Improving Access to Opioid Substitution Treatment. The role of the community pharmacist in prescribing Opioid Substitution Treatment

Abstract

Background: Non-medical prescribing, as undertaken by pharmacists, is practised in a number of countries and plays an important role in improving access to medications for patients, particular those with chronic disease. Opioid dependence is recognised as a chronic cyclical illness and opioid substitution treatment (OST) is designed as a harm reduction measure, with access to treatment being vital. Currently in New Zealand there are waiting list for access to OST. New models of care are therefore needed to improve access to OST and provide clients with choice in their care. Aim: This study aims to explore the attitudes and beliefs of health professionals who are involved in the delivery of OST, including pharmacists, specialist alcohol and other drug staff and general practitioners, and clients of OST about the role community pharmacists could play in improving access via prescribing OST for stabilised clients. Methodology: A sequential mixed methods approach was utilised, with the qualitative key informant interviews and focus groups informing the design and construction of the four quantitative questionnaires. The qualitative data was analysed via a general inductive approach identifying key themes, while the data obtained from the questionnaires was analysed using appropriate descriptive statistics. Key findings: Pharmacists, GPs and clients were in favour of allowing suitably trained and accredited community pharmacists to prescribe OST for stable clients. Specialist AOD staff were significantly different in their support of this proposed model of care. The findings of this study indicate that pharmacists should be allowed to prescribe OST to stable clients under a clinical management plan with stipulations that include dose, number of takeaway days and review periods. Other study recommendations that evolved from the findings were based around the following parameters: training; funding; support; and a model of care. Conclusion: It is this researcher’s conclusion that accredited community pharmacists should be given the opportunity, to prescribe OST to stable clients. The pharmacists would be working under a delegated (or supplementary) model of care according to a clinical management plan alongside specialist AOD staff members, with direct client involvement. This will increase access for clients on OST.