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[post_content] => Nitazenes are becoming more common in the Australian illicit drug market, and are linked to an increasing number of overdoses and deaths.
Last week, nitazines were detected in samples related to a cluster of 20 overdoses in the New South Wales Nepean Blue Mountains local health district.
There have been 16 overdose deaths involving nitazenes in Victoria since 2021, prompting two coroners to recommend the implementation of drug checking services in the state.
[caption id="attachment_10405" align="alignright" width="300"]
Suzanne Nielsen MPS[/caption]
Professor Suzanne Nielsen MPS, Deputy Director of the Monash Addiction Research Centre in Melbourne, explains how this little-understood drug entered the market and why pharmacists need to rethink harm minimisation.
What’s the history of this synthetic opioid?
‘Nitazenes’ are a family of drugs. Substances within the class vary in potency, from lower in potency to significantly exceeding fentanyl’s strength.
After nitazenes were synthesised in the late 1950s, development of the opioid as a therapeutic product was abandoned after early testing revealed high rates of adverse effects – including severe respiratory depression.
In recent years, they have emerged as novel psychoactive substances, said Prof Nielsen.
‘Chemists who make illicit drugs [often] go back to drugs that didn't make it through the development pathway,’ she said.
These drugs are therefore not internationally controlled, meaning their manufacture and distribution is ‘not necessarily illegal’.
‘It takes a while for national and international regulations to catch up and make them controlled substances,’ added Prof Nielsen.
Most nitazenes that have been detected in Australia are also similar to, or stronger than fentanyl in potency.
But while the pharmacology and effects of fentanyl are well profiled, the same can’t be said about nitazenes.
‘There are very few studies [that provide] a good sense of exactly how strong they are, how they work and how long they last,’ she said. ‘We do know they're very strong and have other negative effects we haven't fully characterised yet.’
Where are nitazenes found?
Fentanyl and other novel synthetic opioids are commonly packaged and sold as substances such as oxycodone tablets, said Prof Nielsen.
‘Some people go online to find pharmaceuticals because they can be easier to access than through the healthcare system,’ she said. ‘Unless you're familiar with what to look for, these products look quite similar to pharmaceutical products.’
Some people, in the pursuit of a strong opioid, purchase nitazenes intentionally. But the majority of detections are in unintended purchases, when other substances are sought.
‘Sometimes [they are in] opioids such as heroin,’ said Prof Nielsen. ‘But we've seen detections in drugs being sold as ketamine, MDMA or other stimulants.’
These detections are cause for the most concern. ‘People seeking to use MDMA in a festival environment [likely] won't have any opioid tolerance, and will be very susceptible to an opioid overdose.’
Is Australia at risk of a nitazene epidemic?
Nitazenes are causing large ‘clusters of deaths’ in England, Scotland and Ireland – where fentanyl has yet to emerge in the illicit market. There are concerns among addiction experts that Australia could similarly skip over fentanyl and head straight into a nitazene wave, warned Prof Nielsen.
‘There have been reports that the amount of heroin manufactured is dropping off,’ she said. ‘With the Taliban shutting down poppy production, an 80–95% reduction in heroin availability is expected.’
Programs such as real-time prescription monitoring and a tightening of regulations have also contributed to a ‘supply shock’ – which is historically associated with the entrance of potent substances into drug markets, said Prof Nielsen.
With drug checking not widely accessible in Australia, it’s possible there are more nitazenes out there than we know.
‘Given overdose deaths have gone up fairly quickly in other parts of the world where these drugs have emerged, now is the time to raise the alarm.’
What can pharmacists do to help?
With drugs such as MDMA or ketamine containing nitazenes, pharmacists need to broaden their approach to harm reduction, said Prof Nielsen.
This includes anticipating requests for take-home naloxone (THN) from people who use drugs occasionally who have heard about the synthetic opioid – which should always be met with a positive response.
Pharmacists could say, ‘it’s great you're asking for naloxone. I'm happy to provide it for you’, said Prof Nielsen.
Follow-up questions could include:
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[post_content] => Queenslanders are set to have greater access to high-quality, primary healthcare services from today (24 April 2024) under the state government’s Community Pharmacy Scope of Practice Pilot.
Under the Pilot, trained pharmacists will be able to prescribe for a range of common conditions and better support patients with medication management through therapeutic adaptation and substitution, and continued dispensing.
PSA Queensland President Shane MacDonald welcomed Health Minister Shannon Fentiman’s announcement today in Cairns.
‘The 2020 election commitment to work with PSA, the Pharmacy Guild of Australia, and other stakeholders to implement this Pilot is finally being realised,’ he said.
‘It has been a long journey, and we thank the government for the collaborating with the profession to execute this important work.
‘We must also acknowledge the pioneering pharmacists who, amidst their professional workload and family responsibilities, have dedicated themselves to undertake the extensive education program required to participate.’
Queensland is already leading the nation on pharmacist vaccination scope, delivering more vaccines to more patients, and improving vaccine coverage across the state, said Mr MacDonald.
‘This is a vote of confidence from the Queensland Government in the skills and expertise of our pharmacists to continue delivering safe and accessible primary health care to Queenslanders,’ he said.
‘Empowering pharmacists to manage common acute conditions and better support chronic disease management in community pharmacies is a progressive step towards enhancing healthcare accessibility. Piloting this initiative in Queensland will pave the way for nation-wide impact.’
Pharmacists are already getting involved
Queensland PSA Branch Committee member and Pharmacy Partner at LiveLife Pharmacy Macrossan Street (Port Douglas), James Buckley is one of the first pharmacists to complete the training and be authorised to participate.
‘I am really excited to be able to support my local community to have better access to care. Pharmacists are so accessible and our pharmacies are open late and on weekends. It just makes sense to use us to the top of our scope.’
PSA is currently working with the government to become an approved training provider to support the state-wide roll out of the Pilot.
Pilot services
Pharmacists who are approved participate in the Pilot are able to provide additional services that can be grouped into three categories:
1. Medication management services including therapeutic adaptation, therapeutic substitution and continued dispensing.
2. Autonomous prescribing for specified acute common conditions and health and wellbeing services:
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[post_content] => We’ve passed the halfway mark in the CPD year. Top up your credits and develop the most sought-after pharmacy skills by completing these CPD activities.
In a changing social and healthcare landscape – including fears around opioid overdoses, the rise of injectable medicines and new treatments for chronic pain – pharmacists need to keep on top of trends and education to best serve their communities.
AP outlines the most clicked-on CPD articles over the last 12 months and why you should complete them – along with a few other ways to score credits before the CPD year ends.
1. Disposal of Schedule 8 medicines
Did you know that different dose forms of Schedule 8 medicines need to be disposed of in different ways? Or that requirements for authorised witnesses for destruction of Schedule 8 medicines by pharmacists vary per jurisdiction?
All pharmacists must familiarise themselves with local legislation and best practice guidelines for the correct process for disposal of Schedule 8 medicines.
This helpful CPD article summarises environmental and safety considerations, destruction recommendations and considerations for legislative requirements for disposal of Schedule 8 medicines.
2. How to save a life with naloxone
Opioid overdose deaths in Australia have continued to rise. According to Australia’s Annual Overdose Report by the Pennington Institute, unintentional drug overdose deaths have skyrocketed by 71% in 20 years (2001–2021).
Opioids are the drugs most commonly involved in poly-substance deaths (81%).
With experts warning of an impending influx of synthetic opioids into Australia's illicit drug market and the Take-Home Naloxone program now national – all pharmacists should know how to supply and administer this life-saving medicine.
By undertaking PSA’s How to save a life with naloxone CPD article, pharmacists will learn how to effectively counsel patients on using the medicine, learn the key points of the Take Home Naloxone (THN) program and how to provide support and advice to people who use opioids, their peers, and family – all of which can have a significant impact on reducing the number of lives lost.
3. B12 deficiency
The raft of scope of practice changes that continue to occur across Australian states and territories has meant many pharmacists are able to administer medicines by injection (if suitably trained) – such as intramuscular vitamin B12.
Vitamin B12 deficiency can cause serious haematological, neurological, and psychiatric problems – early detection and treatment may reverse and minimise harms. This CPD article will help pharmacists identify and refer patients with possible deficiency, advise on suitable treatments, and know when administration of intramuscular vitamin B12 treatment is appropriate.
