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Bobby Milroy (right), director of the Pier Health Resource Centre, with Natalie May, the first patient who was ever treated at the pharmacy – for an asthma attack. Coincidentally, May was outside the pharmacy having the attack at the same time staff were putting out the “New pharmacy now open” sandwich board for the first time. Although she isn’t receiving regular care from the pharmacy for any particular condition, May does stop by to visit the team quite regularly.

Life on the streets Life on the street is often full of trauma and violence, which can be exacerbated by medical conditions and even traumatic brain injuries. Typically, people are in a more vulnerable state so there is a much higher degree of stress. They use drugs to stay awake and other drugs to calm their anxiety. As a result, they spend more money, which in turn means they must sell medications or drugs or engage in theft or sex work to survive. That means they're more likely to be arrested or be physically assaulted. Life becomes chaotic and unpredictable. “Patients’ situations worsen considerably when they become homeless,” Milroy explains. Milroy says based on both the hotel study and the work of Dr. Julian Somers, an associate professor in the Faculty of Health Sciences at Simon Fraser University, medication adherence for homeless patients is nearly 40 to 50 per cent less than that of patients who have a home. “We need to find mechanisms to effectively support these individuals, to help them achieve the best quality of life possible, and minimize their cost on society. And pharmacy has to play a part in that,” Milroy says. If you sit in the foyer of the pharmacy during a weekday morning it almost resembles a corner coffee shop. Regulars come in to grab a free hot cup of coffee and chat with friends. The pharmacy cultivates a safe, welcoming and stable environment and builds relationships with all local residents, regardless of whether they are customers. “Our goal is to get to know people because it’s not just medication they need,” Milroy says. Inside the pharmacy, patients are invited to sit face-to-face with a member of the pharmacy team at one of the intake booths to discuss their medication needs and their lives. Dr. Keith Ahamad, an addiction physician at the St. Paul’s Addiction Medicine Consult Service, says pharmacists play a vital role in addictions care as they see patients more frequently than any other health-care provider. “It’s hugely important for pharmacists to discuss their response to medications, look at other medications they are prescribed for side effects, talk about psychosocial functioning, and act as a point of contact between the patient and the rest of the health-care team,” Ahamad says.

in single-room occupancy (SRO) hotels in the DTES. Due to their affordability, SROs are often the only alternative to homelessness for low-income individuals in Vancouver and other major cities. According to the study, two-thirds of tenants suffered from an average of three illnesses at the same time. Ninety-five per cent had substance dependence and almost two-thirds were involved in injection drug use. Nearly half of the participants suffered from psychosis, and nearly half of all participants had a neurological disorder. Eighteen per cent of the residents surveyed were HIVpositive, and 70 per cent had been exposed to hepatitis C.

Quality time is key Spending time with patients should be at the centre of addictions care, says Dr. Keith Ahamad, an addiction physician at the St. Paul’s Addiction Medicine Consult Service. He says the system has become far too reliant on medication. “We have a medical system that financially incentivizes volume rather than time spent with patients to discuss what their needs are. It is not patient centred; it’s way too health-care provider centred, and we need to spend time with these people because their problems are very complicated.” Ahamad says pharmacists play a vital role. They see patients more frequently than any other health-care provider. “It’s hugely important for pharmacists to discuss their response to medications, look at other medications they are prescribed for side effects, talk about psychosocial functioning, and act as a

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