Pharmacists' provision of methadone to intoxicated clients in community pharmacies, Victoria, Australia

This paper concerns pharmacists dispensing methadone to intoxicated clients , drawing on both questionnaire and focus-group data from a 1996 evaluation of the community-based methadone programme in Victoria, Australia. The que stionnaire was sent to registered community methadone pharmacies in Victori a (N = 188). The response rate was 84% and 148 questionnaires were analysed . Pharmacists were asked how they would respond to clients who presented in toxicated for their methadone dose. Results indicated that 32% of pharmacis ts said that they would provide a client who presented intoxicated with his or her usual methadone dose. The analyses suggested that pharmacists who w ere male and those pharmacists whose number of methadone clients exceeded 1 0 were more likely to dispense methadone to an intoxicated client than fema le pharmacists and those pharmacists with less than 10 clients. Pharmacists who would withhold the methadone dose were more likely to inform the clien t's prescribing doctor at the time (74%) than pharmacists who would provide the usual or modified dose (41%). In order to understand the social proces ses underlying provision of methadone to intoxicated clients this theme was later taken up in a focus group with pharmacists. Reasons given by pharmac ists to explain the dispensing of methadone to intoxicated clients were: in sufficient communication between prescribers and pharmacists; a downplaying of the pharmacological dangers; personal beliefs and values; a fear of ret ribution from the client if the dose was refused; difficulty in recognizing intoxication; lack of education and training. The results raise concerns a bout the basis on which pharmacists make decisions about providing methadon e to intoxicated clients.