Carole Smith enters the pharmacy. She is in her mid-thirties. She has been an occasional patient for the last three years. Carole recently married Joe Burton, a patient of over ten years standing. Carole moved into the area when she began a ‘whirlwind romance’ with Joe, who was married to Sarah Montague at the time.
The pharmacy is based in a small rather close-knit English village, where most residents are at least acquainted with each other, and many have deep family ties. Carole and Joe’s relationship did not meet universal approval in the village, to say the least. Many villagers took the view that Sarah was wronged, and that Joe made an unwise choice.
Joe and Sarah have a 14-year-old son, William. William has not taken to his stepmother at all. He is angry with his father ‘for ruining everything’. His performance at school has dropped off dramatically. He is attending school but is increasingly disruptive in class.
Stepmother takes a plastic snap seal sachet from her bag. She hands it to Charles Hanson, the pharmacy owner. She says, “I’m sorry to bother you but I’ve found these pills in my 14-year-old boy’s bedroom drawer, hidden in a compartment. They were in this sachet, not a labelled bottle. I asked him what they are, but he claims to know nothing about them, or at least he won’t tell me. Do you know what they are?”
Charles takes the bag and examines the capsules. There are 20 or so in the bag. Each capsule has a blue opaque cap imprinted with S544 in white and a white opaque body imprinted with “20 mg” in black. He checks a computer record then says, “I may be able to help you. I just need to consult with my colleague.”
Charles walks to the back of the store to talk to his employee, Arika Chopra, in her late twenties. He shows her the pills and explains the situation. He says, “I’m pretty sure these are Equasym XL 20 mg Capsules . The boy didn’t get them from here, but I’ll tell stepmother if you concur?” (https://medicines.org.uk/emc/product/7456/smpc#gref; https://www.child-adolescentadhd.co.uk/assets/downloads/equasym-xl-prescribed-patient-leaflet.pdf)
Equasym is a brand name for methylphenidate and is used to treat attention deficit hyperactivity disorder (ADHD). The most well-known brand is Ritalin. (https://www.nhs.uk/medicines/methylphenidate-adults/)
Arika looks troubled, “I know you mean well Charles, but this is a really bad idea. There are so many issues here. I think you should just say either that you don’t know what the pills are or that legally you cannot identify them.”
“But I can identify them, so I don’t see why not.”
“I do” Arika replies, “We know nothing certain. We don’t even know how she got them. Methylphenidate is a Schedule 2 controlled drug, which means you usually have to prove your identity when collecting your prescription. It’s possible, given Gillick competence, that a 14-year-old would be able to collect without a parent or guardian present but not guaranteed. Where did the boy get them from if not from his stepmother?” (https://assets.publishing.service.gov.uk/media/5a80050540f0b62305b88ae8/TCDO_methylphenidate_NPS.pdf; https://www.pfni.org.uk/wp-content/uploads/2019/07/Pharmacy-Forum-NI-Guidance-Doc-Children-Collecting-Medicines-from-a-Pharmacy-June-2019.pdf)
“The biggest reason just to say you don’t know is that mum and step-mum might disagree.”
“As his stepmother she is his legal guardian.”
“So is Dad and his biological mum,” Arika quickly interjects, “We have no idea what either of them think.”
“As his stepmother she has a right to know if we know. We have information that might be useful to her. We have a professional duty to be truthful so that the family can make informed decisions.”
Arika shakes her head again, “But who is the family here? We should not get sucked into this. I would strongly suggest that we say nothing. You mentioned confidentiality, does the boy have a say in this? He’s 14 so quite possibly Gillick competent. I’m not sure stepmother even has a right to take his medication from him without his permission.”
Charles sits on the desk opposite Arika. “I agree we shouldn’t get sucked in but there are choices the family has to make. We’re pharmacists not ethicists or lawyers. We don’t normally pry into the private lives of our patients, and rightly so. Our job is to provide an efficient clinical service and to answer questions relating to medications. That is as far as it goes, but we can answer stepmother’s question. If I tell her what the tablets are she can make her own choices. We are informing her within our area of expertise.”
Frustrated, Arika says, “Look I concur that this is none of our business, so surely it is best not to get involved at all. If we do, we’re potentially opening a can of worms. Are you prepared to take responsibility for that? Because I’m not.”
Charles stands up. “There’s a safeguarding issue here too. If she doesn’t know what the tablets are then as a parent she can’t safeguard properly.”
Arika walks out of the room.
What should be done?