Skip to main content

Advertisement

Log in

Community pharmacy-based opiate substitution treatment and related health services: a study of 508 patients and 111 pharmacies

  • Original Article
  • Published:
Journal of Public Health Aims and scope Submit manuscript

Abstract

Background and aims

Community pharmacies have a central role in the provision of opiate substitution therapy (OST) for drug misusers, offering accessible, additional health services within recovery-oriented systems of care. However, little is known about the patients receiving OST, availability and uptake of related services and associated pharmacy characteristics. We aimed to describe OST in terms of patients, pharmacies and services within the UK’s largest health authority, NHS Greater Glasgow and Clyde, Scotland.

Methods

Patients completed semi-structured questionnaires and pharmacists provided summary statistics relating to OST provision.

Results

Responses from 508 patients receiving OST from 111 participating pharmacies revealed an established patient population, with 89 % (449/507) aged 30 years or above and 80 % (387/484) attending the same pharmacy for 1 year or more. Methadone was the main form of OST (96 % (487/508), with 97 % (491/504) receiving supervision. Within pharmacies, OST consumption was supervised in one of four main areas: consultation room, dispensing hatch, quiet/private area or over the counter. Location of supervision was considered suitably private by 96 % of patients. Positive staff attitudes, privacy and the provision of additional health services were key factors influencing choice of pharmacy. Additional health services were offered to 75 % of patients and included information provision (43 %), signposting to other health care providers (72 %) and a Scottish service offering free advice and medicines for minor ailments (74 %).

Conclusion

Patients and pharmacists have developed working relationships, enabling access to multiple services associated with health gain and harm reduction. Further development of enhanced services in community pharmacies is merited.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  • Anstice S, Strike CJ, Brands B (2009) Supervised methadone consumption: client issues and stigma. Subst Use Misuse 44:794–808

    Article  PubMed  Google Scholar 

  • Bloor R (2007) Supervised methadone in Staffordshire & Shropshire. A study of factors associated with key outcome variables. Research briefing 25. NHS National Treatment Agency for Substance Misuse, London. Available at: http://www.nta.nhs.uk/uploads/nta_rb25_supervised_methadone.pdf

  • Britton RM, Scott J (2006) Community pharmacy services to drug misusers in the south west of England: results of the 2003–2004 postal survey. Int J Pharm Pract 14:35–41

    Article  Google Scholar 

  • Chief Scientist Office (CSO) (2014) Community pharmacy services for drug misusers: measuring national service delivery and the development of professional attitudes over two decades. Reference CZH/4/998. Chief Scientist Office, Edinburgh. Available at: http://www.cso.scot.nhs.uk/wp-content/uploads/czh4998.pdf

  • Deering DEA, Sheridan J, Sellman JD, Adamson SJ, Pooley S, Robertson R, Henderson C (2011) Consumer and treatment provider perspectives on reducing barriers to opioid substitution treatment and improving treatment attractiveness. Addict Behav 36:636–642

    Article  PubMed  Google Scholar 

  • Department of Health (England) (DOH) and the Devolved Administrations (2007) Drug misuse and dependence: UK guidelines on clinical management. Department of Health (England), the Scottish Government, Welsh Assembly and Northern Ireland Executive, London. Available at: http://www.nta.nhs.uk/guidance.aspx

  • Green TC, Dauria EF, Bratberg J, Davis CS, Walley AJ (2015) Orienting patients to greater opioid safety: models of community pharmacy-based naloxone. Harm Red J. doi:10.1186/s12954-015-0058-x

    Google Scholar 

  • Holland R, Matheson C, Anthony G, Roberts K, Priyadarshi S, Macrae A, Whitelaw E, Appavoo S, Bond C (2012) A pilot randomised controlled trial of brief versus twice weekly versus standard supervised consumption in patients on opiate maintenance treatment. Drug Alcohol Rev 31:483–491

    Article  PubMed  Google Scholar 

  • Information Services Division (ISD) (2010) Scottish Government Urban Rural Classification 2009–2010. ISD, Edinburgh. Available at: http://www.gov.scot/Publications/2010/08/2010UR

  • Information Services Division (ISD) (2014) Estimating the prevalence of national and local problem drug use in Scotland 2012/13. ISD, Edinburgh. Available at: http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/2011-11-29/2011-11-29-DrugPrevalence-Report.pdf?

