Overcoming stigma in pharmacy practice

Health inequities are defined by the WHO as differences in health care and outcomes that are caused by social factors, including education level, income, gender, sexual orientation and ethnicity.1 Certainly, the COVID-19 pandemic has highlighted health inequities in our society. Canada is not immune to this problem and it is our responsibility as privileged health care professionals to recognize and take steps to remove these inequities.

An important component of health inequities is that of stigma.2 Stigma is defined as “labeling, stereotyping, separation, status loss and discrimination in a context in which power is exercised,”2 as in the provision of health care. Patients who are stigmatized experience barriers to health care and are at an increased risk for treatment nonadherence, poorer outcomes and shorter lifespans.3 Examples of patient populations who experience stigma include those with HIV, opioid use disorder, mental illness, obesity, or who are homeless.

Stigmatized individuals often do not seek out health care in traditional settings such as clinics or hospitals. As such, community pharmacies are well positioned to assist this patient population, but do barriers exist for us to do so? There is a small body of research that examines stigma in pharmacy practice, largely focused on the presence of stigma towards patients with mental health or substance use disorders in community pharmacies.3-5 An underlying theme is present within the research literature; pharmacists are interested and motivated to provide care to stigmatized patient populations, but may feel inadequately prepared to provide care to these patients due to misinformation or a lack of knowledge, negative attitudes or prejudice and resulting discriminatory behaviours.3,4 How do we break down these barriers to effectively deal with stigma?

The first step is simply to recognize that a problem exists; stigma exists in community pharmacies and we must do something about it. The solution may, in fact, be relatively straightforward—humanize stigma. Pharmacists may theoretically understand or be able to increase our knowledge on the pathophysiology and treatments available for stigmatized illnesses, but many of us will not fundamentally understand what it is like to be stigmatized. We need to increase our understanding surrounding social determinants of health, ensure our community pharmacies are safe places and ensure our pharmacy staff complete stigma awareness training. We need to collectively brainstorm ways to make community pharmacies more inclusive and welcoming, such as moving opioid agonist therapy (OAT) dispensing to private consultation areas, normalizing pronouns and ensuring patients understand their right to confidentiality. We also need to survey Canadian pharmacists to identify potential barriers and develop solutions to eliminate stigma within pharmacy practice.

Box 1 Anti-stigma resources.

Canadian Centre on Substance Abuse and Addiction

https://www.ccsa.ca/overcoming-stigma-online-learning

Canadian Pharmacists Association

https://www.pharmacists.ca/news-events/news/smashingstigma-new-practice-tools-and-more-to-help-your-lgbt2sqpatients

Centre for Addiction and Mental Health

https://www.camh.ca/en/education/continuing-educationprograms-and-courses/continuing-education-directory/understanding-stigma

Indigenous Cultural Safety Training

https://sanyas.ca/home

Throughout the pandemic, pharmacies have been beacons of hope for the provision of mass immunizations to our population and resources for patients for ambulatory conditions and chronic disease management.6 In the coming years, pharmacists’ roles will continue to evolve to fill gaps in care for stigmatized patients and may involve the administration of injectable OAT therapies or HIV therapies, prescribing of pre-exposure prophylaxis (PrEP) or hepatitis C treatments, or the collection of lab samples. Our profession needs to be prepared to continue to provide invaluable services and ensure pharmacies remain as safe places for our most vulnerable Canadians.