How can pharmacists help address the needs of older drug users?

Dr Carole HunterArticle by Dr Carole Hunter, Lead Pharmacist, Addiction Services, NHS Greater Glasgow and Clyde

The Scottish Drugs Forum (SDF) was established in 1986 and aims to improve Scotland’s response to problem drug use. On 23 June it published a report on the challenges facing the increasing population of drug users. As a specialist pharmacist in substance misuse, this report made interesting reading for me and confirmed my view that pharmacists have an increasingly important role to play in addressing the multiple health issues of this emerging large and vulnerable group.

The report, entitled ‘Older People with Drug Problems in Scotland: Addressing the Needs of an Ageing Population’, investigated the needs of people with drug problems aged over 35 years, with an increasing number in their 50s and 60s. People with drug problems in this age group experience many significant health issues usually associated with an older age group, as a result of their drug use, and the effects of premature ageing. Although based in Scotland, the expert group considered evidence from across the UK. The key findings are that older people with drug problems will increasingly become the norm and that services need to adapt to the changing population. The group have significant physical and mental health issues and do not engage well with existing services. Retaining this group in treatment is the most significant protective factor in helping to prevent fatal overdose.

A companion report was also published, entitled ‘Older People with Drug Problems in Scotland: A Mixed Methods Study Exploring Health and Social Support Needs’. This study showed that 32.5% of the participants used over the counter medicines and that 80.5% were prescribed medication. The health issues described included depression, anxiety, chronic pain, heartburn, constipation, asthma, arthritis, high blood pressure, bronchitis, diarrhoea, COPD and heart disease. The report made a number of recommendations and observations relevant to pharmacy, including that the minor ailments scheme in pharmacies should be promoted to help manage co-morbidity symptoms. It also identified the need to screen for chronic respiratory disease and suggested that this could be carried out in “general practice, specialist drug services and community pharmacies through the use of spirometry”. Many pharmacies participate in smoking cessation programmes and this should be promoted to the increasing numbers of older drug users.

Pharmacists are already experienced in providing traditional services for this group including Opioid Replacement Therapy and needle and syringe programmes. An increasing number also provide additional services for drug users, including pharmacist prescribing, blood borne viruses testing and take-home naloxone supplies. The SDF report would indicate that the majority of older drug users are already attending a pharmacy for a range of reasons and that there is scope to help improve their health by identifying needs and working with partners to promote and provide access to the full range of pharmacy services.

The SDF report warned that treatment services are “generally unprepared” to meet their needs. Pharmacists should take steps to ensure that they and their staff are prepared to meet the challenges and provide important pharmaceutical care to help address the multiple health needs of the increasing numbers of older drug users.

The SDF study demonstrated that this group often felt ‘forgotten about’ in treatment. It’s up to us all to make sure that they are not “forgotten about” in pharmacies.

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