Opiate Substitution Treatment Research Articles

Hepatitis C virus prevention and care for drug injectors: the French approach

After France removed hepatitis C treatment reimbursement restrictions on 25 May 2016, an expert report presented recommendations, which focused on vulnerable groups including people who inject drugs (PWID). This commentary presents the key points of the chapter with a particular focus on policy.Thanks to the official lifting of restrictions based on disease stage and to the excellent efficacy and tolerance of the new DAA (Direct-Acting Antivirals) among PWID, the main issue is to improve the HCV care cascade. In France, many HCV-infected PWID, especially active/current PWID, remain undiagnosed and unlinked to care. Our challenge is to improve HCV screening by point of care testing (POCT), outreach methods with mobile teams, rapid tests, FibroScan, etc. and to provide PWID with appropriate services in all the settings they attend, such as drug treatment or harm reduction services, social services, prisons, etc. Another important issue is the prevention of reinfection through comprehensive and long-term follow-up.The report recommends a new national policy: testing and treating PWID as a priority, since this is the best way to eliminate HCV infection. It requires a global strategy consisting of combined and long-term interventions: prevention, outreach, screening, DAA, drug treatment programs including opiate substitution treatment (OST) and various harm reduction programs, including needle exchange programs (NEP). Ideally, these services should be delivered in the same place with an integrated approach. This should lead to meeting the national objective set by the government of eliminating hepatitis C by 2025.

P1‐106: Very high efficacy and safety of daas in pwid with chronic hepatitis c on opiate substitution treatment with buprenorphine: real life data from central Greece

P1‐106: Very high efficacy and safety of daas in pwid with chronic hepatitis c on opiate substitution treatment with buprenorphine: real life data from central Greece

Predicting health-related quality of life (EQ-5D-5\xa0L) and capability wellbeing (ICECAP-A) in the context of opiate dependence using routine clinical outcome measures: CORE-OM, LDQ and TOP

BackgroundEconomic evaluation normally requires information to be collected on outcome improvement using utility values. This is often not collected during the treatment of substance use disorders making cost-effectiveness evaluations of therapy difficult. One potential solution is the use of mapping to generate utility values from clinical measures. This study develops and evaluates mapping algorithms that could be used to predict the EuroQol-5D (EQ-5D-5 L) and the ICEpop CAPability measure for Adults (ICECAP-A) from the three commonly used clinical measures; the CORE-OM, the LDQ and the TOP measures.MethodsModels were estimated using pilot trial data of heroin users in opiate substitution treatment. In the trial the EQ-5D-5 L, ICECAP-A, CORE-OM, LDQ and TOP were administered at baseline, three and twelve month time intervals. Mapping was conducted using estimation and validation datasets. The normal estimation dataset, which comprised of baseline sample data, used ordinary least squares (OLS) and tobit regression methods. Data from the baseline and three month time periods were combined to create a pooled estimation dataset. Cluster and mixed regression methods were used to map from this dataset. Predictive accuracy of the models was assessed using the root mean square error (RMSE) and the mean absolute error (MAE). Algorithms were validated using sample data from the follow-up time periods.ResultsMapping algorithms can be used to predict the ICECAP-A and the EQ-5D-5 L in the context of opiate dependence. Although both measures can be predicted, the ICECAP-A was better predicted by the clinical measures. There were no advantages of pooling the data. There were 6 chosen mapping algorithms, which had MAE scores ranging from 0.100 to 0.138 and RMSE scores ranging from 0.134 to 0.178.ConclusionIt is possible to predict the scores of the ICECAP-A and the EQ-5D-5 L with the use of mapping. In the context of opiate dependence, these algorithms provide the possibility of generating utility values from clinical measures and thus enabling economic evaluation of alternative therapy options.Trial registrationISRCTN22608399. Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.

