News

Media And Political Bulletin – 30 April 2019

Media and Political Bulletin

30 April 2019

Media Summary

Scottish government announces £2.6m funding boost for community pharmacies

The Pharmaceutical Journal, Corrinne Burns, 29 April 2019

The Pharmaceutical Journal reports that community pharmacy in Scotland will receive an extra £2.6m in funding in the 2019/2020 financial year, matching the increase it was awarded in the previous year.

The Scottish government has announced that the global remuneration sum, which covers fees and allowances, for 2019/2020 will be £183.6 million and, with other forms of income, community pharmacies would be guaranteed remuneration of £224.7m in the 2019/2020 financial year.

The package also includes confirmation that the Pharmacy First scheme, which gives patients access to treatments for uncomplicated urinary tract infections and impetigo from a community pharmacy, has been integrated with the national minor ailments service. Funding for this element of the integrated service will remain at £1.1 million per year.

Opioid painkillers ‘must carry prominent warnings’

BBC News, 28 April 2019

BBC News reports that all opioid medicines in the UK will carry prominent warnings on their labels saying they can cause addiction, the health secretary has announced.

Matt Hancock acted after figures in England and Wales revealed a-more-than 60% increase in prescriptions for opioid painkillers in the last decade. People needed protection “from the darker side to painkillers,” he said.

Health experts welcomed the move, saying opioids can cause “life-altering and sometimes fatal addictions”.

This was also reported in PMLiVE and Pharmacy Business.

UK online pharmacies accused of ‘aggressive’ tactics to sell opiates

The Guardian, Sarah Marsh, 26 April 2019

A Guardian investigation revealed that online pharmacies have been accused of failing to carry out proper ID checks and using inappropriate marketing tactics to sell strong and addictive opiate drugs.

At least two major online pharmacies – registered with the UK regulator – are sending customers emails urging them to order drugs by claiming stocks are running out or telling them their “limit” has been removed and they can now buy more codeine pills.

There is growing concern internationally about the rising use of opioid drugs, such as morphine, fentanyl, oxycodone, tramadol and codeine. The regulator of pharmacies in England, Scotland and Wales recently introduced new rules to protect people from buying inappropriate drugs over the internet.

 

 

Parliamentary Coverage

House of Commons Tabled Written Questions – 29 April 2019

Bridget Phillipson (Houghton and Sunderland South):

  • To ask the Secretary of State for Health and Social Care, whether his Department plans to agree a multi-year funding commitment with community pharmacies to help ensure they can help achieve the goals of the NHS Long Term Plan.
  • To ask the Secretary of State for Health and Social Care, what plans his Department has to use community pharmacies to reduce pressure on urgent care services across England as part of the NHS Long Term Plan.

 

Full Coverage

Scottish government announces £2.6m funding boost for community pharmacies

The Pharmaceutical Journal, Corrinne Burns, 29 April 2019

The Scottish government has announced that community pharmacies will receive an additional £2.6m in funding in the 2019/2020 financial year.

Community pharmacy in Scotland will receive an extra £2.6m in funding in the 2019/2020 financial year, matching the increase it was awarded in the previous year.

The Scottish government has announced that the global remuneration sum, which covers fees and allowances, for 2019/2020 will be £183.6 million and, with other forms of income, community pharmacies would be guaranteed remuneration of £224.7m in the 2019/2020 financial year.

The package also includes confirmation that the Pharmacy First scheme, which gives patients access to treatments for uncomplicated urinary tract infections and impetigo from a community pharmacy, has been integrated with the national minor ailments service. Funding for this element of the integrated service will remain at £1.1 million per year. The Scottish government announced in September 2018 that it would be expanding its existing minor ailments service to make it available universally.

The funding decision was announced in a letter sent to NHS boards by Rose Marie Parr, chief pharmaceutical officer for Scotland, on 23 April 2019. Community Pharmacy Scotland (CPS), which has been negotiating the package with the government, said in a statement that “the package could not be accepted by the CPS board”.

Despite this, the CPS said “there are, nevertheless, many outputs within this package that CPS were willing to accept, and it particularly welcomed “the commitment to Pharmacy First through the introduction of funding into guaranteed streams”. It said it would work with the Scottish government to ensure that the extended minor ailments service would be up and running from April 2020.

