Oral+Presentation+Case+10

=Oral Presentation Case 10=

//Is drug addiction a disability?

In 2003 changes were made to the Federal Disability Discrimination Act 1992, which lead to it being lawful to discriminate against a person who is addicted to a prohibited drug on the basis of that addiction. This was a parliamentary response to a landmark case, Marsden v. Human Rights and Equal Opportunity Commission and Coffs Harbour and District Ex‐Servicemen’s and Women’s Memorial Club Limited, with Marsden successfully claiming he was discriminated against on the basis of his drug addiction.

The then Prime Minister, Mr John Howard referred to this case as a precedent for a court finding that addiction to a prohibited drug is a disability, and is quoted as saying “in effect, drug addicts could enjoy similar legal rights under the Disability Discrimination Act as people who are in wheelchairs or are visually impaired. This is unfair”.

Read the background to this amendment bill at [|http://www.aph.gov.au/library/pubs/bd/2003‐04/04bd084.htm]‐, and consider the implications for pharmacists in the provision of methadone/buprenorphine.//

Stakeholders and Rights and Duties
- Drug addict: right to receive treatment and support, right to access public facilities - Employers: right to have good and clean employees, in the best interest of the business. right to not hire drug addicts if they're evidently detrimental to their business - Private premises: owners have the right to refuse entry, if they believe and have evidence that someone will have negative impact - Government/society: decrease crime(by helping to rehabilitate drug addicts), increase productivity, better society, care for those in need (include drug addicts), also have a right to not include in workforce those who due to their addiction cannot perform their job properly, - Health professionals: duty to provide service to all - Taxpayers: pay for drug addict rehabilitation, and expect a relatively drug-free, also crime free society

My values
difference between drug addicts and disabled: the disabled are not by choice, drug addicts earlier are by choice, latter may not be by choice

Decisions
drug addicts should not be discriminated to receive treatment and to assess public facilities (provided they do not cause problems to those premises), but employers/business owners have the right to chose whoever they think will be most beneficial to their business (even if that includes drug addicts)

Example
The ethical issue here involves a number of points. Firstly I will need to consider whether or not individuals with an addiction to prohibited drugs should receive treatment. In addition to this, I will need to determine whether drug addiction is a disability and the extent to which this definition would effect my decision to treat the addiction. This will also enable me to determine the capacity in which the pharmacist can be involved in the treatment of drug addiction.

I will be exploring this issue using the ethical framework of consequentialism. Consequentialism is the ethical framework that determines the rightness or wrongness of an action by its consequences. It states that an ethical action is one that maximises the positive outcomes and minimises the negative outcomes. Consequentialism is objective in its approach and therefore does not take motive into consideration which will simplify the deciphering process I will need to undertake to address the issue.


 * Before I identify the stakeholders in this situation, I’ll give you a bit of background as to how a methadone/buprenorphine program works. There are two types of programs available in Australia:

The first one is an opioid maintenance program which uses a drug such as methadone or buprenorphine to substitute the illicit drug at doses that are deemed adequate by an accredited medical practitioner who writes a prescription which is dispensed at specialised treatment centres or more commonly, through a community pharmacy based methadone/buprenorphine program making the treatment more accessible. Patients are often on this program for approximately 2-3 years where the dose is gradually reduced until the individual can eventually abstain and go about their daily lives free from addiction.

The second type is an opioid withdrawal program which involves treatment with naltrexone, an opioid antagonist to maintain abstinence once withdrawal over 7 days is achieved. This type of program requires a high level of motivation from participants because there is greater chance of relapse bringing with a greater risk of overdose that can ultimately lead to death. Thus, the majority of drug addicts are placed on the opioid substitution program.

( I didn’t actually include this in my talk because after timing myself at home, the talk was 8 minutes lol After I cut it out I was within my time limit. I’ve put it in anyway because I thought you guys might benefit from the extra information :) )**

One of the most important stakeholders in this situation is the drug addict. Values that may be important to a drug addict are the desire for normalcy in their lives. By this, I mean they can go about living their lives without the fear of being discriminated against. If discrimination ensues, they may be labelled as irresponsible for getting themselves addicted to drugs and may not be trusted with duties involving the care of their children. Similarly, employers may not trust that they are fully capable of handling the requirements of their job if they are still addicted to drugs. The fact that drug addicts often engage in crime that involve the illegal selling and purchase of drugs, or even robbery to obtain more money to maintain their drug habit, creates the impression that they are untrustworthy and their actions are regarded with suspicion not just by police officers and other law regulators but by the wider community in general. So the drug addict craves the trust of their families, their employers and overall the trust of their community.

