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Volume 7; Number 3. September 2006.

Contents In this issue:


Role of Pharmacy Technician 1
We have an article outlining a role for
Pharmacy education in 2
NSW technicians in substance use in Scotland, a
Benzylpiperazine 3
descrption of the Sydney University drug
containing ‘legal party pills’ misuse curriculum development, and an
Recent publications 4 article from New Zealand on an interesting
Conferences/events 4 phenomenon - the use of ‘legal’ party pills.

The role of the The stand alone unit is a small, and alcohol support services to
purpose built portacabin. The merit approx 740 clients (not all of these
pharmacy of this being that the patients are in individuals are on a methadone
technician in a more controlled environment out programme). In addition to the
of public gaze. The unit has three pressure on the services patients
substance misuse. rooms (waiting room, administration were experiencing a limited choice
Deidre Millar, room, an additional room which is in a variety of services available to
Glasgow, Scotland used as a meeting room) and toilet them.
facilities. I found this area of
In response to these local pressures
My name is Deirdre. I am a Pharmacy pharmacy very interesting, and since
and capacity issues a new pilot
Technician of 26 years experience, I was in the middle of the BTEC
facility-Florence Street Methadone
having worked in general pharmacy Certificate in Clinical Pharmacy for
Clinic was developed within Gorbals
and mental health pharmacy in Pharmacy Technicians I decided to
in January 2003.
Glasgow, Scotland. use this new experience as my course
project. The project looked at Each morning Monday to Friday I
During that time I gained a National Pharmacy Technician involvement in uplift and check daily medicine doses
Certificate in Pharmaceutical supervising methadone consumption from 2 local community pharmacies
Sciences, Higher National Certificate and the training issues involved. for all the patients on the scheme.
in Pharmaceutical Science, Final For security purposes I am taxied
Accuracy Checking Qualification and From there a permanent position
between pharmacies and dropped
a BTEC in Clinical Pharmacy for became available and I was the
off at the Methadone Clinic. The clinic
Pharmacy technicians. successful candidate. In preparation
is then opened throughout the day
for this role I undertook the SCPPE
Initially I became involved with substance to issue medication to the patients
distance learning pack and I continue
misuse when volunteers were sought and supervise consumption on a daily
to update my training by attending
to set up a Methadone Supervision basis and to issue multiple doses
STRADA courses.
Programme in a deprived area in the when necessary. I manage this clinic
centre of Glasgow. This was done with The Gorbals area of Glasgow has on an unsupervised capacity. A
a view to setting up a more long term traditionally been an area of high security door has been installed
solution. The programme started with deprivation. At this time the area had which allows individuals to be viewed
a few selected patients before a stand recently undergone a period of prior to entry.
alone unit was established. regeneration resulting in a new
I maintain and keep records, in
incoming population. This new
accordance with the Misuse of Drugs
population had created tension with
Act, of all drugs issued to ensure the
Welcome to PharMAGazine. The Editor and the existing residents and negative
proper procedures are maintained
the Steering Committee would welcome attitudes towards the high numbers
your comments, both positive and negative.
for drugs not issued. Any medication
of patients receiving methadone
Contact Janie Sheridan: School of not collected is returned to the
were strong.
Pharmacy, The University of Auckland, 85 appropriate pharmacy at the end of
Park Road, Grafton, Auckland, New Pharmacies within the area were also the day. I record when the patient
Zealand. Email: j.sheridan@auckland.ac.nz struggling to meet the demands arrives and ask the patient to sign a
placed on them by the increasing record each day.
Neither PharMAG or PharMAGazine accepts number of methadone patients
responsibility for the accuracy of the It is important to maintain a
joining the scheme. Glasgow City
information published here. communication stream with case
Council Social Work Services South
© PharMAGazine. Contents not to be workers, GP’s and community
reproduced without permission.
