Pharmacists are needed in harm minimisation


sad man in front of graffitied wall: harm minimisation story

Pharmacy is an underutilised resource for those living with addiction, writes Angelo Pricolo—and like other health professionals, pharmacists need a better understanding of the issues

Harm minimisation is a philosophy all pharmacists should adopt. I believe, though, that they do not all exercise it when it relates to illicit drug use.

It’s not just pharmacists in this group, as so too are many doctors, other health professionals and indeed a large proportion of the population.

Sending a submission through to the TGA to down-schedule naloxone minijet from S4 to S3 was an act of harm minimisation. The schedule was a barrier to access and the status quo was a barrier to common sense.

I think an encouraging part of the process in Australia is that any member of the public can prepare a rescheduling submission to the TGA. On this occasion it has meant a barrier to access a life-saving drug has been removed.

Naloxone has no potential to be abused but has the potential to save many lives. Until recently it has only been available with a prescription which meant only the drug user could request the minijet.

With the new OTC status, people in the drug user’s network can now purchase this overdose-reversing drug and receive the necessary counseling they need at the pharmacy.

Part of the reason I argued that further trials were not necessary in my submission to the TGA was that we can look to examples where implementation of this change has been successful. Interestingly, that’s in Italy and some states in the USA.

Now we will have a system where more than 5000 community pharmacies will be able to make this life-saving medicine readily available.

Community pharmacists are the medicine experts and the most qualified to counsel and advise patients of the correct and appropriate use of naloxone.

Pharmacists are already involved in many other harm minimisation measures. Upwards of 40% of pharmacies now dispense methadone or buprenorphine (ORT) and most of these also have made syringe packs available.

This compares favourably to doctors where only about 2% of GPs have active permits to prescribe methadone.

Many argued that being an ORT pharmacy by definition meant you could not possibly also provide syringes.

But most now understand addiction better and realise that abstinence, although a goal for many, usually can only be achieved after many attempts. Banning a smoker from purchasing NRT doesn’t seem to make sense, even if they walk in carrying a pack of cigarettes.

The drug that has captured most of the headlines of late is Ice. Methamphetamine is not a new drug but this form of it has mobilised all sorts of responses, especially from the police. The press has labeled all users as violent and out of control addicts.

What we are really seeing is Ice bingeing, much the same as many do with alcohol, and most of these users are not addicts. They are people who need support and education from their peer networks and health professionals, they need friends to look out for them.

Those usually making the headlines and fuelling the debate by their out–of-control use and crazy behaviour are these “weekend” users.

Pharmacy is one of the underutilised avenues for providing the tools to inform how we can help. Every interface should be explored if it has the capacity to provide help.

We need all health providers and legislators to be more circumspect with their drug policy and shift the paradigm so that the patient once more becomes the centre of the health care system.

 

Angelo Pricolo is a member of the PSA’s Harm Minimisation Committee and a National Councillor with the Pharmacy Guild. He successfully applied to the TGA to have naloxone minijet downscheduled to S3.

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2 Comments

  1. Jarrod McMaugh
    21/10/2015

    I hope pharmacists and doctors who are unsure about harm minimisation read this article, and are persuaded by it to look further into what is involved, the benefits it provides, and how to be a part of it.

    Addiction is a chronic disease and needs to have the same resources as any other chronic disease.

    Binge-use of intoxicants is risky behavious that is often a symptom of a large issue.

    Great article Angelo, and great work on naloxone

  2. Jimmy Brurilius
    21/10/2015

    Well said. Deserves more reads.

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