Problems experienced by community pharmacists delivering opioid substitution treatment in New South Wales and Victoria, Australia

Authors

  • Adam R. Winstock,

    Corresponding author
    1. Drug Health Services, Sydney South West Area Health Service, Sydney, NSW, Australia,
    2. National Drug and Alcohol Research Centre, University of New South Wales, Australia,
    3. National Addiction Centre, London, UK and
      Adam R. Winstock, National Addiction Centre, Institute of Psychiatry, 4 Windsor Walk, London SE5 8AF UK. E-mail: adam.winstock@kcl.ac.uk
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  • Toby Lea,

    1. Drug Health Services, Sydney South West Area Health Service, Sydney, NSW, Australia,
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  • Janie Sheridan

    1. School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Adam R. Winstock, National Addiction Centre, Institute of Psychiatry, 4 Windsor Walk, London SE5 8AF UK. E-mail: adam.winstock@kcl.ac.uk

ABSTRACT

Aims  To explore service provision and the range of problems that New South Wales (NSW) and Victoria (VIC) community pharmacists providing opioid substitution treatment (OST) have experienced with clients and prescribers.

Design  Cross-sectional postal survey.

Setting  All community pharmacies providing OST in NSW (n = 593) and VIC (n = 393), Australia.

Participants  Completed questionnaires were received from 669 pharmacists (68% response rate).

Measurements  The questionnaire addressed pharmacy characteristics, recent problems experienced with clients including refusal to dose, provision of credit for dispensing fees, termination of treatment, responses of pharmacists to problems experienced with clients, as well as problems experienced with OST prescribers.

Findings  In the preceding month, 41% of pharmacists had refused to dose a client for any reason, due most commonly to expired prescriptions (29%), or ≥3 missed doses (23%). Terminating a client's treatment in the past month was reported among 14% of respondents, due most commonly to inappropriate behaviour and missed doses. Treatment termination was reported by a significantly higher proportion of pharmacists in VIC (P < 0.001). Treatment termination in last month was predicted having more clients (P < 0.001), the provision of buprenorphine treatment (P = 0.008), having a separate dosing area (P = 0.021), and being a female pharmacist (P = 0.013). Past month refusal to dose was predicted by the pharmacy being in VIC (P < 0.001) and having more clients (P < 0.001). Problems experienced most commonly in the past month with prescribers were difficulty contacting prescriber (21%) and provision of takeaway doses to clients considered unstable by the pharmacist (19%) (higher in VIC: both P < 0.001).

Conclusions  This study highlights the range of problems experienced by community pharmacists in the delivery of OST and the consequences for people in treatment. Particular attention should be focused upon considering number of clients per pharmacy and improving professional communication between pharmacists and prescribers.

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