Objectives
Pervasive misuse of prescription opioids in Ontario has contributed to increased demand for community-based management programs. Rural patients have limited access to methadone maintenance treatment (MMT), an opioid addiction-treatment service that could be offered by community pharmacists. The aim of this study was to identify rural community pharmacists perceived barriers, motivations and solutions to offering MMT in their communities.

Methods
Potential participants were identified using the Ontario College of Pharmacists online pharmacy and member search tool, and stratified by criteria such as geographical location and type of pharmacy. One-on-one, semi-structured interviews were conducted with community pharmacists who practiced in two Counties in rural Southwestern Ontario. Interview transcripts were analyzed using inductive content analysis.

Results
11 pharmacists participated in the study. Participants included owners (n=4), managers (n=3) and staff pharmacists (n=4) in independent/banner pharmacies (n=4) or chain pharmacies (n=7). Increased workload, extended operating hours, and concerns about safety, theft, community resistance and the availability of methadone training courses were identified as pharmacist-related barriers to providing MMT services. Professional satisfaction was the strongest motivation. Limited pharmacy staff availability exacerbated concerns about increased workload and security. Rural emergency-response times were cited among safety concerns. Participating pharmacists felt that rural regions had fewer MMT prescribers and that community members in rural regions had greater apprehension about addiction-treatment services than those in urban regions. Pharmacists proposed that a coordinated, multi-center approach to providing MMT could improve access to treatment for rural patients.

Conclusion
Rural community pharmacy practice has unique barriers to implementing and providing MMT services. A coordinated, multi-pharmacy approach may be an option to provide and expand MMT services in rural regions.