  • Information Services Division (ISD) (2015) The National drug-related deaths database (Scotland) Report: Analysis of Deaths occurring in 2013. ISD, Edinburgh. Available at: http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/2015-04-28/2015-04-28-NDRDD-Report.pdf

  • Kimber J, Copeland L, Hickman M, Macleod J, McKenzie J, De Angelis D, Robertson R (2010) Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment. BMJ 340:c3172. doi:10.1136/bmj.c3172

    Article  Google Scholar 

  • Lawrie T, Matheson C, Bond CM, Roberts K (2003) Pharmacy customers’ views and experiences of using pharmacies which provide needle exchange services in Aberdeen and Glasgow, Scotland. Int J Drug Policy 14:445–447

    Article  Google Scholar 

  • Lawrie T, Matheson C, Bond CM, Roberts K (2004) Pharmacy customers’ views and experiences of using pharmacies which provide drug misuse services. Drug Alcohol Rev 23:195–202

    Article  PubMed  Google Scholar 

  • Luger L, Bathia N, Alcorn R, Power R (2000) Involvement of community pharmacists in the care of drug misusers: pharmacy based supervision of methadone consumption. Int J Drug Policy 11:227–234

    Article  PubMed  Google Scholar 

  • Maas J, Barton G, Maskrey V, Pinto H, Holland R (2013) Economic evaluation: a comparison of methadone versus buprenorphone for opiate substitution treatment. Drug Alcohol Depend 133:494–501

    Article  PubMed  Google Scholar 

  • Mackridge AJ, Beynon CM, McVeigh J, Whitfield M, Chandler M (2010) Meeting the health needs of problematic drug users through community pharmacy: a qualitative study. J Subst Use 15:367–376

    Article  Google Scholar 

  • Madden A, Lea T, Bath N, Winstock AR (2008) Satisfaction guaranteed? What clients on methadone and buprenorphine think about their treatment. Drug Alcohol Rev 27:671–678

    Article  PubMed  Google Scholar 

  • Matheson C, Bond CM, Mollison J (1999) Attitudinal factors associated with community pharmacists’ involvement in services for drug misusers. Addiction 94:1349–1359

    Article  CAS  PubMed  Google Scholar 

  • Matheson C, Bond CM, Tinelli M (2007) Community pharmacy harm reduction services for drug misusers: national service delivery and professional attitude development over a decade in Scotland. J Public Health 29:350–357

    Article  Google Scholar 

  • Mattick RP, Breen C, Kimber J, Davoli M (2009) Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev (3): CD002209. doi:10.1002/14651858.CD002209.pub2

    PubMed  Google Scholar 

  • National Institute for Health and Care Excellence (NICE) (2007) Methadone and buprenorphine for the management of opioid dependence. NICE, London, Available at: http://www.nice.org.uk/guidance/ta114/resources/guidance-methadone-and-buprenorphine-for-the-management-of-opioid-dependence-pdf

  • Neale J (1998) Drug users’ views of prescribed methadone. Drugs Educ Prev Policy 5:33–45

    Article  Google Scholar 

  • NHS Health Scotland (2009) Educational interventions to prevent hepatitis C: a review of the literature and expert opinion. NHS Health Scotland, Edinburgh, Available at: http://www.healthscotland.com/documents/3580.aspx

  • Notley C, Holland R, Kouimtsidis C, Maskrey V, Robinson A, Swift L, Harvey I, Schifano F, Lowe A, Rosenbloom K (2014) Pharmacist and patient views of supervised consumption—findings from a randomised controlled trial and qualitative study of supervised consumption in patients managed with opiate maintenance treatment. Int J Pharm Pract 22(S1):19

    Google Scholar 

  • Palmateer NE, Taylor A, Goldberg DJ, Munro A, Aitken C, Shepherd SJ, McAllister G, Gunson R, Hutchinson SJ (2014) Rapid decline in HCV incidence among people who inject drugs associated with national scale-up in coverage of a combination of harm reduction interventions. PLoS One 9(8):e104515

    Article  PubMed  PubMed Central  Google Scholar 

  • Roberts K, Hunter C (2004) A comprehensive system of pharmaceutical care for drug misusers. Harm Red J 1:1–6

    Article  Google Scholar 

  • Roberts K, McNulty H, Gruer L, Scott R, Bryson S (1997) The role of Glasgow pharmacists in the management of drug misuse. Int J Drug Policy 9:187–194

    Article  Google Scholar 

  • Roe B (2010) Developing nursing practice, treatment and support services for ageing drug users. Nurs Times 106:20–21

    PubMed  Google Scholar 

  • Roe B, Beynon C, Pickering L, Duffy P (2010) Experiences of drug use and ageing: health, quality of life, relationship and service implications. J Adv Nurs 66:1968–1979

