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Article ; Online: Community Pharmacists' Views and Experiences with ADR Reporting for Complementary Medicines: A Qualitative Study in New Zealand.

Barnes, Joanne / Butler, Rachael

2020 Volume 43, Issue 11, Page(s) 1157–1170

Abstract: Introduction: Detecting signals of safety concerns associated with complementary medicines (CMs) relies on spontaneous reports submitted by health professionals and patients/consumers. Community pharmacists are well placed to identify and report ... ...

Abstract	Introduction: Detecting signals of safety concerns associated with complementary medicines (CMs) relies on spontaneous reports submitted by health professionals and patients/consumers. Community pharmacists are well placed to identify and report suspected adverse drug reactions (ADRs) associated with CMs, but pharmacists submit few CMs ADR reports. Objectives: The aim of this study was to explore New Zealand community pharmacists' views and experiences with ADR reporting for CMs. Methods: Qualitative, in-depth, semi-structured interviews were undertaken with 27 practising community pharmacists identified through purposive and convenience sampling. Data were analysed using a general inductive approach. Results: Participants were familiar with systems for reporting ADRs, believed ADR reporting for CMs important, and that pharmacists should contribute. However, few submitted reports of CMs ADRs and none encouraged patients/consumers to do so. Participants explained this was because they had never been informed by patients about ADRs associated with CMs. Participants said they would report serious ADRs; time pressures, lack of certainty around causality, lack of awareness of mechanisms for reporting CMs ADRs, and lack of remuneration were deterrents to reporting. Participants were aware of intensive-monitoring studies for prescription medicines, understood the rationale for considering this approach for CMs and recognised there would be potential practical difficulties. Conclusions: Participants used their knowledge of CMs safety concerns to minimise risk of harms to consumers from CMs use, but most had a passive approach to identifying and reporting ADRs for CMs. There is substantial potential for pharmacists to adopt proactive strategies in pharmacovigilance for CMs, particularly in recognising and reporting ADRs, and empowering CMs users to do the same.
MeSH term(s)	Adult ; Adverse Drug Reaction Reporting Systems/standards ; Attitude of Health Personnel ; Biological Products ; Community Pharmacy Services ; Complementary Therapies/adverse effects ; Data Collection ; Drug Interactions ; Female ; Humans ; Male ; Middle Aged ; New Zealand ; Pharmacists ; Risk Factors ; Surveys and Questionnaires ; Young Adult
Chemical Substances	Biological Products
Language	English
Publishing date	2020-12-17
Publishing country	New Zealand
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1018059-x
ISSN	1179-1942 ; 0114-5916
ISSN (online)	1179-1942
ISSN	0114-5916
DOI	10.1007/s40264-020-00980-x
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Article ; Online: Community pharmacists' professional practices for complementary medicines: a qualitative study in New Zealand.

Barnes, Joanne / Butler, Rachael

International journal of clinical pharmacy

2020 Volume 42, Issue 4, Page(s) 1109–1117

Abstract: Background Complementary medicines are a popular healthcare choice among patients/consumers, and most pharmacies sell these products. Pharmacists are well-placed to advise on complementary medicines, but their training and practices for these products ... ...

