Pharmacy accused of poor treatment of methadone patients


A Guild leader says improvements are needed to the way Australia offers opioid replacement therapy, following an article attacking pharmacists for perpetuating stigma

Writing in 10 Daily, freelance journalist Katie Horneshaw has slammed a number of unnamed pharmacists over an incident where a patient felt compelled to lick methadone from a benchtop, an incident where a methadone safe could not be opened for nearly an hour, and over assuming patients on ORT are inherently untrustworthy.

She writes about an unnamed pregnant patient, “Sophie”, who began to feel early symptoms of withdrawal while waiting in a pharmacy for her dose of methadone.

“She knows there’s no point kicking up a stink,” Ms Horneshaw writes. “Like they do every other morning, the staff will make sure that all the ‘regular’ customers are served before turning their attention to the methadone queue.”

After the pharmacist, “Gary”, “ambled” over, Sophie was served.

“But Sophie is fumbly from early withdrawal, and in one horrific moment, she nudges the flimsy cup and watches the syrupy liquid spill out across the benchtop. Eyes wide, she stares at Gary. ‘Shit. Oh my God. I’m so sorry, could I please…’”

However, the pharmacist told her that he was only permitted to give her one serve a day.

“In a sickening jolt, she knows what she has to do, and she leans over to suck the dirty liquid from the benchtop before disgust and shame can stop her. She dry heaves; forces the solution back down.

“She doesn’t look up once as she hurries from the pharmacy. She can’t stand to see the horror and pity on people’s faces.”

Writing that ORT/OST patients are “guilty until proven innocent” by pharmacists, Ms Horneshaw also highlighted an incident where methadone patients were forced to queue for an hour because the safe could not be opened; a man who found that his pharmacy had lost his methadone script and had to get an emergency appointment from his doctor but felt he was powerless to complain because he could be banned; and a patient who said they had been banned from shopping in their pharmacy because “they think you’re going to steal”.

This patient, Frankie, “says she’s expected to use the same old medicine bottles for months; she simply brings them back each time to be refilled,” Ms Horneshaw writes.

“They don’t even clean them,” the patient said “so they end up looking really disgusting.”

“But she reckons the worst thing is the ‘attitude’ of the staff.’Even the ones who are nice, they talk to you like you’re stupid, like you’re a child. They don’t trust us to make our own decisions about our healthcare’.”

Ms Horneshaw called for a review of the “inordinately tight” prescribing rules and “plainly discriminatory” policies faced by people attempting recovery from substance abuse.

Responding to the article, Pharmacy Guild Victorian branch president Anthony Tassone told the AJP that many pharmacists feel very strongly about helping their patients, rather than stigmatising them.

“It is unfortunate to hear of any experience about community pharmacy from a patient that is not positive – however pharmacies across Australia are playing an essential role each and every day in helping promote harm minimisation and helping patients who have a drug dependency concern get their lives back on track,” he said.

“Being Schedule 8 medicines, methadone and buprenorphine that are used in opioid replacement therapy have very strict regulatory controls at the state and territory level for their; storage, handling and recording to help protect the public and for patient safety.  

“As custodians of medicines, pharmacists take their role in quality use of medicines extremely seriously.

“Also, having patients being dosed in a separate area from a main service counter is about ensuring patient privacy for an ORT client and not at all trying to worsen stigma.

“The journalist did not seem to bother to want to interview a prescribing doctor or pharmacist who runs an opioid replacement therapy program and see from a health professional perspective how passionate practitioners are in making a positive difference to a patient’s life or circumstances which have gone down a path that puts them at risk,” he said.

“If they are genuinely interested in learning more about ORT, there are countless examples of great pharmacies that they could be introduced to.”

However, Mr Tassone agreed that the system could do with change, including around reducing stigma around substance dependency, and improving access for patients.

“There is a lot that must be done in the harm minimisation and opioid replacement therapy space to help make it less complex for pharmacies to participate and for better patient outcomes,” he said.

“The Guild believes there must be a standardised opioid dependence treatment program which would improve coordination between the Commonwealth Government and State and Territory governments, and improve the consistency of the ORT program and service delivery. 

“The Guild believes that these initiatives would also lead to a greater number of pharmacies being involved in the program, and a large number of people gaining a benefit.

