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