Community pharmacists' role in preventing opioid substitution therapy-related deaths: an investigation into current practice in England

Abstract

Abstract
Opioid substitution therapy involves prescribing opioid substitutes, most commonly methadone and buprenorphine, to those who are addicted to opioids. The community pharmacist undertakes the majority of the dispensing of the substitute and often sees the patient daily. They also provide other related services like supervised consumption of the prescribed substitute, needle and syringe, and take-home naloxone service. The introduction of supervised consumption of methadone in the UK community pharmacies in the mid-1990s saw a four-fold reduction in methadone-related deaths. All these services are intended to reduce the risk of harm and prevent overdose deaths. It is hypothesised that the policy to prevent opioid overdose deaths is not fully implemented by community pharmacists in England, and more could be done to avoid these deaths.

This study aimed to investigate the English community pharmacists' role in preventing opioid substitution therapy-related deaths and exploring what more can be done to prevent such deaths.

A mixed-method sequential exploratory design was used to answer the research question. Qualitative interviews with 24 community pharmacists gave a nuanced picture of pharmacists' understanding of the risks associated with substitution therapy and their perceived role in preventing overdose deaths. A subsequent qualitative observation at nine community pharmacies further explored the delivery of these services in pharmacy. A cross-sectional telephone survey of English community pharmacies was then utilised to quantify pharmacists' reported practice and describe whether more can be done to prevent opioid overdose deaths.

The findings of the three studies undertaken in fulfilment of this thesis demonstrate that community pharmacists' current practice is not optimal to the national guidance and the practice policy intended for preventing overdose deaths. The findings supports the hypothesis that more could be done by community pharmacists to prevent opioid overdose deaths. Local commissioning of OST services has led to variations in the delivery of service. Pharmacists' knowledge and skills gap mean some patients at high risk of harm may not have their risks acted upon. Inaction by pharmacists, for example, not checking patient medication record for possible interactions, not talking to patient about possible side effects and outcomes of OST, dispensing OST doses to intoxicated patients can all increase the risk to the patient. The privacy and dignity of OST patient are not always given the due consideration. Delivery of the service outside of the consulting room and the rushed nature of the interaction between CPs and OST patients did not provide a conducive environment for patients to engage in their treatment. The practice of community pharmacists in England is centred on the mechanics of delivery of the service, and the notion of preventing opioid overdose death appears to be peripheral. Clarity in the guidance for pharmacists and a national commissioning framework specifying the training requirements and standardised service protocol could improve community pharmacists' role in preventing opioid substitution therapy-related deaths.

Date of Award	17 Nov 2021
Original language	English
Awarding Institution	University of Bath
Supervisor	Jennifer Scott (Supervisor), Denise Taylor (Supervisor), Philip Rogers (Supervisor) & Gordon Taylor (Supervisor)