Harm minimisation from the past to the future

cartoon syringe and hand saying stop

Whether helping smokers or those who use illicit drugs, pharmacists are at the coalface of harm minimisation, writes Angelo Pricolo

Pharmacists are the most important and effective health professional in the implementation of harm minimisation. We can make this statement when we consider the volume of customers and number of programs offered throughout the sizeable network of community pharmacy.

Harm minimisation is an overarching strategy that aims to prevent and reduce the myriad harms associated with the use of psychoactive drugs (licit and illicit) in the community. Pharmacy is involved in all three.

Harm minimisation comprises three major strategies:

  • supply reduction;
  • demand reduction; and
  • harm reduction.

About one-third of all syringes that are used by people who inject drugs are supplied through the pharmacy chain. This is probably a conservative estimate but still represents many millions of clean equipment devices that actively reduce the spread of disease.

Usually these syringes are only available in packs that include swabs, water, filters sometimes and most importantly, a disposal container.

It is also interesting to consider that the drugs being injected include the expected ones from the opioid family, like heroin and diverted prescription drugs. But they also include drugs purchased through the gym industry where the majority of steroids are supplied.

Often these clients have less experience with injecting so pharmacists have the opportunity to inform and educate them so that less harm is done.

The importance of the staged supply of medicines has finally been acknowledged in the 6CPA, so that it is now funded for a small number of patients. It should be expanded and more widely utilised as it represents a unique method for the safe consumption of medicine.

Pharmacists have known this for years.

In fact, pharmacists have employed the staged supply of medicine for some time. On occasions doctors or social workers request it, although sometimes the pharmacist instigates this system, in an attempt to make medicine use safer. Often patients appreciate the intervention although this is not always the case.

Of course running an opioid replacement program is a version of staged supply. Since the 70s in Australia this program has seen lives changed and saved as well as families re-united. About 40% of community pharmacies provide this treatment which compares well with the very small percentage of GPs willing to treat opioid addiction.

Smoking cessation has saved millions of lives around the world and there is still scope for so many more interventions. Pharmacy is perfectly placed with product and knowledge to facilitate the transition to non-smoker.

We need to look at new nicotine liquids that are increasingly being used successfully especially in the US and UK. Limiting ourselves to current treatments is a narrow view and regulators should look at the bigger picture.

Brief intervention is a technique used to initiate change for an unhealthy or risky behaviour such as smoking, lack of exercise or alcohol misuse. As an alcohol intervention it is typically targeted to non-dependent drinkers whose drinking may still be harmful.

Pharmacy is ideally placed to instigate these brief interventions and have been doing them possibly without the technical title for many years.

Of course we will soon be entering a new era as cannabis products become available through medical channels. What pharmacy involvement will be is still not clear but there is no doubt for this drug to be efficiently available to patients of all ages pharmacy networks should be utilized.

Pharmacy has been and continues to be an essential part of the strategy and implementation of harm minimisation in this country.

It is important we understand this and ensure our place in treatment options is appreciated, understood and expanded.

Angelo Pricolo is a National Councillor with The Pharmacy Guild of Australia and a member of the PSA Harm Minimisation Committee. He will be one of several speakers at the Harm Minimisation workshop to be held as a pre-conference event before Pharmacy Connect, on 1 September 2017.

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