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

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 30years or above and 80% (387/484) attending the same pharmacy for 1year 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