4. Cannabis drug interactions
The Australian Institute of Health and Welfare estimates 600,000 Australians use cannabis for medicinal purposes. This is a dramatic uptick from the 2,560 medicinal cannabis prescriptions approved through Therapeutic Goods Administration’s (TGA) Special Access Scheme (SAS) in 2018. In fact, last year there were 132,000 SAS-B applications approved by the TGA from 2,565 medical practitioners.
This CPD article explains the common mechanisms whereby medicinal cannabis may interact with other medicines, and the role of the pharmacist in reviewing and identifying these interactions.
5. Immediate-release melatonin for jet lag
Melatonin is now a schedule 3 medicine for Australians aged 55 years of age or older with primary insomnia with poor sleep quality, and for those aged 18 or older to treat jet lag.
But do you know when melatonin should be taken to stave off jet lag, or its potential adverse effects and drug interactions? There are also several non-pharmacological options to treat jet lag that pharmacists should also be across. Pharmacists can access all this information and more in PSA’s Immediate-release melatonin for jet lag article.
How else can I gain CPD credits?
Prefer to rack up your CPD credits in other ways? If networking with other healthcare professionals while gaining knowledge from the industry's top thought leaders is more your thing, AP has rounded up the top up-coming conferences to attend:
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[post_content] => Influenza is one of the most common vaccine-preventable diseases in Australia. While reported cases are significantly higher than what they were this time last year, vaccination rates are slipping.
There were 30,404 reported cases of influenza from January–March this year, compared to 18,584 during the same time period last year. With 39,230 cases reported to date in 2024, there has been a significant spike in cases over the last few weeks.
As we approach World Immunisation Week (24–30 April 2024), here’s how pharmacists can help to protect the community this season.
Children are undervaccinated and frequently hospitalised. How can this cohort be reached?
In 2023, influenza notifications were highest in children aged 5–9 years old, with hospitalisations peaking in those 15 years of age or younger. Yet the 5–15 age group is the most under-vaccinated cohort, with vaccination rates sitting at only 16% for 2023.
Vaccination rates among children aged 6 months to 5 years of age have been startlingly low post-COVID pandemic (28.3% in 2023), despite the considerable risk to this age group, said Dr Eden Mifsud, Medical Science Liaison, Influenza Vaccines Medical Affairs, at CSL Seqirus in the PSA webinar Influenza 2024 – The Right Vaccine for the Right Patient, held on 17 April 2024.
So how can pharmacists approach this conversation with parents and carers? Firstly, you can remind them that the influenza vaccine is covered under the NIP for children aged 6 months to 5 years because they are susceptible to severe disease associated with influenza, and death.
Making vaccination more accessible for patients aged 5–15 can be achieved by scheduling and promoting after-school vaccination, said webinar co-host Peter Guthrey MPS, PSA Senior Pharmacist, Strategic Policy.
While parents may be hesitant to administer vaccines on a school night due to concern about adverse effects, pharmacists can reassure them that adverse events from influenza vaccines are relatively low compared to other vaccines, said Mr Guthrey.
‘Booking the whole family for the flu vaccine, school holiday or after-school appointments can be a powerful way to help people engage in vaccination,’ he said. ‘Parents are looking to protect the health of their children in a way that doesn't disrupt the routine.’
What are the new ATAGI recommendations in 2024?
There have been a number of updates included in the Australian Technical Advisory Group on Immunisation (ATAGI) advice regarding the administration of 2024 seasonal influenza vaccines.
This year, ATAGI recommends pregnant women who received an influenza vaccine in 2023 receive the 2024 influenza vaccine if available before the end of their pregnancy, said Dr Mifsud.
‘We know antibodies can be passed through the placenta, and these antibodies can also be passed on if the woman chooses to breastfeed,’ she said. ‘That means those maternal antibodies can protect the infant for the first 6 months of its life.’
Another change to the ATAGI recommendations this year is the inclusion of conditions that increase the risk of severe influenza that are not attached to NIP funding eligibility, including:
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[post_content] => Squadron Leader Michael Whitney MPS, an avid traveller on and off duty, tells AP about his career path in the Defence Force.
Why choose pharmacy?
I’ve always been interested in helping people and performed well in science and maths subjects at school. When the time came to participate in Year 10 work experience, my sister – a nurse – suggested pharmacy. After a week-long stint in my local community pharmacy, which morphed into an after-school job, I was hooked. The rest is history!
What led you to the military?
Without any background in Defence, I only became aware you could join the Australian Defence Force (ADF) as a pharmacist during a careers session while a first-year university student.
It sounded like a niche, but interesting, area of pharmacy. I ended up applying a year or so into my studies after thinking I’d like to try a career path that differs from the usual hospital or community pharmacy options. Defence sponsors university students throughout their study and internship years, so it was a great fit.
Tell us about your career as a military pharmacist?
Air Force pharmacists are employed as both logisticians and clinicians. The role comprises health logistics, planning and administration along with more traditional elements of community (and sometimes hospital) pharmacy practice.
I’ve been lucky enough to work in a variety of clinical and non-clinical settings across Australia and overseas. Some career highlights include deploying to the Middle East Region in 2019 to run the pharmacy at our main operating base, and secondment to the National Vaccine Taskforce at the Department of Health during the COVID-19 pandemic. I served as a logistics liaison officer for ADF and Department of Foreign Affairs and Trade cohorts.
My current role is Senior Pharmacist and Health Logistics Flight Commander of No. 1 Expeditionary Health Squadron at RAAF Base Amberley – just outside Brisbane. Our unit is responsible for support to expeditionary health tasks through deployment of the Air Force Role 2 Medical Treatment Facility.
Why is the military a good career path for pharmacists?
I’d encourage other pharmacists to join the ADF if they’re up for an adventure, challenge and are interested in seeing a different side of the profession.
What the job sometimes lacks in traditional dispensing and medication management, can be made up for in leadership and an opportunity to serve the nation in new and exciting ways as a Defence Health practitioner. It really is a pharmacist job you can’t do anywhere else, and every day can be completely different.
Was your catch-up with colleagues at the International Federation of Pharmaceutical Sciences in Brisbane last year valuable?
While the Defence pharmacy community is strong, it is quite small and geographically displaced. Opportunities like the FIP Congress are great, as they allow for networking and professional development that can’t take place in isolation.
ADF pharmacists are involved in FIP’s Military and Emergency Pharmacy Section (MEPS), so the conference in September 2023 was an excellent opportunity to network and learn with other military pharmacists from around the globe.
Thoughts on the future of pharmacy in the Defence Force?
Defence Health is currently undertaking the largest health assets and systems upgrade in our history. The pharmacist’s role, particularly in regards to health material management of the new equipment, is a big undertaking and an exciting challenge.
Clinical-wise, it will be interesting to see how new scope of practice opportunities for pharmacists in the civilian sector can be adapted to suit military pharmacists.
A Day in the life of Michael Whitney, Military Pharmacist, RAAF Base Amberley, Queensland
| 7.00 am |
Training time Unit Physical Training Session (PT) at Base Gym, a group-orientated fitness session comprising a mixture of cardiovascular and strength exercises. |
| 9.00pm |
Clinical care Assisting Amberley Defence Health Facility (Garrison), which is like a big GP clinic, with clinical pharmacy duties. This includes management of pharmaceutical accounts and dispensing medicines such as longer term prescription repeats for management of chronic health conditions and over-the-counter products for acute colds, headaches, aches and pains etc. Also use this time for management and clinical governance of expeditionary health kits. |
| 12.00pm |
Lunch break Pause for lunch at Mess (dining facility), which also provides an opportunity to network with other base personnel. Food is always great and prepared by in-house Air Force chefs! I love their curries. |
| 2-5pm |
End-of-day planning Command briefing on the next series of upcoming expeditionary health tasks and priorities, which can include requests for health support in a wide variety of locations both within Australia and overseas. Respond to a Short Notice to Move task involving the provision of pharmaceuticals and/or health material (medical equipment). |
| 7.00pm |
Wind down Like a true pharmacist I’ve been re-watching Ozark on Netflix, about a financial planner who turns money launderer for a drug cartel. Otherwise, I support the current sporting series – most recently celebrating Brisbane Heat winning the Big Bash League cricket competition! |
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[post_content] => Nitazenes are becoming more common in the Australian illicit drug market, and are linked to an increasing number of overdoses and deaths.
