I attended a very interesting clinical update recently organised by the LPC in conjunction with First Contact Clinical - the local substance misuse team in South Tyneside. We had a really good overview of harm reduction and its place in substance misuse, followed by a case study and an overview of a pharmacy based project to improve uptake of blood born virus screening by positioning nurses from the team into a couple of community pharmacies. The latter may lead to a greater role for pharmacy via the development of a new service...

But by far the most exciting part of the evening was a demonstration of "how to inject heroin safely" and "how to smoke heroin" by a couple of Recovery Buddies. They used coffee granules for the demonstration. Everybody was fascinated by these demonstrations; we heard about chasing the dragon (Smoking heroin off of a piece of tin foil. As the heroin rolls across the tin foil, the smoke moves with it and looks like a dragon. The user follows the smoke with their straw, so chases the dragon), grafting (stealing), beetles (residue left on the foil), gouge (when you're high - the world is peaceful, everything is perfect, you're numb, but in the best way possible). Actually there's a whole new dictionary of terms!

We were told how vulnerable a person is when "gouging" - a person tends to drool, and can fall hurting themselves or be attacked/robbed by people around them.

One of the buddies described how it feels to use heroin..."you have a high and begin gouging, but soon, it starts wearing off. Your mind races, you're pulled out of your dream world. You crave the drug more and more, wanting to feel the same way as you did when high. You go to the dealer and buy the same amount you had the first time, and smoke. Still feels good, but not as good as first time. You go and buy more. Closer, but not quite there. You're stuck; you don't know what to do. You want to go back to that little dream world and stay forever, but your body is already developing a tolerance. You panic. You use all your money to buy more and more and more, but still, not the same as that first time. You realise that you have no more money, so you start selling your things, pawning whatever could get you that next bag. Still, nothing compared to what you had on that first, magical time. So, you're broke and own nothing. But you don't care; all you care about is getting back to the first high. You start stealing, doing "favours", whatever gets you the money for the attempt. Your life becomes a living hell, all in search of a repeat of the first high."

Another of the buddies explained how difficult it is to inject safely, how it's so easy to miss veins leading to infections, how it's so easy when desperate to share needles, how important needle exchange is, and what's in the needle exchange kit. The little pan, the citric acid, the syringe - in fact the whole ritual associated with injecting..."if it's red go ahead, if it's pink, stop and think (it's not the vein)."

As a contractor, offering pre-registration training can be one of the most professionally rewarding things that a pharmacist can do; but it can be time consuming and labour intensive - and there are some competencies that are simply too difficult to offer easily and that are essential for adequate training and preparedness for the pre-registration exam.  As a consequence pharmacist tutors have to seek out these training needs via a 3rd party agency - often at a distance.
 
I am delighted, therefore, to see that our local university - Sunderland University - is now offering an exciting new training program to satisfy these learning objectives. The course is delivered over 10 weeks (one day per week), and, in addition to satisfying the theory required for the examination, gives the pre-registration pharmacist the opportunity to network with other graduates - and experience a trial examination in the actual place were the exam is done - surely a good thing to help with exam nerves!