Background
Pharmacies across Scotland provide methadone dispensing for over 9000 drug users. The majority of these (65%) visit the pharmacy daily to consume their methadone under a pharmacist's supervision1. It has been proposed that the frequent, if brief, time pharmacists spend with drug users every day could be used constructively to improve the overall outcomes of methadone maintenance treatment. This is called providing enhanced pharmacy activities for methadone maintenance patients. Pharmacists are familiar with behavioural change theory through smoking cessation, it is proposed that training in Motivation Interview which builds on behaviour change could enable pharmacists to actively improve the aims of methadone treatment. Any such training would have to take into account the context and constraints of pharmacy and build on the existing care plan devised by the specialist nurse/clinician.

Aim
The aim of the study was to design and evaluate a training intervention of enhanced pharmacist activities for patients receiving daily supervised methadone, based on motivational interviewing and behavioural change. Five research questions were posed:
1. What type of enhanced activities are feasible in the community pharmacy setting?
2. What type of enhanced activities would complement existing treatment plans devised by nurses/GPs/consultants?
3. Does training for enhanced activities influence pharmacists' attitudes, knowledge and belief in self-efficacy?
4. How feasible are enhanced activities in practice following training?
5. Do pharmacists implement changes in practice following training.

Methods
Mixed methods were used. An initial structured survey assessed interest in training as well as attitudes, knowledge and involvement in methadone dispensing (n=120). Initial focus groups with the network of Scottish Specialist Pharmacists in Substance Misuse, and specialist nurses from the Substance Misuse Service informed the design of the training intervention. Training was delivered by Scottish Training in Drugs and Alcohol (STRADA) to 11 pharmacists. Following the intervention an evaluation focus group with pharmacists who had undergone motivational interviewing training was undertaken and a postal, structured questionnaire survey (as above) was used to assess pharmacists' attitudes, knowledge, and beliefs in self-efficacy. Researcher observation assessed the extent to which pharmacists had implemented motivational interviewing in their professional practice. A researcher administered brief questionnaire was used to assess patients' views.

Discussion
Training in motivational interviewing was viewed postively both by pharmacists and specialist nurses. Pharmacists who received training had significantly more positive attitude to methadone patients following training. Those who had received training had higher self-efficacy scores generally than those who did not receive training, althougth there was no significant difference pre and post training in these scores. All the methadone patients interviewed were very positive about pharmacists being trained to provide such support.

Conclusion

A large scale Randomised Controlled Trial to assess whether pharmacists providing enhanced activities would improve outcomes of methadone maintenance therapy is recommended.