The impact of employment on perceived recovery from opiate dependence

Purpose Less than 15 per cent of people starting opiate substitution treatment (OST) in England are employed, but few gain employment during treatment. Increasingly punitive approaches have been tried to encourage individuals with substance dependence into employment in the hope of facilitating recovery. It is not clear which factors are associated with the successful maintenance of employment whilst receiving OST, and whether this group can be said to be “in recovery”. The paper aims to discuss these issues. Design/methodology/approach A cross-sectional study of the OST population in one English region was conducted between January and April 2017. Measures of physical health, employment patterns, drug use, mental health, recovery capital, and dependence severity were administered to 55 employed and 55 unemployed clients. Findings Those in employment had higher levels of “recovery capital”, better physical and mental health, fewer drug problems, and less severe dependence, despite reporting heroin use at a similar level. Three variables were significantly associated with employment: longest period of employment (OR=1.01, p=0.003); number of chronic medical conditions (OR=0.44, p=0.011); and number of days of psychological problems in the last month (OR=0.95, p=0.031). Practical implications These results suggest that abstinence may not be required in order to maintain stable employment when OST is in place. Different treatment strategies are required for clients receiving OST already in employment compared with those who are unemployed. Originality/value This is the first UK study to the author’s knowledge to focus on people receiving OST who are also in employment.

Pain and Sleep Measures in Methadone and in Suboxone Patients

Background: Pain and impaired sleep are often reported by patients in opiate substitution therapy. Objectives: We compared sleep and pain ratings by patients treated with methadone to those treated with suboxone (buprenorphine/naloxone combination). Patients and Methods: Sixty-eight patients (44 men, 24 women) undergoing opiate substitution treatment were treated with methadone (mean dose = 42.2 mg, SD = 24.6) or suboxone (mean dose = 9.7 mg, SD = 5.0). Their ratings of current level of pain on a scale from 0 (no pain) to 10 (extreme pain), their sleep ratings on the Pittsburgh sleep quality index, and outcomes of their urine screening tests for cocaine, oxycodone, opiates, and benzodiazepines were recorded. Results: Sleep quality was rated as “fairly bad” by 42.0% and as “very bad” by 8.2% of our patients. Moderate to severe levels of pain (pain ratings > 3 points) were reported by 55.9% of our patients. Neither the dose of suboxone nor the dose of methadone correlated with pain and sleep ratings (rho, P > 0.05). Suboxone patients did not differ from those on methadone in their sleep and pain ratings (Mann-Whitney, P > 0.05). Conclusions: Suboxone and methadone patients did not differ in their ratings of pain and sleep.

A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services

BackgroundApproximately 3% of people receiving opioid substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing treatment. Involvement of families and wider social networks in supporting psychological treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST.MethodsA two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit opiate use in the past 28 days to one of three treatments: 1) treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, treatment satisfaction, social network size and support).ResultsA total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence.No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial treatment intervention sessions was low across all three arms (44% overall).ConclusionsPatients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at treatment sessions makes it uncertain whether an adequate dose of treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement.Trial registrationISRCTN Trial Registration Number: ISRCTN22608399.Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.

The Evolution of the Health Status and Quality of Life of Heroin Addicts Treated with Methadone in the City of Tangier, Morocco

Opiate substitution treatment with methadone (STM) is one of the most effective means of treating heroin addiction. It presents itself as a beneficial treatment for health, and insertion into work but also for the reduction of infectious risks and crime. Improving the quality of life of patients during treatment including social and relational life and somatic state has been considered by some research to be more important than abstinence from the substance itself. The objective of this study is to evaluate the effect of methadone treatment on the quality of life of 101 drug-addicted patients in a health center in Tangier city, including the possible improvement of their socio-professional, relational and somatic state, using the characters of the official questionnaires of request of cure and based on the multidisciplinary method of the ASI (Addiction Severity Index). Our questionnaire included a rubric for sociodemographic data and another one for the evaluation of the impact of this treatment on the somatic, socio-professional and relational state of the patients according to two periods: before and after the treatment, and according to the duration of the treatment. The results obtained showed an improvement in the somatic state including weight, sleep, nutritional status and socio-occupational and relational status after inclusion in treatment.

