The Importance of a Moral Compass for Pharmacists

After working on the Downtown Eastside of Vancouver in methadone pharmacies, I noticed a common source of pain for just about every homeless individual I met receiving methadone maintenance therapy for addiction – loneliness. I found it so heartbreaking to watch that I quickly burnt out and had to take a hiatus from working in methadone pharmacies despite finding the work very personally rewarding.

Since I’ve moved to Victoria, I’ve worked in a few places that dispense methadone, Suboxone, and Kadian for opioid addiction. These pharmacies don’t specifically cater toward this population, but service them in addition to many other patient groups. Still, I noticed the same aura of loneliness among those using these medicines. Over time, I’ve endeavoured to change my approach to serving this community. Before I even approach one of these patients, I set an intention to connect with them in some small way every single time, human to human. Too often pharmacies consider people with opioid addictions to be a source of conflict and it certainly can be true – theft, disputes, and drama can seem like common occurrences with these patient groups. It can be simpler for a pharmacist to overlook the humanity hiding behind the problem standing in front of them, and sometimes easier to take the role of medication dispenser, nothing more. This very much contradicts why we got into this profession in the first place – we want to help people.

The last pharmacy in which I practiced before beginning my MBA had several patients taking a drug called Kadian for opioid addiction. It’s a capsule to be taken orally, but a particular physician in town wanted the capsules to be opened and the beaded contents spread across a big, unpleasant spoon of pudding to be ingested at the pharmacy counter. Normally, the patient would simply swallow the capsule, and glass of water, but this method is intended to prevent diversion or spitting it out which is a very common problem.

On my first day at this pharmacy, I was warned about a young man, maybe twenty-five, who was apparently a “problem patient”. I was informed of a history of anger and aggression. I decided to reserve judgement and devote an extra effort to this gentleman – I wasn’t going to simply write him off as an “angry addict” although I knew that each interaction would be more challenging. I endeavoured then to see if I could get him to engage differently with me. This meant that I had to be different than the usual pharmacist.

I stood tall and strong when he approached but smiled warmly and demonstrated my willingness to make sure he was attended to in a timely manner. Right away, I could see a shift in his eyes as he hadn’t been exposed to this behaviour before. I talked to him using simple banter, treating him as an absolute equal. He had a bit of a tremor in his hand and a slouch from a possible pain syndrome of which I got the feeling he was rather self-conscious. I tried to honour his humanity by just talking to him like I would anyone else. His first interaction with me was an in-and-out. We discussed how silly it was to make him eat sugary pudding and I offered my opinion that I found it unnecessarily unpleasant and thus demeaning. He agreed and left.

The next day, he appeared more content to see me and offered a little bit more than the day before. I asked him how the therapy was helping him. He didn’t respond with much but was once again surprised to experience someone talking to him as an equal.

The third day, I asked him if he thought his medication was helping. He said, “No”, and we talked about the therapies he’d tried in the past. We discussed how he used and what he wanted to achieve with his therapy. The entire time, the staff at this pharmacy was surprised to see this patient calm and content for the third visit in a row.

Ultimately, he and I had a productive set of interactions over a two-week period. Eventually I wrote a detailed, evidence-based letter to his physician discussing his dose, admission of continued illicit use, and his concerns around his own behaviour. It was based on and described the patient’s desires for his therapy and the issues I saw arising from suboptimal management. Without taking the time to connect with him, I don’t believe he would have engaged with me enough for me to be able to credibly write such a letter. I would have liked to work with him further if only to provide him with the decency it seems like our system can often lack when attempting to help such patient groups.

Six months later, I still think about him and hope that he’s doing well but I fear that the status quo around the way the front-lines interact with individuals like this man are setbacks to his self-esteem, treatment, and ultimately, his wellness. I would have welcomed the opportunity to regularly communicate back and forth with his physician as he progressed through his therapy; I would have liked to build a safety net around him of connected, caring practitioners who together were collaborating on and advocating for his well-being. Sadly, I find that the system in which we work can be more effective at alotting the tangible resources needed for therapy while overlooking the need for human connection.

I believe there’s so much more we could be doing, beginning with re-examining a lot of our assumptions and judgements about those suffering from drug addiction. While nearly every health professional with whom I’ve worked has been understanding and reasonable, in practice, healthcare delivery can reflect a negativity perpetuated by media, politics, and the public at large. Furthermore, working in a burnout environment lacking adequate resources can easily weaken healthcare delivery to patients who are at their lowest point. In an ideal world, every interaction with a patient suffering from drug addiction would be in a system where all incentives were aligned with freely providing empathy and compassion. Unfortunately, it can often seem hopeless trying to find a balance between our moral compass and a system that favours quick, simple interactions.

No matter our pre-conceived notions around addiction and self-determination, we must understand at the most basic human level that behind the erratic body language, the disengagement, and the shouting is another human being – just like us – who’s been ravaged by an illness. It’s not happening to them because they are less worthy nor weaker than ourselves and most of all, it was not a choice. They are not failures at being human. They are not their addiction.