“There should be an investigation into the appropriate scheduling, funding and management of the medicines used in ORT, which may include the PBS, a specific program for opioid dependence under Section 100 or an independently funded national program.

“A review of the pharmacist fee is necessary which is currently not reflective of the level of service required by patients on ORT. The Guild encourages a patient co-payment scheme subsidised by governments to minimise the cost of ORT to consumers, whilst ensuring the remuneration to the pharmacist is commensurate with the work involved.”

The Guild also believes that there should also be a uniform policy across jurisdictions regarding patient quota and takeaway doses based on clinical evidence, he said.

“There are encouraging upcoming initiatives in the ORT space with new product formulations coming soon such as a depot buprenorphine treatment that only requires dosing once per month. 

“This may not be suitable for all patients, but it will be another option for prescribers in helping patients manage drug dependency and live as normal life as possible.”

More than 50,000 patients nationally are enrolled in an opioid replacement therapy program, with more than 3,000 dosing points nationwide – about 90% of which are community pharmacies, Mr Tassone said.

“There is more work that we must all do in the community and society generally about reducing stigma around drug dependency,” he told the AJP.

“With community pharmacy playing such a central role in harm minimisation including around real time prescription monitoring, needle and syringe exchange and ORT – we are part of the overall solution.” 

Read the full 10daily article here.

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30 Comments

  1. Jarrod McMaugh
    04/10/2019

    With regards to stigma, the Victorian government assistesnin the creation of great resource on the power of words.

    Please read it https://adf.org.au/resources/power-words/

  2. Vicki Dyson
    04/10/2019

    Let us hope that the injectable buprenorphine proves to be a satisfactory strategy for managing opioid dependence. It will bring into line how other patients with a chronic illness are treated. The unfair costs and the degrading need for regular attendance with all the associated issues (for both the patient and pharmacist) will be eliminated. It may also result in larger numbers of patients being managed, as it will solve many of the hassles from the GP side. Bring it on!

    • S.C
      12/12/2019

      Agonist treatment” versus an “antagonist treatment” Keeping an eye on it , Shame Methadone cant be adminsterd similiar since you can get it in tablet form. I prefer Methadone Over Suboxone is all !we need a few treatments!

  3. Jim Tsaoucis
    04/10/2019

    there are bad eggs in every basket……in my past life I served the maximum of 50 patients with a waiting list of many, including a few that moved out of area which I had relocated and then had them coming back “begging” for me to be their methadone provider again. Strict but fair was my motto, and all my patients understood this as I made it my responsibility to do so and regularly (6 monthly) it was re-inforced to all and more frequently to those who tried to stretch the aggreement that they all signed off on. And for those pharmacists that complain about these patients being a problem, if you treat them like every other patient and in turn like every other patient then everybody is happy, regular patients, methadone patients, staff, pharmacists, doctors, and lastly but not so importantly, the business’s bottom line. Set it up properly at first it just works for all !!

  4. Andrew
    04/10/2019

    Freelance and spec writers doing what they need to do for recognition…and it’s working.

    Without any way to prove what was described actually happened I think there might be some artistic licence at play here.

    • Jarrod McMaugh
      04/10/2019

      I think.most pharmacists whom have been in ORT for a long period of time can say they have seen behaviour like this.

      And by “behaviour” I’m referring to the way pharmacists treat people who access ORT services

  5. Jeff Lerner
    04/10/2019

    Quote from above article:

    This patient, Frankie, “says she’s expected to use the same old medicine bottles for months; she simply brings them back each time to be refilled,” Ms Horneshaw writes.
    “They don’t even clean them,” the patient said “so they end up looking really disgusting.”

    I wonder whether Frankie ever considered washing the bottles herself before they reach that stage?

    • Peter Crothers
      05/10/2019

      Do people seriously re-use bottles? Is it even allowed? Would it be acceptable for any other medication? Of course not.

      • Anthony Crowley
        09/10/2019

        Reduce. Re-use. Recycle.

        • Jarrod McMaugh
          09/10/2019

          Sounds like a great policy. Let’s implement it for all medicines, in all settings.

          Or we could see how inappropriate this is and move beyond reusing bottles. I mean, the dairy industry phased this out decades ago, I’m sure we can catch up to them, right?

