Alcohol and Substance Misuse

High numbers of people are drinking above recommended limits. 41% of men (16-74yrs) and 15% (16-74yrs) of women are drinking at levels hazardous to their health.

Approximately 1 in 8 men and 1 in 24 women have some degree of alcohol dependence. Excess drinking puts long term health at significant risk with excessive alcohol consumption associated with an increased risk of a range of illnesses that collectively contribute to a massive impact on morbidity and mortality.

What Community Pharmacists Can Do

  • Offer advice on sensible drinking
  • Provide prevention activities
  • Give advice on prescription and Over the Counter (OTC) medicines and any interactions with alcohol.

Topics

Drinking Guidelines

The Department of Health's current advice on sensible drinking is:

Men:   It is recommended that men do not drink more than 3 - 4 units per day and no more than 21 units per week.

Women:  It is recommended that women do not drink more than 2 - 3 units per day and no more than 14 units per week.

Drink Free Days

  • Everyone should have at least two alcohol free days per week. 

Pregnant Women

  • Woman who are pregnant or trying to conceive should avoid drinking alcohol. 

Units of alcohol

  • 1 unit = 10ml of pure alcohol.  The number of units of alcohol in a drink depends

 Alcohol units can also be worked out using the following calculation:

   Strength (ABV) x Volume (ml) ¸ 1,000 = Number of Units.

Prevention Activities

As a pharmacist you are more likely to get involved in education and prevention activity such as supporting local and national campaigns. Pharmacists can ensure availability of educational material ie posters, window displays as well as health education leaflets to support campaigns such as "Drinkwise" organised jointly by the Scottish Council on Alcohol and the Health Education For Scotland.

Providing advice to parents It is widely recognised that parental attitudes to drinking and their drinking behaviour can have a profound influence on children's alcohol related attitudes and behaviour. Situations within the pharmacy setting may arise when a parent seeks advice on safe drinking levels, child excessive drinking behaviour.  Packages, information leaflets are available.

Signposting patients to support services As a pharmacist you should be aware of the different local services and document contact details that are available to help people with alcohol problems beyond the scope of your pharmacy practice e.g. Community addiction teams.  NHS Greater Glasgow & Clyde provide access and referral pathways to reduce harm to health caused by the misuse of alcohol.
 
The Scottish Council on Alcohol: The approach employed by this group of agencies is primarily one to one counselling.Through a process of counselling with a trained alcohol counsellor, drinkers are encouraged to identify their own particular problems and to decide their course of action.
 
Alcoholics Anonymous: Provide a form of therapy based on a disease model of alcoholism which assumes fundamental differences between real alcoholics and excessive drinkers.

Links and references

NHS Greater Glasgow & Clyde project manager for Alcohol Screening and Brief Interventions, 
Maureen O'Neil Craig, Telephone 0141 276 6600. To find your local Alcohol Brief Interventions (ABI) Lead, contact Maureen O'Neill Craig on 0141 276 6600.  

Alcohol Focus Scotland - To find support throughout Scotland. Al-Anon   0141 339 8884  Helpline offering support for families and friends of problem drinkers. 

Drinkaware  A Charity promoting responsible drinking, finding ways to challenge the national drinking culture to help reduce alcohol misuse and minimise alcohol-related harm by providing accessible, evidence-based information about alcohol and its effects.
Drinkline
Please note from 1 May 2013, the new operating hours for the Scottish Government’s Know the Score (Drugs information and advice) and Drinkline Scotland (Alcohol information and advice) free, confidential helplines will be from 8 am to 11 pm, 7-days a week.

A 24 hour service had previously been provided, however the new operating hours have been reduced to more closely mirror the hours of demand.

Please be aware, when the Drinkline Scotland helpline is closed (11pm to 8am), callers will be advised of the operating hours and directed to the Samaritans. For non-urgent medical advice, callers will also be advised to contact their to GP or NHS 24.

When the Know the Score helpline is closed (11pm to 8am), callers will be advised of the operating hours and directed to the website at http://knowthescore.info/. For medical emergencies, callers will be advised to contact 999 immediately, or for non-urgent medical advice to contact their GP or NHS 24.

DrinkSmarter
  A Scottish Government practical website with many handy tools, supporting healthier drinking habits. 
NHS 24 -  NHSinform website for drinking questionnaire. 

Alcohol Concern   A charity campaigning for effective alcohol policy and improved services for people whose lives are affected by alcohol-related problems. 

Alcohol Learning Centre   Provides more detailed information on alcohol misuse. 

Community Addiction Team (CAT)  CAT's organise and provide services for those living in Glasgow affected by drugs and alcohol, including accessing 24 / 7 drug crisis centres, Addiction Services to Offenders, Carers Services and Family Support, Community Rehabilitation Services, Mental Health, etc. following an "assessment of needs". 

Glasgow Council on Alcohol (GCA) Providing support, counselling, advice, information, group work and training for those affected by alcohol misuse. 

  • 7th Floor, Newton House, 457 Sauchiehall Street, Glagow G2 3LG
  • Tel: 0141 353 1800
  • Open Monday & Tuesday 9 am - 9 pm
  • Open Wednesday to Friday 9 am - 5 pm

Try this website to find support services through Scotland

Community Addition Team website

Renfrew Council on Alcohol (RCA) Trust  Telephone No. 0141 887 0880.  A charity helping people (their friends, families and employers) with problems with drinks, drugs or gambling. 
 
