Introduction
The government sees tackling drug misuse as one of its highest priorities. In Birmingham the Drug Action Team (DAT) has steered its expenditure away from prevention into additional support for treatment focused schemes, particularly in the primary care services. GPs can opt to provide general or specialist care, including supervised methadone treatment in conjunction with pharmacists. Under new shared care arrangements GPs, pharmacists, drug workers and drug users should be working together. Drug users participating in a shared care contract are required to take their methadone at the pharmacy. The DAT Funding is providing funding to enable premises to be modified so that supervised methadone treatment can take place in privacy (1).
In 1998 we undertook a service review of the existing arrangements for community pharmacy participation in syringe exchange, methadone dispensing and shared care. Commissioned by the DAT, LPC and Health Authority, the purpose was to provide evidence for the development of community pharmacy services to drug misusers (2). Recommendations were made across five themes: the distribution and location of NES pharmacies, the range and quality of services offered, partnership development, leadership, and contract and service agreement. In 2003 we undertook a follow up postal survey. The aim of this study was to assess the progress in policy change and implementation of the recommendations.

Methods and Results
The postal survey was designed, piloted and edited. It was posted to 231 community pharmacies, with one follow up reminder. There was a 67% response rate (compared to a sample of 241 and 69% response rate in 1999).
• Needle Exchange Pharmacies - no change in number or location (2003: 16% of total, n=25).
• Patient demand for provision of equipment, information, disposal of used needles from non-NES pharmacies unchanged (2003: 9%, 10% and 9% respectively).
• Requests for Supervised Methadone Consumption – 53% increase in requests from prescribers, and CDT staff. Actual Supervision of methadone consumption in the pharmacy – 43% increase compared with 1998.
• Shared Care - same level of interest, in 2003 from 68% (n=110) of pharmacists, but none in place.
• Only 5 pharmacies had received DAT funding to modify premises

Discussion
The authors discuss the research in the context of the evidence based policy / practice debate, using an analytical framework of: ideology, information, interests, institution. Such a framework sees evidence influence on policy as not a linear process but one of complexity, in the context of restructuring the health care economy, formation of PCTs and the location of responsibility for drug misuse services, with the weak influence of LPC on the DAT in driving changes forward.

References
1. Birmingham Drug Action Team Annual Report 2001/2 and Forward Plan 2002
2. Jesson, J. Barton, A. Pocock, R. Wilson, KA. Services for Drug Misusers: realising the full potential of pharmacists, A report to the Birmingham DAT. 1999