Canadian Addiction Treatment Centres (CATC), based in Toronto, has over 14,000 patients, 80% of whom are taking methadone. Unlike in the United States, patients in Canada do not have to receive their medication within the treatment center — they can, if they choose, go to an outside (community) pharmacy with a prescription. But in the CATC model, which is probably unique compared to typical pharmacy practice in Canada, the pharmacies are part of the care continuum, linked to the clinic through daily communication about the patient’s care and a shared Electronic Medical Record (EMR).
“We have pharmacies that are in-house and co-located with the clinic,” explained Christine Folia, RPh, BScPhm, PharmD, pharmacy director of operations for CATC. In some CATC clinics there is a “delegation” pharmacy model, in which the methadone or buprenorphine is delivered to the clinic by the pharmacy, and the physician’s delegate witnesses the dosing formulation. When the patient comes to the clinic, he or she can receive their medication, including take-home doses, from the in-house pharmacy or clinic nurse. (Methadone is liquid only, mixed with juice in 100-milliliter bottles; buprenorphine is the combination product—Suboxone tablets only; only the film is available in the U.S.)
Patients do have a choice, said Ms. Folia. “Not all patients will dose with us,” she said. But after one year, 60% of the patients who use the in-house pharmacy services are still in treatment, compared to only 12% of the patients who get their medication from a non-affiliated pharmacy in the community.
“The opportunity to have a therapeutic relationship is much stronger when you have the connected circle of care,” said Ms. Folia, explaining one reason why the retention is so much higher for patients who pick up their dose at the in-house pharmacy. “You get to know your patients very well. You have that close network of care. Keep them close and make sure they’re on track.” But in the absence of a deliberate coordinated care approach, there is a greater opportunity for breakdown of communication between clinic, pharmacy, and patient.
A community pharmacy may not have the same knowledge of the patient, or, for that matter, a knowledge base about addiction/Opioid Use Disorder, said Ms. Folia. Pharmacists who work as part of a multidisciplinary team that focuses on treatment of addiction, have the opportunity to develop specialized skills and expert knowledge, which ultimately supports better patient care/outcomes.
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 and Alcohol Dependence (2018), https://doi.org/10.1016/j.drugalcdep.2018.04.029