          • Anthony Crowley
            09/10/2019

            I expected a better thought out response from a Moderator.

            A plastic bottle is perfectly fine to re-use for this purpose when washed out and dried ready for the next allotment of drug.

          • Jarrod McMaugh
            09/10/2019

            It’s not though, that’s the point.

            Getting away from the demeaning nature of requiring a person to carry around empty bottles for return to the pharmacy, the significant majority of pharmacies who do reuse bottles are not washing out and drying these bottles before reusing them.

            Not only is this an issue for hygiene, it creates significant legal issues around re-labeling the bottles as well.

            If you refer to the document Policy for maintenance pharmacotherapy for opioid dependence available from https://www2.health.vic.gov.au/public-health/drugs-and-poisons/pharmacotherapy/pharmacotherapy-policy-in-victoria you will note the following:

            Take-away dose bottles should not be re-used unless a satisfactory standard of hygiene can be met. “Satisfactory” requires sterilisation in order to prevent microbial growth.

            This is the responsibility of the pharmacist, not the client.

            Overall, if the decision NOT to reuse bottles isn’t being made for the benefit of the client, then consider the professional ramifications of a person becoming ill due to inadequately sterilised bottles.

            These are Victorian guidelines, but applicable to all pharmacists practicing.

            In my experience training pharmacists in Victoria to deliver MATOD, in those rare instances where I encounter a person working in a pharmacy that reuses bottles, they are not sterilising them. In every instance, I advise them that this is professional misconduct, and if something goes wrong, at the very least they will have egg on their face when they present to regulatory boards for review.

            for contrast, consider compounded medicines. My pharmacy provides quite a lot of them. Never ever ever do we ask people to bring back their omeprazole liquid bottles; their melatonin liquid bottles; the jars for their capsules of whichever medication….. why is it any different for a person receiving a medication for substance use disorder?

          • Jeff Lerner
            11/10/2019

            Jarrod, I accept that you are totally correct about this. I now regret my previous post about Frankie (or others) washing and returning their bottles for refilling.

          • S.C
            12/12/2019

            Why did they change to this yellow stuff too?, bring back GSK formula !

          • S.C
            12/12/2019

            No its not under the lid is a mental thing?, it will leak.

      • Jim Tsaoucis
        12/10/2019

        and doses need to be in sealed containers hence new lids are needed anyway. If I received any bottle from clients they were rinsed out labels removed and squashed before going into recycling waste……..

      • S.C
        12/12/2019

        Not allowed, nor licking the damn bench , they allow for spillage!!! ive been re-dosed they mark it as spill. This guy Pharmacist was on a power trip !!!!!!

      • joanne nilsson
        08/06/2020

        Yes they do! I have to wash my own bottles that are marked recycling or pay 1$ each every time but they have never got any new bottles. I don’t mind as long as they don’t leak. I would just like to be treated with half the respect as a normal patient is given. I’m OK because I grew up with this treatment and overcome it but the others especially the lady with a child, are treated very badly and I hear what is said about them. Me, I just act like it does not affect me which gives me a little bit back as it must really get to them.

  6. pagophilus
    04/10/2019

    What does early withdrawal mean? Some ORT patients are hanging out for every dose, and then immediately feel better once they have it, even before the pharmacokinetics kick in. The author doesn’t realise that many of these patients live their lives by how they feel and have never learnt to do anything disciplined or out of principle. As for assuming they are going to steal, perhaps they have experience in these matters.

    • S.C
      12/12/2019

      Low doses it can happen!!! trust me , people Metabolize differently

    • joanne nilsson
      08/06/2020

      Your right some will steal but when you have done nothing wrong, respectful and wearing your best grin and using your best manners….it still makes no difference. The treatment is just uncalled for. Everyone liked me before the new pharmacist took over, now they have pack mentality?

