Schedule 3: Use it or lose it


Schedule 3 - pharmacist holding out pill bottles

Many pharmacists are taking Schedule 3 medicines for granted, writes Phil Spyrou… which could end up costing the profession dearly.

Pharmacists across Australia are looking to expand the scope of their practice through professional services, but may risk losing access to a group of medicines they take for granted: Schedule 3.

It is widely acknowledged by those within the profession that clinical input from the pharmacist into the supply of Schedule 3 medicines has fallen by the wayside.

By law, the pharmacist should be involved with the provision of every schedule 3 medicine; the ‘involvement’ of the pharmacist can mean different things, depending on a pharmacy’s structure and culture.

Some pharmacists will say that overhearing the interaction between the patient and pharmacy assistant is adequate, and they will intervene if required. Other pharmacists prefer to speak with each client seeking a Schedule 3 medicine.

In my opinion, pharmacists should speak with every patient who seeks schedule 3 medications. Pharmacists have the appropriate training and skills to identify patients who need referral to another health professional and to identify patients who may be at risk of interactions by taking a Schedule 3 medicine.

Even in the most simple cases, pharmacists can counsel patients on the quality use of their medications.

Is it realistic, though, for a pharmacist dispensing 300+ prescriptions per day with only one dispense technician and no other pharmacist/intern available, to personally counsel every patient requesting a schedule 3 medicine?

At a bare minimum, adequate histories should be taken from the client seeking an S3 and then if supply is appropriate, counselling on safe use of the medicine should follow.

In many pharmacies, these conversations are not being had.

Examples include:

  • Supplying chloramphenicol without asking if there is any pain in the eye or visual disturbances. (The patient may have acute glaucoma and not bacterial conjunctivitis).
  • Supplying salbutamol without discussing the patient’s asthma symptoms. (What if the patient is having serious and frequent exacerbations?)
  • Supplying codeine preparations without asking what other medicines the client is taking or asking what type of pain is being treated. (The problem may be medication overuse headache/rebound headaches. Personally, I see too many headache sufferers who have never heard of this condition.)

 

There has been talk recently from the TGA of whether to up-schedule codeine to Schedule 4. The efficacy of over-the-counter codeine preparations is a debate for another blog post.

Nonetheless, it should be a message to pharmacists: use it or lose it! If as a profession we do not treat Schedule 3 medicines with the respect that they deserve, they may be taken away from us.

Three solutions that I propose to this problem are:

  • improving the layout of dispensaries, placing the pharmacist(s) permanently out the front;
  • investing in pharmacists/interns, thus reducing the workload on pharmacies with one pharmacist on duty; and
  • improved training for pharmacy assistants.

 

Phil Spyrou is a community pharmacist and author of the Headache Freedom blog (www.headachefreedom.com).

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