Abstract	Background Complementary medicines are a popular healthcare choice among patients/consumers, and most pharmacies sell these products. Pharmacists are well-placed to advise on complementary medicines, but their training and practices for these products are not optimal. Pharmacists' professional practices for complementary medicines ought to be influenced by professional codes of ethics and standards. Objective To examine community pharmacists' perspectives on complementary medicines in New Zealand, including motivations and justifications for selling these products, and professional and ethical issues complementary medicines raise for pharmacists. Setting Community pharmacists in New Zealand. Method Qualitative, semi-structured interviews with 27 New Zealand practising community pharmacists identified through purposive and convenience sampling. Main outcome measure Participants' views, experiences, and professional practices for complementary medicines. Results Participants struggled to clearly describe products they considered complementary medicines. Perspectives towards these products ranged from strongly supportive to somewhat sceptical; none was strongly opposed. Participants had several motivations for selling complementary medicines, particularly consumer demand and profits. Participants acknowledged ethical issues concerning complementary medicines, including lack of evidence of efficacy and pharmacists' limited training/knowledge. Few referred explicitly to complementary-medicines-related statements in the Pharmacy Council of New Zealand's Code of Ethics, or indicated these guided their practice. Conclusion Participants sold complementary medicines despite having limited knowledge on these products and concerns about efficacy; participants justified this as they believe they are providing an holistic option for patients, and/or ensuring complementary medicines do no harm. Participants were mindful of ethical/professional issues regarding complementary medicines, but were not necessarily aware of, or guided by, explicit statements in the Pharmacy Council of New Zealand's Code of Ethics.
MeSH term(s)	Adult ; Aged ; Community Pharmacy Services/organization & administration ; Complementary Therapies ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Interviews as Topic ; Male ; Middle Aged ; New Zealand ; Pharmacists/organization & administration ; Professional Role ; Young Adult
Language	English
Publishing date	2020-07-20
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2601204-2
ISSN	2210-7711 ; 2210-7703 ; 0928-1231
ISSN (online)	2210-7711
ISSN	2210-7703 ; 0928-1231
DOI	10.1007/s11096-020-01093-2
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Article ; Online: Community pharmacists' views on the regulation of complementary medicines and complementary-medicines practitioners: a qualitative study in New Zealand.

Barnes, Joanne / Butler, Rachael

The International journal of pharmacy practice

2018 Volume 26, Issue 6, Page(s) 485–493

Abstract: Objectives: To examine community pharmacists' perspectives on CMs regulation in New Zealand, where proposals for CMs regulations had recently been suspended and where, currently, CMs are only weakly regulated.: Methods: Qualitative, in-depth, semi- ... ...

Abstract	Objectives: To examine community pharmacists' perspectives on CMs regulation in New Zealand, where proposals for CMs regulations had recently been suspended and where, currently, CMs are only weakly regulated. Methods: Qualitative, in-depth, semi-structured interviews with New Zealand practising community pharmacists are identified through purposive and convenience sampling. Data were analysed using a general inductive approach. Key findings: Participants held mixed views regarding harmonisation of CMs regulations across Australia and NZ; some supported an NZ national regulatory framework for CMs, based on the Australian system. Participants recognised the current CMs regulatory framework in NZ as inadequate, that regulation was required to some extent, and that mandatory regulation was not necessarily required. A key reason given in support of CMs regulations was the need for greater assurances around quality of CMs. Participants also supported a regulatory framework that incorporated assessment of the safety of CMs, but were less convinced of the need for, or feasibility of, requiring evidence of efficacy from clinical trials. Participants believed that regulation of CMs practitioners, such as herbalists, and CMs retailers was important, although there were mixed views as to whether regulation should be statutory or whether self-regulation would be adequate. Conclusions: On the basis of these findings, pharmacists would be expected to welcome proposals for national regulations for CMs in NZ: such regulations should address concerns regarding product quality, inappropriate health claims and supporting evidence, and therefore should support pharmacists in meeting their obligations under the NZ Pharmacy Council's Code of Ethics.
MeSH term(s)	Adult ; Aged ; Attitude of Health Personnel ; Australia ; Community Pharmacy Services/organization & administration ; Complementary Therapies/adverse effects ; Complementary Therapies/legislation & jurisprudence ; Female ; Health Personnel/legislation & jurisprudence ; Humans ; Interviews as Topic ; Male ; Middle Aged ; New Zealand ; Pharmacists/statistics & numerical data ; Professional Role ; Young Adult
Language	English
Publishing date	2018-01-19
Publishing country	England
Document type	Journal Article
ZDB-ID	1087040-4
ISSN	2042-7174 ; 0961-7671
ISSN (online)	2042-7174
ISSN	0961-7671
DOI	10.1111/ijpp.12428
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Article ; Online: Innocent parties or devious drug users

Sheridan Janie / Butler Rachael

Harm Reduction Journal, Vol 7, Iss 1, p

the views of primary healthcare practitioners with respect to those who misuse prescription drugs

2010 Volume 21

Abstract: Abstract Background Many health professionals engage in providing health services for drug users; however, there is evidence of stigmatisation by some health professionals. Prescription drug misusers as a specific group, may also be subject to such ... ...

