Harry McQuillan: A pathway to better health for Scotland's older addicts

In July this year, Public Health Minister Aileen Campbell announced a refresh of Scotland's drug strategy, aimed at responding to the changing landscape of the country's substance misuse issues. This refresh is all the more relevant and timeous now, given the recent passing of a resolution on Drug reform at the SNP Autumn conference. Members called for all powers relating to drugs policy to be transferred to the Scottish Parliament, and for problem drug use to be approached as not a criminal issue, but one of public health. This has been the professional view for some time, recognising that addiction is a chronic, relapsing illness which has a devastating effect on the lives of individuals, their families and wider society if not managed properly.

Scotland's pharmacists are helping older addicts self-manage complex medical conditions

Over the last ten years, we have seen substance misuse in younger people fall, and as such the proportion of people over 35 with this issue in Scotland is growing. In fact, nearly half of people assessed for specialist drug treatment in 2014-15 fell into this age bracket. These individuals often have a prolonged history of drug-related problems, and as they age begin to suffer from more and more complex and severe health issues including (but not limited to) viral infections, mental health diagnoses and cardiovascular disease. Whilst each locality has well-established and accessible care pathways for those who have drug problems, a poor social experience and outlook combined with an often chaotic lifestyle can prevent people from staying in treatment, or indeed entering it in the first place.

This is particularly pronounced in this growing, older population which is why the refreshed drug strategy will be built around a “seek, treat and keep” principle. With this aim, the Scottish Government is acknowledging it is not enough just to respond to those seeking help, more must be done to encourage people to stay in programmes, bringing much-needed stability to their lives and those of the people surrounding them.

Across the country, community pharmacy teams often play an integral part in improving the health of those with addictions. Medication provided in pharmacies does have a role in helping those with otherwise chaotic lifestyles find order and consistency, but although this is the part of treatment which garners most attention, it is only one piece of a larger puzzle which leads to improved outcomes for this patient group. Pharmacists and their teams usually have more direct contact with the people they treat for substance misuse than any other health or social care staff, and they provide support in many ways. Minor ailments can be assessed and treated as appropriate, links with community and third sector organisations can lead to education and employment opportunities and clinical handovers to other healthcare professionals can be facilitated where necessary. More recently, community pharmacy teams have been getting closely involved with the Scottish Government’s drive to eradicate Hepatitis C. By working closely with hospital teams and patients, they have made a significant contribution to this public health issue, delivering success rates beyond that seen in any other healthcare setting so far.

Harry McQuillan is chief executive of Community Pharmacy Scotland.

However, there is much more that can be done. With more and more older people coming through the system with multiple long-term conditions, community pharmacists are well placed to support self-management and avoid admission to secondary care by using their unique expertise in medicines usage. This already happens where patients settle enough to feel able to turn their attentions to health issues other than addiction, but we are limited in the number of people that can achieve this level of stability when the system and policy surrounding them was not designed for people with complex needs. This is why Community Pharmacy Scotland welcomes the refresh of the “Road to Recovery” strategy, and is looking forward to contributing to the new vision.

Harry McQuillan is chief executive of Community Pharmacy Scotland.