Perceived Barriers and Facilitators to Providing Methadone Maintenance Treatment Among Rural Community Pharmacists in Southwestern Ontario.

Abstract

Misuse of opioids has become a public health concern across North America. Rural patients have limited access to methadone maintenance treatment (MMT), an opioid addiction-treatment service that could be offered by community pharmacists. The aim of this study was to identify rural community pharmacists' perceived barriers, motivations, and solutions to offering MMT to their patients. One-on-one, semistructured interviews were conducted with 11 community pharmacists who practice in rural southwestern Ontario. Interview transcripts were analyzed using inductive qualitative content analysis. Increased workload, extended operating hours, and concerns about safety, theft, burglary, community resistance, and availability of methadone training courses were identified as pharmacist-related barriers to providing MMT services. Professional satisfaction and community service were primary motivations for offering the service. Limited pharmacy staff availability exacerbated concerns about increased workload and security. Slower rural emergency-response times were cited among safety concerns. Participating pharmacists felt that rural regions had fewer MMT prescribers and that rural community members had greater apprehension about addiction-treatment services than those in urban communities. Pharmacists proposed that coordinating MMT service provision across multiple community pharmacies in the region could help improve access to treatment among their patients. Rural community pharmacy practice has unique barriers to implementing and providing MMT services. A coordinated, multipharmacy approach may be an option to provide and expand MMT services in rural regions.