A welcoming pharmacy for people with substance use disorders

Community pharmacies are often the first and easiest healthcare contact for people who use alcohol or drugs. A prescription refill, an opioid treatment dose, naloxone or an injury can bring someone through the door without an appointment. If that encounter is met with suspicion, embarrassment or a lecture, the pharmacy can reinforce the stigma that already affects their care.

Change begins with how the whole pharmacy team communicates. People with substance use disorders, including opioid dependence and alcohol use disorder, deserve respectful, confidential and clinically useful care. This requires practical changes to language, privacy, medication services, referral pathways and staff training rather than a symbolic gesture or a single poster.

How stigma reaches the counter

Stigma at the counter can be subtle. A raised eyebrow, a delayed prescription, a change in tone or a public comment about another person’s substance use can communicate disapproval. Labels such as “non-compliant”, “drug seeker” or “difficult patient” reduce a person to behaviour and make honest communication less likely. They also obscure issues that matter for safe treatment, including withdrawal, pain, side effects and difficulty maintaining a dosing routine.

These attitudes can discourage people from asking for naloxone, disclosing an overdose, requesting a private consultation or accepting referral to treatment. Some may leave and seek another pharmacy, while others delay urgent care. The resulting harm extends beyond one missed interaction: delayed treatment, repeated presentations to emergency departments and increased exposure to unsafe supply.

Stigma also comes from systems. Busy dispensaries, insufficient staffing, limited privacy and targets focused on throughput can make it difficult to slow down for a conversation. Individual compassion cannot remove those pressures. Pharmacists can examine their own assumptions through professional reflection, such as the perspective offered by Johnathan Laird, while pharmacy owners and managers address the organisational conditions that shape each encounter.

Language that protects dignity and safety

Use language that identifies a person and their condition without defining them by it. “Person who uses drugs” is generally more respectful than “drug abuser”, while “treatment for opioid dependence” is preferable to implying that a person is merely dependent on a substance. Ask how the person describes their situation, especially when discussing preferred names, pronouns, substance use and goals for care.

A trauma-informed approach supports this language. Give people choice, explain what will happen with their information and avoid demanding disclosure as a condition of receiving ordinary pharmacy services. A simple acknowledgement— “I’m glad you asked” or “there are options for keeping you safe”— can make a person feel heard. Teach-back is also useful because it checks understanding without blaming the person when instructions were not clear.

Clinical documentation should be factual and free of moral judgements. Describe observed behaviour, reported use, medication doses, withdrawal signs and the care plan. A Spanish-language Exantema clinical review illustrates the importance of careful assessment when skin findings occur in people with HIV and opportunistic infections. Presenting symptoms deserve rigorous investigation regardless of a patient’s lifestyle, substance use or social circumstances.

Design the space and workflow for privacy

Privacy is a clinical safeguard as well as a courtesy. A counselling area should be available, sound-protected and used consistently for sensitive discussions. The team should avoid announcing a person’s medicine, treatment status or concern at the counter. Where a private room is unavailable, offer a quieter space or arrange an appropriate referral rather than conducting a detailed clinical conversation within earshot of other customers.

Physical design must also support accessibility. Seating, clear signage, accessible entrances and materials in community languages help people remain engaged. High-street and neighbourhood pharmacies in Melbourne, Sydney, Brisbane and Perth, along with those serving regional and remote communities, often combine healthcare duties with retail activity. Layouts should preserve dignity even in small premises where the dispensary is visible from the front counter.

Cultural safety requires more than translated signage. Aboriginal and Torres Strait Islander people may have established relationships with Aboriginal Community Controlled Health Services or local medical services. Pharmacists should learn how their nearest services operate, ask about relevant cultural protocols and avoid assuming that one approach will suit every person. Involving an Aboriginal health worker or liaison service can support better communication and continuity when the patient wants that support.

Deliver medication care without moral judgement

Opioid agonist treatment with methadone or buprenorphine is a central service in many Australian community pharmacies. Access and supply arrangements differ between states, and doses may be supervised or taken away according to jurisdictional rules and clinical circumstances. Pharmacy staff should know the local requirements while avoiding a common error: treating a person receiving opioid agonist treatment as inherently unstable or incapable of participating in ordinary healthcare decisions.

