I’ve had a couple of conversations this week about the way some people feel they are treated in pharmacies when they collect needles. This is something that comes up from time to time, both when I’m talking to injectors and also when I’m talking to pharmacy staff.
It’s even something I cover when I’m training pharmacy staff, and I think it comes from a lack of understanding by some people on both sides.
Pharmacies are an incredibly important aspect of needle distribution in the UK. And they have been ever since needle programmes started back in the 80’s. One of the first was Boots the Chemist in Sheffield which started distributing free needles in 1986.
There are now around 2000 pharmacy programmes, they outnumber formal NSPs by about 3 to 1, and without them we wouldn’t have even a fraction of the coverage we need to get clean equipment out there.
So what is the whole issue with attitudes? Well, from conversations I’d had with injectors they often complain that they are treated with suspicion, mistrust, fear or even disgust by some pharmacy staff. But on the flip side I’ve also spoken to pharmacy staff who say they are treated with aggression and anger by injectors.
As I’ve said, this is something I talk about when training pharmacy staff and when talking to injectors in NSP. Both sides have the following expectations and attitudes:
Fear (of aggression) Mistrust (shoplifting, lying) Lack of confidence in their own knowledge
Fear (of aggression) Mistrust (who will they tell) Expecting to be questioned Lack of confidence in staff knowledge
As you can see the expectations on both sides are mostly the same and these expectations colour the way people react to each other. If you go into a situation expecting a fight then you are going to be hyper defensive. As we already know, heroin users are more likely to be able to identify signs of disgust and anger in others (Study 1, Study 2), so is it any surprise that they are defensive when they enter a pharmacy? Of course there may be many reasons for the reaction they are getting; the worker may just be having a bad day, be tired, be busy, or they could be reacting because of a bad experience they have had in the past. What both sides actually want from the situation is the following:
Respect/polite Positive/friendly Open Confident (in their own knowledge)
Respect/polite Positive/friendly Open Confident (in the workers ability)
Again it’s clear that both groups want the same thing. So, how can we achieve it?
I think when it comes to the confidence issues that this is a training need for pharmacy staff. Pharmacies tend to have a quite high turnover of staff and it’s usual for some of the bigger chains to have locum pharmacists who will only spend a short time in each branch, so training needs to be regularly repeated. It’s also important for all training to have a strong focus on attitudes as well as knowledge.
But most of it can be changed by people in both groups taking time to think what it is like for the other person and to realise that even if someone appears to be in a mood with them then it’s even more important to be polite, friendly and open.
Everyone is different
Of course in the same way that it’s not every heroin injector that shoplifts and gets aggressive in a pharmacy, not every pharmacy worker treats injectors with mistrust and suspicion. If anything the bulk of them are doing their best in a busy job, and in some cases they are fantastically supportive. Those pharmacies that are the most supportive also seem to be the ones who have very few problems with shoplifting and aggression – cause and effect?
The recent NICE NSP guidance which talks about the need to move focus away from strict one to one exchange, which was historically one of the biggest causes of conflict in pharmacy provision.
Nigel Brunsdon is the owner of Injecting Advice.com. He's been working in harm reduction since the 1990's, although he's previously a frontline needle programme worker he now spends most of his time developing online resources for drugs workers and users.