In opioid treatment programs (OTPs) in the United States, all pharmacy is “in-house,” meaning that patients are dispensed medication by nurses in the facility. There is no need to go to an outside community pharmacy—and for methadone, it’s not even legal for pharmacies to dispense for treatment of opioid use disorder (OUD).
In Canada, however, methadone patients can—and do—go to community pharmacies for their methadone, which is dispensed by the pharmacist, often on a daily basis. But it’s better if they stay in their facility to get the medication—in Canada, the treatment facility can have its own on-site pharmacy—because they are more likely to stay in treatment.
David K. White, PhD, president and CEO of BayMark Health Services, which has OTPs in both the United States and Canada, discussed the importance of pharmacy with AT Forum, focusing on the benefits that result from an in-house pharmacy that ultimately improves retention.
“The main benefits are convenience and lack of stigma,” Dr. White told AT Forum. This applies to the pharmacy in the United States, as well as to the proprietary pharmacy offered in Baymark’s Canada programs. “Our pharmacists deal every day with people who need methadone, buprenorphine and naltrexone,” said Dr. White. “They have the specific answers our patients need at their fingertips.”
Study Links In-House Pharmacies With Better Retention
A study published last year in Drug and Alcohol Dependence found that patients who receive medication at in-house pharmacies are more likely to stay in treatment. When Canadian patients choose to use an outside pharmacy, the percentage remaining in treatment one year later drops to 12%, compared to 56% of patients who receive their medication at the in-house specialty pharmacies (the study was conducted at Baymark treatment programs in Ontario).
While there are no significant cost implications for the patient or the payer in terms of medication delivery, the costs related to poor treatment retention are huge, said Dr. White. “If we retain more patients in treatment, it’s helpful to the patient and it saves money,” he said. He noted that studies in the United States show that for every dollar spent on treatment, 7 to 10 dollars are saved in costs related to criminal justice, medical problems, and work-related problems.
Most Baymark patients get methadone, but about 10 years ago some started receiving buprenorphine. Currently, about 6% of Baymark patients take buprenorphine.
“The costs of methadone are low, and the setup of the pharmacy system isn’t that complicated,” said Dr. White. “The retention rates for the collocated pharmacy are huge.”
It is also reassuring to patients to get their medication with other methadone and buprenorphine patients, “as opposed to walking into a pharmacy and feeling stigmatized,” said Dr. White. “It’s important to have a sensitive group of staff who understand the addiction issue, particularly given all of the misinformation out there, and the unfortunate stigma of medication- assisted treatment, both within and outside of the industry,” he said. “It’s better not to have patients exposed to that, to have them walk in and be accepted.”
Gauthier G, Eibl JK, Marsh DC. Improved treatment-retention for patients receiving methadone dosing within the clinic providing physician and other health services (onsite) versus dosing at community (offsite) pharmacies. Drug Alcohol Depend. 2018; Oct 1;191:1-5. Epub 2018 May 31. doi:10.1016/j.drugalcdep.2018.04.029.