Aileen Bryson, deputy director of the Royal Pharmaceutical Society (RPS) Scotland, also welcomed the increase in funding, and the further commitment to the national minor ailments service.

“The RPS supports the Scottish government’s vision for more people to use their community pharmacy as a first port of call and believes that the minor ailment service offers huge benefits to patients. We would like to see it offered to everyone across Scotland as a priority,” she said.

Rajshri Owen, head of professional and patient services at pharmacy wholesaler and community pharmacy membership company Numark, said although the funding announcement was welcome, “a longer period of funding assurance would have been favoured by Scottish contractors, particularly as we still remain uncertain how, when or even if Brexit will happen”.

Further details of the funding package are that the guaranteed minimum margin retained by contractors will be reduced from £100 million in 2018/2019 to £80m for 2019/2020. But the letter from Parr says that, “dependent on market conditions”, community pharmacy contractors will keep 100% of the first £10m earned above that minimum. Margin earned above £90 million will, the letter says, be shared on a 50:50 basis with NHS boards.

As with the 2018/2019 financial year, a sum of £20m will be set aside from the generic drugs tariff for guaranteed funding of an “agreed basket of targeted drugs”. This, the letter says, means that “the total amount of guaranteed remuneration in 2019/2020 will be £224.7m”.

The clawback on margin accumulated in 2018/2019 will between £18m and £20m, with the clawback rate set at 6% as of 1 April 2019.

Opioid painkillers ‘must carry prominent warnings’

BBC News, 28 April 2019

All opioid medicines in the UK will carry prominent warnings on their labels saying they can cause addiction, the health secretary has announced.

Matt Hancock acted after figures in England and Wales revealed a-more-than 60% increase in prescriptions for opioid painkillers in the last decade.

People needed protection “from the darker side to painkillers,” he said.

Health experts welcomed the move, saying opioids can cause “life-altering and sometimes fatal addictions”.

  • NHS accused of fuelling rise in opioid addiction
  • What are opioids and what are the risks?
  • Illicit and prescription drugs ‘played role in 10 deaths’ in NI

Opioids, such as morphine or fentanyl, can be highly effective for managing severe pain but they can also be highly addictive, the Department of Health (DoH) said.

It warned the number of prescriptions in England and Wales issued for these sorts of medicines had risen dramatically from more than 14 million in 2008 to 23 million last year.

The DoH added there are also some opioids available over the counter, such as codeine-based painkillers, which are weaker in strength but can also cause addiction.

From 2008 to 2018, the number of codeine-related deaths in England and Wales has more than doubled to more than 150, it said.

In Scotland, codeine-related deaths spiked at 43 in 2016, dropping to 27 in 2017, National Records of Scotland said.

In Northern Ireland, there were 16 codeine-related deaths in 2017.

What are opioids?

  • A large group of drugs used mainly to treat pain
  • Includes naturally occurring chemicals like morphine and codeine, as well as synthetic drugs
  • Codeine, morphine and methadone are among opioids judged by the World Health Organization as essential for treatment of pain and end-of-life care
  • Some opioid medications – methadone and buprenorphine – are used to help people break their addictions to stronger opioids like heroin

What are they used for?

  • Moderate and severe pain relief
  • Limited time treatment of pain that does not respond to standard painkillers like aspirin, ibuprofen and paracetamol
  • Usually used for acute pain – such as after surgery or terminally-ill cancer patients

Why are they dangerous?

  • They can be highly addictive
  • Pleasurable feeling that results from taking opioids can contribute to psychological dependence on the drugs
  • Higher doses can slow breathing and heart rate, which can lead to death
  • Mixing with alcohol or other sedatives such as benzodiazepines can also have serious consequences

Mr Hancock said: “I have been incredibly concerned by the recent increase in people addicted to opioid drugs.

“Painkillers were a major breakthrough in modern medicine and are hugely important to help people manage pain alongside their busy lives but they must be treated with caution.

“We know that too much of any painkiller can damage your health, and some opioids are highly addictive and can ruin lives like an illegal drug.

“Things are not as bad here as in America, but we must act now to protect people from the darker side to painkillers.”

