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Letters to the Editor
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Community pharmacy
Many pharmacists find satisfaction in dealing with drug misusers
From Mr G. N. Parsons, MRPharmS
J. S. Bowman puts forward the case of excluding “drug misusers” from
community pharmacies (PJ, 14 February, p184). I do not think that as
a caring health care profession we have the right to choose the people
who visit our pharmacies. Taking this to its logical conclusion, one
could argue whether it is right to dispense for the schizophrenic patient
who could easily fall within the criteria listed in Mr Bowman’s
letter, especially if he or she is a dual diagnosis patient.
Mr Bowman’s labelling of this whole group as “threatening
... intimidating ... security risk to the store” is irresponsible.
Yes, some clients do fall within this category and if they do not abide
by the agreements in place they will be excluded from treatment or their
prescription will be dispensed by a “specialist” community
pharmacy which deals with the more challenging clients in the community.
The great majority of the service users in my pharmacy do not fall into
this category.
If Mr Bowman is concerned with the “hassles of receiving accurately
written prescriptions ... suitable storage ... and book keeping” perhaps
he should consider not dispensing schedule 2 and 3 Controlled Drugs at
all.
If we want to engage this client group we must ensure that the treatment
meets their needs, and this includes convenient dispensing of their prescriptions.
Having to travel across a town or city every day to pick up their prescriptions
from a designated drug clinic will not only stigmatise them but would
be difficult logistically for many service users and would soon lead
to disengagement from service provision.
Many pharmacists get great satisfaction from dealing with “drug
misusers” and forming good pharmacist-patient relationships with
them. In addition this is often appreciated by the service user. Negative
attitudes in any area of service provision will be picked up by the service
user and will not help in developing this relationship.
The role of the community pharmacist in the treatment of drug misusers
should continue. It is one area in which there is a true multidisciplinary
approach with pharmacists fully integrated into the treatment plan of
the patient. Long may it continue.
Graham Parsons
Plymouth, Devon
Only untreated addicts are to be feared
Mr R. I. Dunkley, MRPharmS
I must remonstrate in the fullest degree about the comments of J.
S. Bowman (PJ, 14 February, p184) on the treatment of drug misusers in community
pharmacies. The addicts that visit my pharmacy are well behaved and take
their supervised medicines as prescribed. I believe that if an addict
is getting enough methadone then he or she has no need to shoplift in
order to buy heroin. I would suggest that Mr Bowman approach his drug
services to make sure that the doses of methadone being prescribed are
adequate. This is what I did when I experienced regular shoplifting in
my pharmacy. The ceiling dose of methadone was 30ml and patients had
to use heroin on top of this because their methadone dose was sub-optimal.
Pharmacists who treat addicts are in a privileged position — they
see them every day and can assess the condition they are in. If they
come in on a hot day swaddled in clothes then they are in withdrawal,
and the drug worker needs to be informed. If they are all “droopy” and
on the point of “guaching” (addict slang for dozing), then
the dose is too high and this should be relayed back to the drug clinic.
There are few enough pharmacists who take a real interest in what happens
to drug misusers. If Mr Bowman’s proposal is followed then there
would not be any at all, and a valuable contact with this patient group
would be lost.
As to the remuneration aspect, I would provide a service to addicts free
of charge, so convinced am I that it is vital. The only addicts that
the community have to fear are those who are not in treatment. I believe
that addicts in treatment, at the correct dose, are a joy to behold because
they appreciate that you are helping to get them back to some sort of
normality.
Bob Dunkley
Dewsbury,
West Yorkshire
Discrimination is wrong
From Mr A. Bellingham, MRPharmS
I was shocked by J. S.
Bowman’s views on drug misusers (PJ, 14
February, p184). I have provided drug misuse services and I have seen
all the negative things that Mr Bowman describes. However, I believe
that it is wrong to discriminate against all drug misuse patients, based
on the actions of some others. Most methadone schemes require the patients
to sign a behaviour contract that outlines what is expected of them and
what the repercussions will be if they break this contract.
Mr Bowman believes that
these individuals should be hidden away from society and dealt with
in separate clinics. The individuals are already isolated and shunned
by society. By treating these patients in the community we are helping
reintegrate them into society.
Mr Bowman finds it is a “hassle” to deal with regulations
surrounding dispensing a prescription for Controlled Drugs. Would he
refuse to dispense MST for a terminally ill patient?
As health care professionals we have a duty of care to all our patients
and should not pick and choose whom we deal with. Personally I get a
great deal of satisfaction from helping my methadone patients in an attempt
to rebuild their lives.
Andrew Bellingham
Nottingham
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Pharmaceutical Journal