ABSTRACT
Introduction ............................................................................................................ 310 Attitude, Stigma and Partnership Working ............................................................ 311 Harm Reduction and Harm Minimization ............................................................. 312 Health Needs Related to the Route of Drug Administration .................................. 313
Injecting............................................................................................................. 313 Skin/Vein Problems ........................................................................................... 313 Viral Infections .................................................................................................. 313 HIV/Acquired Immune Deciency Syndrome (AIDS) ..................................... 313 Hepatitis ............................................................................................................ 315 Hepatitis B ......................................................................................................... 315 Hepatitis C ......................................................................................................... 316
How to Avoid Contracting/Transmitting Hepatitis C ................................... 317 Non-Injection Routes of Administration ........................................................... 317 Health Needs Related to the Drug Being Used ................................................. 317
Drug Interactions ................................................................................................... 319 Poly-Drug Use ....................................................................................................... 319 Premature Death ..................................................................................................... 320
Overdose ........................................................................................................... 320 Psychological and Psychiatric Morbidity .............................................................. 321 Lifestyle-Related Health Needs ............................................................................. 322
Poor Nutritional Status ...................................................................................... 322 Poor Dental Health ............................................................................................ 322 Asthma .............................................................................................................. 322 Diabetes ............................................................................................................. 322 Epilepsy ............................................................................................................. 323 Hepatic and Renal Failure ................................................................................. 323
Special Groups ....................................................................................................... 323 Pregnant Drug Users ......................................................................................... 323 The Homeless .................................................................................................... 324
Specic Points Regarding the Community Pharmacist’s Role .............................. 324 Conclusion ............................................................................................................. 325 Further Reading ..................................................................................................... 325 References .............................................................................................................. 326
Community pharmacists usually encounter a relatively narrow spectrum of the drug-using population. By the nature of the services that they provide, they tend to see either people being dispensed medication to assist them to stop using illicit drugs, usually opiates, or people seeking sterile injecting equipment. However, not all illicit drug use leads to problematic drug use and dependence. The use of heroin and cocaine is, however, particularly associated with dependence. Injecting drug users (IDUs) face particular health risks and social problems. Additionally, they may be reluctant to access treatment or services. This can put pharmacists who operate needle and syringe programmes (NSPs) in a unique position, where they have regular contact with this hard-to-reach, vulnerable group. The provision of sterile injecting equipment is in itself an effective intervention to prevent blood-borne virus (BBV) spread. Additional advice and care can reduce or manage injecting-related complications, such as skin and soft-tissue infections. Signposting to specialist treatment services or general practitioners can lead to large reductions in risk to the individual and benets for the wider public, especially through crime reduction. This chapter is focused on information for pharmacists to inform the delivery of effective pharmacy services for IDUs. Best practice guidance, updated in 2014, is published by the National Institute for Health and Care Excellence (NICE) in England (PH52).
