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.