Community Addiction Team is
pharmacists regarding progress or
located in the area, providing drug

1
regression of he patients in the seek advice from other health conduit to treatment, are often
scheme or ones who may be eligible professionals. This has come through apprehensive and ignorant about
for the scheme. With other health experience. treating this population and as a
and social care professionals I assess This is a very challenging and result, many make the choice not
potential patients for suitability to enjoyable role. It is a new area of to dispense opioid replacement
join the scheme. The criteria for pharmacy for technicians to move pharmacotherapies. (Ironically, what
inclusion to Florence St Methadone into and become very much involved. many of them fail to realise is that
Clinic is:- As drug misuse is a big part of society, members of this population are often
Ø Stable it is good to know that pharmacy already customers). Generally
technicians can be very much part speaking, pharmacists in NSW do not
Ø Methadone prescription only feel confident in dispensing
(Initially this was true but now 1/3 of the team trying to make a
difference. There is a lot of pharmacotherapies to people who
of the patients attending are on are opioid dependent.
benzodiazepines) knowledge to be gained from taking
on a role in substance misuse. When surveyed a number of barriers
Ø Agreement between agencies, were identified including: not enough
including patient, prescriber, addiction I am asked on a regular basis if I feel
threatened or at risk. No, I do not time, remuneration too low, no skills
worker and community pharmacist. to ensure compliance, no adequate
and have never felt that. The
Part of my duties is to provide advice majority of patients that attend rely knowledge about drug misuse or
to patients with ongoing medication, very much on the service and are relevant skills in this area, disruptive
doses, possible side-effects, benefits friendly. Sometimes I am the only behaviour of clients, not wanting this
of taking medicines: provide person they see from one day to the type of client in their pharmacy, and
information to other healthcare and next and they enjoy coming in for a training difficult to access
social care professionals on patient chat or sometimes just to unload One way to begin addressing some
progress/problems; provide information some of their problems. No two days of these barriers, namely the lack of
to patients on a wide range of health are the same. Even though it is the knowledge and ignorance of drug
related topics. same routine every day there is and alcohol (AOD) issues, would be
I have close links with GP’s especially always something going on or a to include some learning/information
when a patient is newly prescribed patient has a tale of woe to share, on this area in the undergraduate
Buprenorphine (Subutex). One GP and I as their confidante feel I am Bachelor of Pharmacy.
in particular asks for daily reports on making a difference. Drug Summit
the patient’s progress. Deirdre Millar is the pharmacy technician at the
Florence St Methadone Clinic. For more information In 1999 the then Premier of NSW
There are occasions where I have contact: Deirdre.Millar@glacomen.scot.nhs.uk recognised that illicit drugs were a
to make a judgement on whether a health, social, economic and political
patient’s medication should be issued issue. As a result a drug summit was
or withheld due to a patient turning called inviting comment from many
up intoxicated on either alcohol/ areas of health, social welfare, and
drugs. On these occasions I contact other interested parties and key
the patient’s addiction worker and stakeholders (law enforcement,
GP to notify them of my concerns. Pharmacy education consumers organisations, religions
If a patient missed three or more in NSW – the state organisation, NGOs, government
doses I contact their addiction departments, etc).
worker and GP to alert them to the of play
fact. There is usually a good Jennie Houseman, One outcome of the drug summit
explanation as to why they had was that money was allocated to a
Sydney, Australia. number of different organisations for
disappeared.
the treatment of people with drug
Dealing on a personal level with Dependence on drugs, whether legal dependence issues. One recipient of
patients with different levels of or illicit, has a large impact on our this funding was the Pharmacy Guild
problems and communication skills is community, in both human and of Australia (NSW branch). Part of
part of my daily duties. This can be economic terms. There is a need in this funding was then allocated to
very challenging sometimes. I find the community for skilled professional the University of Sydney to be used
myself dealing with patients who are help in these areas. Pharmacists specifically for education of
sometimes looking for advice or help represent a large and geographically undergraduate pharmacy students
on situations ranging from problems available professional group who are about drug dependence issues.
with partners to minor health highly thought of in the community.