  7. Paul Sapardanis
    04/10/2019

    Not one pharmacist/doctor was interviewed. End of story

  8. Peter Crothers
    05/10/2019

    My (long-ish) experience is that pharmacists are generally more respectful in their treatment of ORT clients than public dosing points and those who transfer from public to pharmacy tell us so all the time. The elephant in the room here is dosing payments – or as I prefer to call them client service fees. Payments are a huge impost on clients, a massive barrier to uptake of Pharmacy ORT and a source of conflict between clients and pharmacies. Realistically, the only way pharmacies can manage the payments challenge is to be insistent to the point of autocratic and that doesn’t sit well with our ORT role. Things like CentrePay deductions make it a bit easier, but don’t solve the problem. If ORT in pharmacies was publicly funded, we’d be able to devote 100% of our efforts to providing care and clients would be able to vote with their feet. If that happens I predict a tripling in Pharmacy ORT uptake.

    • Nicholas Logan
      20/10/2019

      Great post PC. $50 a week claimed through PBS online would free up so much time for professional interaction.

      • S.C
        12/12/2019

        Costly wish we paid $5 like diabetics!! its why many drop out? Substance abuse is a chronic disease also!!

  9. Peter McGregor
    05/10/2019

    I’ve seen the above situations happen in various pharmacies I’ve worked for and done locums in, re-using of bottles, banning clients from shopping, making them wait before ‘normal’ customers are served, enforcing the spilt dose policy (although, the prescriber was called and another dose authorised) etc. So this article isn’t far off the mark, and bringing it to light will hopefully force those pharmacists that treat their clients in this manner to rethink their humanity.

    I’ve even had assistants criticise me for treating clients like humans, “They’re only methadone patients.”

    I find it appalling that these clients have the added difficulty of having to step over these unnecessary hurdles to get their life back on track – the people who are supposed to be ‘helping’ them.

  10. Romany Metry
    09/10/2019

    Unfortunately, few Pharmacists are very judgmental and arrogant. Majorities of these Patients went through hard circumstances in their life. May be that Pharmacist will do worse if he/she was in the same situation. It is not excuse still, but will be great if they stop Judging and being humble.
    The Patients should be encouraged from their clinics to report any bad attitude from any Pharmacist or staff. In Our Pharmacy, these Patients put their name once they arrive to the Pharmacy, they take turn equally as any other Patients.
    Well done Journalist. Katie Horneshaw for a great article.

    • Anthony Crowley
      09/10/2019

      I AGREE with your statement: “Unfortunately, few Pharmacists are very judgmental and arrogant”.

      You’re right. The bad behavior is only of a “few” out of many. And this article is all about the “few” instead of the many.

      However, I DISAGREE that you praise the journalist for this very ONE-SIDED article.

      No pharmacists or GPs were mentioned or interviewed in this article about how they go out of their way to help their many patients.

  11. joanne nilsson
    28/03/2020

    I have been to several chemist’s in my time on methadone and I can tell you it hasn’t gotten better. I believe that people treat you as you treat them and I have been pleasant cooperative honest and respectful yet its the same bad attitude every time I have to pick up. It’s “HAVE YOU PAID” and “DO YOU HAVE A Script when they know I always keep up to date with such things. Never check the pc first and human error on their part never happens even when you are shoving a receipt under their nose it’s no apology for us. I have been refused doses because my on call shifts don’t comply with their policies and they quite enjoy seeing you go without and beg even if they have an empty chemist they still won’t budge when I say “please I was working and cannot call or call from my car”. I have had them loose my script and tell me that they will not call my Dr and admit that they lost it. I get we don’t like it when people make complaints about us,please understand. UNDERSTAND!!! They never understand me but I suppose that’s easy when you are not a me, but a sub human. I am doing my best to come off the stuff but it’s a slow process, you can’t work and not sleep and drive etc

  12. joanne nilsson
    08/06/2020

    Something has to be changed and quickly. I have been a patient for over 10 years, I have seen pharmacists at their worst in many chemist’s and there is not even any information out there to find out if you are in the wrong or the right. My current pharmacist is an impossible woman to talk to because she speaks at you and not to you. I have seen this lady bully the inturn pharmacists. If I pay on the same day every week I’m wrong, if I ring when I’m late I’m wrong, I get yelled at, she says “I do this for you and that for you when it’s just part of her job. I get told to do one thing by one of them then get told off by the other person for doing it and when I try to explain I get told to calm down. I smile, I say yes thank you and be cheerful but it’s never enough. My other scripts are always getting lost, whilst I’m telling them I need the script and can they please call me when they find it, I see them snicker at each other and my Dr will swear he has sent the script. I think I am dealing with a narcissist or something.

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