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for a gig or a good time . You ’ re there because you ’ ve lost control of your life , basically . And that ’ s a very scary thing .’
The stigma is not usually deliberate , but the product of ‘ a mixture of ignorance and apathy ’, he says .
‘ They have preconceived prejudices until someone points it out – that these people are more than the label you ’ re slapping on them . They ’ re people ’ s husbands , fathers , sons , mothers , daughters , and they have careers and a whole range of interests , fears and fantasies . The difference is that they ’ re addicted to drugs , but apart from that they are just like you . They ’ re not from Mars .’
While they ‘ don ’ t even realise beforehand that their attitude could be described as problematic ’, there ’ s a slow dawning process that ‘ addiction ’ s just a label and these are human beings just like them , and should be treated with the same respect ’.
With chemist shops moving more and more into community-based medicine , we have a ‘ golden oppor - tunity ’ to give pharmacists a better frame of reference for interacting with the community , says Goldstein .
In his short , rushed training slot , he is aware that staff from a large pharmacy chain are going to be restricted by standard shop layout and company protocol , relating to the routines they can influence – things like whether OST should be dispensed from a separate window – but he introduces the idea of ongoing dialogue .
‘ I ’ ll say to the pharmacists , ask your clients what they want and at least take that into account when making your decision . Don ’ t just present them with a fait accompli because that just disenfranchises people from the process and from the treatment .’
Both Collingham and Goldstein talk about the importance of fair play on both sides of the counter . Collingham mentions behavioural contracts as a way of establishing a respectful relationship , for example : ‘ I promise that I won ’ t treat you like an idiot by stealing from your shop – and on the pharmacy side , I won ’ t keep you waiting past clients that come in after you , or identify you as an OST user .’
Goldstein sometimes comes across pharmacists who are keen to share episodes of bad behaviour that took place in their shop , and agrees there are responsibilities that the client must sign up to . He reminds them : ‘ We are individuals . Some of us are fat , some of us are thin . Some of us are nice guys and some of us are assholes . Be clear about this – but believe in giving the assholes a fair break .’
He is also acutely aware that pharmacists just entering their profession will have no influence over long-established company protocols . ‘ You can point out the dangers of these protocols till you ’ re blue in the face , but it ’ s not going to help because they ’ re not responsible for them . Somebody needs to talk to head office and say “ hey guys , have you thought about x , y and z ?”’
But through the modest training initiative , Goldstein hopes to awaken a desire to know more – and there is a lot to learn . For instance , they are ‘ completely ignorant ’ about naloxone . ‘ Out of the few hundred I ’ ve trained now , I ’ ve had only two or three who know what it is . They ’ re pretty clueless about it ,’ he says , adding , ‘ Naloxone is one of those things that should have been around for years , and now it ’ s happening that ’ s a great thing . But the way it ’ s being implemented and put out there leaves a lot to be desired .’
In the limited time he has with the trainee pharmacists , he hammers home the increasingly important role they have to play : ‘ You see your key worker once in a blue moon . You see your consultant even more infrequently . You see your pharmacist fairly regularly , so I point out that they become a key point of contact in the treatment chain .
‘ And that can be the difference – their attitude and behaviour – between someone staying in treatment and someone leaving . That ’ s the difference between life and death in some cases .’
This article has been produced with support from Martindale Pharma , which has not influenced the content in any way .
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