Effects of opiate substitution treatment on mortality for opioids users: a systematic review and meta-analysis

BackgroundOpioid dependence is associated with high risk of premature death. Opiate-substitution treatment (OST) is the major treatment in community for opioid dependence worldwide. We aimed to estimate crude mortality rates (CMRs) and the effects of OST on mortality risk by meta-analysis. MethodsWe searched PubMed and Embase databases for articles that were published until Sept 30, 2016 with a combination of terms including “opiate substitution treatment”, “substitution or maintenance”, “methadone or buprenorphine”, “mortality”, and “longitudinal or cohort studies”. We restricted the search to articles written in English. We assessed the CMRs and relative risks (RR) for different OST status. We did subgroup analysis and meta-regression to determine the effect of treatment period, drug type, and drug dose on mortality. Findings29 longitudinal cohort studies involving 395 055 participants (1 611 377·8 person-years) were eligible for inclusion in the meta-analysis. From 22 studies, the pooled all-cause CMRs of opioids users were 0·90 per 100 person-years (95% CI 0·77–1·02) while receiving OST, 1·63 (1·41–1·84) after cessation of OST, and 4·91 (3·52–6·30) for an untreated period. On the basis of ten studies, the pooled overdose CMRs were 0·18 (0·16–0·20) while receiving OST, 0·76 (0·52–1·00) after cessation of OST, and 2·02 (1·30–2·74) for an untreated period. Compared with patients receiving OST, untreated participants had higher risk of all-cause mortality (RR 2·48; 95% CI 1·73–3·54) and overdose mortality (6·60; 4·73–9·21), and participants discharged from OST had a higher risk for all-cause mortality (2·27; 1·99–2·59) and a higher risk of fatal overdose (3·76; 2·24–6·30). The risk of death was greatest in the first 2 weeks after discharge from OST (all-cause CMR 4·71; 95% CI 1·69–7·73). We found evidence that buprenorphine was associated with a lower mortality risk than methadone after terminating OST (0·81; 0·70–0·93). We found no difference of mortality risk to be associated with different types and dosages of substitution medication. InterpretationOST could decrease mortality risk in opioids users, especially death from drug overdose. The findings highlight the importance of OST in the prevention of premature death among opioids users. Prevention of discharge from OST and post-treatment follow-up should be encouraged to reduce mortality. FundingThirteenth Five-Year Programme of the Chinese Ministry of Science and Technology (2016YFC0800907).

Management of Facial Trauma in the Prisoner Population

More than 10 million people are imprisoned worldwide, and the prevalence of all investigated mental disorders is higher in prisoners than in the general population. Although the extent to which prison increases the incidence of mental disorders is uncertain, considerable evidence suggests low rates of identification and treatment of psychiatric disorders. Prisoners are also at increased risk of all-cause mortality, suicide, self-harm, violence, and victimisation, and research has outlined some modifiable risk factors. Few high quality treatment trials have been done on psychiatric disorders in prisoners. Despite this lack of evidence, trial data have shown that opiate substitution treatments reduce substance misuse relapse and possibly reoffending. The mental health needs of women and older adults in prison are distinct, and national policies should be developed to meet these. In this Review, we present clinical, research, and policy recommendations to improve mental health care in prisons. National attempts to meet these recommendations should be annually surveyed.

Effets uro-néphrologiques des produits utilisés par les usagers de drogues : revue de la littérature et enquête pharmaco-épidémiologique en France et dans la région de Marseille

A great diversification of drugs of abuse has been observed in recent years, both in the populations using them and in the types of drugs. Although dependency and psychiatric disorders associated with the abuse of these substances is well known, somatic complications, uro-nephrotoxicity in particular, are less recognized. We propose here an overview of the products used by drugs abusers in France, through the analysis of the national pharmaco-epidemiological study Observation des produits psychotropes illicites ou détournés de leur utilisation médicamenteuse (OPPIDUM). Among the 5003 patients who participated in this survey, 84% were on prescribed psychoactive substances, with indicators of abuse in 28% of cases; more than half of these patients had also been using drugs of abuse (mainly cannabis) in the previous week. We then describe the main urological and renal toxicities of these drugs, in particular of heroin, cocaine, cannabis, ecstasy, LSD, amphetamine, new designer drugs, ketamine and opiate substitution treatment. We finally present a pharmaco-epidemiological survey of patients hospitalized for drugs complications in nephrology at the university hospital of Marseille. Between 2000 and 2015, 22 patients aged 18 to 57 years were hospitalized for renal adverse effects of drugs of abuse, such as glomerulonephritides, focal segmental glomerulosclerosis, acute kidney injury or chronic kidney disease. The somatic complications of drugs participate in their dangerousness and should be a red flag. They should be systematically reported to the addictovigilance national network to allow the improvement of information given to the patients and the medical community, and to adapt the prevention and risk reduction policies.

