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Factors influencing pharmacy services in opioid substitution treatment


  • Betty B. Chaar BPharm MHL PhD MPS, Lecturer in Professional Ethics and Pharmacy Practice, Holly Wang BPharm (Hons), Honours Candidate, Carolyn A. Day PhD, Associate Professor, Jane R. Hanrahan PhD, Associate Professor, Adam R. Winstock MD MRCP MRCPsych FAChAM, Consultant Psychiatrist and Addiction Medicine Specialist, South London and Maudsley National Health Service Trust and Honorary Senior Lecturer, Romano Fois BPharm PhD MPS, Lecturer.

Correspondence to Dr Betty B. Chaar, Faculty of Pharmacy, University of Sydney, Room S303 Pharmacy and Bank Building A15, Sydney, NSW 2006, Australia. Tel: +61 (2) 9036 7101; Fax: +61 (2) 9351 4447; E-mail:


Introduction and Aim

Heroin dependence is a serious health burden in Australia. Opioid substitution treatment (OST) has been delivered in Australian community pharmacies since 1985. The effectiveness of pharmacy-based OST is evident and the demand is increasing; however, the participation rate of community pharmacies is low, with over 60% non-providers. While previous Australian studies have focused on perspectives of community pharmacists providing the service, the views of non-providers have not yet been explored. This study aimed to further investigate factors influencing pharmacists' participation in provision of OST in the community pharmacy setting in New South Wales, Australia.

Design and Methods

Semi-structured interviews were conducted with 35 NSW community pharmacists (20 providers, 15 non-providers). Transcripts of interviews were thematically analysed.


Factors influencing non-providers were mainly stigma and fear, the nature of an opt-in scheme, professionals' moral responsibilities, lack of awareness and knowledge, disproportionate distribution of clients and lack of financial support for OST clients. Providers were motivated by positive attitudes, functional relationships with OST clients/stakeholders, professional satisfaction and financial rewards. Recommendations to improve participation in OST services were offered by both groups.

Discussion and Conclusion

This study explored views from both OST providers and non-providers, revealing a number of previously undocumented barriers that affect the uptake of OST provision in New South Wales community pharmacies. There were also profound ethical issues raised for consideration. These findings may help inform future policies aimed at encouraging pharmacists' provision of OST, to address the unmet needs of the ever-increasing number of heroin-dependent clients in the community. [Chaar BB, Wang H, Day CA, Hanrahan JR, Winstock AR, Fois R. Factors influencing pharmacy services in opioid substitution treatment. Drug Alcohol Rev2013;32:426–434]