matters or even pet matters. One They constitute an appropriate and At that time in NSW, the only
patient was looking for advice on underutilised resource in the pharmacy school was at the
how to tame the latest addition to treatment of drug dependence. University of Sydney and the only
the family - a pet hamster! I see this People who are dependent on illicit AOD content in the undergraduate
as part a sign that one of the goals drugs, specifically opioids, often course was the pharmacology of
of the scheme is being achieved. experience discrimination. Many are drugs of addiction. This was a failing
The patients are feeling human and also disadvantaged by limitations of the course and perpetuated the
can open up in a way they might being placed as to where they can ignorance of the pharmacists. Young
not elsewhere. On a professional be dispensed their treatment graduates left the course and went
level it is always important for me to medication, as they would any other out into community pharmacy with
know when to tell the patient to prescription. Pharmacists, one no understanding of the psychosocial
aspects this area of treatment, nor
of the mechanics of dispensing these been provided by the NSW government, their use spread, and
treatments. In society, attitudes Department of Health Centre for many different products became
towards people who use illicit drugs Drug and Alcohol to ensure that the available containing in addition to
tend to be negative and very AOD content is included in the BZP, chemicals such as
moralistic and by and large, these undergraduate Pharmacy curriculum. trifluoromethylphenyl-piperazine
attitudes are reflected by the As a result, the University of Sydney (TFMPP), and amino acids and herbal
pharmacy students. is now searching for a practitioner extracts. They are often known as
What was needed was not only some teacher to take up this role, but legal herbal highs or social tonics. BZP
training in the actually pharmacological there have been no applicants for is banned in the USA, and parts of
aspects of drug dependence but also this position. So, caught up in a Europe and Australia.
some way of changing these “catch 22” situation, students need BZP, initially manufactured as an
attitudes. Allowing pharmacists to see the information, but there is no one potential anthelminthic agent for
drug dependence as a health issue. to teach them, as there is limited animal use, and an analogue was
As I was working as a clinician with recognition of the importance and briefly marketed as an antidepressant
drug dependent patients and had limited knowledge amongst in Europe.
some experience in teaching at a pharmacists of this area of
treatment. Rat studies indicate than BZP has
tertiary level, I was invited to write amphetamine like properties, and
the drug and alcohol curriculum for As a result of this extra funding, the TFMPP might mimic the effects of
the Bachelor of Pharmacy at the University of Sydney started ecstasy. There has been some
University of Sydney. searching for a practitioner/teacher research into the effects these
The main aim of incorporating new to take up this role. For two years chemicals have on monoamines and
information into the curriculum was no applicant could be found for this other chemicals in the brain. In high
to change attitudes and reduce the position. It was a “catch 22” doses, some piperazines can cause
fear and ignorance generally held by situation, students needed the hallucinations2, respiratory depression
pharmacists on matters of illicit drug information, but there was no one and convulsions3. They are irritant to
dependence. to teach them, and there is no one skin, and as such pose a potential
to teach them, as there was limited harm to those who ‘snort’ or inhale
The Curriculum recognition of the importance and the chemicals in powder form.
limited knowledge amongst
Some content was inserted into each pharmacists of this area of In 2004 the New Zealand government
year of the four year degree with treatment. The position was became concerned about these
most of the content being in the final eventually filled last year. We have products and the Expert Advisory
fourth year. yet to evaluate the outcomes of this Committee on Drugs (EACD), was
education. Will the attititudes of the tasked with reviewing available
Overall aims
new pharmacists who have been evidence and advising on whether the
Ø To provide students with an understanding exposed to this content be less products should be banned or in some
of recreational drug use, drug misuse and other way use legislated. Their report
discriminatory towards these
drug dependence in a historical and found a lack of evidence on which to
psychosocial context. patients?
base any decision, and as such the
Ø To provide an overview of treatment for Jennie Houseman is a Consultant Pharmacist/
products remained freely available4.
drug dependence, and in particular, treatment AOD Counsellor and Community Pharmacy
Liaison. For more information contact: However, in 2005, an amendment to
for opioid dependence.
jhouseman@nsccahs.health.nsw.gov.au the Misuse of Drugs Act restricted their
Ø To provide the skills for safe and correct sale to those aged 18 or more, banned
dispensing of pharmacotherapies prescribed free samples, and restricted
for the treatment of drug dependence advertising.
