ࡱ> BDA bjbj -$zN +++8cw$+G%tvvv$$$$$$$$&])$vv$%FFFX$F$FF"ln$+DX$*$%0G%D$*)L)Tn$)n$Dv>,F$vvv$$^vvvG%)vvvvvvvvv :  Supervised Subutex (Buprenorphine) Your doctor has prescribed Subutex and stated that this is to be supervised consumption. This means the following must happen. You come into the pharmacy on your own. You hand in your medication card We positively identify you You remove any chewing gum or sweets from your mouth and dispose of them in a waste bin. Having a drink of water at this stage speeds up the time it takes for the tablets to dissolve. The dispensed tablet is taken from the container with your name on and squeezed out of the foil and into a plastic medicine measure If the prescriber specifies crushed then the tablet(s) will be broken into smaller granular pieces. This will have been explained to you by your prescriber as crushing is off licence You are expected to tip the tablet(s) or granules under your tongue without touching them and hand back the measure. You must then sit down and allow these to dissolve - this usually takes between 3 and 5 minutes for tablets - significantly less time for granules. During this period you may be recorded via a CCTV system. Once the tablets have dissolved you should report to the pharmacist and will be provided with a drink of water, which you should drink. The pharmacist may ask to look into your mouth to check the tablets have dissolved. You will then be given back your medication card and may leave. Important Failure to follow the points above will result in the prescription being suspended and you being referred back to your doctor. Missing 3 consecutive doses will also mean that you have to contact your clinic/doctor. I have read and understood the supervised crushed Subutex scheme and agree to take part. Signed ..Print Name Date Note to Pharmacists Crushing Subutex tablets takes the product Off Licence. You should check with your liability insurer as to whether they cover this activity. The main advantage of crushing is that it reduces the chance of diversion and subsequent injection of the tablets. In addition it does speed up the supervising process. It has been used widely in Australia and is mandatory in the state of Victoria. The disadvantages are that it is Off Licence, there is potential for variation in the amount absorbed and there is a theoretical possibility of burns to the buccal mucosa caused by the citric acid content within the tablets. NPA/CDAs Indemnity Insurance will cover this activity provided: The prescriber is in agreement to crushing - ideally the prescriber should indicate crush on the prescription. Alternatively, a signed protocol between the pharmacist and prescriber should specify that supervised Subutex is to be given crushed under specified circumstances (eg where diversion is suspected / doses of 8mg or over / for all patients / etc). The patient is aware that this is Off Licence and agrees to receiving crushed tablets. Here the choice would not normally be between crushed or whole .........but between crushed Subutex or possibly nothing as the patient would have to be referred back to the prescriber who may then opt for prescribing supervised Methadone as the better option for avoiding diversion. Provide the patient with an information leaflet (example overleaf). It would be good practice to obtain a signature from the patient to say that they have read the leaflet and are aware that the product is Off Licence. A record is kept that the medication has been given to this patient crushed - this could be via the PMR (Tip -creating a new product called Subutex Xmg Tablets (CRUSHED) and dispensing this would show up clearly on the patients record.) 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Arial Black;WingdingsA BCambria Math"4҆4҆&)Q )Q !xx4ss2QHP ?bL2!xx"Supervised Subutex (Buprenorphine)Martin Bennett T             Oh+'0   @ L X dpx$Supervised Subutex (Buprenorphine)Martin Bennett Normal.dotm 2Microsoft Office Word@Ik@.>"@ڐ@ڐ)Q ՜.+,0, hp  $Associated Chemists (Wicker) Ltd.s #Supervised Subutex (Buprenorphine) Title  !"#$%&'()*+,-./02345678:;<=>?@CRoot Entry FEData 1Table=*WordDocument-$SummaryInformation(1DocumentSummaryInformation89CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q