Services Database Supervised Consumption (Cambridgeshire Area)

Service ID



Supervised consumption provision is available to those aged 18 years and over who are prescribed opiate substitute treatment (OST) as part of a substance misuse treatment programme where:

    • Supervised consumption is specified on the prescription
    • Prescribing is undertaken by a prescriber at a CGL base or by a GP with Special Interest (GPwSI)/GPs participating in formal Shared Care arrangements within the Cambridgeshire.
    • the individual is usually resident within the Cambridgeshire area
  • The service will require the pharmacist to supervise the consumption of prescribed medications when indicated by the prescriber, ensuring that the dose has been administered appropriately to the service user.
  • The prescribing service will contact the service users chosen pharmacy prior to the service user attending the pharmacy, to ensure the pharmacy has capacity to take on a new service user. The pharmacy will be provided with the service users’ details.
  • The service user’s recovery worker will be responsible for obtaining the service users agreement to supervised consumption.
  • Terms of agreement between the prescriber, pharmacist, service user and recovery worker (four-way agreement) should be discussed and agreed. This should detail how the service will operate, what is considered acceptable behaviour by the service user and what will happen if the agreement is breached. Signatures should be obtained and a copy of the agreement given to the service user and a copy kept by the pharmacy. The service user should be provided with any relevant pharmacy information at this time (e.g. opening hours).
  • The pharmacy will provide support and advice to the service users, including referral to other primary care services or specialist substance misuse services where appropriate.
  • The pharmacy will continue to provide advice and support to service users who are moving from supervised consumption to daily pick-up and beyond; this may include referral back to the prescriber where appropriate.
  • If medication is dispensed for non-supervised consumption (e.g. Sundays, Bank Holidays) the service user must be provided with information regarding the safe storage of the medication and reminded of the danger it presents to others.
  • Methadone: The pharmacy will present the medicine to the service user in a suitably labelled receptacle and will provide the service user with water to facilitate administration and/or reduce the risk of doses being held in the mouth. If a service user’s dose is measured out in advance of their visit then suitable containers with lids should be used. These shall be individually labelled as per normal labelling regulations. Prior to disposal of these containers, all identifying labels shall be removed/anonymised.
  • Buprenorphine and buprenorphine/naloxone: The pharmacy will prepare the dose. The service user will be provided with water (in a disposable cup) prior to issuing the dose, this may speed up the process of the medication dissolving under the tongue. The medication should be tipped directly under the tongue without handling. The service user will need to be supervised until the tablet has dissolved. This may take up to 10 minutes. When most of the tablet is dissolved, and only a chalky residue remains, talk to the service user to determine the dose has fully dissolved. Offer a further drink of water.

Crushing of tablets is off-licence and therefore should not be undertaken unless the prescriber requires this. If required the prescriber must write this on the prescription and both the prescriber and service user must be aware that this is off-licence.

  • Espranor: The pharmacy will prepare the dose. The oral lyophilisate should be removed from the blister pack with dry fingers and placed whole on the tongue until dispersed, which usually occurs within 15 seconds. The service user will need to be supervised until the lyophilisate has dissolved. Swallowing must be avoided for 2 minutes and food and drink not consumed for 5 minutes after.
  • If a service user misses three consecutive doses of OST, the prescribing service must be contacted and no further doses dispensed unless advised by the prescriber. Any patterns of non-attendance e.g. always missing the same day or regularly missing days should also be advised to the prescribing service so dispensing arrangements can be reviewed.
  • The instalment direction is a legal requirement and must be complied with; however, the Home Office has approved specific wording to be used which gives pharmacists a degree of flexibility when making a supply. The following wording allows a pharmacy to supply the balance of an instalment if the interval date is missed:
  1. Please dispense instalments due on pharmacy closed days on a prior suitable day.
  2. If an instalment’s collection day has been missed, please still dispense the amount due for any remaining day(s) of that instalment.
  3. Consult the prescriber if 3 or more consecutive days of a prescription have been missed.
  4. Supervise consumption on collection days.
  5. Dispense daily doses in separate containers.

Location of service

Cambridgeshire & Peterborough LPC


Other: Change, Grow, Live

Method of commissioning

Source of funding

Service type

Supervised administration

Other organisations involved


Start date:
End date:




  • The lead pharmacists providing the service are required to successfully complete:
    • CPPE Substance Use and Misuse (Modules 1 – 4) and the associated learning
    • CPPE Safeguarding Children and Vulnerable Adults and the associated learning
  • All pharmacists will be required to complete the CPPE Declaration of Competence for Supervised Consumption of Prescribed Medicines. The declaration will need to be confirmed on PharmOutcomes via enrolment.
  • The training requirements must be met within three months of joining the service and updated every three years.
  • A representative from the pharmacy may be required to attend an annual training event.
  • The accredited pharmacist will attend the initial training and accreditation evening organised by Change Grow Live before commencing the service.
  • The lead pharmacists will be responsible for identifying staff training needs and for recording their own Continuing Professional Development, and cascading training to all staff where appropriate.