DrugInfo seminar: The Pharmacotherapy, Advocacy, Mediation and Support (PAMS) Service
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Presentation by Sarah Lord to the DrugInfo seminar: Heroin and other opioids, 27 September 2011 in Melbourne, Australia.
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DrugInfo seminar: The Pharmacotherapy, Advocacy, Mediation and Support (PAMS) Service
- 1. The ‘Pharmacotherapy Advocacy, Mediation and Support (PAMS) Service A Program of HRV Presented By: Sarah Lord ADF Seminar – ‘Heroin and Other Opioids’
Editor's Notes
- Issue: accused of bupe diversion by pharmacist (says he “didn’t divert” and tells pharmacist to “shove it”), he is then told program is in jeopardy due to suspected diversion and rude behaviour. No other pharmacy with vacancy in his area. Rings PAMS to find out what he can do to ‘clear his name’ and record his complaint. PAMS negotiates a ‘treatment agreement’ between pharmacist and consumer to allow Jason to stay on the program under strict conditions – Jason agrees. 2 months later Jason rings PAMS and says his pharmacist is awful to him makes him wait and, he believes gave him ‘crushed Panadol’ in a TAD. PAMS speaks to the pharmacist about not crushing bupe TADs, locates another pharmacy (much further away) and supports Jason through formal complaints process to AHPRA, who investigate and are unable to find evidence to prove consumer allegation.
- Issue: Renee is told she is 8.5 weeks pregnant by prescriber who encourages her to consider swapping to methadone or at least BPN. Renee wants to keep the baby and doesn’t want to swap to methadone, but agrees to take BPN. Prescriber explains there are some risks with BPN and pregnancy and says it is her choice to remain on buprenorphine during the pregnancy. Pharmacist then informs Renee she shouldn’t be on bupe at her next dose. Renee explains she has spoken to her doctor, but feels she is now ‘treated differently’ by the pharmacist, shop assistant and other customers since becoming pregnant. With increased appointments for her pregnancy (and increased travel costs, etc), Renee falls behind in her dispensing fee payments. Her pharmacist has told her no $, no dose! Renee is terrified of potential miscarriage from withdrawal and she is very stressed. She normally lives on $40.00 per fortnight for food after paying other expenses. She has been buying second hand goods for her baby and now can’t pay her dispensing fees. She rings PAMS to find out what she should do. PAMS manages to refer Renee to a welfare agency who agree to pay for two weeks of her dispensing fees and discusses with the pharmacist the research around pregnancy and buprenorphine, along with the value of pharmacotherapy programs for pregnant women. Issue: Renee is told she is 8.5 weeks pregnant by prescriber who encourages her to consider swapping to methadone or at least BPN. Renee wants to keep the baby and doesn’t want to swap to methadone, but agrees to take BPN. Prescriber explains there are some risks with BPN and pregnancy and says it is her choice to remain on buprenorphine during the pregnancy. Pharmacist then informs Renee she shouldn’t be on bupe at her next dose. Renee explains she has spoken to her doctor, but feels she is now ‘treated differently’ by the pharmacist, shop assistant and other customers since becoming pregnant. With increased appointments for her pregnancy (and increased travel costs, etc), Renee falls behind in her dispensing fee payments. Her pharmacist has told her no $, no dose! Renee is terrified of potential miscarriage from withdrawal and she is very stressed. She normally lives on $40.00 per fortnight for food after paying other expenses. She has been buying second hand goods for her baby and now can’t pay her dispensing fees. She rings PAMS to find out what she should do. PAMS manages to refer Renee to a welfare agency who agree to pay for two weeks of her dispensing fees and discusses with the pharmacist the research around pregnancy and buprenorphine, along with the value of pharmacotherapy programs for pregnant women.
- Michael needs to take his dose before he goes to work each morning. He starts work at 7.30AM when the pharmacy isn’t open. He asks his prescriber for additional T/As who says “no” after a +UDS and 5 ‘missed doses’ in the last month. Michael is afraid of losing his job and rings PAMS to find out what he can do. PAMS offer to speak to Michael’s prescriber on is behalf. Prescriber agrees to provide Michael with a ‘split dose’ (1/2 dose before work, ½ after work at the pharmacy), the prescriber agrees to do this on a trial basis with “no TADs” and to review the situation after one month, Michael is pleased with this as an ‘interim’ outcome and agrees to call PAMS back in one month to discuss how things are going.
- GP prescribes Oxycontin (80mg 2Xs p/d) for 6 weeks, applies for a permit – permit application denied on the basis of IDU history, GP refers J to a PMS but waiting list is at least 6 months. GP can’t do anything until he has a recommendation from the PMS! Jamie tries 5 other GPs and is ‘knocked back’ – original GP is informed J has been to 6 GPs in 3 months (‘doctor shopper’ notification by HIC), J is in excruciating pain constantly with no quality of life until his shoulder can be operated on. Jamie contacts PAMS and asks what we can do to assist him!