ROLE OF PHARMACISTS. If doctor and patient agree to move away from supervised consumption GPs should pay attention to the orange book guidance on the role of the community pharmacist (section 5.4.1). The total dose to be taken home should not normally exceed 500 ml. This is based on the practical considerations of carrying and storing the methadone. If patients are on larger doses then twice or thrice weekly collections should be considered. Consideration can also be given to prescribing methadone in daily doses, particularly where the quantities involved are large, or when patients first move away from supervised consumption. Where patients will be travelling abroad doctors may, at their discretion prescribe additional methadone to cover a holiday abroad. Guidance provided by the “Substance Misuse Management in General Practice” website is attached to this guidance as Appendix 2. Please note that Home Office permission to take methadone out of the country does not mean that the country visited will necessarily allow the medication in. See also Drug misuse and dependence UK guidelines on clinical management Annex 4 page 108. Pharmacists should ensure that a suitable method of measuring the daily dose from a bulk supply of methadone is provided – this can be a tarred [marked] bottle, a plastic measuring cup or a 5ml spoon, depending on the size of dose. Prescribers should note that they need to clearly state the intervals and quantities to be dispensed on each prescription for “take home” doses and consider bank holidays. If pharmacists have concerns about a patient – for example they are missing collections, or their health or social functioning are deteriorating they should communicate these to the prescriber and/or key worker.
