From controlled opioid substitution treatment to pharmacy delivery of buprenorphine-naloxone and to treatment in primary health care: the views of patients and personnel

INTRODUCTION: There are 4000–5000 opioid abusers and about 1700 patients in opioid substitution treatment in Finland. New legislation (2008) allows less restrictive treatment models than before. AIMS: To assess advantages and disadvantages of pharmacy delivery of buprenorphine-naloxone and referral of stabile patients into primary health care. THEORY AND METHODS: The setting was five Finnish outpatient clinics involved in treatment of opioid dependence in 2008–2009. Seventy-four patients (75% males, mean age 33, ½– 8 years in treatment) were interviewed. A questionnaire regarding the patients'´ situation was filled in by the nurses (n=166 patients). The view of personnel was studied in five group interviews (n=24) and through a questionnaire (n=36). Qualitative and quantitative methods were used. RESULTS: Most patients were unemployed, had psychiatric problems, and had heavy history of drug abuse. Transition to pharmacy delivery and to primary health care was more difficult and time-consuming than expected. This was due to patients' insistent personal need for psychosocial treatment or concerns of the personnel. Financial and organizational factors also played an important role. CONCLUSIONS: A variety of treatment models, careful evaluation of the patients’ situation, and training of personnel of clinics and health centres, and pharmacy staff is needed. Both patients and personnel were willing to move towards less restrictive models, if they were flexible enough.