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drinkanddrugsnews
| February 2012
www.drinkanddrugsnews.com
Technology |
Onsite dispensing
ON 19 DECEMBER 1991, in the reception of a red brick hostel in Kingston-upon-
Thames, something revolutionary was about to happen. The first computerised
onsite methadone dispensing system in the UK was set to go live.
John Lipscomb and Ulrich Kohler of Kaleidoscope, who had painstakingly put
the system together, switched it on with considerable trepidation as Home Office
inspectors looked on. The Home Office – which would determine if Kaleidoscope
would be given a licence for this controversial approach to onsite methadone
dispensing – had a good working relationship with Kaleidoscope, one of the only
voluntary sector providers for medical treatment at the time. This positive
relationship was crucial for Kaleidoscope, in the light of hostility from other NHS
bodies and the police.
So why did Kaleidoscope opt for computerised onsite dispensing? Firstly the
increasing numbers attending our services – 300 a day by 1990. Because of the
difficulty in accessing treatment in south London, Kaleidoscope provided services
to a far wider client base than Kingston residents and, unusually for the time,
refused to have a waiting list for treatment. As numbers grew it became necessary
to look at new models for ensuring we gave medication safely.
Kaleidoscope staff went to New York to look at how they did things there, and
it was after seeing the Beth Israel Medical Center’s computerised methadone
dispensing system in operation that we sought out the software company to set
up a similar system in Kingston.
‘It was very rare to give methadone on the site of a treatment agency,’ says
John Lipscomb, who still manages Kaleidoscope methadone dispensing systems
in Wales and England. ‘Even in hospitals it was not possible. I remember working
with my colleague Ulrich Kohler on ensuring the software supplied by Johnsons
Computers, Oregon, properly linked with the pump. The ability for accurately
dispensing methadone was vital, although having a system that is just a
computerised pouring system is not that helpful. The main point of computerised
systems is to maximise interaction with a client and to integrate medical and care
plans, and the companies we work with continue to develop further the integration
of care and medical plans.’
Kaleidoscope has always been committed to harm reduction, but the emphasis
has been on service, which means more than just giving out a condom,
methadone or a needle. Kaleidoscope founder Eric Blakebrough said, ‘methadone
is the carrot into service and our task then is to provide a menu for people to make
their own life choices’.
Uli Kohler went from Kaleidoscope to work for the European Commission and
then to a German drug agency developing services across the world, but we
continued to work alongside him with agencies across South East Asia, setting up
the first onsite computerised methadone system in Asia – in Kathmandu, Nepal –
with his support.
John Lipscomb is surprised there aren’t more agencies offering onsite systems
in the UK. ‘When you manually dispense methadone, all your concentration is on
the transfer of the medication, from the bottle to the cup,’ he says. ‘But when you
dispense via the computerised system, you have time to meet a client eye to eye.’
The importance of such programmes is to enhance the clients’ treatment
experience, he stresses – a computerised system is safer, more accurate, provides
better time with the client and proper records where there is information sharing.
‘What is crucial today is to further develop better case management systems,’
he says. ‘There are systems that in effect purely dispense as pouring systems.
The problem with such systems is that you cannot plan detox, or message a client
or put basic notes on the system. In reality any onsite system must add to client
care. I believe the whole idea of onsite dispensing is to provide case management
with dispensing. Onsite dispensing means workers can deal with a client’s crisis
immediately. A good computerised dispensing system means key workers and
nurses share information, and case management is properly integrated.’
COMPUTER WORLD
Highly controversial at the time, Martin Blakebrough
looks back at 20 years of computerised onsite
dispensing at Kaleidoscope’s headquarters
The other development in computerised systems is enhanced security, he says.
‘To be honest this development is great for commissioners but actually does not
achieve an awful lot for the money. The amount of dispensing to the wrong people
through photo ID was never a problem in the first place and when you compare the
photo system with the biometric system there is minimal, if any, difference in
terms of errors.’
Looking back over 20 years, John says that the biggest critics of onsite
dispensing were the public health services. ‘I think they always felt that they had
exclusivity when it came to medical issues. The reason why health services have
sometimes struggled to deliver good quality drug services is because they are an
illness service. The consequence of such services is that they look at the illness
rather than the whole person.
‘Having worked for over 20 years in this field I recognise that a drug service
needs to offer medication but that is just a small part of care. I believe care must
include housing, education, training, employment opportunity, counselling,
spirituality and, above all, human interaction.’
Martin Blakebrough is chief executive of Kaleidoscope