As the friendly and regular face at the heart of community-based medicine, the pharmacist has an opportunity to profoundly influence welfare, as DDN reports. Lee Collingham: 'The pharmacy is central to everyone's treatment... it's not about checking people out, it's about helping.' \u2018If you\u2019re struggling, you say, \u201cI\u2019m alright\u201d. People pass you and ask, \u201cAre you OK?\u201d and you say, \u201cYes, I\u2019m fine.\u201d It\u2019s just a normal greeting. But you could say, \u201cYou\u2019re going to wish you\u2019d never asked me that. Do you really want to know? I feel like shit, I can\u2019t be arsed with anything, I\u2019m just going through the motions.\u201d\u2019 Lee Collingham is explaining how it can feel when you\u2019re trying to stay in treatment for problematic drug use. He speaks from personal experience and as a service user advocate and peer supporter. \u2018You may not have seen your drug worker for a month. You may have had a breakdown, got yourself back together, had another breakdown.\u2019 And from his own experience: \u2018I\u2019ve regularly started to miss doctor\u2019s appointments. Sometimes it\u2019s because it\u2019s the opposite week to when I get paid and I have to walk two miles. Or it might be because my appointment\u2019s at 8.30am and with me not sleeping well, I might have dropped off at 7am.\u2019 He sees his local pharmacist regularly, just a short walk away, and points out that at the heart of an overloaded treatment system, the pharmacy has an increasingly important role. \u2018The pharmacy is central to everyone\u2019s treatment and they see people more often than anyone else in the system. So there\u2019s a lot of stuff they can do.\u2019 He reels off a list of basic interventions and harm reduction advice, as well as the opportunity to introduce patients to the right kind of hepatitis C treatment to suit their condition \u2013 \u2018if you\u2019re on OST you get one kind of treatment, if you\u2019re a drinker you get another one, and so forth.\u2019 But there\u2019s an overseeing role that can be equally important as far as he\u2019s concerned. \u2018The chemist is the one place they will attend regularly, and there could be better integration with other services,\u2019 he says. \u2018Some people might come in for daily OST pick-up on a Monday, then miss Tuesday and Wednesday. They\u2019re just keeping in treatment, but what are they doing for the other two days if they\u2019re not needing their script? Are they still using? It\u2019s not about checking people out, it\u2019s about helping them to reach their goals and where they want to be \u2013 about not making it problematic so they can\u2019t even come forward with an issue.\u2019 Personally, he values the regular contact and the concern for his welfare \u2013 the little chat while waiting for medication to be made up. \u2018They\u2019ll say \u201care you alright Lee? You seem a bit quiet\u201d or \u201cyou seem a bit off these last few days\u201d. It\u2019s the conversation that leads to help with all aspects of health and wellbeing. \u2018As services and needle exchanges are cut, your prime relationship is more and more with your pharmacist,\u2019 says Nick Goldstein, who is tasked with helping to make this relationship a positive one. Called upon as a representative of the drug-using community (a label he is uncomfortable with, as \u2018we\u2019re not all alike\u2019), he is involved in an initiative by Martindale Pharma with Boots, supporting current and former service users to engage with pre-reg pharmacists as part of their addictions training programme. Goldstein is cautious about overvaluing his role for several reasons. He is talking to pharmacists at the start of their career, rather than decision-makers in charge of culture change. He only has a slot of about half an hour in the training day \u2013 not enough time to go into the level of detail he would like, although questions from participants often take the session beyond its allocated slot. \u2018If I was cynical I\u2019d say it was a case of saying, \u201chey, come and watch the bear dance\u201d. It\u2019s a show for them,\u2019 he says. \u2018In a dry academic day I turn up and I\u2019m a little bit different. And they\u2019re always fascinated, always paying attention.