Telementoring with project ECHO: a pilot study in Europe

The Extension of Community Healthcare Outcomes (ECHO) project is a novel educational intervention designed in New Mexico to transfer subspecialty knowledge about hepatitis C virus (HCV) to primary care providers,...

Association between harm reduction intervention uptake and skin and soft tissue infections among people who inject drugs

BackgroundBacterial skin and soft tissue infections (SSTIs) are a health issue for people who inject drugs (PWID). There is a lack of evidence on the associations between harm reduction (HR) uptake and SSTIs. This paper examines the associations between the uptake of injecting equipment (IE) and opiate substitution treatment (OST) on SSTIs among PWID, and the injecting behaviours associated with having had an SSTI. This is the first large-scale, national study to examine the association between IE uptake and SSTIs. MethodsA cross-sectional, voluntary and anonymous survey was undertaken with PWID recruited from pharmacies/agencies providing IE across mainland Scotland during 2013–2014. Participants were asked: if they had an SSTI within the past year; about their uptake of HR within the past 6 months (including needle/syringes (N/S), paraphernalia and OST); and about their frequency of injecting, sharing of IE and re-use of own N/S. Data from 1876 PWID who had reported injecting within the past 6 months were analysed. FindingsIn multivariate logistic regression, those with high combined IE-OST uptake (adjusted odds ratio [AOR] 0.614, 95% CI 0.458–0.823, p=0.001) and medium combined IE-OST uptake (AOR 0.725, 95% CI 0.546–0.962, p=0.026) had lower odds of having had an SSTI compared to those with low combined IE-OST uptake. ConclusionsIE and OST uptake may reduce the level of SSTIs among PWID, suggesting increasing combined uptake may be beneficial. Nevertheless, a sizeable proportion of PWID with high HR uptake experienced SSTIs, suggesting the importance of other interventions.

Are UK opioid substitution treatment agencies fit for purpose?

Commentary to: Psychosocial interventions in opiate substitution treatment services: does the evidence provide a case for optimism or nihilism?

Psychosocial interventions in opiate substitution treatment services: does the evidence provide a case for optimism or nihilism?

Clinical guidelines from around the world recommend the delivery of psychosocial interventions as part of routine care in opiate substitution treatment (OST) programmes. However, although individual studies demonstrate benefit for structured psychosocial interventions, meta-analytical reviews find no benefit for manual-based treatments beyond 'routine counselling'. We consider the question of whether OST medication alone is sufficient to produce the required outcomes, or whether greater efforts should be made to provide high-quality psychosocial treatment alongside medication. In so doing, we consider the nuances and limitations of the evidence and the organizational barriers to transferring it into routine practice. The evidence base for psychosocial interventions in opiate substitution treatment (OST) services can be interpreted both positively and negatively. Steering a path between overly optimistic or nihilistic interpretations of the value of psychosocial treatment in OST programmes is the most pragmatic approach. Greater attention should be paid to elements common to all psychological treatments (such as therapeutic alliance), but also to the sequencing and packaging of psychosocial elements and their linkage to peer-led interventions.

Benzodiazepine maintenance in opiate substitution treatment: Good or bad? A retrospective primary care case-note review.

