Patient perspectives on community pharmacy administered and dispensing of methadone treatment for opioid use disorder: a qualitative study in the U.S.

Pharmacy administration and dispensing of methadone treatment for opioid use disorder (PADMOUD) may address inadequate capability of opioid treatment programs (OTPs) in the US by expanding access to methadone at community pharmacies nationally. PADMOUD is vastly underutilized in the US. There is no published US study on OUD patients’ perspectives on PADMOUD. Data are timely and needed to inform the implementation of PADMOUD in the US to address its serious opioid overdose crisis. Patient participants of the first completed US trial on PADMOUD through electronic prescribing for methadone (parent study) were interviewed to explore implementation-related factors for PADMOUD. All 20 participants of the parent study were invited to participate in this interview study. Each interview was recorded and transcribed verbatim. Thematic analysis was conducted to identify emergent themes. Seventeen participants completed the interview. Patients’ perspectives on PADMOUD were grouped into five areas. Participants reported feasibility of taking the tablet formulation of methadone at the pharmacy and identified benefits from PADMOUD (e.g., better access, efficiency, convenience) compared with usual care at the OTP. Participants perceived support for PADMOUD from their family/friends, OTP staff, and pharmacy staff. PADMOUD was perceived to be a great option for stable patients with take-home doses and those with transportation barriers. The distance (convenience), office hours, and the cost were considered factors most influencing their decision to receive methadone from a pharmacy. Nonjudgmental communication, pharmacists’ training on methadone treatment, selection of patients (stable status), workflow of PADMOUD, and protection of privacy were considered key factors for improving operations of PADMOUD. This study presents the first findings on patient perspectives on PADMOUD. Participants considered pharmacies more accessible than OTPs, which could encourage more people to receive methadone treatment earlier and help transition stable patients from an OTP into a local pharmacy. The findings have timely implications for informing implementation strategies of PADMOUD that consider patients’ views and needs.

阿片类药物使用障碍的美沙酮治疗的药房管理与配药（PADMOUD）可能通过在全国社区药房扩大美沙酮获取途径来解决美国阿片类药物治疗项目（OTP）能力不足的问题。PADMOUD在美国的利用率极低。美国没有已发表的关于阿片类药物使用障碍患者对PADMOUD看法的研究。及时的数据是必要的，以便为美国实施PADMOUD提供信息，以应对其严重的阿片类药物过量危机。 通过美沙酮电子处方进行的美国首个关于PADMOUD的已完成试验（母体研究）的患者参与者接受了访谈，以探究PADMOUD的实施相关因素。母体研究的所有20名参与者都被邀请参加此次访谈研究。每次访谈都进行了录音并逐字转录。进行了主题分析以确定新出现的主题。 17名参与者完成了访谈。患者对PADMOUD的看法分为五个方面。参与者报告了在药房服用美沙酮片剂配方的可行性，并指出与OTP的常规治疗相比，PADMOUD具有益处（例如，更好的获取途径、效率、便利性）。参与者感觉到他们的家人/朋友、OTP工作人员和药房工作人员对PADMOUD的支持。PADMOUD被认为对于有带回家剂量的稳定患者以及有交通障碍的患者是一个很好的选择。距离（便利性）、营业时间和费用被认为是影响他们决定从药房获取美沙酮的最主要因素。无评判性的沟通、药剂师的美沙酮治疗培训、患者的选择（稳定状态）、PADMOUD的工作流程以及隐私保护被认为是改善PADMOUD运作的关键因素。 这项研究首次呈现了患者对PADMOUD看法的研究结果。参与者认为药房比OTP更容易到达，这可能会鼓励更多的人更早地接受美沙酮治疗，并有助于将稳定的患者从OTP转移到当地药房。这些研究结果对于为考虑患者观点和需求的PADMOUD实施策略提供信息具有及时的意义。