‘Like thousands of insects inside your skin’

Lisa Peake, from London

I was prescribed painkillers for chronic neck pain after an accident in February 2014 but the pain didn’t go away.

I was taking codeine four to five times a day, tramadol as a top-up once a day, as well as naproxen and co-dydramol four or five times a day.

Opioids affect your mental capacity, you feel dizzy, you can’t concentrate and it’s hard for you to do your job.

I went on a three-week hospital pain management programme in October 2016 and they helped wean me off the meds and rely on other methods of pain control.

I had all the symptoms, albeit to a lesser extent, of a drug addict doing the same.

It feels like you’ve got thousands of insects inside your skin. You can’t find any comfort, you can’t sleep and your bowel movements are shot to pieces.

Professor Dame Sally Davies, the chief medical officer for England, has welcomed the government action.

She said: “We know that long-term use of painkillers can lead to life-altering and sometimes fatal addictions, so I am delighted to see measures put in place to raise awareness of the risks of codeine and prescribed drugs.

“It is vital that anyone who is prescribed strong painkillers takes them only as long as they are suffering from serious pain.

“As soon as the pain starts to alleviate, the drugs have done their job, and it is important to switch to over-the-counter medication like paracetamol which do not carry the same risk of addiction that comes with long term use.”

Analysis by Fergus Walsh, BBC medical correspondent

Until the late 90s in the UK, opioids were usually restricted to cancer patients and for those in acute pain following surgery, but then they began being increasingly prescribed for chronic pain.

As our population ages, the number of people living with low back or nerve pain is soaring. Opioids can be effective in the short term, but don’t work for pain that lasts for months or years.

The medicine packets already contain leaflets warning about potentially dangerous side-effects and the risks of addiction. Making these more prominent may encourage patients and their doctors to discuss alternatives such as physical and talking therapies.

The variation in prescribing rates between NHS regions shows that it is possible to limit their use.

Things have been getting worse here, but are nowhere near as bad as the US which has four times the rate of opioid prescriptions as the UK.

Public Health England is already undertaking a review into prescription medication addiction and is due to report its findings this year.

Under Mr Hancock’s plan, the Medicines and Healthcare products Regulatory Agency (MHRA) will have the power to enforce warnings on opioids packaging, following recommendations from the UK’s Commission on Human Medicines (CHM) Opioid expert working group.

Dr June Raine, director of the MHRA’s vigilance and risk management of medicines division, said: “This is an important first step to help minimise the risks of addiction associated with opioid medicines, while supporting patients to get the right information at the right time to support their care.”

UK online pharmacies accused of ‘aggressive’ tactics to sell opiates

The Guardian, Sarah Marsh, 26 April 2019

Online pharmacies have been accused of failing to carry out proper ID checks and using inappropriate marketing tactics to sell strong and addictive opiate drugs, a Guardian investigation can reveal.

At least two major online pharmacies – registered with the UK regulator – are sending customers emails urging them to order drugs by claiming stocks are running out or telling them their “limit” has been removed and they can now buy more codeine pills.

Online pharmacies have a limit on the amount of prescription drugs that can be ordered within a certain time period.

There is growing concern internationally about the rising use of opioid drugs, such as morphine, fentanyl, oxycodone, tramadol and codeine. The regulator of pharmacies in England, Scotland and Wales recently introduced new rules to protect people from buying inappropriate drugs over the internet.

The Doctor-4-U website contacted one customer about buying codeine, which costs £84.99 for 200 30mg tablets, writing: “What are you waiting for? … This item is going fast so grab them while you still can.”

Another online vendor, MyUKDoctor, alerted customers whenever they could order highly addictive opiate drugs again, saying their “limit” had been removed. “Please click here to reorder your medication again,” it said.

Ash Soni, the president of the Royal Pharmaceutical Society, said he was astounded by the marketing.

“That is, for me, something that should be firmly investigated by the regulators, that is appalling. That really is – to turn around and say ‘the restriction on that product has now been lifted if you want to buy some more please go and do so’. That is something you would never expect a reputable pharmacist to do.”

Dr Jane Quinlan, a consultant in anaesthesia and pain management at Oxford University hospitals NHS foundation trust, described the tactics as “really shocking”.