Last week, nitazines were detected in samples related to a cluster of 20 overdoses in the New South Wales Nepean Blue Mountains local health district.
There have been 16 overdose deaths involving nitazenes in Victoria since 2021, prompting two coroners to recommend the implementation of drug checking services in the state.
[caption id="attachment_10405" align="alignright" width="300"] Suzanne Nielsen MPS[/caption]
Professor Suzanne Nielsen MPS, Deputy Director of the Monash Addiction Research Centre in Melbourne, explains how this little-understood drug entered the market and why pharmacists need to rethink harm minimisation.
What’s the history of this synthetic opioid?
‘Nitazenes’ are a family of drugs. Substances within the class vary in potency, from lower in potency to significantly exceeding fentanyl’s strength.
After nitazenes were synthesised in the late 1950s, development of the opioid as a therapeutic product was abandoned after early testing revealed high rates of adverse effects – including severe respiratory depression.
In recent years, they have emerged as novel psychoactive substances, said Prof Nielsen.
‘Chemists who make illicit drugs [often] go back to drugs that didn't make it through the development pathway,’ she said.
These drugs are therefore not internationally controlled, meaning their manufacture and distribution is ‘not necessarily illegal’.
‘It takes a while for national and international regulations to catch up and make them controlled substances,’ added Prof Nielsen.
Most nitazenes that have been detected in Australia are also similar to, or stronger than fentanyl in potency.
But while the pharmacology and effects of fentanyl are well profiled, the same can’t be said about nitazenes.
‘There are very few studies [that provide] a good sense of exactly how strong they are, how they work and how long they last,’ she said. ‘We do know they're very strong and have other negative effects we haven't fully characterised yet.’
Where are nitazenes found?
Fentanyl and other novel synthetic opioids are commonly packaged and sold as substances such as oxycodone tablets, said Prof Nielsen.
‘Some people go online to find pharmaceuticals because they can be easier to access than through the healthcare system,’ she said. ‘Unless you're familiar with what to look for, these products look quite similar to pharmaceutical products.’
Some people, in the pursuit of a strong opioid, purchase nitazenes intentionally. But the majority of detections are in unintended purchases, when other substances are sought.
‘Sometimes [they are in] opioids such as heroin,’ said Prof Nielsen. ‘But we've seen detections in drugs being sold as ketamine, MDMA or other stimulants.’
These detections are cause for the most concern. ‘People seeking to use MDMA in a festival environment [likely] won't have any opioid tolerance, and will be very susceptible to an opioid overdose.’
Is Australia at risk of a nitazene epidemic?
Nitazenes are causing large ‘clusters of deaths’ in England, Scotland and Ireland – where fentanyl has yet to emerge in the illicit market. There are concerns among addiction experts that Australia could similarly skip over fentanyl and head straight into a nitazene wave, warned Prof Nielsen.
‘There have been reports that the amount of heroin manufactured is dropping off,’ she said. ‘With the Taliban shutting down poppy production, an 80–95% reduction in heroin availability is expected.’
Programs such as real-time prescription monitoring and a tightening of regulations have also contributed to a ‘supply shock’ – which is historically associated with the entrance of potent substances into drug markets, said Prof Nielsen.
With drug checking not widely accessible in Australia, it’s possible there are more nitazenes out there than we know.
‘Given overdose deaths have gone up fairly quickly in other parts of the world where these drugs have emerged, now is the time to raise the alarm.’
What can pharmacists do to help?
With drugs such as MDMA or ketamine containing nitazenes, pharmacists need to broaden their approach to harm reduction, said Prof Nielsen.
This includes anticipating requests for take-home naloxone (THN) from people who use drugs occasionally who have heard about the synthetic opioid – which should always be met with a positive response.
Pharmacists could say, ‘it’s great you're asking for naloxone. I'm happy to provide it for you’, said Prof Nielsen.
Follow-up questions could include:
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[post_content] => Queenslanders are set to have greater access to high-quality, primary healthcare services from today (24 April 2024) under the state government’s Community Pharmacy Scope of Practice Pilot.
Under the Pilot, trained pharmacists will be able to prescribe for a range of common conditions and better support patients with medication management through therapeutic adaptation and substitution, and continued dispensing.
PSA Queensland President Shane MacDonald welcomed Health Minister Shannon Fentiman’s announcement today in Cairns.
‘The 2020 election commitment to work with PSA, the Pharmacy Guild of Australia, and other stakeholders to implement this Pilot is finally being realised,’ he said.
‘It has been a long journey, and we thank the government for the collaborating with the profession to execute this important work.
‘We must also acknowledge the pioneering pharmacists who, amidst their professional workload and family responsibilities, have dedicated themselves to undertake the extensive education program required to participate.’
Queensland is already leading the nation on pharmacist vaccination scope, delivering more vaccines to more patients, and improving vaccine coverage across the state, said Mr MacDonald.
‘This is a vote of confidence from the Queensland Government in the skills and expertise of our pharmacists to continue delivering safe and accessible primary health care to Queenslanders,’ he said.
‘Empowering pharmacists to manage common acute conditions and better support chronic disease management in community pharmacies is a progressive step towards enhancing healthcare accessibility. Piloting this initiative in Queensland will pave the way for nation-wide impact.’
Pharmacists are already getting involved
Queensland PSA Branch Committee member and Pharmacy Partner at LiveLife Pharmacy Macrossan Street (Port Douglas), James Buckley is one of the first pharmacists to complete the training and be authorised to participate.
‘I am really excited to be able to support my local community to have better access to care. Pharmacists are so accessible and our pharmacies are open late and on weekends. It just makes sense to use us to the top of our scope.’
PSA is currently working with the government to become an approved training provider to support the state-wide roll out of the Pilot.
Pilot services
Pharmacists who are approved participate in the Pilot are able to provide additional services that can be grouped into three categories:
1. Medication management services including therapeutic adaptation, therapeutic substitution and continued dispensing.
2. Autonomous prescribing for specified acute common conditions and health and wellbeing services:
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[post_content] => We’ve passed the halfway mark in the CPD year. Top up your credits and develop the most sought-after pharmacy skills by completing these CPD activities.
In a changing social and healthcare landscape – including fears around opioid overdoses, the rise of injectable medicines and new treatments for chronic pain – pharmacists need to keep on top of trends and education to best serve their communities.
AP outlines the most clicked-on CPD articles over the last 12 months and why you should complete them – along with a few other ways to score credits before the CPD year ends.
1. Disposal of Schedule 8 medicines
Did you know that different dose forms of Schedule 8 medicines need to be disposed of in different ways? Or that requirements for authorised witnesses for destruction of Schedule 8 medicines by pharmacists vary per jurisdiction?
All pharmacists must familiarise themselves with local legislation and best practice guidelines for the correct process for disposal of Schedule 8 medicines.
This helpful CPD article summarises environmental and safety considerations, destruction recommendations and considerations for legislative requirements for disposal of Schedule 8 medicines.
2. How to save a life with naloxone
Opioid overdose deaths in Australia have continued to rise. According to Australia’s Annual Overdose Report by the Pennington Institute, unintentional drug overdose deaths have skyrocketed by 71% in 20 years (2001–2021).
Opioids are the drugs most commonly involved in poly-substance deaths (81%).
With experts warning of an impending influx of synthetic opioids into Australia's illicit drug market and the Take-Home Naloxone program now national – all pharmacists should know how to supply and administer this life-saving medicine.
By undertaking PSA’s How to save a life with naloxone CPD article, pharmacists will learn how to effectively counsel patients on using the medicine, learn the key points of the Take Home Naloxone (THN) program and how to provide support and advice to people who use opioids, their peers, and family – all of which can have a significant impact on reducing the number of lives lost.
3. B12 deficiency
The raft of scope of practice changes that continue to occur across Australian states and territories has meant many pharmacists are able to administer medicines by injection (if suitably trained) – such as intramuscular vitamin B12.
Vitamin B12 deficiency can cause serious haematological, neurological, and psychiatric problems – early detection and treatment may reverse and minimise harms. This CPD article will help pharmacists identify and refer patients with possible deficiency, advise on suitable treatments, and know when administration of intramuscular vitamin B12 treatment is appropriate.
