by Phil Emberley BSc. (Pharm)
I have often been asked what led me to leave my position working for a national pharmacy association to once again work on the pharmacy frontlines. While at the time the decision was a difficult one, at this moment, I would not hesitate to make the same decision.
Late in my pharmacy career, I became interested in the subject of addiction, as the intensity of the opioid crisis increased.
Many of us have lived experiences of mental health disorders in our families. It is clear that addiction, with its propensity for destroying lives, is one of the most devastating mental health disorders that we as pharmacists encounter. One of the sobering realities, and one that cries out for us to take a humanistic approach to those suffering from addiction, is that a majority of addictions can be traced back to childhood or young adult trauma. Most notably, this has been extensively researched by the Canadian addiction specialist and author Gabor Maté.
As a staff pharmacist at Respect Rx Pharmasave in Ottawa, I interact daily with the survivors of addiction; I use the word survivors, because tragically many never make it to treatment, but rather succumb to their addiction. Many of our clients bear not only the scars of childhood/young adulthood trauma, but also the trauma of having lost a close friend or relative to addiction. Since the introduction of fentanyl and its derivatives into the local street drug supply, this additional trauma has become much more prevalent.
While some of our clients became addicted to prescription opioids, the majority were former users of street drugs; this distinction is an important one, as we as a society consider the need for a safer supply of opioids to mitigate the rising fatality rate due to tainted street drugs.
The road to recovery from opioid addiction is a long one. While a person can become addicted in a matter of days, it can take years of treatment to overcome the dependency. Therefore, it is unsurprising to see clients who have been using methadone for several years; in fact, in many cases this is a good sign, because over that time frame, such clients have usually managed to piece together their lives. For many, the cost of addiction includes the loss of jobs, relationships and self-dignity. The latter is extremely important and it is with respect to the de-stigmatization of addiction where pharmacists can have significant impact in the treatment of addiction.
In addiction, as in many chronic disease states, patients most often see their pharmacist the most of any health care professional. I am convinced that the quality of the interaction between a pharmacist and client undergoing treatment for addiction can be a significant determinant of success or failure. Even though it may not be perceptible, many patients with addictions feel a sense of stigma, and this in itself may prevent them from seeking treatment. speak to patients who regularly tell me that for example, when they are hospitalized, they are treated differently as soon as they state that they are being treated for addiction. Patients carry this dread of stigma with them when they enter pharmacies, unsure as to whether they will be dehumanized because of their addiction or whether they will be treated like any other patient. Pharmacists have a wonderful opportunity to build a respectful rapport with these clients. It is of no surprise to me that my boss chose the name Respect Rx; he wanted to make it clear that stigma, and dehumanization have no place in facility where the goal is to help those with addictions to become rehabilitated.
Respect Rx Pharmacy is closely affiliated with Recovery Care, a clinic staffed by addiction specialists. The unique format of the practice allows for a significant amount of interprofessional collaboration, and mutual respect between practitioners, all focussed on helping their clients succeed in treatment. In my 30 years of experience as a pharmacist, I have never experienced this level of collaboration, which is not only professionally fulfilling, but also allows me to have a greater impact on the treatment of clients.
As the opioid crisis has intensified, it has become clear that simply treating those with opioid addiction with methadone or buprenorphine is only part of the solution. Unfortunately, not all patients succeed in recovery, and there are those who will revert to using street drugs. At present strategies to mitigate this and to try and prevent further fatalities include the widespread distribution of naloxone and the creation of a framework for the safer supply of opioids for those who continue to use.
Working at an addiction treatment clinic is, in my mind, a unique experience. More frequently than in any other practice where I have worked, we experience loss of life due to patients losing their battle against addiction and mental health challenges. We also experience success; stories of lives stitched back together again, victory over addiction and the perseverance of the human spirit.
There are no easy solutions to the opioid crisis. However, pharmacists can play a pivotal role in steering their patients towards recovery.
Phil Emberley BSc. (Pharm) is a community pharmacist with over 30 years of experience as a pharmacist, having worked in community practice, government and for the Canadian Pharmacists Association. He is currently clinical lead at Respect Rx Pharmacy, a specialty pharmacy focused on mental health and addictions.