The impact of community pharmacy dispensing fees on the introduction of buprenorphine-naloxone in Australia

Determinants of interest in extended-released buprenorphine: A survey among 366 French patients treated with buprenorphine or methadone

AIM

To explore the factors determining the interest in extended-release buprenorphine (XR-BUP) injections among patients receiving opioid agonist treatment (OAT) in France.

METHODS

366 patients receiving OAT for opioid use disorder, recruited in 66 French centers, were interviewed from 12/2018 to 05/2019. A structured questionnaire assessed their interest in XR-BUP using a [1-10] Likert scale. 'More' vs. 'less' interested groups were defined using the median score of interest, and their characteristics were explored using adjusted odds ratios (aORs) and 95 % confidence interval (95 %CI). Independent variables were as follows: sociodemographic characteristics, OAT-related features (e.g., type of OAT and prescriber, dosing, or duration of treatment), OAT representations, and personal objectives of treatment.

RESULTS

The median interest in XR-BUP was 7 (interquartile range: 3-9) out of 10. The participants who were 'more interested' (i.e. those scoring ≥7) showed no substantial difference in sociodemographic characteristics, relative to the 'less interested' participants. However, they more frequently reported forgetting to take their OAT (OR = 1.81; CI95 % = 1.06-3.10) or reported experiencing situations where taking their OAT was impractical (aOR = 1.69; CI95 % = 1.05-2.73). Their treatment objective was more focused on stopping illicit drugs (aOR = 1.67; 95 %CI = 1.02-2.70), reducing health risks (aOR = 3.57; 95 %CI = 1.67-7.69) and craving (aOR = 2.38; 95 %CI = 1.39-4.02) or improving family (aOR = 1.81; 95 %CI = 1.03-3.13) or professional (aOR = 2.22; 95 %CI = 1.43-3.85) recovery.

CONCLUSIONS

In France, where the access to OAT is relatively unrestricted, the majority of participants were interested in XR-BUP formulations. Being interested was associated with treatment objectives focused on abstinence and recovery, and with experiencing constraints in taking a daily oral OAT.

Buprenorphine prescription, misuse and service provision: a global perspective

Buprenorphine, a partial μ-opioid agonist and κ-opioid antagonist, is recommended as safe and effective maintenance treatment for opioid dependence. It offers the possibility of management in primary care settings. However, its prescription has led to diversion for illicit recreational use and resulted in medical complications and, rarely, fatal overdose in combination with other sedatives. The outcome of buprenorphine maintenance programmes varies from country to country and it is determined by the local therapeutic traditions, regulatory restrictions and existing service provision for opioid misusers. This article addresses the pharmacology of buprenorphine, the benefits and drawbacks of its prescription, service provision for opioid misuse around the world, policy recommendations, and prescribing training requirements.

Provision of opioid substitution therapy services in Australian pharmacies

Opioid dependence, despite being the subject of significant public funding, remains a costly burden to Australian society in human and economic terms. The most cost-effective public health strategy for managing opioid dependence is opioid substitution therapy (OST), primarily through the use of methadone or buprenorphine. Supervised dispensing of OST from specialist clinics and community pharmacies plays a crucial role in enhancing compliance, monitoring treatment and reducing diversion. Australia, compared with other countries in the world, ranks very high in illicit opioid use; hence there is a great demand for OST.The utilisation of community pharmacies for stable patients has many advantages. For public clinics, patient transfer to community pharmacies relieves workload and costs, and increases capacity for new OST patients. From a patient's perspective, dosing at a pharmacy is more flexible and generally more preferable. Pharmacists stand to gain clientele, profit and receive small incentives from state governments in Australia, for their services. Yet, many "unmet needs" exist and there is a high demand for more involvement in OST service provision in community pharmacy in Australia.In the UK there has been a steady increase in community pharmacy provision of OST, and pharmacists appear ready to provide further healthcare services to these patients.The role of pharmacy in some countries in Europe, such as Germany, is less prominent due to their approach to harm minimisation and the complex, variable nature of OST provision across the European Union (EU). The provision of OST by pharmacists in the USA on the other hand is of lesser frequency as the healthcare system in the USA encourages detoxification clinics to handle cases of illicit drug addiction.At a time when harm minimisation strategies constitute a topic of considerable political and public interest, it is important to understand the scope and variability of pharmacy involvement in drug policy in Australia. Hence, this review highlights the role of pharmacists in OST and explores the scope for expanding this role in the future.