Community pharmacists' role in preventing opioid substitution therapy-related deaths: a qualitative investigation into current UK practice

Patient's and healthcare provider's experiences with Opioid Maintenance Treatment (OMT): a qualitative evidence synthesis

BACKGROUND

Opioid Maintenance Treatment (OMT) is the gold standard for people with opioid dependence. However, drop-out rates are high, and many patients do not reach desired outcomes. Understanding patients' and healthcare providers' experiences with the treatment can provide valuable information to improve the quality of OMT and to increase acceptability and accessibility of services. The aim of this systematic review is to explore and synthesise the experiences of OMT among persons with opioid dependence and health care providers, to inform policy makers and practitioners on how to improve OMT outcomes.

METHODS

We conducted a qualitative evidence synthesis. We systematically searched in electronic databases (CINAHL, Embase, MEDLINE, and nordic databases) and searched for grey literature. As we identified many studies that met our inclusion criteria, we purposively sampled a manageable number of studies to include in this review. Two researchers independently extracted and coded data from the included studies and used the Andersen's healthcare utilization model to organize and develop codes. We assessed the methodological limitations of the studies, and our confidence in the findings using GRADE CERQual.

RESULTS

We retrieved 56 relevant studies and purposively sampled 24 qualitative studies of patients' and healthcare providers' experiences with OMT. Our analyses resulted in six main themes: (1) External stigma prevents engagement and retention in treatment, (2) Being identified as in OMT contributed to an increased experience of stigma (3) Inadequate knowledge and expertise among healthcare providers affected patients' treatment experiences, (4) Quality of communication between personnel and patients impacts patients' engagement with treatment and treatment outcomes, (5) Patients wanted help with many aspects of their lives not just medication, and (6) Balancing positive expectations of OMT with treatment stigma. We found that stigma was an overarching theme across these themes.

CONCLUSION

Our findings suggest that OMT could be more beneficial for patients if treatment programs prioritize efforts to diminish societal and OMT provider stigma and find strategies to better address patient needs. Initiatives should focus on improving treatment knowledge among providers, encouraging the use of client perspectives, considering the context of family members, and establishing a more holistic and flexible treatment environment.

Factors that influence pharmacists' efforts in addressing substance use in Nigeria: An exploratory study

Introduction

Substance use is a major global public health problem. Over the years, the burden of substance use has increased worldwide, with Nigeria having a prevalence that is substantially above the global average. Tackling this challenge requires a collaborative effort between different health professionals. Despite the critical roles pharmacists could play in substance use prevention and management, exploration of pharmacists' role in mitigating substance use in society has received limited attention in most sub-Saharan countries. In this study, we explored the experiences of pharmacists in substance use prevention and management.

Methods

We conducted semi-structured interviews to explore pharmacists' perceptions of their roles in the prevention and management of substance use in Nigeria. Following data transcription, we conducted a thematic content analysis.

Results

The four major themes that emerged included 1) the extent of pharmacists' involvement in the decision-making process for addressing substance use, 2) factors that influence pharmacists efforts in addressing substance use in Nigeria, 3) how to improve rational prescribing practices and, 4) capacity building to enhance pharmacists participation in addressing substance use.

Conclusion

Pharmacists have the opportunity to play critical roles in the prevention and management of substance use, but several individual and systemic challenges limit their full potential. Addressing these challenges is crucial in increasing pharmacists' participation in preventing and managing substance use.

'We're just seen as people that give out the methadone…': exploring the role of community pharmacists in the opioid substitution treatment team

INTRODUCTION People receiving opioid substitution treatment are a vulnerable population who experience significant health inequities and stigma, but have regular interactions with community pharmacists. Many pharmacists now work collaboratively with other health providers to ensure effective and safe use of medicines, as well as being involved in the prevention and management of chronic health conditions. AIM To explore the role of New Zealand community pharmacists in the provision of opioid substitution treatment and how they perceive their role as part of the wider opioid substitution treatment team. METHODS Semi-structured video interviews with a purposive sample of 13 diverse pharmacists explored their current practices in providing opioid substitution treatment, and their perceived role in the treatment team. Interviews were audio-recorded and transcribed verbatim. Data were coded and analysed using an inductive thematic approach. RESULTS This study found that pharmacists are providing accessible support to a population with known barriers to accessing health care. However, participants also identified challenges with communication and a perceived lack of understanding of the pharmacist role as barriers to collaboration with the wider opioid substitution treatment team. DISCUSSION Collaboration within health-care teams has been shown to improve health outcomes, and pharmacists are well placed to provide health-care services as well as offer valuable insight into clients' mental and physical wellbeing. Improved communication channels that facilitate information sharing, as well as the opioid substitution treatment team's recognition of a pharmacist's role, may facilitate collaboration and, in turn, improve the quality of health care provided to this vulnerable population.

Medication treatment for opioid use disorder and community pharmacy: Expanding care during a national epidemic and global pandemic

Medications for opioid use disorder (MOUD), such as methadone and buprenorphine, are effective strategies for treatment of opioid use disorder (OUD) and reducing overdose risk. MOUD treatment rates continue to be low across the US, and currently, some evidence suggests access to evidence-based treatment is becoming increasingly difficult for those with OUD as a result of the 2019 novel corona virus (COVID-19). A major underutilized source to address these serious challenges in the US is community pharmacy given the specialized training of pharmacists, high levels of consumer trust, and general availability for accessing these service settings. Canadian, Australian, and European pharmacists have made important contributions to the treatment and care of those with OUD over the past decades. Unfortunately, US pharmacists are not permitted to prescribe MOUD and are only currently allowed to dispense methadone for the treatment of pain, not OUD. US policymakers, regulators, and practitioners must work to facilitate this advancement of community pharmacy-based through research, education, practice, and industry. Advancing community pharmacy-based MOUD for leading clinical management of OUD and dispensation of treatment medications will afford the US a critical innovation for addressing the opioid epidemic, fallout from COVID-19, and getting individuals the care they need.