Co-prescribing benzodiazepines to patients in opiate substitution treatment is controversial and often alleged to increase mortality. In an inner-London general practice, patients with problematic benzodiazepine co-dependence were allowed benzodiazepine maintenance treatment (BMT) since 1994, providing an opportunity for analysis. 1) Case-note review of all 278 opiate substitution treatment patients, accruing 1289 patient treatment years; 46% had concurrent BMT. 2) National Health Service database search for patients who died after leaving accrued a further 883 years of information; only patients who left the UK were unaccounted for (4%). Three groups were studied: 1) never obtained benzodiazepine prescription (NOB): n=80); 2) briefly/occasionally prescribed benzodiazepines (BOP): n=71; 3) BMT: n=127. Treatment retention (months); deaths/100 patient treatment years; deaths after leaving the service/100 years of information. Treatment retention: NOB: 34 months; BOP: 51 months; BMT: 72 months. In-treatment mortality: NOB: 1.79/100 patient treatment years; BOP: 0.33/100 patient treatment years; BMT: 1.31/100 patient treatment years. Deaths after leaving service: NOB: 2.24/100 years of information, BOP: 0.63/100 years of information. However, mortality for previously BMT-patients increased by 450% to 5.90/100 years of information. BMT patients had longer treatment retention than NOB or BOP and lower mortality than NOB patients. It is unlikely that patients had access to prescribed benzodiazepines on leaving the service because of restrictions in the national guidelines but co-dependent patients are a high-risk group who may stand to gain most benefit from opiate substitution treatment if combined with benzodiazepine-maintenance.

Eligibility for opiate substitution therapy in recently released prisoners with high-risk amphetamine use, and their perceptions of its effectiveness

ABSTRACTIntroduction and Aim: The harmful consequences of amphetamine (including methamphetamine) misuse in Australia and internationally have been well documented. There has been surprisingly little exploration, however, of the role of opiate substitution therapy (OST), an evidence-based harm minimization strategy for opiate dependence, in eligible high-risk amphetamine users. Design and Methods: This survey study explored histories of substance use and dependence, and eligibility for OST, in a group of Queensland adult male ex-prisoners recently released into a residential supported parole program. Results: 57% of participants were identified as high-risk amphetamine (HRA) users. Of these HRA users, 74% were eligible for opiate substitution treatment under current Australian guidelines, and 59% believed that suboxone (buprenorphine and naloxone) maintenance would reduce their risks of going back to prison due to amphetamine use. Discussion and Conclusions: In recently released prisoners with a history of high-risk amphetamine use and opiate dependence, OST may be a strategy to reduce the harms of both opiate and amphetamine use. Further studies are needed to understand poly-drug use in this population, and optimize the safety, effectiveness, and attractiveness of suboxone maintenance for these potential clients.

HBV and HCV serological monitoring among injection drugs users in opiate substitution treatment in Bosnia and Herzegovina.

Use of intravenous heroin carries a risk of serious medical conditions, including acquiring blood-borne infections. Therefore, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection represent a threat for people who inject drugs (PWID). The objectives of this study were to determine the extent and characteristics of risk factors for acquiring HBV and HCV infection in PWID included in opiate substitution treatment in the southern part of Bosnia and Herzegovina (B&H). The study included 120 adult PWID of both sexes who participated in opiate substitution treatment. All participants were interviewed, and their blood samples were tested for the presence of the surface hepatitis B virus antigen (HBsAg) and hepatitis C virus antibodies (anti-HCV). Prevalence data were obtained and compared to the serological status. HBsAg prevalence among PWID was 0.8% (1/120), whereas seroprevalence of anti-HCV was 52.5% (63/120). PWID exposed to risk-behavior factors (such as unsafe sexual activity, serving prison sentence, and tattooing) were more frequently anti-HCV positive. Sharing drug paraphernalia was found to be the most significant risk factor. The highest predictive values for acquiring HCV-infection were attributed to PWID who used heroin for more than three years and who were unmarried. HBsAg prevalence among PWID is rare (0.8%), while HCV-infection (52.5%) presents an important health and social issue among PWID in B&H. Sharing drug paraphernalia and intravenous heroin use longer than three years were the most prominent risk-behavior factors among the patients we investigated.