\u2019 But while paying attention, he hopes they are picking up the core points he\u2019s giving them \u2013 and while doing so, that the sessions are helping to address stigma and personalise the process of coming to the pharmacist for OST. \u2018I try to get them to look beyond the reductive labeling and see that we should be treated as individuals,\u2019 he says. Beginning the training three years ago, Goldstein came face to face with the scale of his task. \u2018I realised after doing a few of these sessions that pharmacists have a huge miscomprehension about why people are actually in treatment \u2013 they seem to think we\u2019re there for one long party on the state,\u2019 he says. \u2018And you have to explain to them that that\u2019s not true, especially nowadays. No one goes into treatment for a gig or a good time. You\u2019re there because you\u2019ve lost control of your life, basically. And that\u2019s a very scary thing.\u2019 The stigma is not usually deliberate, but the product of \u2018a mixture of ignorance and apathy\u2019, he says. \u2018They have preconceived prejudices until someone points it out \u2013 that these people are more than the label you\u2019re slapping on them. They\u2019re people\u2019s husbands, fathers, sons, mothers, daughters, and they have careers and a whole range of interests, fears and fantasies. The difference is that they\u2019re addicted to drugs, but apart from that they are just like you. They\u2019re not from Mars.\u2019 While they \u2018don\u2019t even realise beforehand that their attitude could be described as problematic\u2019, there\u2019s a slow dawning process that \u2018addiction\u2019s just a label and these are human beings just like them, and should be treated with the same respect\u2019. With chemist shops moving more and more into community-based medicine, we have a \u2018golden oppor\u00adtunity\u2019 to give pharmacists a better frame of reference for interacting with the community, says Goldstein. In his short, rushed training slot, he is aware that staff from a large pharmacy chain are going to be restricted by standard shop layout and company protocol, relating to the routines they can influence \u2013 things like whether OST should be dispensed from a separate window \u2013 but he introduces the idea of ongoing dialogue. \u2018I\u2019ll say to the pharmacists, ask your clients what they want and at least take that into account when making your decision. Don\u2019t just present them with a fait accompli because that just disenfranchises people from the process and from the treatment.\u2019 Both Collingham and Goldstein talk about the importance of fair play on both sides of the counter. Collingham mentions behavioural contracts as a way of establishing a respectful relationship, for example: \u2018I promise that I won\u2019t treat you like an idiot by stealing from your shop \u2013 and on the pharmacy side, I won\u2019t keep you waiting past clients that come in after you, or identify you as an OST user.\u2019 Goldstein sometimes comes across pharmacists who are keen to share episodes of bad behaviour that took place in their shop, and agrees there are responsibilities that the client must sign up to. He reminds them: \u2018We are individuals. Some of us are fat, some of us are thin. Some of us are nice guys and some of us are assholes. Be clear about this \u2013 but believe in giving the assholes a fair break.\u2019 He is also acutely aware that pharmacists just entering their profession will have no influence over long-established company protocols. \u2018You can point out the dangers of these protocols till you\u2019re blue in the face, but it\u2019s not going to help because they\u2019re not responsible for them. Somebody needs to talk to head office and say \u201chey guys, have you thought about x,y and z?\u201d\u2019 But through the modest training initiative, Goldstein hopes to awaken a desire to know more \u2013 and there is a lot to learn. For instance, they are \u2018completely ignorant\u2019 about naloxone. \u2018Out of the few hundred I\u2019ve trained now, I\u2019ve had only two or three who know what it is. They\u2019re pretty clueless about it,\u2019 he says, adding, \u2018Naloxone is one of those things that should have been around for years, and now it\u2019s happening that\u2019s a great thing. But the way it\u2019s being implemented and put out there leaves a lot to be desired.\u2019 In the limited time he has with the trainee pharmacists, he hammers home the increasingly important role they have to play: \u2018You see your key worker once in a blue moon. You see your consultant even more infrequently. You see your pharmacist fairly regularly, so I point out that they become a key point of contact in the treatment chain. \u2018And that can be the difference \u2013 their attitude and behaviour \u2013 between someone staying in treatment and someone leaving. That\u2019s the difference between life and death in some cases.\u2019 This article has been produced with support from Martindale Pharma, which has not influenced the content in any way.