Abstract	Abstract Background Many health professionals engage in providing health services for drug users; however, there is evidence of stigmatisation by some health professionals. Prescription drug misusers as a specific group, may also be subject to such judgment. This study aimed to understand issues for primary care health practitioners in relation to prescription drug misuse (PDM), by exploring the attitudes and experiences of healthcare professionals with respect to PDM. Methods Tape-recorded interviews were conducted with a purposive sample of general practitioners (17), community pharmacists (16) and 'key experts' (18) in New Zealand. Interviews were transcribed verbatim and a thematic analysis undertaken. Participants were offered vouchers to the value of NZ$30 for their participation. Results A major theme that was identified was that of two different types of patients involved in PDM, as described by participants - the 'abuser' and the 'overuser'. The 'abuser' was believed to acquire prescription medicines through deception for their own use or for selling on to the illicit market, to use the drugs recreationally, for a 'high' or to stave off withdrawal from illicit drugs. 'Overusers' were characterised as having become 'addicted' through inadvertent overuse and over prescribing, and were generally viewed more sympathetically by practitioners. It also emerged that practitioners' attitudes may have impacted on whether any harm reduction interventions might be offered. Furthermore, whilst practitioners might be more willing to offer help to the 'over-user', it seemed that there is a lack of appropriate services for this group, who may also lack a peer support network. Conclusions A binary view of PDM may not be helpful in understanding the issues surrounding PDM, nor in providing appropriate interventions. There is a need for further exploration of 'over users’ whose needs may not be being met by mainstream drug services, and issues of stigma in relation to ‘abusers’.
Keywords	Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2010-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: Prescription drug misuse in New Zealand: challenges for primary health care professionals.

Sheridan, Janie / Butler, Rachael

Research in social & administrative pharmacy : RSAP

2011 Volume 7, Issue 3, Page(s) 281–293

Abstract: Background: Prescription drug misuse (PDM) is an international phenomenon. Prescription drugs sought for this purpose are often obtained through the primary health care network.: Objectives: This study aimed to explore the challenges faced by ... ...

Abstract	Background: Prescription drug misuse (PDM) is an international phenomenon. Prescription drugs sought for this purpose are often obtained through the primary health care network. Objectives: This study aimed to explore the challenges faced by community pharmacists (CPs) and general practitioners (GPs) when faced with the issue of "drug-seeking" and PDM. This forms part of a larger study of PDM issues for primary health care practitioners. Methods: Qualitative interviews were carried out in New Zealand with 17 GPs and 16 CPs, purposively sampled to provide information from a variety of demographic and work environments. Interviews were tape-recorded, transcribed verbatim, and a thematic analysis conducted. Data collection took place between June 2007 and January 2008, and interviewees were offered an NZ$30 voucher in recognition of their contribution to the research. Results: GPs and CPs faced a series of challenges in managing PDM, including identification of PDM, dealing with requests for inappropriate requests for psychoactive prescription drugs, verifying the legitimacy of requests and managing threatening behaviors. Specific issues were faced by rural practitioners, female practitioners and by locums and part-time staff. In particular, some participants reported feeling emotionally stressed after unpleasant drug-seeking incidents and some acknowledged that they may have missed identifying some drug-seeking because of lack of knowledge, "drug-seekers'" sophisticated strategies, or patients falling outside of their image of the archetypal "drug-seeker." Conclusion: This study demonstrated that PDM can be an issue for primary health care practitioners, and it can cause disruption to their work. Training in how to better manage threatening and escalating incidents may be useful as would increasing the level of awareness of PDM issues among health professional students.
MeSH term(s)	Attitude of Health Personnel ; Drug Users ; Drug-Seeking Behavior ; Female ; General Practitioners ; Health Personnel/psychology ; Humans ; Male ; New Zealand ; Pharmacies ; Pharmacists ; Prescription Drugs ; Primary Health Care ; Professional Practice Location ; Professional-Patient Relations ; Time Factors ; Violence ; Workload
Chemical Substances	Prescription Drugs
Language	English
Publishing date	2011-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2192059-X
ISSN	1934-8150 ; 1551-7411
ISSN (online)	1934-8150
ISSN	1551-7411
DOI	10.1016/j.sapharm.2010.06.005
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Article ; Online: BZP-party pills: a review of research on benzylpiperazine as a recreational drug.