Leaflets available from Alcohol Focus Scotland
Drinks Diary Available as a useful tool.
Drink Aware Information Available as a useful tool. 
Drinkline Scotland 24 hour freephone – 0800 731 4314
NHS Greater Glasgow and Clyde /Alcohol Services
NHS Greater Glasgow and Clyde - Brief Intervention with Alcohol Use
Link to PERL publications directory – Health Education Resources - leaflets on alcohol

Substance Misuse

Scotland has had a significant problem due to substance misuse for several decades. Substance misuse covers drug misuse both orally and by injection, alcohol consumption, smoking, laxative and solvent abuse- these have a very significant effect on the nation’s health.

The misuse of drugs affects all sectors of society. Pharmacists play an important part in controlling the availability of medicines, in providing information and advice about substances liable to misuse and the associated risks and in providing harm reduction programmes e.g. methadone.
 
What community pharmacists can do?

Raise awareness of potential problems with prescriptions and Over the Counter (OTC) medicines.
Respond to symptoms and problems
Support patients
Refer patients and families to agencies working in partnership.
 
Drug Misuse - Prevention Section

Display of materials relating to substance misuse and substance substitution.

Awareness of OTC sales of substances liable for abuse e.g.codeine or dihydrocodeine containing preparations, anti-histamine sleeping aids, laxatives, and stimulant preparations such as pseudoephedrine.

Awareness of abuse in prescription medication, through frequent repeat prescriptions of medicines with possible abuse potential or diversion of controlled drugs into general population.

Information provision e.g. infected batches of street drugs, high strength batches.

  • Harm reduction / reduction interventions
  • Community pharmacists are the health care professional on the high street, well-placed to deliver harm reduction interventions due to extended opening hours, convenient locations and accessibility of a pharmacist who can provide confidential advice on a wide range of healthcare issues.
  • Harm minimisation is not just for the patient but also for others, who may accidentally be exposed to risks, such as used syringes, and other paraphernalia, and reduces the possible transmission of Hepatitis, HIV and other Blood Borne Viruses (BBV).
  • Provision of clean injecting apparatus at Pharmacy Needle Exchanges – this maybe the only contact with health care professionals that these patients have so sign posting to services as appropriate is essential – encourage the safe disposal of used syringes. It should also be stressed the importance of only using a needle once to reduce the transmission risks and improve vein care.
  • It is important that individuals use not just clean syringes but all paraphernalia as sharing paraphernalia is a source of possible cross infection of Blood Borne Viruses or other bacterial infections.
    Advice may also be given on wound care management, safer injecting practices and referral as appropriate.

Support

  • Ensure Standard Operating Procedures (SOPs) are in place for addiction services offered in the pharmacy, reviewing and standardising procedures for consistent approach from all staff and locums and ensuring these are followed.
  • Once accessing service, patients undergoing substitute therapy still need support and assistance. They may encounter side effects due to the substitute therapy that pharmacists can help with e.g. constipation. Many of these symptoms can be treated through the safe and efficient use of electronic Minor Ailment Service (eMAS) in response to symptoms.
  • Responding to pain may initially be daunting as methadone is an opiate substance, but the analgesic effect of methadone is different to that of normal opiates. The analgesic effect only lasts about 3-4 hours, thus unless receiving a dose about 3 – 4 times a day the pain killing effect is minimal. As a result analgesia for patient receiving methadone is important, but where possible avoidance of codeine and dihydrocodeine containing products is recommended.
  • Dental pain is often significant, poor dental health is caused by several factors such as poor oral hygiene, reduced saliva production and the acidic nature of methadone. The sugar in methadone is not thought to be a significant factor in this process.
  • Child protection guidelines: guidance is provided in the Supervision of Methadone Consumption Standards.
  • Overdose awareness is important, early treatment for a suspect overdose; Naloxone (Narcan) can be administered in life threatening circumstances (Medicines Act, outlined in Medicines, Ethics and Practice (MEP) - a guide for pharmacists and pharmacy technicians.  The Pharmacists and staff should be aware of the possible risks of overdose and the signs of overdose.
  • Referral links – Community Addiction Teams – contact details of each team printed within the Supervision of Methadone Consumption Standards and issued to all pharmacies at regular periods for Glasgow area. 

References and links 

Scottish Drug Forum SDF  Telephone: 0141 221 1175   SDF works in partnership with others to reduce drug harm in Scotland. 

Know the Score    Telephone: 0800 587 5879 Provides information and advice about drugs and the effects of drugs in Scotland. 

Frank     Telephone: 0800 776600    

Supervision of Methadone Consumption Standards     

Glasgow Addiction Services     Telephone: 0141 277 7660              

Narcotics Anonymous               

Blood Borne Viruses (BBV) (Assorted leaflets available from Pharmacy Health Promotion)

Hepatitis C -  C-level     Telephone: 0141 332 2520   C-Level works with those at risk of becoming infected with Hep C, those already affected, their family and friends, and in partnership with professionals supporting "hard to reach" or "at risk" individuals.   

Alcohol / Medicine Interactions
 
Pharmacists can offer advice to individuals on sensible drinking levels in relation to dispensing of prescribed medicines/over the counter medicines with potential hazardous interactions with alcohol.
Drunk man on street