Ø To challenge some of the myths and
Currently, many dozens of products
stereotypes of drug abuse (and abusers).
exist with names such as Charge,
Ø To increase students’ awareness of their
role as pharmacists in identifying and
Benzylpiperazine- Kandi, Goodstuff, Jump, Bolts, Legal
X, Frenzy and Euphoria. A typical
responding to problems due to dependence containing “legal formula might be as follows:
on illicit and legal drugs.
party pills” in New THE GOOD STUFF
The curriculum was rolled out and run
in its entirety for two years, after
Zealand 80mg BZP
which time the teaching of this Janie Sheridan, New 40mg TFMP
subject lapsed. This was possibly due Zealand 80mg Amino Acid Blend (Leucine,
in part to the fact that there was no Isoleucine, Valine, L-Glutamine)
one to teach it, as there are very New Zealand has over the last few 200mg Electrolyte Blend (Sodium,
few pharmacists with an interest in years, experienced a new Potassium, Magnesium & Calcium salts)
this area of pharmacy, and partly to phenomenon in psychostimulant
the lack of teaching time available. drug use. Around four years ago,
This is not due to a lack of recognition Many products are not appropriately
products containing benzylpiperazine labelled however, so users are unsure
of the importance of this area of (BZP) started to appear in shops and
pharmacy, merely due to the large both about the contents and the
on the internet, marketed as “safe quantities of each chemical contained
number of specialties competing for alternatives” to using stimulants –
a very limited amount of time. in a capsule or tablet. They products
in particular ecstasy and are markets through their packaging
More recently further funding has methamphetamine. Unregulated by to appeal to young people, and to
those attending clubs and music and club owners. The final result of Amphetamine Conference September.
events. this study will be available by the end Sydney Convention Centre Darling
of this year. Other studies are Harbour. For more information contact
Despite an estimated 8 million or more Anex on +61 3 9486 6399 or email
doses having been consumed, there exploring the pharmacokinetics of
conference@amphetamines.org.au.
is currently little evidence of BZP, potential drug interactions, www.amphetamines.org.au
widespread adverse events. Three impact on cognitive functioning and
mood. Future studies are about to 12th -13th October 2006 National Needle
recent New Zealand studies have Exchange Conference. Lord’s cricket ground,
been published. Two report on start into the impact of potential
London. For more information contact:
adverse events presenting at additional legislation. The team is also monique@exchangeconferences.org
emergency departments. The first5, developing and evaluating a range
5th-8th Nov 2006. Australasian Professional
reports on 80 presentations out of of ‘evidence-based’ information
Society on Alcohol and Other Drugs
which 15 experienced toxic seizures. sources. (APSAD) ConferenceCairns Convention
Many of these patients had taken New Zealand has relatively poor Centre, Cairns, Australia. For more info
party pills with other substances such availability of cheap illcit drugs such as contact: apsad2006@icms.com.au. http:/
as alcohol and cannabis, with a small cocaine and ecstasy, and this is one /www.apsadconference.com.au/
minority consuming them with multiple reason people hypothesis that LPPs
illcit substances. Whilst the study have become so popular. Recently
concluded that BZP can cause serious there have been media reports of
toxicity, no analysis was undertaken these products being marketed in the Recent publications
to explore the impact of co- UK, where they are currently legal
consumption of other psychoactive http://www.guardian.co.uk/uk_news/ Kavalirova A, Visnovsky P.Use of
substances, on adverse effects. story/0,3604,1665787,00.html. marijuana in pharmacy students (2000-
Another case study described Whether or not they become as 2005). Biomed Pap Med Fac Univ Palacky
nephrotoxicity of one patient whose popular in the UK as they are in New Olomouc Czech Repub. 2005
condition resolved6. The third study Zealand remains to be seen. Dec;149(2):477-80.