4. Cannabis drug interactions
The Australian Institute of Health and Welfare estimates 600,000 Australians use cannabis for medicinal purposes. This is a dramatic uptick from the 2,560 medicinal cannabis prescriptions approved through Therapeutic Goods Administration’s (TGA) Special Access Scheme (SAS) in 2018. In fact, last year there were 132,000 SAS-B applications approved by the TGA from 2,565 medical practitioners.
This CPD article explains the common mechanisms whereby medicinal cannabis may interact with other medicines, and the role of the pharmacist in reviewing and identifying these interactions.
5. Immediate-release melatonin for jet lag
Melatonin is now a schedule 3 medicine for Australians aged 55 years of age or older with primary insomnia with poor sleep quality, and for those aged 18 or older to treat jet lag.
But do you know when melatonin should be taken to stave off jet lag, or its potential adverse effects and drug interactions? There are also several non-pharmacological options to treat jet lag that pharmacists should also be across. Pharmacists can access all this information and more in PSA’s Immediate-release melatonin for jet lag article.
How else can I gain CPD credits?
Prefer to rack up your CPD credits in other ways? If networking with other healthcare professionals while gaining knowledge from the industry's top thought leaders is more your thing, AP has rounded up the top up-coming conferences to attend:
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[post_content] => Influenza is one of the most common vaccine-preventable diseases in Australia. While reported cases are significantly higher than what they were this time last year, vaccination rates are slipping.
There were 30,404 reported cases of influenza from January–March this year, compared to 18,584 during the same time period last year. With 39,230 cases reported to date in 2024, there has been a significant spike in cases over the last few weeks.
As we approach World Immunisation Week (24–30 April 2024), here’s how pharmacists can help to protect the community this season.
Children are undervaccinated and frequently hospitalised. How can this cohort be reached?
In 2023, influenza notifications were highest in children aged 5–9 years old, with hospitalisations peaking in those 15 years of age or younger. Yet the 5–15 age group is the most under-vaccinated cohort, with vaccination rates sitting at only 16% for 2023.
Vaccination rates among children aged 6 months to 5 years of age have been startlingly low post-COVID pandemic (28.3% in 2023), despite the considerable risk to this age group, said Dr Eden Mifsud, Medical Science Liaison, Influenza Vaccines Medical Affairs, at CSL Seqirus in the PSA webinar Influenza 2024 – The Right Vaccine for the Right Patient, held on 17 April 2024.
So how can pharmacists approach this conversation with parents and carers? Firstly, you can remind them that the influenza vaccine is covered under the NIP for children aged 6 months to 5 years because they are susceptible to severe disease associated with influenza, and death.
Making vaccination more accessible for patients aged 5–15 can be achieved by scheduling and promoting after-school vaccination, said webinar co-host Peter Guthrey MPS, PSA Senior Pharmacist, Strategic Policy.
While parents may be hesitant to administer vaccines on a school night due to concern about adverse effects, pharmacists can reassure them that adverse events from influenza vaccines are relatively low compared to other vaccines, said Mr Guthrey.
‘Booking the whole family for the flu vaccine, school holiday or after-school appointments can be a powerful way to help people engage in vaccination,’ he said. ‘Parents are looking to protect the health of their children in a way that doesn't disrupt the routine.’
What are the new ATAGI recommendations in 2024?
There have been a number of updates included in the Australian Technical Advisory Group on Immunisation (ATAGI) advice regarding the administration of 2024 seasonal influenza vaccines.
This year, ATAGI recommends pregnant women who received an influenza vaccine in 2023 receive the 2024 influenza vaccine if available before the end of their pregnancy, said Dr Mifsud.
‘We know antibodies can be passed through the placenta, and these antibodies can also be passed on if the woman chooses to breastfeed,’ she said. ‘That means those maternal antibodies can protect the infant for the first 6 months of its life.’
Another change to the ATAGI recommendations this year is the inclusion of conditions that increase the risk of severe influenza that are not attached to NIP funding eligibility, including:
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[post_content] => Squadron Leader Michael Whitney MPS, an avid traveller on and off duty, tells AP about his career path in the Defence Force.
Why choose pharmacy?
I’ve always been interested in helping people and performed well in science and maths subjects at school. When the time came to participate in Year 10 work experience, my sister – a nurse – suggested pharmacy. After a week-long stint in my local community pharmacy, which morphed into an after-school job, I was hooked. The rest is history!
What led you to the military?
Without any background in Defence, I only became aware you could join the Australian Defence Force (ADF) as a pharmacist during a careers session while a first-year university student.
It sounded like a niche, but interesting, area of pharmacy. I ended up applying a year or so into my studies after thinking I’d like to try a career path that differs from the usual hospital or community pharmacy options. Defence sponsors university students throughout their study and internship years, so it was a great fit.
Tell us about your career as a military pharmacist?
Air Force pharmacists are employed as both logisticians and clinicians. The role comprises health logistics, planning and administration along with more traditional elements of community (and sometimes hospital) pharmacy practice.
I’ve been lucky enough to work in a variety of clinical and non-clinical settings across Australia and overseas. Some career highlights include deploying to the Middle East Region in 2019 to run the pharmacy at our main operating base, and secondment to the National Vaccine Taskforce at the Department of Health during the COVID-19 pandemic. I served as a logistics liaison officer for ADF and Department of Foreign Affairs and Trade cohorts.
My current role is Senior Pharmacist and Health Logistics Flight Commander of No. 1 Expeditionary Health Squadron at RAAF Base Amberley – just outside Brisbane. Our unit is responsible for support to expeditionary health tasks through deployment of the Air Force Role 2 Medical Treatment Facility.
Why is the military a good career path for pharmacists?
I’d encourage other pharmacists to join the ADF if they’re up for an adventure, challenge and are interested in seeing a different side of the profession.
What the job sometimes lacks in traditional dispensing and medication management, can be made up for in leadership and an opportunity to serve the nation in new and exciting ways as a Defence Health practitioner. It really is a pharmacist job you can’t do anywhere else, and every day can be completely different.
Was your catch-up with colleagues at the International Federation of Pharmaceutical Sciences in Brisbane last year valuable?
While the Defence pharmacy community is strong, it is quite small and geographically displaced. Opportunities like the FIP Congress are great, as they allow for networking and professional development that can’t take place in isolation.
ADF pharmacists are involved in FIP’s Military and Emergency Pharmacy Section (MEPS), so the conference in September 2023 was an excellent opportunity to network and learn with other military pharmacists from around the globe.
Thoughts on the future of pharmacy in the Defence Force?
Defence Health is currently undertaking the largest health assets and systems upgrade in our history. The pharmacist’s role, particularly in regards to health material management of the new equipment, is a big undertaking and an exciting challenge.
Clinical-wise, it will be interesting to see how new scope of practice opportunities for pharmacists in the civilian sector can be adapted to suit military pharmacists.
A Day in the life of Michael Whitney, Military Pharmacist, RAAF Base Amberley, Queensland
| 7.00 am |
Training time Unit Physical Training Session (PT) at Base Gym, a group-orientated fitness session comprising a mixture of cardiovascular and strength exercises. |
| 9.00pm |
Clinical care Assisting Amberley Defence Health Facility (Garrison), which is like a big GP clinic, with clinical pharmacy duties. This includes management of pharmaceutical accounts and dispensing medicines such as longer term prescription repeats for management of chronic health conditions and over-the-counter products for acute colds, headaches, aches and pains etc. Also use this time for management and clinical governance of expeditionary health kits. |
| 12.00pm |
Lunch break Pause for lunch at Mess (dining facility), which also provides an opportunity to network with other base personnel. Food is always great and prepared by in-house Air Force chefs! I love their curries. |
| 2-5pm |
End-of-day planning Command briefing on the next series of upcoming expeditionary health tasks and priorities, which can include requests for health support in a wide variety of locations both within Australia and overseas. Respond to a Short Notice to Move task involving the provision of pharmaceuticals and/or health material (medical equipment). |
| 7.00pm |
Wind down Like a true pharmacist I’ve been re-watching Ozark on Netflix, about a financial planner who turns money launderer for a drug cartel. Otherwise, I support the current sporting series – most recently celebrating Brisbane Heat winning the Big Bash League cricket competition! |
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[post_content] => Nitazenes are becoming more common in the Australian illicit drug market, and are linked to an increasing number of overdoses and deaths.
