Pharmacists’ Moral Obligations in the Provision of Methadone

Dr Betty ChaarFaculty of PharmacyThe University of Sydney

The Problem of Illicit Drug Use

• Stigma

• Economic

• Crime

• Health

• SocialFeyer et al. (2010)Australian Institute of Health and Welfare (2010)The Pharmacy Guild of Australia (New South Wales Branch) (2011)Australian Government Department of Health and Ageing (2007) Darke et al. (2007)

Harm Minimisation and OST Heroin dependence is a serious health

burden in Australia and Opioid Substitution Treatment (OST) has been delivered in community pharmacies since 1985.

The effectiveness of pharmacy-based OST is evident and the demand is increasing, however it is an opt-in service and the participation rate of community pharmacies is only 30%

A very high “unmet demand” for pharmacy-based dosing, which exceeds supply, projected to escalate in the future.

The Extent of the Problem

• ~3500 new patients per year

• Demand increases 5% yearly

• Pharmacy participation

increases 1% per year

• Av. waiting time:

3.6 yrs (VIC)| 3.3 yrs (NSW) Australian Institute of Health and Welfare (2010) Australian National Council on Drugs (2009) Holt et al. (2002)Ross et al. (2004)

Recent Study Findings

Providers were motivated

positive attitudes

functional relationships with

OST clients/stakeholders,

professional satisfaction,

and

financial rewards.

Recent Study Findings

Non-providers had negative attitudes

Lack of information

Perceived lack of demand

Stigma

Concern that OST provision would affect their business.

Professional Autonomy?

Definition“The quality or state of being

independent and self directing, particularly in decision making, enabling professionals to exercise judgement as they see fit during the performance of their professional duties”

Mosby's Dental Dictionary, 2nd edition. © 2008 Elsevier, Inc.

Professional Autonomy?The Code7. “A pharmacist must:Exercise professional autonomy,

objectivity and independence....”

“ �A pharmacist must not override the professional autonomy of pharmacists in his or her employ unless consumer safety is compromised.”

The Dilemma

3. A pharmacist upholds the reputation and public trust of the profession.

A pharmacist will not abuse the trust and respect of individuals and society.

4. A pharmacist acknowledges the professional roles in and responsibilities to the wider community.

.

The Question is

Is it ethical for pharmacists to choose not to provide a service that the community is in dire need of?