Pharmacy central in harm minimisation innovation: expert

ecstasy or MDMA stop sign

Pharmacy may have opportunities to help harm minimisation efforts in the future as well as playing a key role in supply of medicinal cannabis, says a drugs expert who presented at last week’s National Drug Summit in Canberra.

Dr David Caldicott, an emergency consultant and senior clinical lecturer in Medicine at the Australian National University, told the AJP that in a health-based drugs policy, pharmacy could be “integral”.

Pharmacy’s involvement could be not just in providing products such as naloxone or evolving medicines such as cannabis, but also in reducing harms caused by illicit substances, he says.

“There’s a lot of potential,” he told the AJP. “For example, one of the things that came out of the Summit was unequivocal support for drug checking, pill testing.”

Last month ACT Greens MLA Shane Rattenbury advocated a pill checking scheme, allowing pill users to gauge the chemical makeup of their drugs before taking them, for the Territory.

“The reality is that most drug takers are unaware of the origin and chemical make-up of what they put into their body—the MDMA content in an ecstasy tablet can vary from 5%-60%,” Rattenbury said at the time.

“Even more concerning, many such pills contain a range of substances from tranquilisers to amphetamines, meaning many users are effectively playing Russian Roulette every time they take something.”

Dr Caldicott says that pharmacies could be very helpful in such a scheme, and that funds could be allocated to pharmacies providing professional services such as these.

“If you look at what happens internationally, for example in the Netherlands, there’s a facility for people to go to various geographical locations around the country to request an identification of their products,” Dr Caldicott told the AJP.

“As we reinvent what is going on in Australia, could it be that that geographical location could be a pharmacy?

“The overwhelming consensus from experts gathered at the Summit is that the balance regarding illicit drugs is completely skewed at the moment, and the budget for it needs drastic reallocation. I truly think some of that could be allocated to pharmacy services – not Big Pharma, but pharmacists, as they’re clever and understand drugs better than most physicians, I would say.

“I have tremendous admiration for pharmacy and what it’s capable of in the illicit drugs space. Pharmacy is a space that’s hugely underutilised in Australia and it’s really only up to the imagination of our young people as to how they want to reduce the harms.”

Medicinal cannabis is another area where pharmacy will be key, Dr Caldicott says.

“When it comes to the context of medical cannabis, that’s now a fast-moving space and there’s been a big brouhaha about farm to pharmacy – so ultimately you as a pharmacist are the endpoint in delivery of that,” he says. “The buck stops with you.

“This is an area where pharmacists are going to have a critical role to play, but the interesting thing is that we don’t really know what that role is going to be yet as defined by the federal government.

“My best guess is that it’ll be done much like the opiate legislation – tweak it and make it identical for cannabis would be the easiest thing to do. But a lot of people have been left scratching their heads, wondering whether we need to wait for the next shoe to drop, some Part B legislation out of the Federal Government, so really it’s now a question of whether we should push on and develop our own legislation in each state.”

Dr Caldicott says that he suspects that overall, there’s a preference for a uniform approach to prescribing cannabis.

“But heterogeneity in this space could be good, as it allows for different models to emerge, and then we’ll be able to compare one to another.

“The model I suspect will emerge would probably be a conservative one, something not dissimilar to the New York State model that’s a comparatively restrictive model.

“There’s a limited number of conditions cannabis can be prescribed for, and it can only be prescribed by authorised prescribers, each of whom needs to complete a specific course on medicinal cannabis and prescribing.”

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