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Prof Feng Chang examines methadone maintenance treatment in rural southwestern Ontario

Tuesday, November 28, 2017

As opioid overdoses continue to rise in Ontario, so too does the number of Ontarians seeking services to manage opioid withdrawal. Methadone maintenance treatment (MMT) is one such service: this treatment involves long-term prescribing of methadone, an opioid that replaces the drug the patient was originally dependent on. This safely controlled dose of methadone is then tapered. The goal is that the patient will eventually no longer require the treatment.

Feng ChangCommunity pharmacies are one location where people with opioid addictions can access MMT services. However, such treatment can be hard to locate in rural parts of Ontario. Waterloo Pharmacy Professor Feng Chang (left) and coauthors, in collaboration with the Gateway Centre of Excellence in Rural Health, sought to understand why:  in a recent article published in the Journal of Rural Health, they explored perceived barriers to adopting MMT services in community pharmacies.

Chang and the team interviewed community pharmacists in Huron and Perth counties. These are two rural southwestern Ontario counties that have seen increasing rates of opioid misuse and yet continue to have an unmet need for addiction-treatment services.

"What we found is that many of the challenges cited in our research are the same as those faced by any community pharmacist adopting a new service,” says Chang. “However, in rural environments where communities are smaller and access is scarcer, problems like workload, privacy, security, and a lack of collaborating prescribers are magnified."

One of the most obvious barriers participants cited was the staffing support: MMT was perceived as a significant time commitment, particularly due to its administrative and regulatory requirements. Hiring relief staff or permanent staff is a common response to these concerns, but in rural environments finding such staff can be challenging.  Hours also impact a pharmacy’s ability to offer MMT: some chains dictate hours of operation at a corporate level and some rural pharmacies are closed Sunday. Since methadone needs to be dispensed daily, Sunday dispensing would infringe on the pharmacist’s time off.

The pharmacists also expressed concern around security: both about potential for aggression or theft from MMT patients, but also about general theft because of stocking methadone.

“In rural environments when pharmacists can often work in isolation, some of the pharmacists interviewed worried about the safety of themselves, their staff and/or customers,” explains Chang.

Despite these and other barriers cited by the participants, the participants also identified factors that might motivate them to explore MMT. The foremost was the professional satisfaction gained from being able to see the positive impact in the patient and the community.

But several participants proposed a different solution than offering MMT at their pharmacies: multicenter MMT provision. In small communities where privacy is hard to maintain, alternative access points in nearby communities could help patients maintain confidentiality. If several pharmacies offered MMT in nearby communities, patients could avoid perceived stigma in seeking out services in their hometown, and pharmacists would experience a distributed demand for the service.

“A multi-pharmacy, multi-center approach may address many of the perceived barriers,” says Chang. “Ultimately, we want to improve patient access to MMT services in rural communities. If we can find a solution that will be supported by local practitioners, we should try it out.”

For more on this topic, see the original study.

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