Measuring Health and Broader Well-Being Benefits in the Context of Opiate Dependence: The Psychometric Performance of the ICECAP-A and the EQ-5D-5L

BackgroundMeasuring outcomes in economic evaluations of social care interventions is challenging because both health and well-being benefits are evident. The ICEpop CAPability instrument for adults (ICECAP-A) and the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) are measures potentially suitable for the economic evaluation of treatments for substance use disorders. Evidence for their validity in this context is, however, lacking. ObjectivesTo assess the construct validity of the ICECAP-A and the EQ-5D-5L in terms of convergent and discriminative validity and sensitivity to change on the basis of standard clinical measures (Clinical Outcomes in Routine Evaluation-Outcome Measure, Treatment Outcomes Profile, Interpersonal Support Evaluation List, Leeds Dependence Questionnaire, and Social Satisfaction Questionnaire). MethodsA secondary analysis of pilot trial data for heroin users in opiate substitution treatment was conducted. Baseline convergence with clinical measures was assessed using the Pearson correlation coefficient. Discriminative validity was assessed using one-way analysis of variance and stepwise regressions. Sensitivity to changes in clinical indicators was assessed at 3 and 12 months using the standardized response mean statistic and parametric and nonparametric testing. ResultsBoth measures had the same level of construct validity, except for clinical indicators of well-being, for which the ICECAP-A performed better. The ICECAP-A was sensitive to changes in both health and well-being indicators. The EQ-5D-5L had lower levels of sensitivity to change, and a ceiling effect (27%), particularly evident in the dimensions of self-care (89%), mobility (75%), and usual activities (72%). ConclusionsThe findings support the construct validity of both measures, but the ICECAP-A gives more attention to broader impacts and is more sensitive to change. The ICECAP-A shows promise in evaluating treatments for substance use disorders for which recovery is the desired outcome.

Drugs: Bodies Becoming “Normal”

"People say, “don’t you ever want to come off?” I don’t know. The thought of me getting up without taking something is totally... to me that’s normal. If I haven’t taken anything then I’m not normal. And for me to even, I can’t contemplate not taking something, you know. I’m not a lost cause. I know what my problem is. It’s other people that want me to stop. I don’t want to stop. I don’t want to. Does that make sense to you?" (Mya) This extract is taken from an interview that formed part of my doctoral research looking at people’s experiences of injecting drug use and treatment services in London, UK. Here I consider one of the ways participants described their use of drugs through a concept of becoming “normal.” I pay particular attention to Mya’s account and explore the very sense-making that her question (above) demands. Mya uses the concept of normality not only to reflect how drugs have become part of her everyday routines, or part of feeling normal, but actually in materially becoming herself—in embodying a “normal body.” As she puts it, “if I haven’t taken anything then I am not normal.” In this sense, Mya’s problem is not the drugs, but the people who want her to stop taking them. This understanding is important for challenging recent policy shifts towards reducing opiate replacement/substitution services in the UK (HM Government; Home Office).

Community pharmacy-based opiate substitution treatment and related health services: a study of 508 patients and 111 pharmacies

Community pharmacies have a central role in the provision of opiate substitution therapy (OST) for drug misusers, offering accessible, additional health services within recovery-oriented systems of care. However, little is known about the patients receiving OST, availability and uptake of related services and associated pharmacy characteristics. We aimed to describe OST in terms of patients, pharmacies and services within the UK’s largest health authority, NHS Greater Glasgow and Clyde, Scotland. Patients completed semi-structured questionnaires and pharmacists provided summary statistics relating to OST provision. Responses from 508 patients receiving OST from 111 participating pharmacies revealed an established patient population, with 89 % (449/507) aged 30 years or above and 80 % (387/484) attending the same pharmacy for 1 year or more. Methadone was the main form of OST (96 % (487/508), with 97 % (491/504) receiving supervision. Within pharmacies, OST consumption was supervised in one of four main areas: consultation room, dispensing hatch, quiet/private area or over the counter. Location of supervision was considered suitably private by 96 % of patients. Positive staff attitudes, privacy and the provision of additional health services were key factors influencing choice of pharmacy. Additional health services were offered to 75 % of patients and included information provision (43 %), signposting to other health care providers (72 %) and a Scottish service offering free advice and medicines for minor ailments (74 %). Patients and pharmacists have developed working relationships, enabling access to multiple services associated with health gain and harm reduction. Further development of enhanced services in community pharmacies is merited.