Medication safety, privacy, and stigma: A qualitative study of pharmacy opioid agonist treatment disruptions and adaptations in the 2022 Northern Rivers floods, Australia

Abstract

BackgroundOpioid agonist treatment (OAT) involves the daily consumption of long-acting opioid medications to assist in managing health and wellbeing issues related to illicit or high-strength opioid drug use. Flooding events disrupted OAT service systems in the Northern Rivers region (Australia) in 2022. This study describes the experiences of OAT consumers and pharmacists during this time, including how structural stigma may have limited clinician behaviours and influenced consumer experiences. MethodsInterview transcripts from eleven pharmacists and thirteen consumers were collated and thematically analysed. ResultsOpioid agonist treatment consumers experienced disruptions when their prescribing and pharmacy treatment sites were destroyed by flood or where roads were cut off, and faced long delays if they attended the primary public clinic for emergency dosing or prescription re-issuing. Absent prescriptions were the main barrier to enabling emergency dosing. Pharmacists’ efforts in providing advance takeaways or discretionary doses reduced consumer hardships and distress. The treatment access difficulties that consumers experienced were found to be constrained by stigma, and this intensified risks related to medication safety and privacy. ConclusionsTreatment access was enabled when pharmacists operated outside of the restrictive medication safety protocols that opioid agonist treatment is uniquely subject to, and that is informed by structural stigma towards OAT consumers. Potential distress was averted where pharmacists took responsive approaches to protecting and maintaining OAT access. Future emergency planning should aim to protect and transmit OAT dose authorisation records more effectively, while striving to minimise adverse impacts including decreased privacy and accessibility.