was a survey of emergency 1. Russell B. Party pills – how little is known? Forman RF, Woody GE, McLellan T, Lynch
department (ED) attendees7, and New Zealand Family Practitioner KG. The availability of web sites offering
found that of the 1043 who 2006;33(1):46-48. to sell opioid medications without
completed the questionnaire, 11.9% 2. National Drug Intelligence Center. National
prescriptions. Am J Psychiatry. 2006
drug threat 2004. Johstown, PA: U.S. Jul;163(7):1233-8.
had ever used party pills, and that
Department of Justice, NDIC; 2004 April.
74% would use them again. Thirty
six percent did not read the label and 3. National Drug Intelligence Center. Children
at Risk. Information Bulletin. Non-Classroom Use:
38% had at some time consumed Department of Justice, Washington, DC. NDIC;
more than the recommended dose. 2002. Report No.: No-2002-L0424-001. News
The study did not explore whether 4. The Expert Advisory Commitee on Drugs
these ED presentations were BZP- (EACD): Advice to the Minister on: Kay Roberts, chair of PharMAG, has
related; rather it explored previous use benzylpiperazine (BZP): EACD, Wellington; been awarded The Royal
2004.
of BZP products into his cohort. Pharmaceutical Society’s Charter
5. Gee P, et al.Toxic effects of BZP-based herbal gold medal for 2006, for her
Massey University has recently party pills in humans: a prospective study in
siginificant role in the development
published a study in which legal party Christchurch, New Zealand. New Zealand
Medical Journal 2006;118(1227). of substance misuse policy and
pill users were interviewed about their
servcies, and her reserach in this field.
use8. This formed part of a national 6. Alansari M, et al. Nephrotoxicity of BZP-based
herbal party pills: a New Zealand case report. A HUGE congratulations to Kay!!
household survey-type study, which New Zealand Medical Journal 2006; May
found 1:5 of respondents had ever 5;119(1233):U1959.
used LPPs. Of these, the majority 7. Nicholson TC. Prevalence of use,
were in the age group 18-24, and epidemiology and toxicity of ‘herbal party pills’
the majority ahd used them only once among those presenting to the emergency
department. Emergency Medicine Australasia
And finally - thanks
or twice in the last year. Adverse
effects reported to be associated
2006;18(2):180-184. to our sponsors
8. Wilkins C, et al. Legal party pill use in New
with use included: ‘trouble sleeping’ Zealand: Prevalence of use, availability, health ·Britannia Pharmaceuticals Ltd
(50.4%), ‘poor appetite’ (41.1%) harms and ‘gateway effects’ of benzylpiperazine ·Reckitt Benckiser Ltd
‘loss of energy’ (18.4%), ‘strange (BZP) and triflourophenylmethylpiperazine
·Rosemont Pharmaceuticals Ltd
thoughts’ (15.6%), ‘heavy sweating’ (TFMPP). Auckland: Centre for Social and
Health Outcomes Research and Evaluation ·Frontier Medical Ltd
(23.4%), ‘stomach pains/nausea’ ·Cardinal Pharmaceuticals
(SHORE), Massey University; 2006.
(22.2%), ‘headaches’ (21.9%) and
‘tremors and shakes’ (18.4%). Janie Sheridan is Head of Pharmacy Practice
at the School of Pharmacy, University of
Currently, at the university of Auckland, NZ. For more infromation
Auckland, we are studying the use contact: j.sheridan@auckland.ac.nz
of LPPs amongst young people aged
16-24. This qualitative study is Anyone wishing to become a
exploring amongst other things, use member of PharMAG should
patterns, reasons/function of use, contact Kay Roberts - 14
purchasing patterns. Interviews are
Conferences and Crown Gardens, Downahill,
Glasgow G12 9HL UK Tel:
also being carried out with key meetings +44 (0)141 337 6799 email:
experts such as youth workers, kay@mymbrob.freeserve.co.uk
youth drug and alcohol, specialists, 28th-29th Sept 2006. Australasian