Services Database Supervised Consumption (St Helens Council Area)

1.2 To enhance public health and safety by:

»      Minimising the risk of medication diversion and illicit supply of controlled drugs.

»      Reducing the prevalence of drug-related deaths in the community.

»      Supporting people accessing the service to achieve stability, aiding their recovery journey.

1.3 To ensure close monitoring of people accessing the service during critical treatment phases, including the titration period, where medication doses are adjusted incrementally. Supervision during this phase is essential for identifying tolerance levels and ensuring the safe administration of medication.

1.4 To maintain effective communication between pharmacies and prescribers, particularly during instances where:

»      People accessing the service miss doses, especially during the titration phase, to safeguard against overdose risks.

»      Supervision of treatment is reviewed, with the need for continued supervision reassessed regularly (e.g. after four weeks for methadone or one week for buprenorphine).

1.5 To provide people accessing the service with key harm reduction and safety messages, including:

»      The dangers of medication diversion.

»      Safe storage of prescribed medications, especially during non-supervised consumption (e.g. weekends or bank holidays).

»      Advice on the risks of drug or alcohol intoxication and how this may affect their treatment.

1.6 To facilitate access to broader support networks by encouraging people accessing the service to engage with prescribers, recovery workers, and other health and social care professionals as needed.

1.7 To ensure the safe and supervised administration of medications:

1.8 For methadone: Providing the medication in a suitably labelled container, ensuring the dose is consumed in full under supervision, with water offered to minimise the risk of retained doses.

1.9 For buprenorphine: Supervising the administration of sublingual tablets, ensuring they fully dissolve before the person accessing the service leaves. Providing water before and after dosing to aid the process and confirming that the dose has been absorbed. If the prescriber instructs that buprenorphine tablets must be crushed, the pharmacist must acknowledge that this is an "off-license" use of the medication and confirm that both the prescriber and person accessing the service are aware of the associated risks.

1.10 For Espranor: Supervising the administration of the oral lyophilisate, ensuring it dissolves on the tongue within 15 seconds, with the individual avoiding swallowing for 2 minutes and refraining from food or drink for 5 minutes post-administration.

1.11 To establish clear agreements with people accessing the service at the outset of treatment, setting expectations around behaviour, missed doses, and safe medication use. Agreements must be documented in a four-way contract signed by the person accessing the service and pharmacy staff.

1.12 To promote consistency and safety during exceptional circumstances, such as when medication is collected by a representative (e.g. family member, key worker or police officer). Pharmacists must consult with prescribers to confirm arrangements, as supervision cannot be carried out in such cases.