‘Lena left a big impression on me and my practice as a pharmacist’
Dr Rachel Britton, Director of Pharmacy for the charity With You, talks to the SSA’s Natalie Davies about the significant impact one person had on her professional life and perspective, and the role pharmacists and pharmacy technicians can play in a person’s recovery.
Natalie: You recently published a blog in the Pharmaceutical Journal, which opens with a story about Lena (name changed to protect her privacy). Can you tell us about Lena – where you met her, what she was like, and how she informed your professional life?
Rachel: “I first met Lena in 1997 when I was working in a small Bristol pharmacy a year after I qualified as a pharmacist. Lena stood out amongst the people who came in everyday for supervised methadone. This was because she often wore a pouch around her neck which I assumed was a purse, until a little brown head with a pointy nose and whiskers popped its head out one day. The next time I was working I asked Lena about the creature in her pouch. It was Nibbles – her pet rat! I quite like rats, so gradually through Nibbles I got to know Lena. She told me about her childhood and the abuse that she’d suffered at the hands of a relative. She found heroin when she was 17 and said it felt like a comforting hug compared to the memories of the abuse she’d experienced.”
As a pharmacist who saw Lena most days, I was able to notice her behaviour and be an early warning system to any changes
“I remember telephoning Lena’s drug worker when I became concerned that she’d missed a few days of pick-up. He reluctantly told me that she’d been in hospital after overdosing on methadone and alcohol. We spoke about Lena and it became clear that I knew things about her and her life that were not apparent to her drug worker. Because of this, I was invited to a multidisciplinary team meeting about Lena – the first time that the drug service had asked a community pharmacist to attend. This surprised me because, as a pharmacist who saw Lena most days, I was able to notice her behaviour and be an early warning system to any changes.”
“Sadly, Lena began to deteriorate, which took its toll on me. I felt powerless. I cried a lot. I moved on from that small city-centre pharmacy after nine months. By the time I left, Lena had stopped coming in altogether. For years I didn’t know whether she was alive or dead, but a chance meeting with her drug worker confirmed that she’d sadly passed away.”
You undertook a PhD after you had qualified as a pharmacist, and decided to focus your research on how pharmacies can support people who use drugs, for example through services such as supervised consumption and needle exchanges. Was Lena one of the motivations for tackling this subject?
“Lena left a big impression on me and my practice as a pharmacist. Wherever I worked I made sure that dispensary staff looked at supervised consumption of methadone through the eyes of the client. For example, in one large pharmacy in the centre of Bristol, I was able to have a small partition installed to give people a little more privacy.”
My research found that pharmacists with a positive attitude to people who use drugs tended to have service users who did ‘better’ than pharmacists who demonstrated negative attitudes
“In 2001, I attended a Centre for Pharmacy Postgraduate Education (CPPE) lecture given by Dr Jenny Scott, a pharmacist researcher/lecturer at Bath University. She spoke about how pharmacists could improve care for people who use drugs. We met for coffee a few weeks later and I asked her about the possibility of conducting some research into this. Fast forward six years (and one baby) later and I successfully defended my PhD thesis, and changed the title on my cheque book to ‘Dr Rachel Britton’!”
“My research found that pharmacists with a positive attitude to people who use drugs tended to have service users who did ‘better’ than pharmacists who demonstrated negative attitudes. Sadly, I had fellow pharmacists telling me that drug use was a ‘choice’ and that people who use drugs are in some way weak or lazy. However, on the flip side, I met some incredible pharmacists who were passionate about supporting people who use drugs, and who to this day remain close friends and colleagues.”
You are now Director of Pharmacy at With You, a charity that offers free, confidential support to people in England and Scotland who have problems with drugs, alcohol or mental health. What does your role involve, and what do you hope to achieve while in this job?
“My team supports the safe and effective use of medication prescribed in our services. We work with our prescribers and recovery workers to ensure that interventions such as supervised consumption of medication are used appropriately and that liberation from daily attendance at the pharmacy is achieved as soon as possible. We also work with our prescribers to support them to prescribe evidence-based doses of methadone and buprenorphine, and that detoxification is a defined part of treatment rather than a gradual ‘chipping away’ at doses, which can erode the ability to manage cravings in someone who is not ready to detox.”
My hope is that our services fully integrate clinical care with psychosocial techniques in a trauma-informed environment using optimum doses of medication, which give the best opportunity and support for our service users to achieve recovery (whatever recovery looks like for the individual)
“Crucially, my team and the pharmacists and pharmacy technicians based in our services provide regular support and training to our community pharmacy colleagues. As advocates for our service users we work closely with colleagues – who we understand are dealing with workforce shortages and increased workloads – so they can provide the best care to people who use drugs. Practically speaking, this happens through training, audits, incident support and feedback, and review of our service-level agreements to ensure that they meet the needs of our service users. Our service-based pharmacy professionals have worked hard to build up relationships with their community colleagues and I am proud of what they have achieved.”
“My hope is that our services fully integrate clinical care with psychosocial techniques in a trauma-informed environment using optimum doses of medication, which give the best opportunity and support for our service users to achieve recovery (whatever recovery looks like for the individual). I hope my community pharmacy colleagues play an active part in an individual’s recovery. The sector has suffered from chronic underfunding for years, but my hope is that the new money that has accompanied the Government’s drug strategy will help us to improve and innovate and reverse the sickening trend of drug-related deaths.”
You talked in your blog about the crucial role of the pharmacy technician for improving the delivery of services for people with substance use problems. For people who don’t know, can you explain what a pharmacy technician does, and why pharmacy technicians “are in a great position to know how pharmacies can best support […] clients”?
“Pharmacy technicians are key members of the pharmacy team, involved in purchasing, manufacturing, preparing and conducting the final check before supplying the medicines. They may also support medicine use reviews to help ensure patients are taking their medication properly, and help provide medication in hospitals and prisons.”
Technicians can ‘set the tone’ for how services are provided
“Technicians are very likely to come into contact with our service users in their day-to-day job, which means they are ideally placed to support services for people who use drugs and can ‘set the tone’ for how those services are provided. When there are questions or problems with prescriptions it is often the pharmacy technician that our clinical staff will speak to in order to work out a solution.”
“Because technicians are trained in the environment in which they work they have a strong understanding of how pharmacies operate but also the operational issues that some pharmacies face. This is why With You took the decision to invest in pharmacy technicians to be based in our services so they can be the main liaison with the pharmacies we work with.”
Dr Rachel Britton is Director of Pharmacy for With You, a drug, alcohol and mental health charity in England and Wales. In June 2022, she published a blog with the Pharmaceutical Journal titled “Pharmacies and opioid dependency: working together to better support recovery”.
edited by Natalie Davies
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