COMMUNITY PRACTICE

New Hampshire addiction project eyes use of R.Ph.s

A New Hampshire project is planning to enlist pharmacists to dispense methadone and observe recovering addicts taking the medication as a way to move treatment out of centralized clinics and into the medical mainstream.

The New Hampshire Regional Opioid Treatment and Education Project (NHReMOTE) seeks to address the problem of opioid addiction by integrating its treatment into mainstream medical care, said project director Seddon Savage, M.D. Funded by a grant from the U.S. Center for Substance Abuse Treatment, the project proposes to team trained pharmacists with primary care physicians and addiction counselors for community-based treatment.

"Pharmacists will have a very, very important role," Savage told Drug Topics. "We're in the planning stages. How it evolves depends on input from pharmacists. The model we are proposing is very similar to what is currently employed in many parts of Canada, where methadone is dispensed through [community] pharmacies."

Pharmacists who participate in NHReMOTE will dispense methadone and then watch to be sure that the patient addict actually takes the medication, Savage said. They will also assess whether the patient is intoxicated before dispensing the opioid agonist therapy. Patient confidentiality will also be an issue.

One big reason to move methadone treatment into the medical care arena is New Hampshire's geography. Currently, recovering addicts in remote northern areas must travel up to five hours every day to get their medication doses from one of the state's two, freestanding methadone clinics in the more-populated southern part of the state. Using pharmacies and physicians in remote communities would cut down on travel time and make it easier for patients to take their medications.

Ways to reimburse participating pharmacists for their services are also being explored, Savage said. "We can't expect pharmacists to put in a lot of time and effort with more responsibility without some kind of reimbursement. Since methadone is so cheap, it may just be a markup on the drug."

Jumping through federal drug regulatory hoops also has to be taken into account in the planning phases. "The Drug Enforcement Administration hasn't given final approval of office-based opioid treatment programs, but we know it's coming at some point," said Peter Grasso, the state pharmacy board's chief compliance officer and one of three pharmacists on the project's advisory board.

It hasn't been decided which pharmacy practice settings will be included, Grasso said. Local conditions may determine whether the program will enlist pharmacists in hospitals, clinics, or community pharmacies. He added that chain drugstores have issues at the corporate level that might not affect independent pharmacies as much.

Savage hopes to have the program running at six sites in two years. Rural areas where the demand is small but the need is great will be targeted first. "Over time, if we're successful, we will generalize it to the state and other people can consider it for their own states," she added.

Carol Ukens

Carol Ukens. New Hampshire addiction project eyes use of R.Ph.s.

Drug Topics

2001;21:21.