Hey Mr. Pharmacist

Minister for Health Mary Harney says the current level of payment to pharmacists by the State is unsustainable – but pharmacists say the new cuts will make their businesses (you’ve guessed it) unsustainable.

Meanwhile, vulnerable patients – including those with medical cards, or suffering from long-term illnesses like haemophilia, cystic fibrosis and Parkinson’s – are caught in the crossfire.
The situation is particularly worrying for methadone users. You can’t just walk into a pharmacy and buy methadone, even with a prescription. It’s a controlled substance, so it can only be accessed under a special methadone scheme.

In Ballymun, north Dublin, pharmacist Edward McManus has 70 methadone clients on his books. From August 1 he will no longer supply them with the drug – but the local methadone clinic, Domville House, is full and can’t accept any more clients.
“There is no plan, no alternative,” says Mairéad Kavanagh from Ballymun Youth Action Project, a community response to drug abuse.

“The Domville House methadone programme is already full so people who are out-reached to their doctor are left with nowhere to go,” she says.
“The danger is people will go back to using other substances. Or they’ll start trying to source it [methadone] on the street and the street price will go up.”

Accessing methadone through a pharmacy, rather than a methadone clinic, allows recovering addicts their privacy – it means they don’t have to publicise the fact that they are a former addict. They’re also much less likely to meet someone who could sell them gear at the pharmacy than at a clinic.

“Their pattern of addiction has got to a good point,” says Kavanagh, of methadone users who attend their GP and pharmacist. “Now that’s pulled from under them. They don’t want a soup kitchen situation. They’ll go back to their older habits, buying from somewhere else, not neccessarily legal. It’s a back step in their progress,” she says.

But it’s not just the individual methadone user who is affected. Pharmacists’ withdrawal from the methadone scheme could have a devastating ripple effect, extending from methadone users themselves to their families and to the wider community.
“The effect on the individual is felt throughout the family,” says Kavanagh. “If they’re going to buy it on the street, they’re going to need the money to do that. It will affect the crime rate. If there’s a rise in crime, in the number of robberies, as a result there’s an effect on the community,” she explains.

Ballymun pharmacist Edward McManus says he just can’t afford to dispense at the new rates. Seventy percent of McManus’s income is from government-funded schemes. He has already let two members of staff go this year, due to the recession.
Having withdrawn from government-funded schemes, McManus is now considering which of his remaining 10 staff to let go.

“As a director of a company, I have a responsibility not to trade recklessly. I’m not sure what the future of the business is without these schemes. But certainly without them, it’s going to be very difficult to trade because the numbers aren’t adding up and I’m losing a huge amount of money if I continue. I’d be in the red for about €60,000 [per annum],” he says.

The Irish Pharmacy Union (IPU) says 1,100 of 1,521 pharmacies currently contracted by the HSE to provide medicines under the various community drug schemes will withdraw the service on 1 August. The IPU says a cut of 34% in pharmacists’ margins (which Minister for Health Mary Harney is enforcing unilaterally under emergency legislation) is excessive and unfair.

But Mary Harney says the cut is only 24%, and insists that the amount of taxpayers’ money currently being paid to pharmacists and wholesalers (€640 million annually) is ‘not sustainable’. The Department of Health maintains that 800 pharmacists will continue to dispense drugs under community schemes.

The Minister told Hot Press: “There can be no grounds for causing upset or anxiety about the supply of prescribed medicines to any patients.”
“I believe these threats are unjustified and not in patients’ interests. I would urge pharmacists to consider the impact of such a threat, if it were carried out, on this vulnerable group of patients,” said the Minister of methadone users.

But pharmacists like Edward McManus say they are no longer licensed to dispense methadone from August 1, which leaves them no option but to turn people away.
“The HSE has told me that I can’t dispense from August 1 because my contract has terminated,” says McManus.

“I’ve rung up the HSE to see what the situation is for patients. Clearly, I’ve an ethical responsibility and so does the HSE to make sure that people are looked after and I’ve been told the patients will be looked after. My patients haven’t. When I’ve asked them to ask the HSE, they’ve come back and said the HSE told them there isn’t a contingency plan. The HSE advised them that they didn’t know what they’re going to do,” he says.

A spokeswoman for the HSE in North East Dublin said that alternative arrangements will be put in place to ensure that there is no interruption in the supply of methadone for patients. At the time of going to print, the spokeswoman was unable to specify what these arrangements are.
Neither the Minister nor the IPU looks likely to back down in this dispute. The feeling among methadone users in Ballymun is one of panic as 1 August approaches.

“Seventy people are now wondering where in the name of God they are going to get their methadone,” says Mairéad Kavanagh. “What’s going to happen? Our clients are not aware of any contingency plan.”