Both MyUKDoctor and Doctor-4-U are approved by the Medicines and Healthcare products regulatory agency, and both display the EU common logo with the message “click to verify if this website is operating legally”.

Yasir Abbasi, the clinical director for addiction services at Mersey Care NHS foundation trust, described the marketing as aggressive.

He said: “When it comes to opioid medications there should not be any direct marketing towards the consumer and if there is then there needs to be clear regulations and guidelines around that.”

A spokesperson for Doctor-4-U said the message was not a marketing email, rather, it was sent out when a person had placed an order but abandoned it before paying.

“This is not a marketing tactic and we would stress it is not possible to purchase any opioids through the website without a doctor’s approval,” the spokesperson said.

However, the company confirmed it would stop sending the message “in a bid to make our policy clearer on this matter”.

MyUKDoctor did not respond to the Guardian’s requests for comment.

Opioids tend to be prescribed for chronic lower back pain and arthritis, despite research showing the drugs are not the most effective way to treat such pain. There are concerns about growing prescription levels amid a rise in overdoses and an increasing problem of dependence and addiction to prescription drugs.

Codeine on its own is only available on prescription, with unauthorised possession being illegal. Small amounts of the drug are in some medicines that can be bought without prescription, but only in pharmacies.

Quinlan said: “We are trying to reduce the number of pain patients being prescribed opioids for chronic pain, as we know they don’t work for the majority of patients, and are trying to support those now dependent on high-dose opioids prescribed and taken in good faith.

“However, these online sales of opioids represent an invisible population of drug dependence, with what appears to be minimal checks and poor governance, risking patient safety.”

The Guardian was able to obtain 200 codeine tablets in two weeks by ordering 100 30mg tablets from the UK Meds website as “David Smith”, but with a card registered under a different name. A further 100 tablets were obtained from PillDoctor, using the same “David Smith” pseudonym and a payment card under another name. Random photos were uploaded instead of proof of ID and the proof of address. Both websites said customers should use their own name and card.

Abbasi said: “The method and governance around the way medication is ordered should raise a lot of concerns in the UK.”

PillDoctor, which is based in London but uses EU doctors to issue consultations and prescriptions, said the order went through by mistake due to “human error”.

“This does not reflect our practice … Human error has contributed to this and we have now taken swift measures to avoid such errors in the future,” a spokesperson said.

UK Meds, based in Nottingham, said its products were prescribed by General Medical Council-regulated doctors or other licensed prescribers and dispensed by a General Pharmaceutical Council-regulated pharmacy.

“The company acknowledges and is alive to the reality that the potential for abuse of the service is an ever-present risk that it needs to address. It continually strives to put in place rigorous procedures, operating in accordance with applicable legislation, which attempt to limit the potential for abuse of its service,” they said.

Prof Helen Stokes-Lampard, the chair of the Royal College of GPs, said the revelations were of great concern.

She added: “Codeine is an opioid and well-known to be highly addictive and so its use needs to be very carefully monitored. GPs are experts in prescribing and will be extremely cautious about starting a patient on opioids, but will also make sure they are closely monitored and regularly reviewed.”

One customer said she had obtained drugs for more than three years from different websites, citing the same condition each time. “I’ve been ordering from one website since citing the same condition every time (lying basically, saying that I’d had a pilonidal cyst removed) and they’ve never questioned it and just sent me the meds … This would be unheard of at any doctors’ surgery.”

The use of online pharmacies has increased rapidly in recent years, but issues have been raised about regulation.

Concern has also been raised about a legal loophole that allows people to buy strong painkillers from doctors based in Europe. It comes after the death of Jennifer Anne Lacey, 51, who was found dead in a Travelodge hotel in Morden, south London, last summer.

The coroner concluded (pdf) Lacey had killed herself after overdosing on tramadol and alcohol. She had taken 210 tablets, half of which she bought online.

The doctor who gave her 100 tablets of 50mg tramadol was based in Prague, Czech Republic. He had never seen her and had no access to her medical records, nor had he spoken to her GP. Lacey simply filled in an online form.

Concluding the inquest into her death, the coroner Fiona Wilcox said she was concerned such potentially dangerous and addictive drugs were so freely available online.

Media And Political Bulletin – 30 April 2019

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