Introduction: Guernsey is a British Protectorate island (population 65k) in the English Channel. Illicit drugs are difficult to import and expensive people look to alternative substances, mainly pharmaceuticals.
Aims: To reduce availability of dangerous pharmaceuticals in a community with high levels of prescription only medication misuse.
Methods: 3 triangulated audits: Unnatural deaths (2002-2011); Substances misused by Tier 2/3 Drug Team referrals (2011-13); and Prescribing data.
Results: Fentanyl-related deaths equalled heroin-related death numbers at post mortem case review. Reported patterns of use tended to follow local availability and poly-drug misuse was common. A high risk sub-group injecting fentanyl (derived from fentanyl patches) was identified.
We then developed a cross-agency Guernsey Addictive Prescription Only Drugs (GAPOM) group including Public Health, Primary Care, the Pain Service, Addictions, Prison, Border Agency, and Prescribing Advisor. This allowed for information sharing and developing joint strategies to address prescribing in our community. It resulted in a significant reduction in fentanyl and benzodiazepine prescribing.
Conclusions:
High rates of pharmaceutical drug misuse on Guernsey may reflect the low availability of illicit drugs. This increases demand for addictive POMs and OTCs. Developing a cross agency co-ordinated approach changed prescribing patterns. Prescribers in isolated communities need to be more cautious when prescribing addictive POMs, and pharmacists need to monitor for OTC drug misuse. We believe the Guernsey APOM Group is a useful model for other communities where pharmaceutical drug misuse is a concern.
