‘We don’t want those sorts of people in our pharmacy.’

Pharmacists need to get off their “high horses” about pharmacotherapy, according to a pharmacist profiled by the ABC

This week ABC News ran a feature on the “opioid addiction crisis” affecting rural Australia, focusing on the Victorian town of Bairnsdale.

Iain Cartney, managing pharmacist at Bairnsdale Advantage Pharmacy, told the ABC that he knew of eight deaths due to misuse of fentanyl and other prescription drugs, which were connected to his pharmacy.

Now, he is urging Australia’s pharmacists to consider offering methadone and other pharmacotherapy services.

“You hear comments: ‘we don’t want those sorts of people in our pharmacy, that’s not the image we want’,” he told the AJP.

“Well, I have Chanel, I have Estée Lauder, I have a gift shop with French giftware… my pharmacy is service-driven. I run clinics, my model is professional service provision.”

Helping patients treat their addictions is very much part of the pharmacy’s image, he says, because “I would like to think I look after everyone in my community equally”.

“I’ll help someone with COPD, I do spot checks for melanoma… why is that person more important than someone who needs pharmacotherapy?

“We need to get off our high horses as pharmacists. How can we expect the public to embrace a different outcome for pharmacy if we’re too staid or too set in our ways to grow as people?”


A growing crisis

The ABC piece, by regional affairs reporter Lucy Barbour, featured a young woman who started the day with a shot of Fentanyl: a risky behaviour, given users cannot predict the dose of the drug they inject themselves with.

“People overdose all the time,” the former user told Ms Barbour.

Mr Cartney told the AJP that some of these overdoses have been by his own patients.

“Being such a potent medication it seems to result in fatalities more than other drugs… if you get the dose wrong, you don’t seem to get a second chance to get it right,” he says.

“We’ve known of eight deaths in the last year attributable to fentanyl in relation to people who come directly into my pharmacy, or their associates.

“I’m the only pharmacy in town that does pharmacotherapy, so I’ll hear that so-and-so passed away, and it was through fentanyl abuse.”

There are similar problems with the misuse, and diversion, of other opioids including oxycontin, he says.

In his experience, some of these patients – and those who go on to abuse illicit substances such as heroin – developed a reliance on the drug while being treated by hospitals for legitimate pain.

Poor self-esteem, unemployment, environmental factors and peer pressure may also be factors, he says, as is the fact that on-selling prescription drugs can be lucrative business.

A fentanyl patch can be on-sold for around $100, and Mr Cartney says that oxycontin can fetch $1 a milligram – “so an authority script for a box of oxycontin 80mg, as a genuine painkiller prescribed to the individual, can earn you a lot of money”.

“Somewhere, we need to break the cultural behaviours of these people.”

The Bairnsdale community has teamed up to plan a rehabilitation service, and is seeking Government funding to make it a reality.

Health experts are on board with the project, and Mr Cartney says that now, stakeholders at a federal and local level are needed to work together to create change.

“We want to provide a facility that provides rehabilitation that can help our community.

“We need, as pharmacists and health care providers, to work together to build a more cohesive outcome for these patients.

“The pharmacist and the doctor will see them for half an hour out of a 24-hour period; what are we doing [as a society] to integrate health and education and to help people for the other 23 hours? It’s sadly lacking at the moment.”

He said more work needs to be done countrywide to help prepare for the upschedule to prescription only of low-dose codeine next February.

“It’s good in that it will reduce people using it inappropriately, but how to facilitate the volume of people presenting to local GPs?”

In the meantime, Mr Cartney urged pharmacists who have reservations around offering pharmacotherapy services to reconsider, particularly in rural areas where disadvantaged residents may not have good access to transport to seek these services.

“If you don’t look after them, you increase the chances of them using an illicit drug,” he says.

“Just really revisit it. You’re generally in this business to look after people – so look after all the people you can.”

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  1. Andrew

    Yep – it speaks volumes about the profession that so many stores refuse to dispense OST due to the issues with the patients – usually that they knock off stock, or it isn’t profitable enough. And in doing so these stores have actively decided to focus on being retailers rather than “the most accessible etc etc etc” and contributing to improving the health of the community.
    Is pharmacy risking it’s social license by having such low uptake of OST, picking and choosing which medical treatments to provide the community? Especially in this time of nascent opiod crisis?

  2. Gavin Mingay

    There are legitimate reasons for pharmacies not wanting to provide opioid therapy. The levels of theft skyrocket, the frequency of threats towards pharmacists and staff, the frustration at seeing your opioid replacement patients using therapy as a baseline and continuing to use on the side, frustration at seeing your clients drive after taking a 20ml dose of methadone and knowing that their drivers licence is cancelled for the next twenty years, never ever seeing a patient actually get off the program, the remuneration is not worth it and having to chase up payments from months ago from clients who wont pay…

    • Jarrod McMaugh

      A couple of points Gavin:

      Your points about theft and threats are very valid and should never be tolerated, regardless of the person or the complexity of their condition.

      Frustration for patients using OST as a baseline and continuing to use on the side – keep in mind that OST is about harm minimisation, not abstinence. Clearly it is not ideal, and it is risky behaviour to use both; but abstinence is not actually the purpose.

      Never seeing someone get off the program – addiction to opioids is a chronic condition, the same as diabetes, heart disease, etc. It isn’t cured by OST, and you would not be hoping to see a patient with diabetes “get off” their insulin. While it would be fantastic to see anyone with a chronic condition overcome the underlying cause and not require medication, it isn’t the purpose of treatment.

  3. Michael Khoo

    Did it for years, despite the threats of violence, stalking, having a
    bloody syringe waved at my wife. Never again. not ever. I’d rather leave
    the profession. Can you imagine a night out at the cinema, and being
    followed down the street by a junkie yelling out how you make millions
    selling to addicts? He wanted me to give him 20$ to make him shut up.

  4. Graeme Holloway

    Spot on Ian. A lot of public support is needed from pharmacists now and after the upscheduling. Some pharmacists have let the profession down in the past. I remember seeing Nurofen Plus binned in a Vic country pharmacy of a well known chain a few years ago. Better control by all pharmacists and upscheduling may not have been needed. Addiction is just another disease state with very unfortunate consequences if we do not care appropriately.

    Former large pharmacy owner and now dosing pharmacist in semi-retirement.

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