Last week, nitazines were detected in samples related to a cluster of 20 overdoses in the New South Wales Nepean Blue Mountains local health district.
There have been 16 overdose deaths involving nitazenes in Victoria since 2021, prompting two coroners to recommend the implementation of drug checking services in the state.
[caption id="attachment_10405" align="alignright" width="300"] Suzanne Nielsen MPS[/caption]
Professor Suzanne Nielsen MPS, Deputy Director of the Monash Addiction Research Centre in Melbourne, explains how this little-understood drug entered the market and why pharmacists need to rethink harm minimisation.
What’s the history of this synthetic opioid?
‘Nitazenes’ are a family of drugs. Substances within the class vary in potency, from lower in potency to significantly exceeding fentanyl’s strength.
After nitazenes were synthesised in the late 1950s, development of the opioid as a therapeutic product was abandoned after early testing revealed high rates of adverse effects – including severe respiratory depression.
In recent years, they have emerged as novel psychoactive substances, said Prof Nielsen.
‘Chemists who make illicit drugs [often] go back to drugs that didn't make it through the development pathway,’ she said.
These drugs are therefore not internationally controlled, meaning their manufacture and distribution is ‘not necessarily illegal’.
‘It takes a while for national and international regulations to catch up and make them controlled substances,’ added Prof Nielsen.
Most nitazenes that have been detected in Australia are also similar to, or stronger than fentanyl in potency.
But while the pharmacology and effects of fentanyl are well profiled, the same can’t be said about nitazenes.
‘There are very few studies [that provide] a good sense of exactly how strong they are, how they work and how long they last,’ she said. ‘We do know they're very strong and have other negative effects we haven't fully characterised yet.’
Where are nitazenes found?
Fentanyl and other novel synthetic opioids are commonly packaged and sold as substances such as oxycodone tablets, said Prof Nielsen.
‘Some people go online to find pharmaceuticals because they can be easier to access than through the healthcare system,’ she said. ‘Unless you're familiar with what to look for, these products look quite similar to pharmaceutical products.’
Some people, in the pursuit of a strong opioid, purchase nitazenes intentionally. But the majority of detections are in unintended purchases, when other substances are sought.
‘Sometimes [they are in] opioids such as heroin,’ said Prof Nielsen. ‘But we've seen detections in drugs being sold as ketamine, MDMA or other stimulants.’
These detections are cause for the most concern. ‘People seeking to use MDMA in a festival environment [likely] won't have any opioid tolerance, and will be very susceptible to an opioid overdose.’
Is Australia at risk of a nitazene epidemic?
Nitazenes are causing large ‘clusters of deaths’ in England, Scotland and Ireland – where fentanyl has yet to emerge in the illicit market. There are concerns among addiction experts that Australia could similarly skip over fentanyl and head straight into a nitazene wave, warned Prof Nielsen.
‘There have been reports that the amount of heroin manufactured is dropping off,’ she said. ‘With the Taliban shutting down poppy production, an 80–95% reduction in heroin availability is expected.’
Programs such as real-time prescription monitoring and a tightening of regulations have also contributed to a ‘supply shock’ – which is historically associated with the entrance of potent substances into drug markets, said Prof Nielsen.
With drug checking not widely accessible in Australia, it’s possible there are more nitazenes out there than we know.
‘Given overdose deaths have gone up fairly quickly in other parts of the world where these drugs have emerged, now is the time to raise the alarm.’
What can pharmacists do to help?
With drugs such as MDMA or ketamine containing nitazenes, pharmacists need to broaden their approach to harm reduction, said Prof Nielsen.
This includes anticipating requests for take-home naloxone (THN) from people who use drugs occasionally who have heard about the synthetic opioid – which should always be met with a positive response.
Pharmacists could say, ‘it’s great you're asking for naloxone. I'm happy to provide it for you’, said Prof Nielsen.
Follow-up questions could include:
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[post_content] => Queenslanders are set to have greater access to high-quality, primary healthcare services from today (24 April 2024) under the state government’s Community Pharmacy Scope of Practice Pilot.
Under the Pilot, trained pharmacists will be able to prescribe for a range of common conditions and better support patients with medication management through therapeutic adaptation and substitution, and continued dispensing.
PSA Queensland President Shane MacDonald welcomed Health Minister Shannon Fentiman’s announcement today in Cairns.
‘The 2020 election commitment to work with PSA, the Pharmacy Guild of Australia, and other stakeholders to implement this Pilot is finally being realised,’ he said.
‘It has been a long journey, and we thank the government for the collaborating with the profession to execute this important work.
‘We must also acknowledge the pioneering pharmacists who, amidst their professional workload and family responsibilities, have dedicated themselves to undertake the extensive education program required to participate.’
Queensland is already leading the nation on pharmacist vaccination scope, delivering more vaccines to more patients, and improving vaccine coverage across the state, said Mr MacDonald.
‘This is a vote of confidence from the Queensland Government in the skills and expertise of our pharmacists to continue delivering safe and accessible primary health care to Queenslanders,’ he said.
‘Empowering pharmacists to manage common acute conditions and better support chronic disease management in community pharmacies is a progressive step towards enhancing healthcare accessibility. Piloting this initiative in Queensland will pave the way for nation-wide impact.’
Pharmacists are already getting involved
Queensland PSA Branch Committee member and Pharmacy Partner at LiveLife Pharmacy Macrossan Street (Port Douglas), James Buckley is one of the first pharmacists to complete the training and be authorised to participate.
‘I am really excited to be able to support my local community to have better access to care. Pharmacists are so accessible and our pharmacies are open late and on weekends. It just makes sense to use us to the top of our scope.’
PSA is currently working with the government to become an approved training provider to support the state-wide roll out of the Pilot.
Pilot services
Pharmacists who are approved participate in the Pilot are able to provide additional services that can be grouped into three categories:
1. Medication management services including therapeutic adaptation, therapeutic substitution and continued dispensing.
2. Autonomous prescribing for specified acute common conditions and health and wellbeing services:
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[post_content] => We’ve passed the halfway mark in the CPD year. Top up your credits and develop the most sought-after pharmacy skills by completing these CPD activities.
In a changing social and healthcare landscape – including fears around opioid overdoses, the rise of injectable medicines and new treatments for chronic pain – pharmacists need to keep on top of trends and education to best serve their communities.
AP outlines the most clicked-on CPD articles over the last 12 months and why you should complete them – along with a few other ways to score credits before the CPD year ends.
1. Disposal of Schedule 8 medicines
Did you know that different dose forms of Schedule 8 medicines need to be disposed of in different ways? Or that requirements for authorised witnesses for destruction of Schedule 8 medicines by pharmacists vary per jurisdiction?
All pharmacists must familiarise themselves with local legislation and best practice guidelines for the correct process for disposal of Schedule 8 medicines.
This helpful CPD article summarises environmental and safety considerations, destruction recommendations and considerations for legislative requirements for disposal of Schedule 8 medicines.
2. How to save a life with naloxone
Opioid overdose deaths in Australia have continued to rise. According to Australia’s Annual Overdose Report by the Pennington Institute, unintentional drug overdose deaths have skyrocketed by 71% in 20 years (2001–2021).
Opioids are the drugs most commonly involved in poly-substance deaths (81%).
With experts warning of an impending influx of synthetic opioids into Australia's illicit drug market and the Take-Home Naloxone program now national – all pharmacists should know how to supply and administer this life-saving medicine.
By undertaking PSA’s How to save a life with naloxone CPD article, pharmacists will learn how to effectively counsel patients on using the medicine, learn the key points of the Take Home Naloxone (THN) program and how to provide support and advice to people who use opioids, their peers, and family – all of which can have a significant impact on reducing the number of lives lost.
3. B12 deficiency
The raft of scope of practice changes that continue to occur across Australian states and territories has meant many pharmacists are able to administer medicines by injection (if suitably trained) – such as intramuscular vitamin B12.
Vitamin B12 deficiency can cause serious haematological, neurological, and psychiatric problems – early detection and treatment may reverse and minimise harms. This CPD article will help pharmacists identify and refer patients with possible deficiency, advise on suitable treatments, and know when administration of intramuscular vitamin B12 treatment is appropriate.
