day.

Intoxication. 15.1 Methadone and buprenorphine Buprenorphine should not be dispensed in instances when the pharmacist considers the patient to be significantly intoxicated due to drug from drugs or alcohol usealcohol. When a patient presents in this manner the The pharmacist should establish if this is a result of alcohol or drug use. 15.2 If significant intoxication due to alcohol or drugs is suspected, what the pharmacist should telephone the prescribing service to client has used and then seek advice from the care co- ordinator key worker or prescriber before medication prescriber. If the client is dispensed. 15.3 In instances when the patient presents as significantly intoxicated and the care co-ordinator or prescriber cannot no one can be contacted then the following courses of action will be taken: • If the patient presents as significantly intoxicated at the end of a working recovery clinic ask the client to return back to the pharmacy later in the day after where possible. If this is not possible or they return later still intoxicated the prescribing agency is closed, the pharmacist must withhold the patient’s daily dose and ensure that the matter is discussed with the care co-ordinator or prescriber the following working morning. (Pharmacists handing over to locums / other pharmacists must ensure that the matter is communicated and that the pharmacist is able to deal with the matter on their behalf)should be withheld. The patient should be given have an explanation as to why their dose is being withheld and if possible, advice given regarding asked to return the risks following day. The risk of overdoseover dosage should be explained as well. • If necessary and the patient presents pharmacy is closed the next day then the take home dose will have to be withheld as significantly intoxicated on a Saturday or a long bank holiday period when well. Ensure notes are left for the pharmacist the next day to contact the prescribing agency is closed, the pharmacist should decline to dispense the patient’s medication and ask them to return for their medication later in the day when the patient’s suitability to have their medication can be re-assessed. The pharmacist should explain to the patient that if they are still intoxicated when they return, both their daily dose, and any take home/Sunday dose will be withheld and if possible, give advice regarding the risks of overdose. Regardless of the outcome, the pharmacist must ensure that the prescribing agency is contacted and informed at the beginning of clinic first thing on the next working day.day for guidance. Key Contacts Stoke-on-Trent Adult & YP Integrated Drug & Alcohol Service Wood House Etruria Road ▇▇▇▇▇▇ Stoke on Trent ST15NQ Tel: SPOC ▇▇▇▇▇ ▇▇▇ ▇▇▇ / Wood House (▇▇▇▇▇▇) 01782 283113 / ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ Fax: ▇▇▇▇▇ ▇▇▇ ▇▇▇ Dilated pupils with sluggish response to light Loss of co-ordination Smell of alcohol on breath Drowsiness and sedation especially if taken with another depressant e.g. benzodiazepines Lateral nystagmus (spontaneous, rapid, rhythmic eye movements) Irritability Drowsiness and sedation especially if taken with another depressant e.g. alcohol Loss of co-ordination Slurred speech Droopy eyelids Dizziness Poor comprehension Irritability Pinpoint or constricted pupils Sedation and drowsiness especially when taken with other depressants (e.g. benzodiazepines, alcohol, barbiturates) Droopy eyelids Slow speech Brisk reflexes Fine tremor of limbs Blurred vision Irrational behaviour Confusion Appendix B Supervised Consumption Incident Report Form Patient Name Date of Birth TYPE OF INCIDENT (tick one or more boxes) Client declined observation Prescription problem Intoxication Disruptive behaviour Threatening conduct Shoplifting Missed three doses Irregular Attendance Other (specify) Appendix C Supervised Consumption Pathway Needle exchange scheme explained, as appropriate Client requiring supervised consumption, as part of treatment package This is the pathway for clients who, in line with the clinical guidelines, require supervised consumption. Pharmacist checks client identity and prescription details are correct and legal First Visit Repeat Visit Prescription prepared in advance Regular Irregular Attendance Attendance Assessment of client’s health and well-being Other Health Intoxicated Issues Supply withheld Contact prescriber No Issues

Intoxication. 15.1 Methadone and buprenorphine & Buprenorphine should not be dispensed in instances when the pharmacist considers the patient to be significantly intoxicated due to drug or alcohol use. When a patient presents in this manner the pharmacist should establish if this is a result of alcohol or drug use. 15.2 If significant intoxication due to alcohol or drugs is suspected, the pharmacist should telephone the prescribing service to seek advice from the care co- ordinator coordinator or prescriber before medication is dispensed. 15.3 In instances when the patient presents as significantly intoxicated and the care coRecovery Co-ordinator or prescriber cannot be contacted then the following courses of action will be taken: • If the patient presents as significantly intoxicated at the end of a working day after the prescribing agency is closed, the pharmacist must withhold the patient’s daily dose and ensure that the matter is discussed with the care co-ordinator or prescriber the following working morning. (Pharmacists handing over to locums / other pharmacists must ensure that the matter is communicated and that the pharmacist is able to deal with the matter on their behalf). The patient should be given an explanation as to why their dose is being withheld and if possible, advice given regarding the risks of overdose. • If the patient presents as significantly intoxicated on a Saturday or a long bank holiday period when the prescribing agency is closed, the pharmacist should decline to dispense the patient’s medication and ask them to return for their medication later in the day when the patient’s suitability to have their medication can be re-assessed. The pharmacist should explain to the patient that if they are still intoxicated when they return, both their daily dose, and any take home/Sunday dose will be withheld and if possible, give advice regarding the risks of overdose. Regardless of the outcome, the pharmacist must ensure that the prescribing agency is contacted and informed at the beginning of the next working day.