Cohen, Bruce M Z / Butler, Rachael

The International journal on drug policy

2011 Volume 22, Issue 2, Page(s) 95–101

Abstract: Background: BZP-party pills are yet another 'designer drug' which mimics the stimulant qualities of amphetamines and MDMA/Ecstasy. As legal markets for the substance have developed in the last decade (especially amongst young people) so has public and ... ...

Abstract	Background: BZP-party pills are yet another 'designer drug' which mimics the stimulant qualities of amphetamines and MDMA/Ecstasy. As legal markets for the substance have developed in the last decade (especially amongst young people) so has public and governmental concern. Methods: This article provides a summary of the available international research on benzylpiperazine (BZP) and its popular use in the compound form known as 'party pills'. Through performing an analysis of the available medical and social scientific literature, the review outlines current knowledge on the compound, the prevalence of usage of BZP-party pills, as well as the associated harms, risks and rationales for use of the drug. Results: Despite moves towards legislative control of BZP-party pills, the evidence presented suggests limited social and health harms associated with the drug, although research on long term effects is a significant gap in the literature. It also remains inconclusive as to whether BZP-party pills act as a 'gateway' to illegal drugs or, conversely, play a role in harm reduction with illegal drug users turning to legal alternatives; there is some evidence for both positions. Conclusion: With increasing controls of BZP-party pills, and with the increasing numbers of 'legal highs' and new designer drugs on the market, we conclude that new legal alternatives will continue to surface to replace the drug in the future. Considering a harm reduction approach to drug taking, it is suggested that policy makers consider the creation of a legal holding category which restricts and regulates the market in legal highs whilst the social and health harms associated with each drug can be thoroughly investigated.
MeSH term(s)	Administration, Oral ; Adolescent ; Adult ; Commerce ; Crime ; Designer Drugs/administration & dosage ; Designer Drugs/adverse effects ; Designer Drugs/economics ; Drug and Narcotic Control ; Female ; Harm Reduction ; Humans ; Male ; Piperazines/administration & dosage ; Piperazines/adverse effects ; Piperazines/economics ; Risk Assessment ; Street Drugs/adverse effects ; Street Drugs/economics ; Street Drugs/legislation & jurisprudence ; Substance-Related Disorders/complications ; Substance-Related Disorders/economics ; Substance-Related Disorders/epidemiology ; Tablets ; Young Adult
Chemical Substances	Designer Drugs ; N-benzylpiperazine ; Piperazines ; Street Drugs ; Tablets
Language	English
Publishing date	2011-03
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2010000-0
ISSN	1873-4758 ; 0955-3959
ISSN (online)	1873-4758
ISSN	0955-3959
DOI	10.1016/j.drugpo.2010.12.002
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Article ; Online: Innocent parties or devious drug users: the views of primary healthcare practitioners with respect to those who misuse prescription drugs.

Butler, Rachael / Sheridan, Janie

Harm reduction journal

2010 Volume 7, Page(s) 21

Abstract: Background: Many health professionals engage in providing health services for drug users; however, there is evidence of stigmatisation by some health professionals. Prescription drug misusers as a specific group, may also be subject to such judgment. ... ...