4. Cannabis drug interactions
The Australian Institute of Health and Welfare estimates 600,000 Australians use cannabis for medicinal purposes. This is a dramatic uptick from the 2,560 medicinal cannabis prescriptions approved through Therapeutic Goods Administration’s (TGA) Special Access Scheme (SAS) in 2018. In fact, last year there were 132,000 SAS-B applications approved by the TGA from 2,565 medical practitioners.
This CPD article explains the common mechanisms whereby medicinal cannabis may interact with other medicines, and the role of the pharmacist in reviewing and identifying these interactions.
5. Immediate-release melatonin for jet lag
Melatonin is now a schedule 3 medicine for Australians aged 55 years of age or older with primary insomnia with poor sleep quality, and for those aged 18 or older to treat jet lag.
But do you know when melatonin should be taken to stave off jet lag, or its potential adverse effects and drug interactions? There are also several non-pharmacological options to treat jet lag that pharmacists should also be across. Pharmacists can access all this information and more in PSA’s Immediate-release melatonin for jet lag article.
How else can I gain CPD credits?
Prefer to rack up your CPD credits in other ways? If networking with other healthcare professionals while gaining knowledge from the industry's top thought leaders is more your thing, AP has rounded up the top up-coming conferences to attend:
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[post_content] => Influenza is one of the most common vaccine-preventable diseases in Australia. While reported cases are significantly higher than what they were this time last year, vaccination rates are slipping.
There were 30,404 reported cases of influenza from January–March this year, compared to 18,584 during the same time period last year. With 39,230 cases reported to date in 2024, there has been a significant spike in cases over the last few weeks.
As we approach World Immunisation Week (24–30 April 2024), here’s how pharmacists can help to protect the community this season.
Children are undervaccinated and frequently hospitalised. How can this cohort be reached?
In 2023, influenza notifications were highest in children aged 5–9 years old, with hospitalisations peaking in those 15 years of age or younger. Yet the 5–15 age group is the most under-vaccinated cohort, with vaccination rates sitting at only 16% for 2023.
Vaccination rates among children aged 6 months to 5 years of age have been startlingly low post-COVID pandemic (28.3% in 2023), despite the considerable risk to this age group, said Dr Eden Mifsud, Medical Science Liaison, Influenza Vaccines Medical Affairs, at CSL Seqirus in the PSA webinar Influenza 2024 – The Right Vaccine for the Right Patient, held on 17 April 2024.
So how can pharmacists approach this conversation with parents and carers? Firstly, you can remind them that the influenza vaccine is covered under the NIP for children aged 6 months to 5 years because they are susceptible to severe disease associated with influenza, and death.
Making vaccination more accessible for patients aged 5–15 can be achieved by scheduling and promoting after-school vaccination, said webinar co-host Peter Guthrey MPS, PSA Senior Pharmacist, Strategic Policy.
While parents may be hesitant to administer vaccines on a school night due to concern about adverse effects, pharmacists can reassure them that adverse events from influenza vaccines are relatively low compared to other vaccines, said Mr Guthrey.
‘Booking the whole family for the flu vaccine, school holiday or after-school appointments can be a powerful way to help people engage in vaccination,’ he said. ‘Parents are looking to protect the health of their children in a way that doesn't disrupt the routine.’
What are the new ATAGI recommendations in 2024?
There have been a number of updates included in the Australian Technical Advisory Group on Immunisation (ATAGI) advice regarding the administration of 2024 seasonal influenza vaccines.
This year, ATAGI recommends pregnant women who received an influenza vaccine in 2023 receive the 2024 influenza vaccine if available before the end of their pregnancy, said Dr Mifsud.
‘We know antibodies can be passed through the placenta, and these antibodies can also be passed on if the woman chooses to breastfeed,’ she said. ‘That means those maternal antibodies can protect the infant for the first 6 months of its life.’
Another change to the ATAGI recommendations this year is the inclusion of conditions that increase the risk of severe influenza that are not attached to NIP funding eligibility, including:
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[post_content] => Squadron Leader Michael Whitney MPS, an avid traveller on and off duty, tells AP about his career path in the Defence Force.
Why choose pharmacy?
I’ve always been interested in helping people and performed well in science and maths subjects at school. When the time came to participate in Year 10 work experience, my sister – a nurse – suggested pharmacy. After a week-long stint in my local community pharmacy, which morphed into an after-school job, I was hooked. The rest is history!
What led you to the military?
Without any background in Defence, I only became aware you could join the Australian Defence Force (ADF) as a pharmacist during a careers session while a first-year university student.
It sounded like a niche, but interesting, area of pharmacy. I ended up applying a year or so into my studies after thinking I’d like to try a career path that differs from the usual hospital or community pharmacy options. Defence sponsors university students throughout their study and internship years, so it was a great fit.
Tell us about your career as a military pharmacist?
Air Force pharmacists are employed as both logisticians and clinicians. The role comprises health logistics, planning and administration along with more traditional elements of community (and sometimes hospital) pharmacy practice.
I’ve been lucky enough to work in a variety of clinical and non-clinical settings across Australia and overseas. Some career highlights include deploying to the Middle East Region in 2019 to run the pharmacy at our main operating base, and secondment to the National Vaccine Taskforce at the Department of Health during the COVID-19 pandemic. I served as a logistics liaison officer for ADF and Department of Foreign Affairs and Trade cohorts.
My current role is Senior Pharmacist and Health Logistics Flight Commander of No. 1 Expeditionary Health Squadron at RAAF Base Amberley – just outside Brisbane. Our unit is responsible for support to expeditionary health tasks through deployment of the Air Force Role 2 Medical Treatment Facility.
Why is the military a good career path for pharmacists?
I’d encourage other pharmacists to join the ADF if they’re up for an adventure, challenge and are interested in seeing a different side of the profession.
What the job sometimes lacks in traditional dispensing and medication management, can be made up for in leadership and an opportunity to serve the nation in new and exciting ways as a Defence Health practitioner. It really is a pharmacist job you can’t do anywhere else, and every day can be completely different.
Was your catch-up with colleagues at the International Federation of Pharmaceutical Sciences in Brisbane last year valuable?
While the Defence pharmacy community is strong, it is quite small and geographically displaced. Opportunities like the FIP Congress are great, as they allow for networking and professional development that can’t take place in isolation.
ADF pharmacists are involved in FIP’s Military and Emergency Pharmacy Section (MEPS), so the conference in September 2023 was an excellent opportunity to network and learn with other military pharmacists from around the globe.
Thoughts on the future of pharmacy in the Defence Force?
Defence Health is currently undertaking the largest health assets and systems upgrade in our history. The pharmacist’s role, particularly in regards to health material management of the new equipment, is a big undertaking and an exciting challenge.
Clinical-wise, it will be interesting to see how new scope of practice opportunities for pharmacists in the civilian sector can be adapted to suit military pharmacists.
A Day in the life of Michael Whitney, Military Pharmacist, RAAF Base Amberley, Queensland
| 7.00 am |
Training time Unit Physical Training Session (PT) at Base Gym, a group-orientated fitness session comprising a mixture of cardiovascular and strength exercises. |
| 9.00pm |
Clinical care Assisting Amberley Defence Health Facility (Garrison), which is like a big GP clinic, with clinical pharmacy duties. This includes management of pharmaceutical accounts and dispensing medicines such as longer term prescription repeats for management of chronic health conditions and over-the-counter products for acute colds, headaches, aches and pains etc. Also use this time for management and clinical governance of expeditionary health kits. |
| 12.00pm |
Lunch break Pause for lunch at Mess (dining facility), which also provides an opportunity to network with other base personnel. Food is always great and prepared by in-house Air Force chefs! I love their curries. |
| 2-5pm |
End-of-day planning Command briefing on the next series of upcoming expeditionary health tasks and priorities, which can include requests for health support in a wide variety of locations both within Australia and overseas. Respond to a Short Notice to Move task involving the provision of pharmaceuticals and/or health material (medical equipment). |
| 7.00pm |
Wind down Like a true pharmacist I’ve been re-watching Ozark on Netflix, about a financial planner who turns money launderer for a drug cartel. Otherwise, I support the current sporting series – most recently celebrating Brisbane Heat winning the Big Bash League cricket competition! |
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[post_content] => Nitazenes are becoming more common in the Australian illicit drug market, and are linked to an increasing number of overdoses and deaths.
