As the Department of Health reveals impressive new statistics reflecting an increase in uptake of pharmacy services for drug users, such as the Needle and Syringe Exchange Scheme, focus has shifted towards how pharmacy can help those with addictions.

Michele Horner, a drug outreach worker for the Antrim and Coleraine areas, works to complement existing services as well as often reach users who are as yet not engaged with any services. Michele spoke with NIPinF about her interesting and very valuable role, and how community pharmacists can contribute towards helping drug users to live more fulfilled lives.

“My role means that I approach people in an empathetic, non-judgmental way, whilst promoting healthy lifestyle options and helping the individual to help themselves,” Michele explained. “In my experience, outreach is particularly effective within rural areas where there are fewer services available. It means that for those in need of impartial and professional advice, such services are more accessible through an outreach programme.

“My approach is harm reduction based as opposed to abstinence meaning that the client does not need to be drug-free before I engage with them. In my view, policies that advocate total abstinence treatment as a cure for addiction can be ineffective, as with a programme such as smoking cessation, it is not about a ‘one size fits all’ approach.”

Harm Reduction, as Michele explains, essentially involves healthier options that reduce harm to the individual, their families and the wider community. “Harm Reduction takes a public health or sociomedical approach to drug-use and its consequences,” she continued. “Pharmacists carry out such consultation daily, when they advise their clients which nicotine replacement or alternatives are available, while offering encouragement and explaining the benefits of quitting smoking.”

Since there is no such thing as a typical day as an outreach worker, Michele is highly trained in a number of key consultation areas. “I liaise with both my clients and their families and statuary and non statuary agencies.

“Just within a week I recently advocated on behalf of clients within the judicial system, engaged clients in ‘back to work’ programmes, advised and supported clients around educational projects, attended both physical and mental health appointments, counseled and advised clients in areas pertaining to sexual health and blood born viruses,” Michele added. “I was also involved in crisis intervention, advocacy, referrals to treatment services and sign-posting to the appropriate agencies. Sometimes just a cup of tea and a chat is often support within itself. I also assist and support my clients in developing new skills and offer continuing support.”

So what about involvement with pharmacy services? “I have engaged with pharmacies in the past and often signpost my clients to the appropriate chemist that offers substitute prescribing and/or perhaps needle exchange,” Michele said. “I was previously involved with the development and implementation of community based pharmacy and outreach-based protocols for safer drug-use/safer injection exchange.” Around this time, Michele was also involved as Dr Karen McIlrath’s co-author and researcher on The Prevalence and Risk Behaviour of Intra-Venous Drug Users in Northern Ireland (2005).

Michele believes that there is currently an excellent level of training available to any pharmacy considering providing substitution therapy. “There are many established pharmacies participating in the scheme such as Urban Pharmcay in Belfast that already do wonderful work in this area. The prescribing of methadone in essence is a harm-reduction measure as a vast body of research demonstrates that methadone efficacy in reducing drug-related morbidity, mortality, and criminality, and also improves the quality of life of those dependant on opiates.

Michele also added that pharmacies should be knowledgeable in areas that are often associated with problematic drug-use, for example soft tissue care. “Pharmacists should also be able to avail of their local harm reduction and treatment sources in order to signpost clients their clients in the right direction, for example, the Belfast Outreach Team, Threshold in Ballymena and myself in Coleraine/Antrim,” she added.

“Research shows that brief interventions such as needle exchange are effective models of care. Many of my clients have already formed therapeutic relationships with their pharmacists and it has become a continuum of care that is totally respected by the client group.”

Michele has been liaising with pharmacies for several years now and she reports that all her interactions have been positive. “From my personal experience I believe that negative myths around the drug user or the ‘junkie’ have either eroded or been completely dispelled, with people now looking beyond the addiction and see the person,” she explained. “Pharmacists have made significant steps in helping to remove such stigma and should be accessible, empathetic and tolerant. Of course, within reason since pharmacists are just like outreach workers, only human!”