If
pharmacies
COUNTER
As the friendly and regular face at the heart of communitybased medicine, the pharmacist has an opportunity to profoundly influence welfare. DDN reports
‘ you’ re struggling, you say,“ I’ m alright”. People pass you and ask,“ Are you OK?” and you say,“ Yes, I’ m fine.” It’ s just a normal greeting. But you could say,“ You’ re going to wish you’ d never asked me that. Do you really want to know? I feel like shit, I can’ t be arsed with anything, I’ m just going through the motions.”’
Lee Collingham is explaining how it can feel when you’ re trying to stay in treatment for problematic drug use. He speaks from personal experience and as a service user advocate and peer supporter.
‘ You may not have seen your drug worker for a month. You may have had a breakdown, got yourself back together, had another breakdown.’
And from his own experience:‘ I’ ve regularly started to miss doctor’ s appointments. Sometimes it’ s because it’ s the opposite week to when I get paid and I have to walk two miles. Or it might be because my appointment’ s at 8.30am and with me not sleeping well, I might have dropped off at 7am.’
He sees his local pharmacist regularly, just a short walk away, and points out that at the heart of an overloaded treatment system, the pharmacy has an increasingly important role.
‘ The pharmacy is central to everyone’ s treatment and they see people more often than anyone else in the system. So there’ s a lot of stuff they can do.’ He reels off a list of basic interventions and harm reduction advice, as well as the opportunity to introduce patients to the right kind of hepatitis C treatment to suit their condition –‘ if you’ re on OST [ opioid substitution treatment ] you get one kind of treatment, if you’ re a drinker you get another one, and so forth.’
But there’ s an overseeing role that can be equally important as far as he’ s concerned.‘ The chemist is the one place they will attend regularly, and there could be better integration with other services,’ he says.
‘ Some people might come in for daily OST pick-up on a Monday, then miss Tuesday and Wednesday. They’ re just keeping in treatment, but what are they doing for the other two days if they’ re not needing their script? Are they still using? It’ s not about checking people out, it’ s about helping them to reach their goals and where they want to be – about not making it problematic so they can’ t even come forward with an issue.’
Personally, he values the regular contact and the concern for his welfare – the little chat while waiting for medication to be made up.‘ They’ ll say“ are you alright Lee? You seem a bit quiet” or“ you seem a bit off these last few days”. It’ s the conversation that leads to help with all aspects of health and wellbeing.‘ As services and needle exchanges are cut, your prime relationship is more and more with your pharmacist,’ says Nick Goldstein, who is tasked with helping to make this relationship a positive one. Called upon as a representative of the drug-using community( a label he is uncomfortable with, as‘ we’ re not all alike’), he is involved in an initiative by Martindale Pharma with Boots, supporting current and former service users to engage with pre-reg pharmacists as part of their addictions training programme.
Goldstein is cautious about overvaluing his role for several reasons. He is talking to pharmacists at the start of their career, rather than decision-makers in charge of culture change. He only has a slot of about half an hour in the training day – not enough time to go into the level of detail he would like, although questions from participants often take the session beyond its allocated slot.
‘ If I was cynical I’ d say it was a case of saying,“ hey, come and watch the bear dance”. It’ s a show for them,’ he says.‘ In a dry academic day I turn up and I’ m a little bit different. And they’ re always fascinated, always paying attention.’
But while paying attention, he hopes they are picking up the core points he’ s giving them – and while doing so, that the sessions are helping to address stigma and personalise the process of coming to the pharmacist for OST.‘ I try to get them to look beyond the reductive labeling and see that we should be treated as individuals,’ he says.
Beginning the training three years ago, Goldstein came face to face with the scale of his task.
‘ I realised after doing a few of these sessions that pharmacists have a huge miscomprehension about why people are actually in treatment – they seem to think we’ re there for one long party on the state,’ he says.‘ And you have to explain to them that that’ s not true, especially nowadays. No one goes into treatment
‘ The pharmacy is central to everyone’ s treatment and they see people more often than anyone else in the system... It’ s not about checking people out, it’ s about helping... They’ ll say“ are you alright Lee? You seem a bit quiet”.’ Lee CoLLIngham
12 | drinkanddrugsnews | March 2017 www. drinkanddrugsnews. com