At the Update Pharmacy pre-reg trainee Jan is on prescription reception. A woman approaches her holding a consultant physician’s private prescription form.

“Can you do this prescription for my husband?” she asks. “I’ve been to two other chemists already. They both seemed puzzled by it and then just said that they didn’t have it.”

“Well,” Jan replies, “even if we don’t have it in stock I’m sure we could get it for you very quickly. Can I have a look at the prescription?”

The woman hands it over and Jan looks at it. It reads:

‘Sativex spray 1x3x10ml

Start with one spray daily, increasing gradually if necessary by one spray per day until optimum relief is obtained. Maximum dose: 12 sprays daily.’

“I’m afraid that I’m not familiar with this medicine,” Jan says, “but give me a minute.”

She then takes it to pharmacist David Spencer, who looks at it and says: “Yes, I know what it is. But if she wants it, she’ll have to go back to the prescriber. And, in any case, I think she’ll be wanting to get this on the NHS.”

QUESTIONS

1. What is Sativex and what is it used for?
2. What is its legal classification?
3. Why will the patient or his representative need to go back to the prescriber?
4. Why will the patient be wanting to get the drug on the NHS?

ANSWERS

1. Sativex is an oromucosal spray containing the cannabinoids cannabidiol and delta-9-tetrahydrocannabinol in a 1:1 ratio.

It is derived from whole plant extracts of the plant Cannabis sativa. In the UK it is indicated as an add-on treatment for patients with moderate to severe spasticity as a result of multiple sclerosis who have experienced an inadequate response to other anti-spastic medicines.

2. Sativex is a Schedule 1 controlled drug, but the Home Office has issued an open general licence for the product; this removes the legal requirement for doctors, pharmacists and patients to apply for individual licences with the Home Office in order for it to be prescribed, dispensed and possessed respectively. To be legally valid prescriptions must comply with the prescription-writing requirements for CD Schedule 2 drugs, but Sativex is exempt from CD record-keeping requirements.

3. In line with Schedule 2 prescription requirements, for private prescriptions Sativex must be prescribed on standardised private prescription forms issued by PCTs. Also, the total quantity of the medicine must be stated in words and figures.

4. The cost. The basic price of a 3x10ml pack is £375.

REFERENCES

1. Royal Pharmaceutical Society, Sativex factsheet (www.rpharms. com/support-tools/sativex.asp)

2. SPC for Sativex Oro-mucosal Spray (www.medicines.org.uk/EMC/ medicine/23262/SPC/Sativex+Oromucosal+Spray/#COMPOSITION)