Many of us will be able to identify our own ‘addiction’, whether it’s for tea, coffee, alcohol or nicotine. Most of these behaviours are socially acceptable, but for those that can be harmful — such as drinking and smoking — pharmacists provide support and treatment to minimise harm to users and those around them.
But views around street drugs can be very different; illicit drug use is currently subject to criminal sanctions so users are less likely to seek help and support. They are a vulnerable group who are often overlooked by mainstream healthcare services.
There is a clear need for improved care for people who take street drugs and for better information about their drugs’ content. Healthcare professionals have a significant role to play here.
Telling people about their drugs
In March 2018, at a conference on street drugs held by the University of Manchester, I heard the results of The Loop’s drug-testing initiative at music festivals, which show that many substances tested were not what they were purported to be, contained contaminants or, in some cases, were stronger than indicated.
After receiving this information, many people chose not to use what they had bought and advised friends of the risk. Drug testing reduced medical incidents by 25% at Boomtown festival. And the lives of two festival-goers were saved in intensive care after they were revealed to have taken a dangerous substance, and not MDMA as they had intended. But people will volunteer information about the drugs they are taking only when they do not fear the risk of criminal sanctions.
Pharmacists building trust with patients
In the pharmacy, we see many people who have used or are using street drugs — this is a perfect opportunity to ‘make every contact count’. We should engage with these people and allow them to build trust so they can feel they are in a safe place to seek advice and help.
As a pharmacist, I should have a non-judgemental attitude and demonstrate my willingness to help and support those already in an opiate substitution programme and also those who may be using a needle exchange programme, or seeking advice and support for other reasons.
These people can have very complex issues and needs, and we must be able to direct them to support networks that can help them. Pharmacists should make an effort to find out about the resources and services available in their local area, and act as a guiding hand.
We also have the opportunity to intervene before triggers lead to substance abuse. Pharmacists who are able to provide advice, support and referral to local community and voluntary organisations can support people in avoiding becoming addicted drug users.
A human touch
Pharmacists should see caring for people at times of need as part of our public health duty. Our role as advocates for those whose needs may be lost in mainstream healthcare is an opportunity for us to show our essential place in supporting the health and wellbeing of the whole population. The human touch cannot be replaced by helplines or online resources; they do not reach those who are likely to have the greatest need or those for whom the current criminal approach makes most vulnerable.
Of course, in the long run, society needs to deal with the root cause of much of this alienation — the criminal status of those who use street drugs. In 2016, the Royal Society of Public Health’s report ‘Taking a new line on drugs’ advocated for the control of drug policy to pass from the Home Office to the Department of Health and Social Care, and for policy to be based on evidence rather than ideology. And in April 2018, Jane Dacre, president of the Royal College of Physicians, supported this position: “The criminal justice system is not the place to address the often complex needs of people addicted to drugs.”
In my personal view, as a profession, we should align ourselves with the Royal Society of Public Health and the Royal College of Physicians: users of street drugs need health advice and support, not criminal convictions.
Ash Soni, community pharmacist and president, Royal Pharmaceutical Society (RPS).
This is a personal view and should not be seen as the policy position of the RPS.