Provision of opioid substitution therapy services in Australian pharmacies

Abstract

Opioid dependence, despite being the subject of significant public funding, remains a costly burden to Australian society in human and economic terms. The most cost-effective public health strategy for managing opioid dependence is opioid substitution therapy (OST), primarily through the use of methadone or buprenorphine. Supervised dispensing of OST from specialist clinics and community pharmacies plays a crucial role in enhancing compliance, monitoring treatment and reducing diversion. Australia, compared with other countries in the world, ranks very high in illicit opioid use; hence there is a great demand for OST.The utilisation of community pharmacies for stable patients has many advantages. For public clinics, patient transfer to community pharmacies relieves workload and costs, and increases capacity for new OST patients. From a patient's perspective, dosing at a pharmacy is more flexible and generally more preferable. Pharmacists stand to gain clientele, profit and receive small incentives from state governments in Australia, for their services. Yet, many "unmet needs" exist and there is a high demand for more involvement in OST service provision in community pharmacy in Australia.In the UK there has been a steady increase in community pharmacy provision of OST, and pharmacists appear ready to provide further healthcare services to these patients.The role of pharmacy in some countries in Europe, such as Germany, is less prominent due to their approach to harm minimisation and the complex, variable nature of OST provision across the European Union (EU). The provision of OST by pharmacists in the USA on the other hand is of lesser frequency as the healthcare system in the USA encourages detoxification clinics to handle cases of illicit drug addiction.At a time when harm minimisation strategies constitute a topic of considerable political and public interest, it is important to understand the scope and variability of pharmacy involvement in drug policy in Australia. Hence, this review highlights the role of pharmacists in OST and explores the scope for expanding this role in the future.

Pharmacists and Harm Reduction: A Review of Current Practices and Attitudes

“…Through the provision of opioid substitution therapy in Australian pharmacies, IDUs have been able to rehabilitate in a less-stigmatized environment. 20 Opioid substitution therapy is also offered at community pharmacies in many countries in Europe, as well as Canada, China, India, Australia and others. [24][25][26][27][28] Sexual health services, including education on preventing transmission of bloodborne infections, are another important harm reduction strategy offered at community pharmacies.…”

“…However, other studies noted that, while the introduction of opioid substitution therapy in rural Australian pharmacies was supported by both pharmacy staff and nonparticipating customers, enhanced communication between members of the health care team would lead to optimal service delivery. 20 In Europe, the relationship between pharmacists and health care services was also noted as crucial to the provision of comprehensive services for IDUs. In Estonia, pharmacists were mostly supportive of their role in providing harm reduction services (opioid substitution therapy, syringe exchange), but felt that they needed more knowledge of local health care resources.…”

Knowledge and attitudes of final year pharmacy students toward opioid substitution therapy

“…In 2013 pharmacies represented 88% of the available dosing sites in Australia (n = 2078), dosing 71% of the national OST clientele . Forty years after the initiation of OST in Australia, 47 442 Australians were participating in the program . Participants rely on OST to provide a regular legal dosing option to keep them from going into opioid withdrawal .…”

“…Forty years after the initiation of OST in Australia, 47 442 Australians were participating in the program . Participants rely on OST to provide a regular legal dosing option to keep them from going into opioid withdrawal . Client participation is limited by access to the 2025 prescribing doctors (in 2013) and access to OST pharmacies .…”

“…Reasons for not providing OST include stigma, fear, unattractive financial remuneration and that provision is not compulsory . In studies looking at client concerns with OST, discriminatory treatment by pharmacy staff was a common complaint . The number of OST clients per pharmacy is directly related to the number of negative issues experienced .…”