title: Community pharmacy services for people with drug problems over two decades in Scotland: Implications for future development.
abstract: BACKGROUND
  In Scotland community pharmacies are heavily involved in service delivery for people with drug problems (PWDP) as documented through surveys of all community pharmacies in 1995, 2000 and 2006. A further survey in 2014 enabled trends in service demand/provision to be analysed and provides insight into future development.
  
  
  METHODS
  The lead pharmacist in every Scottish pharmacy (n=1246) was invited to complete a postal questionnaire covering attitudes towards PWDP and service provision and level of involvement in services (needle exchange, dispensing for PWDP and methadone supervision). Additional questions covered new services of take-home naloxone (THN) and pharmacist prescribing for opioid dependence. Telephone follow-up of non-responders covered key variables. A comparative analysis of four cross-sectional population surveys of the community pharmacy workforce (1995, 2000, 2006 and 2014) was undertaken.
  
  
  RESULTS
  Completed questionnaires were returned by 709 (57%) pharmacists in 2014. Key variables (questionnaire or telephone follow-up) were available from 873 (70%). The proportion of pharmacies providing needle exchange significantly increased from 1995 to 2014 (8.6%, 9.5%, 12.2%, 17.8%, p<0.001) as did the proportion of pharmacies dispensing for the treatment of drug misuse (58.9%, 73.4%, 82.6% and 88%, p<0.001). Methadone was dispensed to 16,406 individuals and buprenorphine to 1777 individuals (increased from 12,400 and 192 respectively in 2006). Attitudes improved significantly from 1995 to 2014 (p<0.001). Being male and past training in drug misuse significantly predicted higher attitude scores (p<0.05) in all four years. Attitude score was a consistently significant predictor in all four years for dispensing for the treatment of drug misuse [OR=1.1 (1995 and 2006, CI 1.1-1.3, and 2014 CI 1.1-1.4) and 1.2 (2000), CI 1.3-1.5] and providing needle exchange [OR=1.1 (1995 and 2006), CI 1.1-1.2, 1.1-1.3 and 1.2 (2000 and 2014), CI 1.1-1.3 and 1.1-1.5]. In 2014, 53% of pharmacists felt part of the addiction team and 27.7% did not feel their role was valued by them. Nine pharmacists prescribed for opioid dependence.
  
  
  CONCLUSIONS
  It is possible for pharmacy workforce attitudes and service engagement to improve over time. Training was key to these positive trends. Communication with the wider addiction team could be further developed.
authors.affiliation: Centre of Academic Primary Care, Polwarth Building, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, United Kingdom. Electronic address: c.i.math@abdn.ac.uk.
authors.forename: Catriona
authors.initials: C
authors.lastname: Matheson
authors.affiliation: Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, United Kingdom.
authors.forename: Manimekalai
authors.initials: M
authors.lastname: Thiruvothiyur
authors.affiliation: Centre of Academic Primary Care, Polwarth Building, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Robertson
authors.affiliation: Centre of Academic Primary Care, Polwarth Building, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, United Kingdom.
authors.forename: Christine
authors.initials: C
authors.lastname: Bond
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002047:Buprenorphine / Q000008:administration & dosage; D003157:Community Pharmacy Services / Q000458:organization & administration* / Q000639:trends; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D018671:Needle-Exchange Programs / Q000458:organization & administration; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010595:Pharmacists / Q000458:organization & administration* / Q000639:trends; D024382:Professional Role; D012606:Scotland; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D011795:Surveys and Questionnaires
chemical_list: D002047:Buprenorphine; D008691:Methadone
keywords: Attitudes; Drug misuse; Naloxone; Opiate replacement treatment; Pharmacy; Training; Workforce