Pharmacy has an important role in supporting people with alcohol issues
How can we make more of a difference?
The pharmacy profession is very good at talking to people about their medicines: doses, side effects, indications, interactions etc. As experts in medicines we endeavour to keep up to speed with the latest guidance and evidence. Although we work in challenging climates, we aspire to be as holistic and patient-centred as possible.
We know alcohol dependency is a drain on healthcare resources and has wider socio-economic consequences. Millions of people across the UK have personal experience of an alcohol issue. It’s approximated that four out of five dependent drinkers aren’t in treatment. We know that the people affected are stigmatised, can be vulnerable, have often experienced trauma and frequently present with other physical and mental health needs. So when a patient uses alcohol, what do we do?
Specialist drug and alcohol services are typically commissioned to deliver an integrated service, where people get access to psychosocial (and prescribed) interventions, regardless of the substance that they have a problem with. Sadly our public health budgets continue to shrink at a time when alcohol-related deaths and hospital admissions are increasing. This means that services and their commissioners often can’t afford to do everything they’d like to. Wouldn’t it be great to see more community alcohol detox by pharmacies? We have pathways mapped for services in some areas, for example on the more remote Isles of Scilly and in rural services like Cornwall, so it could happen more across the UK too.
What else makes a difference? There’s very good evidence to support the use of brief interventions. This isn’t something that takes hours to do and doesn’t require highly specialist training. Some community pharmacy contractors are commissioned to do this. Some routinely ask questions about alcohol use in their daily practice without even realising. Asking open, non-judgemental questions during a Medicines Use Review, for example, can be highly effective. With stats like 1 in 8 people reducing their drinking as a result, it’s shown to make a difference.
But how well trained are pharmacy professionals in spotting potential signs of alcohol withdrawal? And where does funding for training come from at a time of scarce resource? There’s not nearly enough pharmacists working in substance misuse, but we’re an enormous asset to organisations where we do exist. This isn’t just a ‘pharmacist’ thing, it’s also vitally important that we don’t forget about pharmacy technicians and assistants. The wider ‘pharmacy team’ has an important role to play and must not be overlooked.
In the local hospital is there a specialist liaison team or someone from the community service who can help you organise a ‘plan’ for support post-discharge? Does the care pathway even exist? In primary care, if there isn’t local specialist pharmacy resource, do you know someone who might be able to help? On an even more basic level, do you know how to contact your local substance misuse service? And perhaps more importantly, are pathways in place for signposting and referring people in to treatment?
Checking adherence is essential — not just about medication but also with alcohol. We know that suddenly stopping when drinking dependently can be fatal and repeated detox increases the risk of complications. When a patient is drinking dependently it is possible that their adherence might not be the best, which means that dosing frequency in the context of that person needs to be thought about more carefully. Also, interactions: we’re familiar with enhanced sedation when alcohol is used alongside medication that can also cause drowsiness, like opioids and benzodiazepines. This means that being alert to the risk of accidental overdose is even more important. How often is cocaethylene discussed?
We have a role in challenging stigma. Remember, no one wakes up thinking ‘I’m going to become dependent on alcohol today’. Supporting loved ones who have a problem with alcohol can also be exhausting and isolating. We need to look and listen and ask. We must not be afraid of the responses we might get.
And finally, we need to look after ourselves and each other. We work in high pressure environments, with challenging targets and scarce resources. Signs that too much alcohol is being drunk can include routinely reaching for a drink to relax, underestimating how much is being drunk or drinking more to get the same effect as before. Support is out there if we need it. In the last three years, Pharmacist Support have provided 156 acts of support (including help with concerns about alcohol) via their Addiction Support Programme, 62 of which were with new people. Groups and 1–2–1 sessions are available, and can also be offered by other organisations and locally commissioned specialist providers such as Addaction.
Reaching out for help and support when we need it isn’t just important, it’s vital. An empty tank will take you nowhere, take time to refuel.
