Martine Kruijtbosch

31 Mo ra l d i l emmas o f commun i t y pha rmac i s t s FIGURE 1: Inclusion of narratives * A situation in which there is a choice between at least two courses of actions, neither of which is obviously morally preferable. Category 1: The pharmacist-patient relationship Drug abuse or addiction Patients who had (or were suspected to have) drug abuse or addiction problems requested for refills too soon. The drugs involved were mainly controlled drugs such as opioids or benzodiazepines. Pharmacists grappled with the problem of possibly sustaining addictive behaviour on the one hand and the need to retain patients’ trust and to relieve pain or anxiety on the other. PHARM-276: This patient is heavily addicted to an opiate and regularly asks for, and gets, a refill too early. ‘ He always has excuses like ‘I carried a heavy load yesterday’ or ‘I lost my medication during holidays’. However, he does experience pain and needs an analgesic. If he needs the opiate because he has really lost it, he should get it. But how long should I contribute to his opiate addiction. ’ Drug misuse Drug misuse can lead to side effects or affect the effectiveness of the prescribed medicine. Pharmacists expressed concern about confronting patients without losing their trust. Dispensing without addressing the issue also had drawbacks.