One month into her term as PSA’s inaugural Harm Reduction Champion, Krishna Nathwani MPS sat down with AP to discuss the importance of patient education, why holistic care matters and the barriers patients encounter when seeking services.
Victorian-based Ms Nathwani has taken up the role, supported by a grant from Camurus, as PSA’s national spokesperson – advocating for and supporting harm reduction work across policy, professional practice and community engagement.
Drawing on her experience in Geelong’s Community Care Chemist network, Ms Nathwani is enthusiastic about integrating harm reduction throughout her practice – and the pharmacy profession.
What’s your background in harm reduction?
My passion for harm reduction came from my work with Community Care Chemist in Geelong. It was a service-focused model where we looked after our patients in more ways than just dispensing prescriptions, and I loved it.
Being in a management position, I had the opportunity to develop and design the service model based on the needs we identified. I thought it could improve people’s lives so much, and as a not-for-profit pharmacy organisation, we also had connections with emergency crisis organisations, such as food relief, homelessness services and domestic violence services.
I also embedded take-home naloxone (THN), and needle and syringe programs in all Community Care pharmacies. Entire teams were trained on their use, not just pharmacists. And when pharmacists in Victoria were able to provide long-acting injectable buprenorphine (LAIB) as a treatment for opioid dependence. I saw its potential to change patients’ lives. I’ve had patients taking oral pharmacotherapy, who had to come into the pharmacy every day, telling me how challenging that could be. LAIB provided an opportunity to ease that burden.
Describe your first month as PSA’s Harm Reduction Champion.
It’s been a whirlwind of making connections and finding ways to collaborate, including recently joining the Parliamentary Friends of Safe and Quality Use of Medicines event to discuss the importance of naloxone. I’ve also spent time with nurse practitioners and attended a GP conference on addiction medicine, gaining a better understanding of how we can work together – from identifying issues at different levels of care to developing plans to tackle them. It’s been incredible learning about the challenges and possibilities – not just for pharmacists, but across the healthcare system.
Tell us about the impact of the harm reduction initiatives you’ve led.
For me, the LAIB program has been most impactful. I had a patient in the program who went on to reconnect with her daughter, buy a car for the first time and regain her driver’s license.
A year after she had been my patient, she came in with her daughter, who was in her early 20s, for their flu shots. Her daughter said, ‘Thank you so much for what you’ve done for mum’. They’ve bonded so well and now they’re accessing care for their whole family; the impact goes beyond each individual patient.
We’ve also talked to patients who have been on hepatitis C treatment about our needle and syringe program, and many have since gone on to refer other people.
THN is another program that could be in every pharmacy, but isn’t. I’ve had a patient come to me to say they used their naloxone for a friend of a friend at a festival.
It’s important to change people’s relationship with healthcare – for them to come in and feel looked after. People should feel comfortable accessing holistic care that meets their needs. Harm reduction is fundamentally non-judgemental; we’re trying to make things as safe as possible for people.
What do you hope to achieve in this role, and what impact would you like to have?
I’d like to see improved access to services for rural communities, as well as policy reform to ensure consistency across jurisdictions. I’d also like to see more harm reduction education built into pharmacy degrees, alongside concepts such as trauma-informed care and approaches to patient care that are free from stigma.
We need a good understanding of the barriers to harm reduction services. I know some patients and practitioners are worried about seeking or providing care because they’ve had negative experiences. But I’ve found harm reduction services to be some of the most rewarding work in my practice. A well-planned and considered approach, with clear expectations from the beginning and a non-judgemental environment, has been key to that. I hope to share these learnings and hear from others across the broader pharmacy profession.
Learn how to provide inclusive harm reduction services by completing PSA’s online module ‘Enhancing Care for People Who Use Alcohol and Other Drugs in Pharmacy’.
