Pharmacists'provision of methadone to intoxicated clients in community pharmacies, Victoria, Australia

FRANÇAIS :
Un questionnaire d'évaluation du programme de traitement par la méthadone, mis en place en 1996, a été adressé à 188 pharmacies communautaires et recueilli avec un taux de réponses de 84%. Les questions portaient sur la manière dont les pharmaciens délivrent la méthadone aux patients qui restent intoxiqués par d'autres drogues, y compris en abusant de leur propre dose de méthadone. 32% des pharmaciens continuent à délivrer le produit à ceux qui sont déjà " intoxiqués ". Il s'agit généralement de pharmaciens hommes, prenant en charge un grand nombre de patients. Ceux qui suspendent la délivrance de méthadone en informent généralement le médecin prescripteur (74%), alors que les pharmaciens qui délivrent la dose habituelle ou une autre dose sont moins nombreux à contacter le médecin (41%). Ce problème a été débattu ensuite dans un groupe de travail. Pour se justifier, les pharmaciens invoquent l'absence de communication patient-pharmaciens, la minimisation des dangers pharmacologiques d'une trop forte dose de méthadone, les croyances personnelles, la crainte des réactions des toxicomanes face à un refus, les difficultés à estimer la situation d'un patient et le manque de formation.
ENGLISH :
This Paper concerns pharmacists dispensing methadone to intoxicated clients, drawing on both questionnaire and focus-group data from a 1996 evaluation of the community-based methadone programme in Victoria, Australia. The questionnaire was sent to registered community methadone pharmacies in Victoria (N = 188). The response rate was 84% and 148 questionnaires were analysed. Pharmacists were asked how they would respond to clients who presented intoxicated for their methadone dose. Results indicated that 32% of pharmacists said that they would provide a client who presented intoxicated with his or her usual methadone dose. The analyses suggested that pharmacists who were male and those pharmacists whose number of methadone clients exceeded IO were more likely to dispense methadone to an intoxicated client than female pharmacists and those pharmacists with less than 10 clients. Pharmacists who would withhold the methadone dose were more likely to inform the client's prescribing doctor at the time (74%) than pharmacists who would provide the usual or modified dose (41%). In order to understand the social processes underlying provision of methadone to intoxicated clients this theme was later taken up in a focus group with pharmacists. Reasons given by pharmacists to explain the dispensing of methadone to intoxicated clients were: insufficient communication between prescribers and pharmacists; a downplaying of the pharmacological dangers; personal beliefs and values; a fear of retribution from the client if the dose was refused; difficulty in recognizing intoxication; lack of education and training. The results raise concerns about the basis on which pharmacists make decisions about providing methadone to intoxicated clients. (Author's abstract.)