A Qualitative Exploration of Pharmacists' Perspectives and Attitudes Towards the 2021 Down-scheduling of Melatonin in Australia

Abstract

Background In Australia, prescription melatonin became ‘Pharmacist Only Medicine’ for people over 55 with insomnia from June 2021. However, little is known about pharmacists’ views on melatonin down-scheduling and their perceived impacts on practice. Objectives To explore the impact of melatonin down-scheduling on Australian community pharmacists’ practice. Methods A convenience sample of community pharmacists and pharmacy interns were recruited. Participants completed a pre-interview survey capturing demographic and professional practice details, followed by a semi-structured interview. Interviews were guided by a schedule of questions exploring the perceived role of melatonin, preparation/response to down-scheduling, practice changes and patient interactions. Interviews were digitally recorded, transcribed verbatim and analysed using the Framework Approach. Results Twenty-four interviews were conducted with Australian community pharmacists (n = 19) and intern pharmacists (n = 5). Pharmacists/intern pharmacists welcomed the increased accessibility of melatonin for patients. However, pharmacists perceived a disconnect between the guidelines, supply protocols and pack sizes with practice, making it difficult to monitor patient use of melatonin. The miscommunication of eligibility also contributed to patient-pharmacist tension when supply was denied. Importantly, 88% of participants indicated their interest in upskilling their knowledge in melatonin use in sleep, specifically formulation differences and dosage titration. Conclusions This study showed the need to refine and unify supply protocols and amend pack sizes in community pharmacy. With further support and training, pharmacists have the potential to extend their scope of practice in sleep health in tandem with the provision of over-the-counter sleep aids.