Harm reduction belongs within routine pharmacy care. Pharmacist-supplied naloxone is available across Australia without a prescription, and every person who uses opioids, lives with a history of overdose or supports someone at risk should be offered a brief conversation about its use. The Pharmaceutical Benefits Scheme, Medicare and state-funded treatment services create different billing and referral pathways, so pharmacy teams should help patients navigate those systems without making access depend on extra appointments or repeated disclosure.

Medication reviews also need to consider pain, alcohol, benzodiazepines, stimulant use and other prescribed medicines. If a person runs out of their opioid medicine early, ask about what happened and offer options for a safe supply or same-day support where appropriate. Assume that a prescription was lost, stolen, changed or affected by a difficult journey until the circumstances are understood. Safe opioid disposal programs can then provide a practical route for returning unused medicines without leaving them accessible to children or others.

Build local pathways around the patient

A welcoming pharmacy is connected to services that can continue care after the consultation. Build relationships with general practitioners, alcohol and other drug services, mental health teams, needle and syringe programs, overdose response services and local hospitals. Include Aboriginal medical services and specialist services where distance or waiting times would otherwise create gaps. A current referral directory with contacts, opening hours and eligibility details is more useful than a general leaflet.

Warm handoffs are often more effective than simply providing a phone number. With the patient’s consent, the pharmacist can make the call, arrange an appointment and send the required information. If the patient declines, record the information provided and offer a private way to revisit it. Explain what confidentiality applies, what information may be shared and how the patient can control consent wherever the law allows.

Follow-up should fit the person’s circumstances. Offer a call, text reminder or next visit at the point of care, then check that the person reached the intended service. Do not assume that a digital pathway is suitable for everyone, particularly people experiencing housing insecurity, limited connectivity or difficulty using a patient portal. A phone call, paper summary or coordinated appointment may be more reliable. The aim is continuity in which the pharmacy remains involved rather than transferring responsibility and disappearing from the patient’s support network.

Practical measures for stigma-free care

Training works best when it reaches every role that interacts with patients, including the pharmacist, technicians, dispensary staff, counter staff and manager. Short scenarios can help the team respond to discriminatory comments, requests for an unexpected medicine, overdose-related concerns and disclosures made at the counter. Training should be recurring and connected to actual work, rather than a one-off session that is easily forgotten.

Policies should also make the desired behaviour clear. The Pharmaceutical Society of Australia’s professional standards and applicable state requirements provide a foundation, but local procedures need to address privacy, respectful language, consent, difficult interactions and escalation. Managers can ask teams to test whether policies work in practice and then revise them. Feedback from people with lived experience should be welcomed without requiring them to justify their comments or disclose personal treatment histories.

Practical measures for stigma-free care:

• Establish a brief language guide covering respectful terms, common assumptions and alternative responses to stigmatising behaviour.
• Provide a clear route to private counselling, including how to offer it discreetly when a person approaches the counter.
• Keep naloxone, safe disposal information and referral details visible, while allowing patients to request them without announcing why they need them.
• Create a referral directory for local treatment, mental health, harm reduction and culturally safe services, with named contacts and current procedures.
• Review complaints, privacy incidents and missed handoffs for patterns of bias, access barriers and recurring operational problems.
• Measure patient-reported respect alongside service uptake, waiting times, naloxone access and continuity of care, rather than relying on prescription volume alone.

Make welcoming care an everyday commitment

A welcoming environment becomes credible through repeated, dependable encounters. Patients need to know that the pharmacist will listen, the dispensary will protect their information and the team will help them reach appropriate care. They also need to know that a difficult day or an honest disclosure will not lead to humiliation, refusal or unnecessary warning from staff.

Begin the next shift with a shared phrase for respectful communication, a clear private consultation route and an updated referral list. Ask patients and colleagues whether the pharmacy feels safe and welcoming, then act on what they reveal. Every respectful conversation and practical barrier removed helps build trust. A welcoming pharmacy becomes part of everyday healthcare through those consistent actions at the counter.