PCA(P)(2023)34 - Naloxone Emergency Supply Service

Published: 10/10/23

Our colleagues at Scottish Government have published the following circular advising community pharmacy contractors and NHS Boards that a naloxone emergency supply service will be added to the community pharmacy Public Health Service from 30th of October 2023.

Through this service, community pharmacies (CP) will hold a supply of Naloxone for administration in an emergency.  This will support a significant increase in access to Naloxone so that it can be used to reverse the effects of an opioid overdose. It once again sees community pharmacy at the heart of the community, delivering care for the citizens of Scotland.  

Community pharmacy contractors should ensure that pharmacy teams complete the e-learning module for naloxone emergency supply, now available on the NES TURAS Learn website at: Community Pharmacy Emergency Naloxone Holding Service | Turas | Learn (nhs.scot). A Frequently Asked Questions (FAQs) resource below has also been developed and is available at the same web link.  However, if your question(s) are not addressed in the FAQ, please feel free to contact us at enquiries@cps.scot. 

FAQ provided by NES

• 1. Does this service cover supply of naloxone to people at risk and general public to take home for use in future emergency?

  No, this service covers immediate emergency situations only. That includes immediate emergency administration or supply to another person to administer e.g practice nurse, off duty police offer, GP, member of public competent in naloxone administration for use in immediate emergency. 

• 2. Does the administration and supply for immediate emergency use need to be on the pharmacy premises?

  No, Administration or supply for immediate emergency use can happen within or out with the pharmacy

• 3. How should I record this service?

  This service should be recorded via UCF. The service will be included as an option under Public Health Services. There will be two options:

  a) administration which will cover when naloxone has been supplied or administered for immediate emergency use and

  b) expiry for when naloxone has expired. 

• 4. Will I require patient details and CHI for recording?

  It is encouraged to record under the patients PMR if patient details are known. If patient details are not known there is an option to record under a “dummy” pharmacy record. Example dummy patient details are provided below. CHI is not required however if known encouraged to record. 

  The service to allow processing without a CHI will be set up and will go live in all pharmacy systems from October 30th. Essentially, this will be the same process CPs followed when bulk claiming LFD Kits during the pandemic, this time using the UCF Services – “Emergency Naloxone Administered” or “Emergency Naloxone Expired”

  A summary is detailed below:

  To submit a claim for out of stock Naloxone kits, or to claim for a resupply when a kit has been used and the patient is not known to you, you will have to create a dummy patient file on your PMR. We suggest using the following details for ease, though please note that these don’t have to be exact, it just helps in validating the claim. The important part is using the correct UCF service, which will either be “Emergency Naloxone – Administered” or “Emergency Naloxone – Expired”.

  Forename: Naloxone

  Surname: Naloxone

  DOB: 01/01/2000

  Address: 1 Any Street, NF1 1AB

• 5. Should I record details of the incident?

  It is recommended you follow your own company procedures in relation to recording of any incidents. Along with this, there is a consultation notes section to be recorded when claiming through UCF. These consultation notes will be held on your PMR for future reference if required. 

• 6. Will I be able to continue delivering under my local service for emergency holding of naloxone?

  This service will supersede local service arrangements for emergency holding only. It will not supersede any other local services in place for example, naloxone for take home services. 

• 7. Do I need to label the naloxone product for emergency use?

  No, label is needed for naloxone administration in an emergency. This is covered in Schedule 19 of The Human Medicines Regulations 2012.

• 8. Why is this replacing the local service we already have in place?

  There was an action in the Drug Death Taskforce Report (published 2022) that all community pharmacies should hold naloxone for administration in an emergency. We have taken a Once for Scotland approach to make this a national community pharmacy service so that all pharmacies will hold stock and follow the same service specification. The Scottish Government has negotiated and agreed the arrangements with Community Pharmacy Scotland.

• 9. Related to point 2.4 of the service specification. If Naloxone is supplied to another to administer in an immediate emergency situation, do I need to record a note as recommended through the PMR of the person the naloxone was supplied to?

  No, the recording should only be placed on the record of the person who overdosed if their details are known. If not known this can be recorded via a dummy patient/pharmacy record. There will be an option to record details in consultation notes on the PMR and it is recommended to record details of the event, including if known, the person who you supplied to administer the naloxone in the emergency situation. You should always follow your own company procedures for incident recording.

• 10. The circular advises “The pharmacy contractor must ensure that there are enough staff trained and skilled during the pharmacy’s normal opening hours”. Why is it defined in this way?

  This is to clarify that the service should be available when the pharmacy is open, but there is no expectation that there will be a service when the pharmacy is closed.

• 11. The circular advises “The pharmacy contractor must make arrangements to ensure each community pharmacy holds at least two naloxone kits for emergency use at any one time. This can be naloxone in injection or nasal form or a combination of both. Why is the situation defined in this way? 

  This is to clarify that there should be at least two kits in stock, or where these have been used in any given day, that arrangements have been made to replenish the stock at the earliest opportunity.

• 12. The circular advises “Replenishment stock should be ordered to ensure arrangements are in place to ensure at least two naloxone kits are held in the pharmacy.” Why is the replenishment defined in this way?

  This is to clarify that when stock has been used in any given day, that arrangements have been made to replenish the stock at the earliest opportunity

• 13. Some of my pharmacy team members do not have access to TURAS in their current roles. How do they complete the Naloxone training?

  Work is underway at NES to fix this issue in the near future. In the meantime, these team members can access the resources through the Scottish Drug Forum website

• 14. Can Naloxone be used after the expiry date?

  The best solution here is to make sure that the Naloxone in the pharmacy is in date through the community pharmacy standard operating procedures. A great tip is to include a regular check of the dates on Naloxone stock in the pharmacy when another regular task is completed – for example when the month end script processes are completed.