The typical way in which prescriptions work is that a person goes to a doctor with a particular issue, the doctor diagnoses it and sees the need for a particular prescription treatment that a local pharmacy will dispense.
This is the standard pathway for medication, but it is not the only way in which medicines can be supplied.
In 2024, the Pharmacy First Scheme was introduced, allowing people who are dealing with
seven common conditions to be examined by a specially trained community pharmacist.
They can, if required, supply prescription-only medicines, as well as offer advice and over-the-counter medication when suitable.
There are also pharmacist independent prescribers (PIPs), often known as pharmacist prescribers, as well as dispensing doctors, who can both prescribe and dispense medication within strict legal guidelines.
Finally, in emergency situations, pharmacists can provide emergency medication, if there is an immediate need for it, no way to provide a prescription through the typical channels, and the medication dispensed has been previously prescribed.
Outside of Pharmacy First and its very strict limits on which conditions can be treated, all of these situations where pharmacists can prescribe and supply are extremely rare, typically only allowed in the absence of alternative arrangements.
However, there is one very unique case where pharmacists can supply one specific prescription-only medication without a prescription. Not only that, but it is more common for it to be supplied without a prescription than with one.
The reason for this is that when this particular medicine is needed, a patient is minutes from death.
The Curious Case Of Naloxone
As an opioid agonist, Naloxone is used to reverse the effects of an opioid overdose, something
that can lead to breathing so shallow it can cause death within minutes.
There are a lot of instances that can cause opioid overdose, from accidental ingestion in combination with other medication, accidental overdose of prescription painkillers and taking recreational drugs knowingly or unknowingly.
There is no specific dosage that can cause it, which makes preparedness the most effective way to save lives. This means ensuring that anyone likely to be close to someone who could be at risk of an overdose is supplied with Naloxone.
The drug, also known as Narcan in the United States, comes in the form of a nasal spray or injection kit, both of which work very quickly to reverse the effects of an overdose, particularly the slowed and stopped breathing.
This can keep someone alive for long enough to call an ambulance and get emergency help if required.
Naloxone is, however, a prescription-only medication, meaning that theoretically it should only be supplied to people who are prescribed it by a doctor, or administered based on emergency prescription regulations.
However, it is an extraordinarily rare example of a prescription medication that is most often supplied without one.
The reason for this is that it falls in between the two main classifications for medicines in the UK. It is not entirely harmless, as it can lead to withdrawal symptoms in people with opioid dependencies, and can affect people who have cardiovascular disease or an allergy to naloxone itself.
It cannot be given to people who are not at risk of an overdose due to the use of opioids, which is why it cannot simply be provided over the counter.
However, it often needs to be given quickly by whoever is close enough to the person overdosing at the time, and whilst anyone is legally allowed to administer Naloxone to save another person’s life, having access to take-home kits has historically been difficult.
This has led to various schemes to expand its access in the United Kingdom, with a particularly successful scheme in Scotland to help reduce opioid-related deaths by allowing certain non-registered medical professionals to supply take-home Naloxone to either people at risk of an overdose or friends and family or someone at risk.
These include:
- Registered pharmacists and pharmacy technicians
- Registered paramedics
- Prison staff
- Registered midwives
- Registered nurses
- Police forces, with a particular emphasis on commissioned drug treatment workers
- Probation officers
It is also a relatively unusual medication in the sense that the person who would have been prescribed it is typically not the one to administer it, and whenever it is needed it is always an emergency.
This means that there needs to be as few barriers as possible to access to someone who needs it or someone likely to be a bystander to someone else who needs it.
It is an unusual medication that is only used in a set of situations that make the otherwise typical prescription system somewhat inappropriate.
Frequently Asked Questions
In most cases, prescription-only medicines (POMs) require a valid prescription from an authorised prescriber. However, pharmacists can legally supply certain medicines without a prescription in specific circumstances, such as under emergency supply regulations or approved Patient Group Directions (PGDs).
An emergency supply allows a pharmacist to provide certain prescription medicines without a prescription if there is an immediate clinical need and specific legal requirements are met. This service is provided at the pharmacist’s professional discretion.
Controlled drugs and many prescription-only medicines cannot usually be supplied without a valid prescription, except in very limited circumstances defined by law. Your pharmacist can advise you if an emergency supply is possible.
Contact your GP surgery or speak to your local pharmacy as soon as possible. If you cannot obtain a prescription in time, the pharmacist will assess whether an emergency supply or another NHS service may be appropriate for your situation.