Abstract	Background: Many health professionals engage in providing health services for drug users; however, there is evidence of stigmatisation by some health professionals. Prescription drug misusers as a specific group, may also be subject to such judgment. This study aimed to understand issues for primary care health practitioners in relation to prescription drug misuse (PDM), by exploring the attitudes and experiences of healthcare professionals with respect to PDM. Methods: Tape-recorded interviews were conducted with a purposive sample of general practitioners (17), community pharmacists (16) and 'key experts' (18) in New Zealand. Interviews were transcribed verbatim and a thematic analysis undertaken. Participants were offered vouchers to the value of NZ$30 for their participation. Results: A major theme that was identified was that of two different types of patients involved in PDM, as described by participants - the 'abuser' and the 'overuser'. The 'abuser' was believed to acquire prescription medicines through deception for their own use or for selling on to the illicit market, to use the drugs recreationally, for a 'high' or to stave off withdrawal from illicit drugs. 'Overusers' were characterised as having become 'addicted' through inadvertent overuse and over prescribing, and were generally viewed more sympathetically by practitioners. It also emerged that practitioners' attitudes may have impacted on whether any harm reduction interventions might be offered. Furthermore, whilst practitioners might be more willing to offer help to the 'over-user', it seemed that there is a lack of appropriate services for this group, who may also lack a peer support network. Conclusions: A binary view of PDM may not be helpful in understanding the issues surrounding PDM, nor in providing appropriate interventions. There is a need for further exploration of 'over users' whose needs may not be being met by mainstream drug services, and issues of stigma in relation to 'abusers'.
Language	English
Publishing date	2010-09-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2146691-9
ISSN	1477-7517 ; 1477-7517
ISSN (online)	1477-7517
ISSN	1477-7517
DOI	10.1186/1477-7517-7-21
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Article ; Online: "They're legal so they're safe, right?" What did the legal status of BZP-party pills mean to young people in New Zealand?

Sheridan, Janie / Butler, Rachael

The International journal on drug policy

2010 Volume 21, Issue 1, Page(s) 77–81

Abstract: Background: The legislation on psychoactive substances has a role to play with regard to shaping social values and influencing the normalisation of drug use. In New Zealand from 2005 to 2008, benzylpiperazine-containing 'legal' party pills (BZP-party ... ...

Abstract	Background: The legislation on psychoactive substances has a role to play with regard to shaping social values and influencing the normalisation of drug use. In New Zealand from 2005 to 2008, benzylpiperazine-containing 'legal' party pills (BZP-party pills) were legally available for purchase, subject to controls around a minimum purchase age of 18 years, and prohibitions on free of charge distribution and advertising in certain media. This paper explores what their legal status communicated to young users. Methods: Interviews and group discussions with young people (n=58) who had used BZP-party pills in the preceding 6 months. Results: Data were collected between June and December 2006 via a series of interviews with individuals, 'friendship' pairs, and groups comprised of participants known to each other. Young people saw BZP-party pills as 'safe' and of good quality as they were legal/government sanctioned, but also thus of inferior strength, suggesting they could take more of them. However, after using them they often reviewed their view of their safety and quality due to varied experiences. Being legal for some people meant they could use the substances without breaking the law, or having to go to 'dealers'. Their legal status also meant they were easily accessible and were seen to be 'socially acceptable', with some young people indicating they would be happy to discuss their use with their parents. However, social acceptability was, for some, a reason not to use them. Conclusion: These data provide a unique insight into the tension between positive and negative harm reduction messages relating to the legal nature of psychoactive drugs and as such begin to fill an information void in this area. The legal status of these 'party pills' conveys mixed messages to young people and whilst being seen as potentially safe and of good quality, this often leads to higher than 'recommended' doses being used. Nevertheless, not breaking the law or having to access BZP-party pills from 'dealers', and being able to discuss their use with their parents are all potentially positive harm reduction issues.
MeSH term(s)	Adolescent ; Adolescent Behavior/psychology ; Adult ; Drug and Narcotic Control/legislation & jurisprudence ; Female ; Harm Reduction ; Humans ; Male ; New Zealand ; Off-Label Use ; Piperazines/adverse effects ; Psychotropic Drugs/adverse effects ; Safety-Based Drug Withdrawals/legislation & jurisprudence ; Substance-Related Disorders/psychology ; Young Adult
Chemical Substances	Piperazines ; Psychotropic Drugs ; 1-benzylpiperazine (3UG152ZU0E)
Language	English
Publishing date	2010-01
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2010000-0
ISSN	1873-4758 ; 0955-3959
ISSN (online)	1873-4758
ISSN	0955-3959
DOI	10.1016/j.drugpo.2009.02.002
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Article ; Online: Atypical alliances: the potential for social work and pharmacy collaborations in primary health care delivery.

