Chamber and committees

Responsibility for the training of sales assistants in non-pharmacy outlets is not a matter for the Executive.

Before a medicine is classified for general sale, it is considered to be safe to use without professional advice.

This information is not available.

The sale and supply of medicines on the General Sales List Order are controlled under section 53 of the Medicines Act 1968.

In Scotland, the Medicines and Healthcare products Regulatory Agency enforces the Medicines Act 1968 on behalf of Scottish ministers. Records held do not identify test purchase initiatives in Scotland in non-pharmacy outlets in respect of amounts of analgesics and other proprietary medicines sold at any one time.

The safety of medicines availableon the UK market is the responsibility of the Medicines and Healthcare products RegulatoryAgency (MHRA) and the expert independent advisory committee, the Committee on Safetyof Medicines (CSM).

There are a number of alternativesfor managing pain and the CSM has issued advice on pain management options to assistprescribers, together with individual patients, in choosing pain management strategies.This guidance also refers to a number of sources of additional advice includingthe British National Formulary, issued to doctors and pharmacists.

On 31 January 2005, The ScottishExecutive Health Department issued advice from Professor Gordon Duff, Chairman,CSM, about the withdrawal of co-proxamol. The CSM’s overview of alternative analgesicoptions is available on the MHRA website (www.mhra.gov.uk).In order to minimise disruption of healthcare provision, co-proxamol will be phasedout over an extended period of time so that patients currently receiving co-proxamolmay be switched to a suitable alternative.

No new patients should be initiatedon co-proxamol therapy.

In December 2004, Chiron, themajor supplier of diamorphine injection in the UK, informed the Department of Healththat its supplies of this product were limited. Since that time, the Scottish ExecutiveHealth Department working with NHS National Services Scotland, the Department ofHealth and NHS Purchasing and Supply Agency, have been monitoring the supply situationfor diamorphine.

Wockhardt UK, the otherUKsupplier, has increased its production and extra supplies are being distributedto the NHS. However, it is likely that diamorphine injection will remain in shortsupply for the immediate future. Health professionals have been asked to conservestocks for patients in whom the need is greatest. Wherever possible, the use ofalternative medicines should be considered. 

In December 2004, Chiron, themajor supplier of diamorphine injection in the UK, informed the Department of Healththat its supplies of this product were limited. The other supplier, Wockhardt UK, continuesto produce diamorphine injection and has increased its production and these extrasupplies are being distributed to the NHS.

Because of the limited availabilityof diamorphine injection, prescribers have been asked, wherever possible, to switchpatients to alternative analgesics. Given the switch in prescribing habits, stocksof diamorphine injection are being conserved for those patients whose need is greatest.The UK Health Departments are taking whatever action is necessary to secure sufficientsupplies of the alternative medicines to meet the needs of patients in the UK.

On 23 December 2004, the Scottish Executive Health Department issued guidance to health professionals alertingthem to a potential shortage of diamorphine injection. Alternative analgesics todiamorphine are available, principally morphine, and clinicians will need to decidewhich product is most appropriate for each individual patient.

The Right Medicine; a Strategyfor Pharmaceutical Care in Scotland identifies community pharmacists as having a role inproviding access to advice in various areas of sexual health promotion such as adviceon safe sex and avoiding sexually transmitted infections as well as providing contraceptiveservices, for example access to emergency hormonal contraception.

As part of its work in PhaseOne (2001-04), the National Demonstration Project Healthy Respect enabledcommunity pharmacists in Lothian to provide Chlamydia testing as part of an integratedsexual health service. Their work on postal Chlamydia testing kits which were widelydistributed in retail outlets including pharmacies has helped to inform the developmentof the Scottish Executive’s sexual health strategy Respect and Responsibility: Strategyand Action Plan for Improving Sexual Health.

I launched the strategy witha statement to the Scottish Parliament on 27 January. The strategy sets out, forthe first time in Scotland, a coherent framework for improving sexual health. Weexpect its implementation to be driven by the relevant agencies, taking accountof input from key stakeholders. Contained within the strategy is a commitment onthe Health Department to consider the possible extension of the Chlamydia postaltesting kit in the light of the evaluation of Healthy Respect. We will also considerthe potential of developing and testing sexually transmitted infections diagnostickits in rural and urban settings.

The safety of medicines availableon the UK market is the responsibility of the Medicines and Healthcare products RegulatoryAgency (MHRA) and the expert independent advisory committee, the Committee on Safetyof Medicines (CSM).

There have been longstandingconcerns about the safety and efficacy of co-proxamol. The CSM first warned prescribersabout the risks associated with co-proxamol in 1985. Despite being identified bythe British National Formulary as “less suitable for prescribing”, co-proxamol remainswidely prescribed.

During 2004, the CSM reviewedall the available evidence regarding the risks and benefits of co-proxamol. A publiccall for evidence on the risks and benefits of co-proxamol was also conducted for12 weeks in 2004; the MHRA wrote to a large number of organisations representinghealthcare professionals, patient groups and other stakeholders as well as publishingthe request for information on their website (www.mhra.gov.uk).The CSM reviewed all the responses together with international evidence on the safetyof co-proxamol. The information gathered during this exercise provided no new objectiveevidence concerning the risk:benefit of co-proxamol.

The CSM noted that previouslystrengthened warnings to doctors and patients on the hazards of co-proxamol provedineffective. After considering the wide range of available evidence and the optionsfor action to reduce the risk of overdose (e.g. prescriber and patient education,smaller pack sizes and restricted indications) the CSM determined that the risksof co-proxamol clearly outweigh the benefits of allowing this medicine to remainon the market.

Diamorphine is one of the opioidanalgesics used in pain relief in cancer patients. On 23 December 2004, the Scottish Executive Health Department wrote to health professionals to alert themto a potential problem with supplies of diamorphine. Health professionals were askedto take every possible step to conserve stocks of diamorphine injection for patientsin whom the need is greatest. Alternative analgesics to diamorphine are availableand care is needed when switching from one opioid analgesic to another to ensureequipotent dosage. The advice which issued from the department included a dosageguidance table.In June 2000, the Scottish IntercollegiateGuidelines Network (SIGN) issued a guideline on the control of pain in patientswith cancer. This guideline, number 44, can be accessed at www.sign.ac.uk.

The British National Formulary(BNF), issued free to doctors, gives advice on prescribing in palliative care. TheBNF can be accessed at www.bnf.org.