    Article  PubMed  PubMed Central  Google Scholar 

  • Royal College of General Practitioners (RCGP) (2011) Guidance for the use of substitute prescribing in the treatment of opioid dependence in primary care. RCGP, London, Available at: http://www.rcgp.org.uk/clinical-and-research/clinical-resources/substance-misuse-resources-for-gps.aspx

  • Scotland A (2012) Health inequalities in Scotland. Audit Scotland, Edinburgh, Available at: http://www.audit-scotland.gov.uk/docs/health/2012/nr_121213_health_inequalities.pdf

  • Scottish Drug Strategy Delivery Commission (SDSDC) (2013) Independent expert review of opioid replacement therapies in Scotland. SDSDC, Edinburgh, Available at: http://www.gov.scot/Resource/0043/00431023.pdf

  • Scottish Drugs Forum (SDF) (2007) on behalf of the Scottish Association of Alcohol and Drug Action Teams. Drugs and poverty: a literature review. SDF, Glasgow. Available at: http://www.sdf.org.uk/index.php/resources/publications/

  • Scottish Drugs Forum (SDF) (2009) Older drug users in Scotland: professionals’ views. SDF, Glasgow, Available at: http://www.sdf.org.uk/resources/reports-and-research/#7

  • Scottish Government (2008) The road to recovery: a new approach to tackling Scotland’s drug problem. The Scottish Government, Edinburgh, Available at: http://www.scotland.gov.uk/Publications/2008/05/22161610/12

  • Scottish Government (2009) Establishing effective therapeutic partnerships—a generic framework to underpin the chronic medication service element of the community pharmacy contract. The Scottish Government Edinburgh, Edinburgh, Available at: http://www.gov.scot/Publications/2010/01/07144120/16

  • Scottish Government (2011) The sexual health and blood borne virus framework 2011–15. The Scottish Government, Edinburgh, Available at: http://www.gov.scot/Resource/Doc/356286/0120395.pdf

  • Scottish Government (2014) Service evaluation of Scotland’s national take-home naloxone programme. The Scottish Government, Edinburgh, Available at: http://www.gov.scot/Resource/0045/00451251.pdf

  • Scottish Government Social Research (2009) Assessing the scale and impact of illicit drug markets in Scotland. The Scottish Government, Edinburgh, Available at: www.gov.scot/Publications/2009/10/06103906/0

  • Seymour A, Black M, Jay J, Cooper G, Weir C, Oliver J (2003) The role of methadone in drug-related deaths in the West of Scotland. Addiction 98:995–1002

    Article  PubMed  Google Scholar 

  • Sheridan J, Manning V, Ridge G, Mayet S, Strang J (2007) Community pharmacies and the provision of opioid substitution services for drug misusers: changes in activity and attitudes of community pharmacists across England 1995–2005. Addiction 102:1824–1830

    Article  PubMed  Google Scholar 

  • Strang J, Hall W, Hickman M, Bird S (2010) Impact of supervision of methadone consumption on deaths related to methadone overdose (1993–2008): analyses using OD4 index in England and Scotland. BMJ 341:c4851. doi:10.1136/bmj.c4851

    Article  PubMed  PubMed Central  Google Scholar 

  • Winstock A, Lea T, Sheridan JL (2008) Patients’ help-seeking behaviours for health problems associated with methadone and buprenorphine treatment. Drug Alcohol Rev 27:393–397

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Alex Adam, Janine Glen, Susie Heywood, Graeme Morrison and David Thomson for their assistance with data collation, literature review and manuscript development.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Colette Montgomery Sardar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval and informed consent were not required for this study as it was an evaluation of a current service provided by NHS Greater Glasgow & Clyde (NHS GG&C). Research and Development (R&D) Management Approval was obtained prior to the initiation of the study. The study was undertaken in accordance with the ethical standards of NHS GG&C R&D and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Appendix 1 OST patient questionnaire

Appendix 1 OST patient questionnaire

This questionnaire relates to the community pharmacy services offered to patients receiving either Methadone, Suboxone, Subutex or Disulfiram from a community pharmacy. Your views on this service are important and will support us to improve and develop the service. Thank you very much for completing this questionnaire, it should only take five to ten minutes to complete.

The information is confidential and completely anonymous. All data will be used in accordance with the Data Protection Act 1998.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Laird, A., Hunter, C., Sardar, C.M. et al. Community pharmacy-based opiate substitution treatment and related health services: a study of 508 patients and 111 pharmacies. J Public Health 24, 193–207 (2016). https://doi.org/10.1007/s10389-016-0714-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10389-016-0714-y

Keywords

Navigation