A small number of pharmacists were permitted to move groups, and this may have had an impact on findings.

The ITT analysis, based on allocated group, suggests that this was not the case The reduction in illicit heroin use in all patients is in line with Thiazovivin chemical structure multiple studies of methadone maintenance treatment.[19] The absolute reduction in heroin use in this study (15%) was in line with other cohort studies.[17] However, there was no significant difference between the groups, indicating EPS did not further reduce illicit heroin use. There was better retention in the intervention group (87.7%) than the control group (80.8%), but the between-group difference was not statistically significant, although retention was very high overall. Retention in this study compared favourably to other methadone studies which ranged from 19–90%.[19] However, it is not entirely appropriate to compare retention with other studies because our participants were not necessarily recruited at the very start of treatment and there may be more attrition in the early weeks. Whilst successful outcomes have been reported from the use of MI in interventions addressing alcohol,[5, 6] smoking[20] and drug dependence[7] it has not always

demonstrated benefits. When used as part of an integrated intervention with cognitive behavioural therapy for people with psychosis and co-morbid substance abuse, it was unable signaling pathway to improve patient outcomes.[21] Other studies also suggest that MI can in fact be counter-productive in people who are already highly motivated.[22] The lack of effect in the

current study may also be because participants were already highly motivated to reduce their heroin use, making it unlikely that this pharmacy intervention service would have a significant impact. Physical health was actually significantly poorer at follow-up in the intervention group compared to control. This may be due to statistical chance. Alternatively, it may reflect an increased awareness by patients of their health as a result of communication with pharmacists, a finding reported in other studies.[23] The intervention may have increased health awareness but was not aimed at addressing other health problems. Psychological health was slightly Protein tyrosine phosphatase worse at follow-up in the intervention group. This is contrary to the NTORS[17] which found these parameters improved over time in a general UK treatment cohort. Although there was no significant difference in treatment satisfaction between groups at follow-up, there was a significant improvement in treatment satisfaction over time in the intervention group. This corresponds with increased treatment retention and may be because intervention patients felt happier in the pharmacy owing to more and possibly ‘better’ communication with the pharmacist. Ideally some qualitative follow-up would have been conducted to explore this further. The suggestion of improved treatment retention and satisfaction are important for policy makers.