With community pharmacy playing an ever-greater role in supporting people living with drug dependency, the organisation representing Scotland’s community pharmacies is calling for a national substance use service setting expectations for patients and pharmacy teams.

It comes as Strathclyde pharmacy research students published a study reporting that, while they also saw evidence of compassionate care, they observed discriminatory treatment, negative language and unfriendly attitudes towards patients with drug dependency.

Community Pharmacy Scotland (CPS) says community pharmacy teams have decades of experience “delivering care across Scotland, close to where people work and live”, including to “holistic support for some of the most vulnerable people in our society, including those living with substance dependency”.

Launching its Holyrood manifesto last month, CPS pointed to the value of placing community pharmacy teams at the heart of national services for weight management, women’s health – and substance dependency.

Responding to research hearing from 22 pharmacy students and six newly qualified pharmacists working across Scotland’s community pharmacies which pointed to a need for improved anti-stigma work, CPS told healthandcare.scot:

“Community Pharmacy Scotland continues to call for a national substance use service to support patients, standardising the service nationwide and setting expectations for patients and Pharmacy Teams alike.

“With appropriate funding and training, pharmacies can play an increased and vital role in harm reduction and support as patients navigate their journey to better health.”

Led by six University of Strathclyde pharmacy research students, the study which focused on the experiences of colleagues early in their careers underlines the need for consistent standards and attitudes.

A snapshot

While compassionate care provision for people being treated for drug dependency in pharmacies was evident to those interviewed, discriminatory treatment, negative language and unfriendly attitudes were also observed.

Researchers conclude that some pharmacy practice in Scotland ‘appears to be characterised by stigma and a lack of professionalism towards people with substance dependency’, pointing to a need for better education and training.

Equally, pharmacy teams who offered holistic support for people with substance dependency were admired by the students and newly-qualified professionals, with one student saying:

“I didn’t quite realise the impact you can have on one person’s life, because you see them every day. If you do it correctly, you can have an amazing impact but equally you can also have a dreadful impact if you do not do it correctly.”

Another reflected that some staff held their believe that people with substance dependency were “too far gone” above professional practice standards, seeing stigma around personal responsibility repeated.

Pharmacists delivering good practice become “positive role models” for students and study lead Dr Natalie Weir says with only 28 participants, this research provides a snapshot – showing a profession progression at a varying pace:

“There is a need for more consistent anti-stigma training and practice, and that the problem is more about the variation that exists in professionalism than exists rather than widespread poor care.

“In the future, we are hoping to help co-produce national training initiatives in stigma and harm reduction for undergraduate students and qualified pharmacy staff in Scotland, and we will involve people with experience of substance dependency in their development.”

She said there was a sense among students that “university training could be enhanced to prepare them for real-world practice”, to ensure compassion and respect is the primary mode of practice.

CPS says the Scotland-wide, multi-disciplinary adoption the Medication Assisted Treatment standards is delivering ongoing improvements in care, but “despite this good work, there are lessons to learn”.

“We are pleased to see this research, involving trainee and newly qualified pharmacists, published,” the spokesperson added.

Only through good research can ongoing progress be delivered.”

Continuous learning

CPS says welcoming, supportive care for patients should be a baseline, which was one of the drivers behind the profession working  alongside the Scottish Drugs Forum to ensure mandatory training for Scotland’s naloxone service supported the delivery of stigma and trauma-informed care.

Meanwhile, a national evaluation of Scotland’s mission on drug and alcohol harm identifying unmet need in the drug crisis reported among wider issues that half of recovery service users experienced stigma.

However, the evaluation which heard directly from service users, saw pharmacists emerge as among the most supportive health and care professionals.

Professor in Substance Use Catriona Matheson, who is co-leading the Pharmacy Alliance on Drug Harms says the nuanced picture of drug harms in Scotland extends beyond community pharmacy and stigma.

She told healthandcare.scot that opportunities for improvement span from educating the health and care workforce to addressing wider barriers or gaps in service provision, adding that pharmacy could lead in delivering the change needed:

“Pharmacists are experts in drugs and that extends to drug harms whether prescribed, over the counter or street drugs However, community pharmacies and primary care pharmacists are busy so for this to be given priority there needs to be more resource.

“There are still some negative experiences – as in all services – but a lot of very positive work is ongoing.

“Training is underway and pharmacy is well-positioned to support people, particularly in more deprived communities as the most easily accessing healthcare provider.

“With more resource the training of the pharmacy workforce could be accelerated and more services developed.”

Healthcare Improvement Scotland’s Pharmacy Clinical Lead for Medication Assisted Treatment Standards and research co-author, Adrian Mackenzie added:

“These findings align with national improvement work to ensure that patients accessing pharmaceutical care are not stigmatised but supported by pharmacy teams in a service that contributes to reduction in harms and a recovery-oriented system of care.

“The study found that some patients using pharmacies also had a similar attitude towards those with a substance dependency, including those who already experience other sources of stigma like being in prison, which demonstrates that this is a problem we have across wider society.

“Reducing this will reduce the inequalities experienced and contribute to retention in treatment.”

Read more: Partnership urges action over Scotland's mental health; Tax alcohol retailers for the harm they cause; Families to shape campaign against stigma; Citizens’ panel to help drugs crisis response; A team sport: caring from the community up; Law change needed for Scotland’s drug crisis; Watchdog criticises homelessness service cuts

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