Last week, nitazines were detected in samples related to a cluster of 20 overdoses in the New South Wales Nepean Blue Mountains local health district.
There have been 16 overdose deaths involving nitazenes in Victoria since 2021, prompting two coroners to recommend the implementation of drug checking services in the state.
[caption id="attachment_10405" align="alignright" width="300"] Suzanne Nielsen MPS[/caption]
Professor Suzanne Nielsen MPS, Deputy Director of the Monash Addiction Research Centre in Melbourne, explains how this little-understood drug entered the market and why pharmacists need to rethink harm minimisation.
What’s the history of this synthetic opioid?
‘Nitazenes’ are a family of drugs. Substances within the class vary in potency, from lower in potency to significantly exceeding fentanyl’s strength.
After nitazenes were synthesised in the late 1950s, development of the opioid as a therapeutic product was abandoned after early testing revealed high rates of adverse effects – including severe respiratory depression.
In recent years, they have emerged as novel psychoactive substances, said Prof Nielsen.
‘Chemists who make illicit drugs [often] go back to drugs that didn't make it through the development pathway,’ she said.
These drugs are therefore not internationally controlled, meaning their manufacture and distribution is ‘not necessarily illegal’.
‘It takes a while for national and international regulations to catch up and make them controlled substances,’ added Prof Nielsen.
Most nitazenes that have been detected in Australia are also similar to, or stronger than fentanyl in potency.
But while the pharmacology and effects of fentanyl are well profiled, the same can’t be said about nitazenes.
‘There are very few studies [that provide] a good sense of exactly how strong they are, how they work and how long they last,’ she said. ‘We do know they're very strong and have other negative effects we haven't fully characterised yet.’
Where are nitazenes found?
Fentanyl and other novel synthetic opioids are commonly packaged and sold as substances such as oxycodone tablets, said Prof Nielsen.
‘Some people go online to find pharmaceuticals because they can be easier to access than through the healthcare system,’ she said. ‘Unless you're familiar with what to look for, these products look quite similar to pharmaceutical products.’
Some people, in the pursuit of a strong opioid, purchase nitazenes intentionally. But the majority of detections are in unintended purchases, when other substances are sought.
‘Sometimes [they are in] opioids such as heroin,’ said Prof Nielsen. ‘But we've seen detections in drugs being sold as ketamine, MDMA or other stimulants.’
These detections are cause for the most concern. ‘People seeking to use MDMA in a festival environment [likely] won't have any opioid tolerance, and will be very susceptible to an opioid overdose.’
Is Australia at risk of a nitazene epidemic?
Nitazenes are causing large ‘clusters of deaths’ in England, Scotland and Ireland – where fentanyl has yet to emerge in the illicit market. There are concerns among addiction experts that Australia could similarly skip over fentanyl and head straight into a nitazene wave, warned Prof Nielsen.
‘There have been reports that the amount of heroin manufactured is dropping off,’ she said. ‘With the Taliban shutting down poppy production, an 80–95% reduction in heroin availability is expected.’
Programs such as real-time prescription monitoring and a tightening of regulations have also contributed to a ‘supply shock’ – which is historically associated with the entrance of potent substances into drug markets, said Prof Nielsen.
With drug checking not widely accessible in Australia, it’s possible there are more nitazenes out there than we know.
‘Given overdose deaths have gone up fairly quickly in other parts of the world where these drugs have emerged, now is the time to raise the alarm.’
What can pharmacists do to help?
With drugs such as MDMA or ketamine containing nitazenes, pharmacists need to broaden their approach to harm reduction, said Prof Nielsen.
This includes anticipating requests for take-home naloxone (THN) from people who use drugs occasionally who have heard about the synthetic opioid – which should always be met with a positive response.
Pharmacists could say, ‘it’s great you're asking for naloxone. I'm happy to provide it for you’, said Prof Nielsen.
Follow-up questions could include:
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[post_content] => Queenslanders are set to have greater access to high-quality, primary healthcare services from today (24 April 2024) under the state government’s Community Pharmacy Scope of Practice Pilot.
Under the Pilot, trained pharmacists will be able to prescribe for a range of common conditions and better support patients with medication management through therapeutic adaptation and substitution, and continued dispensing.
PSA Queensland President Shane MacDonald welcomed Health Minister Shannon Fentiman’s announcement today in Cairns.
‘The 2020 election commitment to work with PSA, the Pharmacy Guild of Australia, and other stakeholders to implement this Pilot is finally being realised,’ he said.
‘It has been a long journey, and we thank the government for the collaborating with the profession to execute this important work.
‘We must also acknowledge the pioneering pharmacists who, amidst their professional workload and family responsibilities, have dedicated themselves to undertake the extensive education program required to participate.’
Queensland is already leading the nation on pharmacist vaccination scope, delivering more vaccines to more patients, and improving vaccine coverage across the state, said Mr MacDonald.
‘This is a vote of confidence from the Queensland Government in the skills and expertise of our pharmacists to continue delivering safe and accessible primary health care to Queenslanders,’ he said.
‘Empowering pharmacists to manage common acute conditions and better support chronic disease management in community pharmacies is a progressive step towards enhancing healthcare accessibility. Piloting this initiative in Queensland will pave the way for nation-wide impact.’
Pharmacists are already getting involved
Queensland PSA Branch Committee member and Pharmacy Partner at LiveLife Pharmacy Macrossan Street (Port Douglas), James Buckley is one of the first pharmacists to complete the training and be authorised to participate.
‘I am really excited to be able to support my local community to have better access to care. Pharmacists are so accessible and our pharmacies are open late and on weekends. It just makes sense to use us to the top of our scope.’
PSA is currently working with the government to become an approved training provider to support the state-wide roll out of the Pilot.
Pilot services
Pharmacists who are approved participate in the Pilot are able to provide additional services that can be grouped into three categories:
1. Medication management services including therapeutic adaptation, therapeutic substitution and continued dispensing.
2. Autonomous prescribing for specified acute common conditions and health and wellbeing services:
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[post_content] => We’ve passed the halfway mark in the CPD year. Top up your credits and develop the most sought-after pharmacy skills by completing these CPD activities.
In a changing social and healthcare landscape – including fears around opioid overdoses, the rise of injectable medicines and new treatments for chronic pain – pharmacists need to keep on top of trends and education to best serve their communities.
AP outlines the most clicked-on CPD articles over the last 12 months and why you should complete them – along with a few other ways to score credits before the CPD year ends.
1. Disposal of Schedule 8 medicines
Did you know that different dose forms of Schedule 8 medicines need to be disposed of in different ways? Or that requirements for authorised witnesses for destruction of Schedule 8 medicines by pharmacists vary per jurisdiction?
All pharmacists must familiarise themselves with local legislation and best practice guidelines for the correct process for disposal of Schedule 8 medicines.
This helpful CPD article summarises environmental and safety considerations, destruction recommendations and considerations for legislative requirements for disposal of Schedule 8 medicines.
2. How to save a life with naloxone
Opioid overdose deaths in Australia have continued to rise. According to Australia’s Annual Overdose Report by the Pennington Institute, unintentional drug overdose deaths have skyrocketed by 71% in 20 years (2001–2021).
Opioids are the drugs most commonly involved in poly-substance deaths (81%).
With experts warning of an impending influx of synthetic opioids into Australia's illicit drug market and the Take-Home Naloxone program now national – all pharmacists should know how to supply and administer this life-saving medicine.
By undertaking PSA’s How to save a life with naloxone CPD article, pharmacists will learn how to effectively counsel patients on using the medicine, learn the key points of the Take Home Naloxone (THN) program and how to provide support and advice to people who use opioids, their peers, and family – all of which can have a significant impact on reducing the number of lives lost.
3. B12 deficiency
The raft of scope of practice changes that continue to occur across Australian states and territories has meant many pharmacists are able to administer medicines by injection (if suitably trained) – such as intramuscular vitamin B12.
Vitamin B12 deficiency can cause serious haematological, neurological, and psychiatric problems – early detection and treatment may reverse and minimise harms. This CPD article will help pharmacists identify and refer patients with possible deficiency, advise on suitable treatments, and know when administration of intramuscular vitamin B12 treatment is appropriate.
