Community pharmacies have always played an integral role in supporting drug users. They provide clean injecting equipment, including needles and syringes, and drugs like Methadone that can help with addiction recovery.

But over the last few years, a group of pharmacies in Lincolnshire has taken this support to another level by joining hands with the charity, With You – formerly Addaction – that assists people struggling with drugs, alcohol and mental health issues.

 

What's happening in Lincolnshire?

 

 

With You started reaching out to community pharmacies across the county in 2012. Today, there are 108 pharmacies working with two pharmacy technicians employed by the charity to help “provide an effective bridge between the community pharmacy and service user”.

Adrienne Horan (pictured above) is a senior technician with the charity, and together with another colleague, she visits the pharmacies in person at least once a year and takes time out to get to know the staff. She also has regular phone conversations with them, handles any questions they have about the charity's clients and gives any related advice. She also offers training and refresher sessions for the use of naloxone kits and lets pharmacists know about projects With You is running so that they can forward the message to their customers.

With You’s director of pharmacy Rachel Britton tells C+D: “Pharmacy technicians are like the glue that make everything work. They have experienced the pressures pharmacists are under and can relate to the challenges.”

For these reasons, “we felt like the technician role was that bridge between my team in central London and our other services across the UK”, she explains.

Right now, With You is focussing on two things: spreading awareness about the prescription medication naloxone, and helping to build better relationships between pharmacists and people using drugs.

 

Why naloxone?

 

Naloxone is used to reverse the effects of drug overdose, mainly life-threatening breathing difficulties. In the UK, it is available in the form of an intramuscular injectable and a nasal spray.

In 2015, legislation was changed to allow drug treatment services commissioned by either the NHS, Public Health England or a local authority to supply naloxone without a prescription to anyone, if an emergency situation arises and it is needed to save a life.

The charity is particularly keen on distributing naloxone given the toll the pandemic has taken on mental health. And in 2021, With You was able to hand out 1,000 kits across Lincolnshire.

Ms Horan says: “We're working really hard to bring more naloxone awareness to pharmacies. In 2021, when we issued all those kits, we changed the narrative around naloxone [in Lincolnshire].

“Pharmacists spoke about it at every single interaction, whether it was face-to-face or over the phone. It was about checking in and asking whether people using drugs still had their kit, whether they had used it.”

Pharmacies themselves cannot offer naloxone directly to patients, but they can tell patients to collect it from With You's service.

However, Department of Health and Social Care proposals to let pharmacists and other professionals such as paramedics, nurses and police officers “hold and give” naloxone have garnered strong support. The results of the consultation and respective actions are due later this year.

Ms Britton explains: “Pharmacies are becoming more interested in understanding naloxone, the next step for us in Lincolnshire is to work with pharmacies to identify groups of clients who they can offer it to.”

 

Relationship building

 

Ms Horan estimates that a person using drugs and undergoing treatment will visit a pharmacy six times a week to collect clean needles or their opioid substitution therapy (OST) medication to aid recovery. And the interaction with a pharmacy team may be the only contact the person has that day or week, which is why it's so important to make it meaningful and positive.

She explains: “We don't want people to be reluctant to access services or help. We need to have professionals checking on our clients' welfare each visit and raising any concerns to us as a prescribing agency.

“It's just a good opportunity to carry out interventions and ask how that person is doing and then signposting to other services like us, GPs or A&E.

“Pharmacists are in a real position to make a positive impact to service users’ lives just by being a welcoming face at each visit.”

“Not everybody treats drug users with the respect they deserve...We treat them just like somebody coming in to pick up a bottle of aspirin”

Margaret Brown is a store manager at Boots pharmacy in Spalding, where there are currently more than 60 patients who either use drugs or are in recovery and seek help and services from her branch.

She has been working with With You for seven years and says just letting patients know that the pharmacists are available to talk to them "has a massive impact" on their wellbeing.

“A lot of patients have mental health issues… Some may not have a lot of self-esteem,” she says. “Lots of these guys aren't allowed to enter other pharmacies because they steal…razor blades, baby milk, anything that's easy to sell.”

As a result, “not everybody treats drug users with the respect they deserve”, Ms Brown says, and With You service users “really appreciate that we're not like that. We treat them just like somebody coming in to pick up a bottle of aspirin”.

A poor relationship – where the person feels stigmatised or disrespected – may mean they pick up their medication less frequently or stop collecting clean injecting equipment.

 

Convincing pharmacies to get on board

 

Ms Britton says the response from pharmacies in Lincolnshire to With You's offer to work together has been “overwhelmingly positive”. And nine out of 10 pharmacies are happy to work with them after a brief conversation.

Ms Brown says her pharmacy's relationship with With You is “amazing”, and she couldn't have taken over 60 patients if they didn't have the charity's support. Working with With You means the pharmacy always has someone to fall back on whenever they need help with a difficult patient, have faulty needles, or need to organise a training session.

“People don't go out of their way to get addicted to drugs, it's just circumstances. It's a passion of mine to help people,” she says, which is made all the easier with the charity’s backing.

"The service provides clean injecting equipment, which reduces drug-related litter, as well as injecting harm, like abscesses, and the spread of blood-borne viruses"

Ms Horan explains that when pharmacies are reluctant to get involved, it's usually due to time constraints, lack of space or miscommunication about what the charity wants. Pharmacy staff have very busy schedules and offer so many additional services like flu vaccinations and now also COVID-19 vaccinations, so they often feel too stretched taking on yet more services like needle and syringe provision.

“Another concern is how much additional traffic the services are going to bring into the pharmacies,” she adds. “From the data I have, I can normally give them an approximation which puts their minds at ease. Pharmacies sometimes think they're going to get a huge influx but really it could just be a handful of people who need that service in their area.”

When Ms Horan encounters a pharmacy that is reluctant to offer these services, she explains what the service entails and how important it is for the local community. For example, providing clean injecting equipment reduces drug-related litter, as well as injecting harm, like abscesses, and the spread of blood-borne viruses, which in turn reduces pressure on GPs and hospitals.

 

Looking to the future

 

With You has got “big plans” for the future says Ms Britton (pictured above), adding how much more pharmacies can do to support people using drugs. Providing wound care packs to people who inject often, but don't seek help for abscesses, is one example. Providing hepatitis C testing, hepatitis B vaccination, and the new medicine Buvidal for opioid dependence is another – some pharmacies in the UK already offer these services, she points out.

The charity also wants to make a more concerted effort to get naloxone into the hands of the hardest-to-reach group, that is, people who use drugs regularly, but are not in contact with a treatment service. One way to do this is by commissioning pharmacies to hand out kits to people coming into their premises, which Ms Britton says is the next step for the charity.

She is now recruiting pharmacy technicians to join her central London team, as With You looks to replicate its success in Lincolnshire across the UK.

“Pharmacies are a fantastic resource and are already doing a lot for our client group but there is more we could commission them to provide,” Ms Britton says.

“The reason that it's not all singing and dancing is because that needs to be funded. But there is additional funding coming into our sector to be able to support more people, so of course we're looking at more ways pharmacy can help us in that.”

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