Community pharmacy could enable more equitable drug and alcohol services and lead to better outcomes for patients, but that more could be done to help them do so, a charity has said.

Mohammed Fessal, the chief pharmacist at national health and social care charity Change Grow Live, has said that only a minority of pharmacies offered drug addiction services, out of line with the distribution of other treatments provided by pharmacies nationally.

On a webinar hosted by Addiction Professionals this morning, he told professionals working in drug and addiction services:  ‘It's actually the minority of pharmacies that dispense medication-assisted treatment [for substance abuse disorders] in community. We need to ask ourselves, why is that you don't find that in any other area of health care when a prescription is presented?’

He said that more might need to be done to tackle stigma or provide education and training to help pharmacies provide addiction support, or understand whether pharmacies do not perceive the service as valuable.

‘Whatever the issues are, we need to identify and resolve those if we want to move forward and expand this as a partnership amongst many more pharmacies than currently provide the services,’ he said.

Pharmacies could help support patients receiving medication-assisted treatment (MAT) without supervised consumption, he added.

The number of people prescribed MAT by Change Grow Live who do not have supervised consumption has risen by 100,000 between February 2020 and February 2022, with the charity’s website explaining that this was to reduce risk of infection during the Covid-19 pandemic.

Mr Fessal told webinar attendees that while this helped service users to take control of managing their medication, community pharmacies are ideally placed to provide support that MAT patients without supervised consumption would not otherwise receive.

For example, during the Covid, Change Grow Live suggested it was no longer feasible for pharmacies to deliver daily supervision services – but said patients could still visit the pharmacy for support.

However, while many pharmacy teams do currently provide support through ‘ad hoc’ conversations to service users, this was based on ‘goodwill’ rather than being a commissioned service, he added.

‘The bottom line is, you can't build services with quality that is based on goodwill, because at the end of the day, you have no assurance of the quality being provided. You have no assurance of the governance and you have no standardisation and assurance on that front either.

‘And, really importantly, the service provider has no ability, with the lack of oversight of that information being shared, to actually improve the delivery of the service.

‘So we need to have to a service that actually recognises the pharmacy and the pharmacy teams input for all those accessing MAT,’ he said.

Pharmacies providing MAT with supervised consumption would be required to supervise the consumption of methadone, naltrexone, buprenorphine or the combination drug of naloxone and buprenorphine at the point of dispensing in the pharmacy, to ensure that the dose has been administered appropriately to the service user.

They would also be required to report if the dose had been missed or if the service user had not attended.

Mr Fessal added that community pharmacies ‘really stepped up to the forefront of being probably the most accessible health care provider and a healthcare setting to the general public’ during the pandemic.

Community pharmacies had the potential to provide more clinical services, which could be used to support drug and addiction treatment, particularly among the 50% of drug users not in structured treatment or those who might not seek help for issues such as alcohol consumption, he added.

‘We know they are seeing people more than any other health care professional and more than the rest of our team such as recovery workers. So what's the value they can add here? They can sit down and talk to people about adherence, identify barriers and identify solutions, reinforcing the message that were given already in services through prescribers to recovery workers,’ he said.

In June, a study led by the University of Dundee found that one of the most accessible ways to reach people with hepatitis C was for nurses in community pharmacies to test people as they came in for methadone treatment.

However, he also said that pressures on community pharmacy, such as workforce pressures and increased time sourcing medications, was leading to temporary and unexpected closures, which had ‘massive consequences’ to those who needed to access medication daily.

He added: ‘We need to make it incentivized in terms of remuneration and we need a clear guidance and support programme to make those conversations work.’