4. Cannabis drug interactions
The Australian Institute of Health and Welfare estimates 600,000 Australians use cannabis for medicinal purposes. This is a dramatic uptick from the 2,560 medicinal cannabis prescriptions approved through Therapeutic Goods Administration’s (TGA) Special Access Scheme (SAS) in 2018. In fact, last year there were 132,000 SAS-B applications approved by the TGA from 2,565 medical practitioners.
This CPD article explains the common mechanisms whereby medicinal cannabis may interact with other medicines, and the role of the pharmacist in reviewing and identifying these interactions.
5. Immediate-release melatonin for jet lag
Melatonin is now a schedule 3 medicine for Australians aged 55 years of age or older with primary insomnia with poor sleep quality, and for those aged 18 or older to treat jet lag.
But do you know when melatonin should be taken to stave off jet lag, or its potential adverse effects and drug interactions? There are also several non-pharmacological options to treat jet lag that pharmacists should also be across. Pharmacists can access all this information and more in PSA’s Immediate-release melatonin for jet lag article.
How else can I gain CPD credits?
Prefer to rack up your CPD credits in other ways? If networking with other healthcare professionals while gaining knowledge from the industry's top thought leaders is more your thing, AP has rounded up the top up-coming conferences to attend:
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[post_content] => Influenza is one of the most common vaccine-preventable diseases in Australia. While reported cases are significantly higher than what they were this time last year, vaccination rates are slipping.
There were 30,404 reported cases of influenza from January–March this year, compared to 18,584 during the same time period last year. With 39,230 cases reported to date in 2024, there has been a significant spike in cases over the last few weeks.
As we approach World Immunisation Week (24–30 April 2024), here’s how pharmacists can help to protect the community this season.
Children are undervaccinated and frequently hospitalised. How can this cohort be reached?
In 2023, influenza notifications were highest in children aged 5–9 years old, with hospitalisations peaking in those 15 years of age or younger. Yet the 5–15 age group is the most under-vaccinated cohort, with vaccination rates sitting at only 16% for 2023.
Vaccination rates among children aged 6 months to 5 years of age have been startlingly low post-COVID pandemic (28.3% in 2023), despite the considerable risk to this age group, said Dr Eden Mifsud, Medical Science Liaison, Influenza Vaccines Medical Affairs, at CSL Seqirus in the PSA webinar Influenza 2024 – The Right Vaccine for the Right Patient, held on 17 April 2024.
So how can pharmacists approach this conversation with parents and carers? Firstly, you can remind them that the influenza vaccine is covered under the NIP for children aged 6 months to 5 years because they are susceptible to severe disease associated with influenza, and death.
Making vaccination more accessible for patients aged 5–15 can be achieved by scheduling and promoting after-school vaccination, said webinar co-host Peter Guthrey MPS, PSA Senior Pharmacist, Strategic Policy.
While parents may be hesitant to administer vaccines on a school night due to concern about adverse effects, pharmacists can reassure them that adverse events from influenza vaccines are relatively low compared to other vaccines, said Mr Guthrey.
‘Booking the whole family for the flu vaccine, school holiday or after-school appointments can be a powerful way to help people engage in vaccination,’ he said. ‘Parents are looking to protect the health of their children in a way that doesn't disrupt the routine.’
What are the new ATAGI recommendations in 2024?
There have been a number of updates included in the Australian Technical Advisory Group on Immunisation (ATAGI) advice regarding the administration of 2024 seasonal influenza vaccines.
This year, ATAGI recommends pregnant women who received an influenza vaccine in 2023 receive the 2024 influenza vaccine if available before the end of their pregnancy, said Dr Mifsud.
‘We know antibodies can be passed through the placenta, and these antibodies can also be passed on if the woman chooses to breastfeed,’ she said. ‘That means those maternal antibodies can protect the infant for the first 6 months of its life.’
Another change to the ATAGI recommendations this year is the inclusion of conditions that increase the risk of severe influenza that are not attached to NIP funding eligibility, including:
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[post_content] => Squadron Leader Michael Whitney MPS, an avid traveller on and off duty, tells AP about his career path in the Defence Force.
Why choose pharmacy?
I’ve always been interested in helping people and performed well in science and maths subjects at school. When the time came to participate in Year 10 work experience, my sister – a nurse – suggested pharmacy. After a week-long stint in my local community pharmacy, which morphed into an after-school job, I was hooked. The rest is history!
What led you to the military?
Without any background in Defence, I only became aware you could join the Australian Defence Force (ADF) as a pharmacist during a careers session while a first-year university student.
It sounded like a niche, but interesting, area of pharmacy. I ended up applying a year or so into my studies after thinking I’d like to try a career path that differs from the usual hospital or community pharmacy options. Defence sponsors university students throughout their study and internship years, so it was a great fit.
Tell us about your career as a military pharmacist?
Air Force pharmacists are employed as both logisticians and clinicians. The role comprises health logistics, planning and administration along with more traditional elements of community (and sometimes hospital) pharmacy practice.
I’ve been lucky enough to work in a variety of clinical and non-clinical settings across Australia and overseas. Some career highlights include deploying to the Middle East Region in 2019 to run the pharmacy at our main operating base, and secondment to the National Vaccine Taskforce at the Department of Health during the COVID-19 pandemic. I served as a logistics liaison officer for ADF and Department of Foreign Affairs and Trade cohorts.
My current role is Senior Pharmacist and Health Logistics Flight Commander of No. 1 Expeditionary Health Squadron at RAAF Base Amberley – just outside Brisbane. Our unit is responsible for support to expeditionary health tasks through deployment of the Air Force Role 2 Medical Treatment Facility.
Why is the military a good career path for pharmacists?
I’d encourage other pharmacists to join the ADF if they’re up for an adventure, challenge and are interested in seeing a different side of the profession.
What the job sometimes lacks in traditional dispensing and medication management, can be made up for in leadership and an opportunity to serve the nation in new and exciting ways as a Defence Health practitioner. It really is a pharmacist job you can’t do anywhere else, and every day can be completely different.
Was your catch-up with colleagues at the International Federation of Pharmaceutical Sciences in Brisbane last year valuable?
While the Defence pharmacy community is strong, it is quite small and geographically displaced. Opportunities like the FIP Congress are great, as they allow for networking and professional development that can’t take place in isolation.
ADF pharmacists are involved in FIP’s Military and Emergency Pharmacy Section (MEPS), so the conference in September 2023 was an excellent opportunity to network and learn with other military pharmacists from around the globe.
Thoughts on the future of pharmacy in the Defence Force?
Defence Health is currently undertaking the largest health assets and systems upgrade in our history. The pharmacist’s role, particularly in regards to health material management of the new equipment, is a big undertaking and an exciting challenge.
Clinical-wise, it will be interesting to see how new scope of practice opportunities for pharmacists in the civilian sector can be adapted to suit military pharmacists.
A Day in the life of Michael Whitney, Military Pharmacist, RAAF Base Amberley, Queensland
| 7.00 am |
Training time Unit Physical Training Session (PT) at Base Gym, a group-orientated fitness session comprising a mixture of cardiovascular and strength exercises. |
| 9.00pm |
Clinical care Assisting Amberley Defence Health Facility (Garrison), which is like a big GP clinic, with clinical pharmacy duties. This includes management of pharmaceutical accounts and dispensing medicines such as longer term prescription repeats for management of chronic health conditions and over-the-counter products for acute colds, headaches, aches and pains etc. Also use this time for management and clinical governance of expeditionary health kits. |
| 12.00pm |
Lunch break Pause for lunch at Mess (dining facility), which also provides an opportunity to network with other base personnel. Food is always great and prepared by in-house Air Force chefs! I love their curries. |
| 2-5pm |
End-of-day planning Command briefing on the next series of upcoming expeditionary health tasks and priorities, which can include requests for health support in a wide variety of locations both within Australia and overseas. Respond to a Short Notice to Move task involving the provision of pharmaceuticals and/or health material (medical equipment). |
| 7.00pm |
Wind down Like a true pharmacist I’ve been re-watching Ozark on Netflix, about a financial planner who turns money launderer for a drug cartel. Otherwise, I support the current sporting series – most recently celebrating Brisbane Heat winning the Big Bash League cricket competition! |
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