People with substance dependency may face stigmatisation when they attend community pharmacies and deserve to be treated with greater dignity and respect, according to new research.

The study found that pharmacy students and newly qualified pharmacists in Scotland sometimes observed discriminatory treatment by staff, including negative language, segregation practices and unfriendly attitudes towards people being treated for drug dependency.

Respect and compassion

However, they also saw exemplary practice when respect and compassion were shown, and the patients displayed appreciation in return. There were also signs that a respectful approach could be helpful to the patients’ wellbeing and journey to recovery from addiction. 

Students and new pharmacists also called for their academic training to include more support for dealing with challenging situations in community pharmacies. Since the study was carried out, work has begun to design interventions for de-stigmatising healthcare for people with substance dependency.

It is estimated that just over 30,000 people in Scotland were prescribed opioid agonist therapy (OAT) – a treatment for opioid addiction that involves using prescribed opioid medications such as methadone  – in 2023. In the same year, the nation had 1,172 deaths which were due to drug misuse.

The research has been published in the journal Addiction.

Dr Natalie Weir, a Lecturer in Strathclyde Institute of Pharmacy and Biomedical Sciences, is the lead author of the paper. She said: “Community pharmacies around the world provide an essential service to people with all kinds of health issues and are there to help and support these people. 

However, our research has found that the empathy and professionalism shown to patients is not always extended to those with dependencies, potentially undermining recovery and increasing inequalities. Positive role models among respectful pharmacy staff helped to form students' professional identities, although there was a sense that their university training could be enhanced to prepare them for real-world practice.

Harm reduction

Adrian Mackenzie, Pharmacy Clinical Lead for MAT (Medication Assisted Treatment) Standards with Healthcare Improvement Scotland, co-author of the research, said:  “These findings align with our national improvement work to ensure that patients accessing pharmaceutical care are not stigmatised but are supported by pharmacy teams in a service that contributes to reduction in harms and a recovery-oriented system of care.

The study found that some patients using pharmacies also had a similar attitude towards those with a substance dependency, including those who already experience other sources of stigma like being in prison, which demonstrates that this is a problem we have across wider society. Reducing this will reduce the inequalities experienced and contribute to retention in treatment.

Pharmacists who offered holistic support for people with substance dependency were admired by the students and newly-qualified professionals. One student said: “I didn't quite realise how big a part, or the impact that you can personally have, on one person's life, because you see them every day. If you do it correctly, equally you can have an amazing impact, but you can also have a dreadful impact if you do not do it correctly.”   

Another participant stated that some staff believed people with substance dependency were “too far gone” and added: “They’re just seen as lower class and like they got themselves into that situation, as if it’s their fault. And actually, no one looks at the bigger picture.”

Professor Andrew Radley, of the School of Health Sciences at the University of Dundee, said, “Pharmacies are at the centre of our communities and offer help and care to some of the most vulnerable individuals. Increasingly, pharmacies are seen as the first port of call for healthcare and offer a widening range of clinical services.

“This piece of work offered students a first-class opportunity to undertake research into their future profession and to observe and reflect on the patient experience of services. I am delighted that their work has been published and that they are able to start their careers in pharmacy with due recognition of an excellent research programme.”