Pharmacists need support to deliver drug and alcohol treatment

A new report by the Australian Institute of Health and Welfare (AIHW) has revealed the burden of drug and alcohol use in rural and remote Australian communities, and the lack of readily available treatment. But community pharmacists can have a big impact in outpatient care.

The report, Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17, found 8% of people in rural and remote areas consumed alcohol daily versus 5% in major cities. They were also more likely to drink at levels associated with long-term harm (21% compared with 15%).¹

While levels of drug use are comparable between rural and remote areas and urban centres, the burden of disease increased with the level of remoteness, with a higher prevalence of self-inflicted injuries, chronic liver disease and road traffic injuries in isolated areas.

While patients in rural and remote areas were more likely to seek rehabilitative treatment than those in urban areas (1 in every 153 in comparison to 1 in 171), it comes with difficulties. In remote areas, 28% of patients had to travel one hour or longer to access treatment services, with only 10% of patients in urban areas needing to do the same.¹

Pharmacist involvement

In the absence of easily accessible services in rural and remote areas, pharmacists have a role to play in supporting rehabilitation programs run by state government systems, according to rural Queensland-based pharmacist and Mackay PSA member Karalyn Huxhagen.

State-specific alcohol and drug replacement programs are designed to support patients, with the supply of medicines such as methadone, buprenorphine or naltrexone.

These programs reduce the need for patients to travel far from home to seek treatment, which is some cases would otherwise be in an inpatient program. Rather, these programs support people to stay in the community with their families and maintain employment.

Treating doctors will devise a maintenance program for the patient with a regular prescription that the patient needs to pick up from the pharmacy, at set intervals.  

Community pharmacists are not just an access mechanism, Ms Huxhagen said they play a wider role in monitoring patient response to treatment, alerting the care team if the patient isn’t coping and they need to be reassessed.

Pharmacists also had a significant role, she said, in raising awareness of local programs and treatment options and how patients can get into them.

However, Ms Huxhagen said that there is  reservation for community pharmacist participation in replacement programs for a variety of reasons.

Barriers to pharmacist participation

There are certain barriers that prevent pharmacist participation in these programs, Ms Huxhagen said. Firstly, there is the time investment required. ‘Seeing these patients can take time, which can have a big impact if you’re in a busy community pharmacy. You have to dose them, record the dosing and interact with them,’ she said.

Then there are certain risks associated with patient behaviour, coupled with the isolation of many remote pharmacies. ‘If you have any patients that are not well-behaved in your pharmacy, they can upset or cause fear in your other patients,’ she said.

However, Ms Huxhagen said that most of the patients she sees are respectful, receptive to treatment and grateful to be receiving the help that they need.

Putting provisions in place

Ms Huxhagen recommended participating pharmacists work closely with their state-run alcohol and other drug services, who are typically understanding of pharmacists’ fears and their restrictions. There are also state-run training services available for healthcare professionals in managing drug and alcohol treatment, such as the Community Pharmacy Program run by SA Health in South Australia or Victoria’s pharmacotherapy webinars and online training series offered by PSA. Last month, PSA also held Drug and Alcohol Forums across NSW in conjunction with the Primary Health Network (For upcoming PSA training and events, click here).

Ms Huxhagen recommends coming to a clear agreement around patient behaviour, what time dosing is available, and any actions that are not acceptable.

It’s also a pharmacist’s responsibility to be aware of the programs and services available in their community, both government and otherwise, Ms Huxhagen said.

‘In Queensland, for example, there is Ozcare, who have a rehabilitation service. The Salvation Army also has a service where they take in women and children that have been exposed to violence as a consequence of substance and alcohol abuse.

‘We have a list of the support services that are available in our local area that we give out to patients in need, because there are a lot and not all of them are government-run. There are plenty of charities that offer support and counselling and can help patients get into a treatment program.’

References

Australian Institute of Health and Welfare 2019. Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17. At: https://www.aihw.gov.au/getmedia/78ea0b3d-4478-4a1f-a02a-3e3b5175e5d8/aihw-hse-212.pdf.aspx?inline=true