Fouche, Christa / Butler, Rachael / Shaw, John

Social work in health care

2013 Volume 52, Issue 9, Page(s) 789–807

Abstract: The growing prevalence of chronic conditions is a cause for concern globally, both in terms of its impact on the health of populations and also the strain it is predicted to place on health resources. There is a push to adopt more holistic and ... ...

Abstract	The growing prevalence of chronic conditions is a cause for concern globally, both in terms of its impact on the health of populations and also the strain it is predicted to place on health resources. There is a push to adopt more holistic and collaborative approaches to health care, and for the education of health care professionals to be reformed if these efforts are to be successful. A research project was undertaken in New Zealand in 2010-2011 aimed at exploring the perceptions of health care professionals on competencies in the field of chronic care. This article aims to highlight learning from the project regarding the "atypical alliance" between social work and pharmacy. Based on this, the authors argue that, with the growing expectations for interprofessional collaboration, effective primary and community health care delivery is increasingly dependent on relationships between educators in different health disciplines, between health professionals-in-training, and between education providers and health organizations.
MeSH term(s)	Attitude of Health Personnel ; Chronic Disease/therapy ; Clinical Competence/standards ; Community Pharmacy Services/manpower ; Community Pharmacy Services/organization & administration ; Community Pharmacy Services/trends ; Cooperative Behavior ; Female ; Focus Groups ; Health Personnel/education ; Humans ; Interdisciplinary Studies ; Interprofessional Relations ; Interviews as Topic ; Male ; Middle Aged ; New Zealand ; Primary Health Care/manpower ; Primary Health Care/organization & administration ; Primary Health Care/trends ; Social Work/manpower ; Social Work/organization & administration ; Social Work/trends
Language	English
Publishing date	2013
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	197616-3
ISSN	1541-034X ; 0098-1389
ISSN (online)	1541-034X
ISSN	0098-1389
DOI	10.1080/00981389.2013.827147
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Article ; Online: Highs and lows: patterns of use, positive and negative effects of benzylpiperazine-containing party pills (BZP-party pills) amongst young people in New Zealand.

Butler, Rachael A / Sheridan, Janie L

Harm reduction journal

2007 Volume 4, Page(s) 18

Abstract: Background: This study aimed to investigate patterns and context of use of BZP-party pills, function of use, and positive and negative effects experienced by a sample of New Zealand young people who had used the products.: Methods: A qualitative ... ...

Abstract	Background: This study aimed to investigate patterns and context of use of BZP-party pills, function of use, and positive and negative effects experienced by a sample of New Zealand young people who had used the products. Methods: A qualitative study comprised of semi-structured interviews and group discussions. Results: The sample included 58 young people aged 17-23 years who had used BZP-party pills in the previous 12 months. Young people were using these substances in a range of settings--primarily during weekend social occasions--particularly as part of the dance party culture. They were mostly used for their stimulant properties and to enhance socialisation, and were often taken in combination with other legal and illicit drugs. Young people had suffered a range of physical and emotional negative effects, although none of these was reported as being life-threatening or long-term. Many participants had reduced the frequency with which they used BZP-party pills due to adverse effects. Potentially risky behaviours identified included taking large doses, mixing BZP-party pills with alcohol and other substances, and driving whilst under the influence of BZP-party pills. Conclusion: Findings suggest that young people in this study were not suffering excessive or dangerous adverse effects. However, potentially risky use of these products raises the issue of the need for developing harm reduction interventions.
Language	English
Publishing date	2007-11-19
Publishing country	England
Document type	Journal Article
ISSN	1477-7517
ISSN (online)	1477-7517
DOI	10.1186/1477-7517-4-18
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