Another value that may be important to the drug addict is getting the support and assistance they need to help them get over their addiction. Thus the drug addict would value a treatment program that could help rehabilitate them back into society.

Another stakeholder is this situation as previously alluded to, is the wider community. The wider community include other people such as the family of the drug addict and neighbours. The life partner of the drug addicts would value someone who would be able to help raise their family or help provide an income to support their homes. So having a treatment program would help the drug addict meet the expectations of those who are dependent on them.

Of course there will always be people in the wider community who would not support the introduction of a methadone program in their local pharmacy. These people would include other regular customers to the local pharmacy who would just feel too uncomfortable knowing that recognised drug addicts could freely walk into their local pharmacy. These individuals may feel that their security would be compromised and thus may not trust that the pharmacy is a safe enough environment in which they can obtain their medicines and the accompanying advice.

Last but certainly not least, the pharmacist can be identified as a stakeholder in this situation. As a healthcare professional, the pharmacist is concerned with enhancing the health and wellbeing of their clients, which includes drug addicts as well as the community. The factors a pharmacist would need to take into consideration when deciding to implement a methadone program is if the pharmacy has an adequate level of security as well as the appropriate setting to provide the methadone or buprenorphine.

A pharmacy with a methadone program needs to have a highly secure area in which the methadone or buprenorphine can be stored. This can only be accessed by the pharmacist in order to prevent them getting stolen and sold illegally. The pharmacy would also need to have an appropriate area such as a private room in which the pharmacist can watch the drug addict take the dose.

Within the confines of this room, the pharmacist can comfortably counsel the individual and establish a rapport. The role of the pharmacist is crucial because individuals undergoing treatment not only require support but also require information about medications or other substances such as alcohol that can interfere with the efficacy of the treatment and in some cases cause toxicities. The pharmacist needs to provide information on signs and symptoms of toxicity and inform the drug addict what needs to be done in those situations. Thus it can clearly be seen that there is quite a large opportunity for the pharmacist to be involved in the treatment of drug addiction.

However, the pharmacist also needs to consider the concerns and needs of other clientele who may not be comfortable with the thought of drug addicts coming to their pharmacy regularly. If the pharmacist decides to have a methadone program other customers may decide to take their business elsewhere and the profitability of the business may suffer. This puts the pharmacist in an awkward situation and the implications of this will be considered using consequentialism.

By promoting treatment through a methadone program, pharmacists will encourage drug addicts to seek treatment for their addiction. This is a good consequence because the sooner they begin the treatment, the quicker the road to recovery is for these individuals. Getting them the treatment they need will help them get their life back on track because they can earn society’s trust and restore their confidence in the individual as a productive member in society.

In addition to better social functioning, treating drug addiction has been proven to show a reduction in involvement in criminal activity and a reduction in the transmission of blood-borne viruses such as Hepatitis B + C and HIV. These are positive outcomes of the treatment and thus it can be argued that although the pharmacists may lose other customers by providing this service, they are contributing to the greater good of the community and the good consequences outweigh the bad consequences.

Personally I see drug addiction as a condition that is brought upon the drug addict by their own short sightedness, albeit often under the influence of factors such as peer pressure. If drug addiction was recognised as a disability, would pharmacists be obligated to have a community pharmacy based methadone program? If we look closer at this issue, we could argue that not providing this service could indeed be interpreted as discrimination towards the drug addict by the pharmacist. But since it is lawful to discriminate against a person on the sole basis of their addiction to a prohibited substance, refusing the implementation of a methadone program would be acceptable in the eyes of the law. Whilst I do not recognise drug addiction as a disability, my response as a health professional is that I have a duty of care to these individuals and that it is an illness that needs to be treated because treatment is only way that harm to the individual as well as to the wider community can be minimised.

In summary, I believe that as a pharmacist, regardless of personal beliefs, I should be most concerned with the health and well being of the society in which I live. While I recognise that other pharmacists have the right to reject the introduction of a methadone program into their pharmacy due to various social and budget related reasons, it would be of most benefit to the wider society as well as to the drug addict if I as a pharmacist agreed to provide the methadone treatment at my pharmacy together with the appropriate counselling

Hope you've all found this useful ---Samar