My time as a kiwi apothecary (part 2)

G’Day, Drug Topics readers!

In this latest installment I would like to go into a little more detail about how medications in New Zealand are classified and supplied. While similar in many regards to the U.S. system, there are several notable areas of difference that I have found interesting thus far.

In New Zealand pharmacy practice there are 3 main classes of medications. These are pharmacy-only medications, prescription-only medications, and pharmacist-only medications. Unlike in the United States where a medication is either “over-the-counter” (or “behind-the-counter” in the case of emergency contraception and pseudoephedrine products) or prescription-only, there is a greater reliance on the pharmacist to use professional judgment in providing patient care and a wider array of options for the patient to choose from.

The first class, pharmacy-only medications, includes items that can be purchased without a prescription, but can only be stocked in a pharmacy setting. Similar to “over-the-counter” products, some of the items included in this class are steroidal nasal inhalers (fluticasone and beclomethasone), topical anti-fungal preparations (miconazole and clotrimazole), products for cold sore treatment (acyclovir), and combination pain relievers that do not contain codeine (paracetamol with ibuprofen).

Prescription medications

Prescription medications are items which an individual needs a prescription in order to obtain (fairly self-explanatory). Prescription medications can further be sub-divided by degree of abuse potential and subsequent restricted nature, similar to the U.S. system of scheduling medications.

Class A drugs are considered to be of the highest abuse potential, are illegal, and cannot be prescribed for medicinal purposes. Included in this group are the usual suspects, such as LSD, heroin, and methamphetamine. Class B drugs are comparable to Schedule II medications in the United States. Included in this group are morphine derivatives, oxycodone products, hydromorphone, and certain amphetamine-based drugs. Class C drugs include benzodiazepines, certain barbiturates, and cannabis. Interestingly, although cannabis is classified as a Class C drug, its use as a medicinal product is limited to a product known as Sativex. Unlike Marinol (which is produced by synthetic means), it is derived from standardized cannabis material and developed into an oral spray. Its current indication is limited to patients with MS, who can use it to alleviate neuropathic pain and spasticity. Possession of loose cannabis plant material, seeds, or oils remains illegal and carries with it potential fines and punishments.

Pharmacist-only medications

One of the more novel elements of pharmacy practice in New Zealand (and in a number of other countries around the world) is the ability of the pharmacist to “prescribe” medications for certain ailments and conditions. Some of the items included in this class of medication are treatments for thrush, sedating antihistamines, chloramphenicol preparations for the eyes, products containing codeine, and treatment for oral ulcers.

With pharmacist-only medications, a patient can come into the pharmacy, and after consulting with the pharmacist to determine appropriateness of therapy, purchase an item to treat a particular condition. In essence the pharmacist serves as prescriber and dispensary in this scenario. I find it professionally satisfying that pharmacists in New Zealand are given the ability to utilize their education and skills in such a way.

A typical consultation will involve the patient describing his or her condition and symptoms to the pharmacist on duty. The pharmacist will inquire about any other medications the patient may be taking, if the condition is something that has occurred in the past, if he or she has any other medical conditions, and if he or she has seen his or her doctor recently. If the pharmacist determines it is safe and appropriate for the patient’s condition, he or she will provide the product to the patient. In addition, the patient’s name and address are recorded with the sale to ensure both patient safety and to prevent misuse and over-consumption of certain medications with potential for abuse, such as pain relievers with codeine. While it can sometimes seem like an inquisition gathering all of the pertinent information when helping a patient, it is essential to ensure the best care.

In a similar fashion to the pharmacist-only sale, emergency contraception can be provided by the pharmacist. In New Zealand a pharmacist must first undergo training and certification to provide this service. The training ensures that the pharmacist is properly educated on how to professionally counsel patients on emergency contraception and provide the appropriate information in a sensitive and private manner. The patient is provided with this information in a part of the pharmacy, secluded from normal business to ensure privacy. Much like a pharmacist-only sale, the patient’s name and address is recorded. If there is not a pharmacist on duty who is trained to provide the service, the patient is directed to the closest pharmacy that does. In a rather progressive move by the New Zealand government, emergency contraception is free of charge to patients under the age of 25.

Closing thoughts

While I may still feel like I’m betraying my native country when I say paracetamol, utilize the metric system, or write a date with the day followed by the month, it’s a small trade-off for the opportunity and challenge of learning to practice in New Zealand. Aided by the ability to provide a greater range of treatment options for patients, I find myself to be more involved in the health-related outcomes of people. In addition, with fewer doctor calls to make as a result of a standard national formulary, and no insurance companies to contact for billing issues, I find I have much more time to counsel patients and make recommendations.

I see the role of the pharmacist in New Zealand as being more empowered than in the United States. Being able to provide education and treatment options to aid in patient care is great for the both the profession and the patient. Having the ability, and, ideally, the time to discuss therapy with patients, ultimately leads to healthier patients, and hopefully fewer physician visits. If only New Zealand pharmacists were compensated for their services at a similar salary to their U.S. counterparts.

Until next time, readers…

Joel Claycomb, PharmD, is a community pharmacist in Manawatu, New Zealand. He can be reached at jcclaycomb@gmail.com.