Setting up a drug treatment service in a COVID-protect hotel in inner London

At the start of the UK's COVID-19 lockdown, the government announced an ‘Everyone In’ strategy to get homeless people off the streets and into accommodation. An Inner London borough opened a hotel to house up to 100 homeless people to address their health needs. Local healthcare providers were asked to provide in-reach services. This article describes the setting up and delivery of a drug treatment service to provide substitute opioid therapy. Thirty-five people were taken into drug treatment in the hotel between April and December 2020. During this time various challenges had to be addressed including same-day prescribing, delivering and supervising controlled drugs and responding to drug dealing in the hotel. Partnership work between the different healthcare providers was essential for the success of this project and offers a model that could be used going forward to deliver comprehensive wrap-around services to hard-to-engage individuals with multiple health needs.

Development of forensic and pharmaceutical researches within the organization of pharmaceutical business, drug technology and pharmaceutical law in Ukraine concerning the turnover of controlled drugs and substances

Background. In recent years, the COVID-19 pandemic has spread and is developing in all countries of the world without exception, affecting not only medical and pharmaceutical, but also social, economic, toxicological and criminal aspects. In such conditions, it is of great importance in the field of healthcare and the pharmaceutical industry of Ukraine to improve the system of legal relations "doctor-patient-pharmacist", based solely on the principles of pharmaceutical and medical law. Among the components of medical and pharmaceutical law there is forensic pharmacy, which studies the causes of offenses in the field of healthcare. The purpose of the study was to analyze history of formation and development of forensic and pharmaceutical researches in Ukraine within the organization of pharmaceutical business, drug technology and pharmaceutical law. Materials and methods. Legislative and regulatory documents were used in the study; scientific publications in the field of "forensic pharmacy"; Internet resources. Normative and legal, documentary, historical, bibliographic, forensic and pharmaceutical, comparative and graphic methods of analysis were used. Results. Forensic pharmacy in the world as a scientific field is known and developed since 1946. The article covers the period of 1990-2004. Prominent scientists of Ukraine were of great importance in the formation of forensic pharmacy. The formation of forensic pharmacy began with the generalization of forensic and pharmaceutical practice in historical retrospect "from police chemistry to forensic chemical and pharmaceutical examination – from forensic pharmacy to pharmaceutical law and medical law" with the support of prof. Chernykh V.P. In the period of 1997-2003, the development of forensic pharmacy took place by improving the regulatory and legal support of the control and licensing system of circulation of medicines. Trends in the prevalence of diseases involving uncontrolled and irrational use and abuse of surfactants have been identified. The causal links between drug addiction, substance abuse and crime have been investigated. The interpretation of "potent", "poisonous" substances in the regulations of Ukraine have been improved. It is substantiated that the main indicator of classifying drugs as "potent" and "poisonous" substance is a forensic criterion that qualifies the consequences of irrational use of drugs by severity of injuries: from mild, moderate to severe injuries, or those that caused fatalities. At the next stage (2003-2004) the scientific and theoretical generalization and the new approach to the decision of a problem which is connected with development of scientifically-based principles of optimization of system of the state control over circulation of narcotic drugs, psychotropic substances and precursors were studied. The possibility of participation of a pharmacy specialist (pharmacist-forensic scientist) at the stages of: investigation, pre-trial investigation in forensic chemical and pharmaceutical studies of physical evidence and participation as a forensic expert in a criminal case in court has been researched. Conclusions. It is substantiated that the formation of forensic and pharmaceutical researches within the organization of pharmaceutical business, drug technology and pharmaceutical law in Ukraine has taken place. Further forensic pharmaceutical research needed to harmonize domestic legislation, international human rights standards in the field of health care, legal regulation of the pharmaceutical market and the medical services market.

Evaluation of an Automated Dispensing Cabinet in Paediatric Intensive Care – Focus on Controlled Medications

Evidence is limited of automated dispensing cabinets (ADCs) impact on effectiveness and efficiency of controlled drugs’ (CDs) governance processes. We carried out a mixed-methods study of an ADC in an intensive care unit. We found ADC improved effectiveness and efficiency of governance of CDs through secure storage, alerts and automated recording of transactions. Limitations were associated with ADC design and ‘fit’ between ADC and some types of CDs.

