Buprenorphine supply by community pharmacists in Victoria, Australia: perceptions, experiences and key issues identified SUZANNE NIELSEN 1,2 , PAUL DIETZE 1,3 , ADRIAN DUNLOP 1 , PETER MUHLEISEN 1 , NICOLE LEE 1 , & DAVID TAYLOR 2 1 Turning Point Alcohol and Drug Centre, Fitzroy, Victoria, Australia, 2 Monash University, Victorian College of Pharmacy, Victoria, Australia, and 3 Monash Institute of Health Services Research, Victoria, Australia Abstract Buprenorphine is dispensed primarily in community pharmacies in Victoria, with buprenorphine prescribing expanding nationally. The aim of this paper was to examine issues that affect the delivery of buprenorphine in the community setting. A cross-sectional survey was conducted of 282 pharmacies participating in the methadone and buprenorphine programme across Victoria. Dispensing pharmacists completed the survey, designed to canvass issues around buprenorphine diversion and other issues related to the programme. Themes from the results indicated that there was concern from the majority of pharmacies with the issue of the supervision of buprenorphine and diversion of dispensed doses. The rate of suspected diversion was 1.5 times per 100 doses per month or 33 times per 100 clients per month. Seventy-four per cent of pharmacists indicated that this was a negative aspect of buprenorphine treatment. Frequency of suspected and confirmed diversion was associated with the number of pharmacy clients. Pharmacists’ perceptions of issues related to buprenorphine appeared to affect opinions of buprenorphine clients and the buprenorphine programme more generally. Pharmacists believe that a significant level of diversion is occurring. This finding warrants serious attention, particularly in light of the increasing use of buprenorphine nationally and internationally. [Nielsen S, Dietze P, Dunlop A, Muhleisen P, Lee N, Taylor D. Buprenorphine supply by community pharmacists in Victoria, Australia: perceptions, experiences and key issues identified. Drug Alcohol Rev 2007;26:143 – 151] Key words: buprenorphine diversion, community pharmacy, supervised dosing. Introduction Substitution pharmacotherapy for the treatment of opioid dependence has been delivered primarily through a community-based model in Victoria, Australia, since the expansion of the methadone programme in the 1980s [1]. In this system people in opioid substitution treatment see a community pre- scriber and pharmacist, with specialist services set up to support these service providers. Unlike some service systems, where clients are first assessed and stabilised in a central clinic, in Victoria trained prescribers initiate treatment in the community. This model has some advantages over specialist clinics, including increased treatment access (both of locality and opening times) and improved accessibility to clinics for more challenging clients. In Victoria 95% of opioid substitution pharmaco- therapy is provided in community pharmacies, and pharmacists play a key role in programme delivery. While there are some benefits to this community-based system there are also some limitations, including inconsistency in the level of service provided and discrepancies between pharmacies in training and interest of staff in the provision of opioid substitution pharmacotherapy. The demands on community phar- macists can also be many and varied; in a busy retail environment a pharmacist must oversee multiple tasks, creating an often challenging environment to provide a service to a client group with numerous needs. Research into the use of buprenorphine in Victoria concentrated on the feasibility of its provision within the existing service system [2]. Subsequent to the Received 15 December 2005; accepted for publication 21 August 2006. Suzanne Nielsen BPharm BPharmSc(Hons), Turning Point Alcohol and Drug Centre, Fitzroy, Victoria, Australia and Monash University, Victorian College of Pharmacy, Victoria, Australia, Paul Dietze PhD, Turning Point Alcohol and Drug Centre, Fitzroy, Victoria, Australia and Monash Institute of Health Services Research, Victoria, Australia, Adrian Dunlop MBBS, FAChAM, PhD, Turning Point Alcohol and Drug Centre, Fitzroy, Victoria, Australia, Peter Muhleisen BPharm, Turning Point Alcohol and Drug Centre, Fitzroy, Victoria, Australia, Nicole Lee PhD, Turning Point Alcohol and Drug Centre, Fitzroy, Victoria, Australia, David Taylor PhD, Monash University, Victorian College of Pharmacy, Victoria, Australia. Correspondence to Suzanne Nielsen, Turning Point Alcohol and Drug Centre, 54 – 62 Gertrude Street, Fitzroy, VIC 3065, Australia. Tel: 8413 8413; Fax: 9416 3420; E-mail: suzin@turningpoint.org.au Drug and Alcohol Review (March 2007), 26, 143 – 151 ISSN 0959-5236 print/ISSN 1465-3362 online/07/020143–09 ª Australasian Professional Society on Alcohol and Other Drugs DOI: 10.1080/09595230601146645