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Part 1 (March 2003 report) featured media reports of issues  impinging on primary health care and medication control in Europe and North America.  Factors underlying current pharmacy developments  were explored by Con Berbatis in meetings with a sample of medical and pharmacy leaders in research, administration and practice  in the UK and North America during  January 2003.

Europe and UK -  misused licit opioids and proving pharmacists’ competence  in primary care

The first of three key figures I saw from 3 to 5 January in London was Dr Michael Farrell, a psychiatrist and veteran researcher in the treatment of opioid dependence in London’s National Addiction Centre. I also visited three  pharmacies (Table 1).

Dr Farrell is a former colleague of Dr Janie Sheridan now Associate Professor in the new School of Pharmacy at  the University of Auckland’s Faculty of Medical and Health Sciences. In 1998 with  Australia’s Professor Wayne Hall  (ex-head  of NDARC, Sydney), they first reported the limited application of supervised  heroin to under 5% of all heroin addicts (Swiss heroin trial results: BMJ 1998; 316: 639).
He was at Adelaide’s famous conference in January 1999 and coedited the resulting Proceedings of an expert workshop on the induction and stabilisation of patients onto methadone  
( Humeniuk R, et al, National Drug Strategy Monograph No. 39, 2000 ).

Table 1. London meetings with medical and pharmacy leaders

Dr Farrell is a warm, focused man who I first  met in March 1998 when visiting the National Addiction Centre as a prelude to our 1999-2000 study of pharmacy services in Australia’s methadone programs. In his Denmark Hill  office at noon 3 January we spoke on retention of patients as the key indicator of the effectiveness of methadone  programs, the  street heroin shortage and the growth, diversion and  misuse of prescribed opioids.
The overdose deaths of over 100 females from the injection of prescribed heroin by  Manchester’s Dr Shipman  showed flaws in Britain’s control of  restricted drugs.
Buprenorphine was now an accepted, but secondary treatment after methadone, of opioid dependence.

Pharmacists’ key primary care role  in harm reduction by supervised methadone dosing, issuing sterile needles and educating the public was recognised through  Europe. The new book ‘ Drug misuse and community pharmacy’  ( Janie Sheridan, John Strang, editors. Taylor & Francis, 2003) was a valid record of pharmacists’ contributions.
He  complimented the chapter The services provided by community pharmacists to prevent, minimise and manage drug misuse : an international perspective, contributed by Western Australia’s Con Berbatis, Bruce Sunderland and Max Bulsara.

We were hosted in the Kent home of  Dr Stuart Anderson  a colleague from the 1980s and 1990s when he was  a prominent hospital pharmacist  and visited Australia. Stuart is now a  senior lecturer in the London School of Hygiene and Tropical Medicine’s  Department of Public Health and Policy and  is an authority on the history and development of  community  pharmacy activities in drug misuse and primary health care (Table 2) .
Stuart is  often invited to Europe to evaluate pharmacy systems and lecture in North America.
The fights for  pharmacist-only or P-status drugs in the UK and Schedule 3 drugs in Australia are current battlegrounds for territory in primary heath care which had been largely lost in the USA.
Measurable markers such as identifying misuse, refusing supply, appropriate selection of medicine  and proper advice are key indicators to show  ‘duty of care’ activities by pharmacists in issuing  these medications. 

Table 2. Key UK publications for pharmacy

Dr Annmarie Ruston is director of research in the University of Greenwich’s Centre for Health Research and Evaluation which is the site of London’s next university pharmacy faculty. 
Dr Ruston headed the national survey of  a 10% random sample Great Britain’s  1262 pharmacies in 2000 .
This achieved a 58% response and  Dr Ruston  for the first time analysed characteristics of pharmacy settings and pharmacists in relation to the practice of ‘extended role’ activities .
She predicted new pharmacy services would develop slowly because pharmacists’ professional commitments, and not settings, determined their implementation.
She advised that we should be able to extend these statistical analyses with our high 81% proportional nationwide response from Australia’s community pharmacies in Curtin University’s  National Pharmacy Database Project.

On Saturday 4^th January I was taken to a sample non-pharmacy corporate pharmacy (Tesco about 500 sq metres NLA) and two  pharmacy-controlled group pharmacies ( Lloydspharmacy, Boots)  pharmacies in  urban London (Table 1) where I spoke to pharmacists about prescription-related , OTC activities, methadone  and screening activities.
I bought or was given publications from them.

Table 3. Great Britain’s  pharmacies in 2003: by group and percentage

(Source : Daily Telegraph 18 January 2003)

Addendum to Part 1: The UK’s Office of Fair Trading (OFT)  recommended to deregulate dispensing pharmacies run by large supermarket groups (eg Tesco, Sainsbury’s) to the Department of Trade and Industry and not the Department of Health as reported in the media (Table 3).
The responses so far from  the four UK Departments of Health have been positive for pharmacy because all have highlighted errors and anomalies in the OFT report.
The OFT report failed to recognise that although 90+% of people do their main shopping in supermarkets, a very high percentage of the people that require pharmaceutical services is included in the 10% who do not have access to transport and therefore supermarkets.
In Scotland the Scottish Executive Health Department (Government) has announced that it does not accept the report's recommendations. 
The next step is for  the Department of Health and the Department of Trade and Industry to sway the thinking of the Treasury. Regarding deregulation of OTC prices in 2001, pharmacy colleagues report supermarkets cut prices at first but they haven't maintained their reduced prices.

Con Berbatis
Lecturer
School of Pharmacy
Curtin University of  Technology of Western Australia
Chief Investigator
National Community Pharmacy Database Project

1 May, 2003