The Price Effect of Drug Price Ceilings: Intended and Unintended Consequences

Policy makers in many developing countries use maximum price or markup policies to control pharmaceutical costs, which represent 20%–60% of their overall healthcare expenditure. We study the price effect of price ceiling policies by exploiting a major policy shift in China: the elimination of longstanding ceilings on retail drug prices. We collect weekly price and characteristics data on more than 4,500 drug stock keeping units (SKUs) from a leading pharmacy chain. By comparing the rate of discontinuous price jumps across drugs with and without price ceilings during the years before and after the policy change, we find that while price ceilings are effective in containing the prices of some drugs, they can lead to higher prices for others, particularly if the ceilings are set at the national level irrespective of local economic conditions. About 5% of nationally controlled drugs (or more than 125 drugs) had inflated prices because of price ceilings, with an average price inflation of 10%. We attribute this perverse price effect to focal point pricing and asymmetric information about production costs. Further supporting this view, we find the perverse price effect most prominent in lower-income regions where the centrally set price ceilings are arbitrarily high considering their poorer economic conditions. Moreover, drugs with highly concentrated production and less elastic demand face heightened risks of inflated prices under price ceilings. Finally, based on a sample of drugs with available price ceiling data, we find that drugs with manufacturer-specific ceilings are 100% more likely to be priced at or near their ceilings and 70% more likely to experience price drops once the ceilings are removed compared with other drugs with regular ceilings. Overall, this paper documents the unintended perverse effect of price ceilings in pharmaceutical markets and sheds lights on the ongoing debate of drug price regulation. This paper was accepted by Stefan Scholtes, healthcare management.

Writing a prescription: the law and good practice

Paramedic independent prescribing offers an opportunity to improve patient access to medications. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. This article in the Prescribing Paramedic series considers: the legal requirements a prescription must meet for prescription-only medicines and controlled drugs; common errors that may occur during prescription writing and potential solutions; and best practice recommendations for prescribers to follow when writing a prescription to minimise errors. The advantages and disadvantages of electronic prescribing are discussed.

Liability in Criminal Law

This chapter highlights the complexity of the interaction of the criminal law with the regulation of medicines and medical devices. It outlines the elements of the broader criminal law that include offences against the person and corporate and financial crimes that can be committed by individuals or corporate entities, such as corporate manslaughter, fraud, and bribery. It also elaborates on the criminal investigation in the UK that can be led by law enforcement agencies, including the Medicines and Healthcare products Regulatory Agency (MHRA). The chapter considers the relevance of the broader criminal law for individuals and corporates and the criminal law aspects of the regulatory regime. It refers to the criminal enforcement process and the role of the Proceeds of Crime Act 2002 (POCA), including the application of the controlled drugs licensing regime to cannabis-based products for medicinal use (CBPMs).

Treatment-resistant Abuse of Oxybutynin With Psychotic Symptoms: A Case Report and Literature Review

BackroundAnticholinergic drugs are the most commonly used addictive drugs among non-prescription drugs. Oxybutynin is one of the anticholinergic drugs widely used for overactive bladder and nocturnal enuresis treatment for both adults and children. Here is a new case of oxybutynin use with high dose and long-term use despite recurrent treatment applications. Case PresentationA 25 years old, unemployed man that was graduated from primary school applied to the inpatient clinic. He reported that he has been using oxybutynin for 8 years. He was taking 500 mg/day of oxybutynin (100 pills in a day), approximately. He stated that he had taken 250-300 pills in some days (1000-1500 mg/day). He described agitation, irritability, anxiety, visual and auditory hallucinations, reference thoughts, and persecution delusions. The patient was diagnosed with Other Substance Use Disorders according to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria. Carbamazepine 400 mg/day, olanzapine 10 mg/day, and lorazepam 2.5 mg/day treatments were started. At the end of the five weeks, both symptoms improved completely. In the follow-up, he had no psychiatric symptoms two months after the discharge. He was not using any substance or addictive drugs; working regularly in his father’s family business. ConclusionsOxybutynin is one of the non-controlled drugs, so can be obtained easily from pharmacies without a prescription in Turkey. Interestingly, case reports about oxybutynin use are all from Turkey. Oxybutynin should be considered for the potential for addiction due to its anticholinergic properties, easily accessible, and cumulative cases. Psychiatrists and non-psychiatric physicians, especially urologists should be aware of the addiction potential of the drug because of anticholinergic effects, especially between substance users, and oxybutynin may cause some psychotic effects.