Pilot randomised controlled trial of community pharmacy administration of buprenorphine versus methadone

Citation

Cameron IM, Matheson C, Bond CM, McNamee P, Lawrie T, Robinson A, Robertson G & Eagles LE (2006) Pilot randomised controlled trial of community pharmacy administration of buprenorphine versus methadone. International Journal of Pharmacy Practice, 14 (4), pp. 243-248. https://doi.org/10.1211/ijpp.14.4.0003

Abstract
Objectives: The established regime for opiate substitute prescribing for drug misusers is daily methadone administered under supervision in community pharmacies. Buprenorphine has recently been introduced as an alternative. However there is a lack of evidence of the effectiveness of buprenorphine maintenance therapy (BMT) in the UK treatment setting. This study aimed to assess methods for a randomised controlled trial (RCT) and the feasibility of pharmacy-based supervised self-administration (SSA) of buprenorphine compared to methadone. Setting: Specialist substance misuse service, general practices and community pharmacies in Aberdeen, Scotland. Method: The design was a pilot RCT. Opiate-dependent drug misusers, newly referred for maintenance treatment were randomised to receive BMT or methadone maintenance therapy (MMT). Clients and pharmacists were interviewed at baseline and at the end of a 12-week intervention period. Clients completed the quality of life measure EQ-5D. Pharmacy activities were timed. Key findings: Twenty-one opiate-dependent clients were recruited (BMT = 11, MMT = 10). Recruitment levels improved as the trial progressed. Clients' treatment preferences were evident. Withdrawals occurred early with BMT. Clients found SSA of buprenorphine acceptable, but found daily administration more manageable than three times weekly. Pharmacists found the dispensing of buprenorphine to be an acceptable role, but felt less certain of ensuring against diversion with buprenorphine than they were with methadone. Pharmacy activities associated with buprenorphine took longer than those associated with methadone (mean = 7 min 25s versus mean = 3 min 27s, respectively). Conclusion: Recruitment to a trial comparing MMT to BMT for opiate-dependent clients within a UK treatment setting is feasible. Clients and pharmacists found buprenorphine acceptable.

Journal
International Journal of Pharmacy Practice: Volume 14, Issue 4