Making pharmacies a stigma-free zone

As someone who is prescribed opioid-based medications to deal with a lifetime of chronic pain due to a genetic condition, Kylie Payne has made going to the pharmacy a part of her daily ritual at various times in her life. Now 42, Kylie has had vastly different experiences interacting with pharmacists over the years. One seemed so cold and judgmental that she ran out in tears. But another supported her through some of her most difficult times, keeping a bowl of her favourite candy around when she came for her daily dose.

Her message to pharmacists everywhere is simple:

“Pain is pain no matter what it is and a person is a person not their addiction,” says Kylie. “That pharmacist who made the effort to get to know me and found out I had a sweet tooth meant so much to me. That warmth and openness made such a difference for someone who was struggling as much as I was.”

With 22 people still dying every day from opioid overdoses, and one in five Canadians without a family doctor, the need for pharmacists to provide frontline care in a supportive and stigma-free environment has never been more important.

That is why CAMH, with funding from the Public Health Agency of Canada and in consultation with stakeholders, has launched a national pharmacy awareness campaign about stigma in pharmacies that includes a new toolkit, Addressing Opioid Stigma in Pharmacies: Strategies for Pharmacy Professionals , to help pharmacy professionals best support clients who have prescriptions for opioids or are on opioid agonist therapy (OAT).

“We know that opioid agonist therapy is life-saving and we know that stigma can be a barrier to that life-saving care,” says the co-designer of the toolkit, CAMH pharmacist and research clinician Beth Sproule. “Ideally treatment is a team effort, a triad between the doctor, the pharmacist and the patient.  This toolkit will help pharmacy professions engage their clients in a stigma-free environment in a way that keeps them coming back for the treatment they seek.”

“It starts from the moment you walk in,” says CAMH patient and family advisor Sean Patenaude, who conducted roundtable consultations with opioid users about their pharmacy experiences, and who has lived experience of opioid use disorder himself. “You might not be feeling great, especially if you are early in your recovery and not used to being out in the world again. You have this long walk to the back of the pharmacy to a desk that is situated a little higher than you are behind a glass partition. If you are on OAT like I was you have to take your dose in front of the pharmacist while people are waiting in line.  It can be a humiliating experience. It’s literally, ‘open your mouth and show me under your tongue’. The most important thing my pharmacist did was make sure I had a quiet space to take my medication. If I had a bad experience with a pharmacist, it really made a difference in how likely I was to continue my treatment.”

The toolkit provides advice, including real-world scenarios presented by people with lived experience during the roundtable consultations, to help pharmacists engage people who are prescribed opioids in a stigma-free environment. It also has custom designed posters that can be downloaded for social media purposes or displayed inside the store.

 “CAMH has always played a leadership role by advocating for OAT and producing national guidelines for that, as well as educating health professionals across the country, so this is a natural extension of that,” says CAMH patient and family education manager Andrew Johnson, who co-designed the toolkit. “This was designed so pharmacists can see the huge impact they can have, positively or negatively, with some of their most vulnerable customers.”

“As leaders, it’s not just important that we do the work, it’s how we do the work,” adds Jordana Rovet, a CAMH Collaborative Learning College coordinator who led much of the engagement work. “This toolkit was thoughtfully designed with the meaningful engagement of people with lived experience and embodied the philosophy of ‘nothing about us without us.’”

“I hope that the patients we engaged feel heard and represented when they see our toolkit, and for the pharmacists using the toolkit,” says CAMH pharmacist Braiden Cutmore who also contributed to the creation of the toolkit. “I hope it allows for some better understanding for our patients using chronic opioids, some more respect for their dignity and humanity, and for some more open and honest communication in order to break down the barriers that stigma has created in our communities.”