Substance abuse is often publicized but regrettably is viewed with a negative point of view. Moreover, the consequences to the pharmacy profession can be disastrous when pharmacists themselves become victims of substance abuse. In addition to an affected pharmacist performing poorly, countless patients could have their safety jeopardized resulting in potential patient harm.
Insert 1
I received my BS-Pharmacy degree in 1997. I had a great start to my career. I was selected as a participant in a Leadership Pharmacy conference held by my state pharmacist association in 2002. In 2004, my career hit bottom as a result of the disease of addiction. I heard of my state Pharmacists Recovery Network (PRN) in 2005. I started attending their monthly meetings. After going through inpatient treatment for addiction, and re-obtaining the privilege to practice pharmacy under a restricted license, I found a position with a hospital pharmacy an hour and a half away from where I was living at the time. Despite the obstacles, I have made it work for the last seven years. Through having a personal understanding and empathy for the disease of addiction, I am making a difference in the lives of pharmacy professionals who attend PRN meetings. I am also involved with the Behavioral Health unit of my hospital, helping patients with chemical dependency as well as other mental health conditions. I have expanded the unit's pharmacy patient education program since starting my position in January 2006. In addition, I attend interdisciplinary rounds on Behavioral Health and provide inservices for the staff. My future career aspirations include taking the BPS exam for the psychiatric pharmacy subspecialty. I am extremely grateful for my second chance in life and hope my story can provide inspiration for other recovering pharmacists.
-Anonymous recovering pharmacist 1
Data suggest that abuse of addictive substances in the pharmacy profession is growing. A survey of pharmacists published in 2001 suggests that nearly 40% of pharmacists have used an addictive prescription medication without a legal prescription.1 At this time, it was estimated that 15% of unemployed pharmacists were impaired due to dependence upon a substance.2 This is a considerable growth from a survey in the1980s, which indicated less than 20% of pharmacists had used a controlled substance without a legal prescription.3 A survey completed in 2002 demonstrated greater use among pharmacists as compared to other health care professionals, suggesting a possible association of drug abuse with ease of medication access.4
More recently, a discussion with recovering pharmacists revealed their impressions as to why a pharmacist may be vulnerable to addiction.5 In addition to increased access to prescription drugs of abuse, pharmacists often feel stuck in a stressful working environment. The culture of many pharmacies often condones non-controlled medication diversion such as taking an ibuprofen for a headache or pantoprazole for acid reflux. This “acceptable” diversion may lead to stronger substances being diverted. Pharmacists agree that education regarding addiction is often insufficient.6,7
State pharmacy boards have long recognized that substance abuse is an issue within the pharmacy profession. An outgrowth of this concern has resulted in the establishment of the so-called Pharmacy Recovery Network(s) (PRN). The PRN is a confidential program providing assistance in the recognition and treatment of substance abuse of affected pharmacists and bringing the afflicted professional back into society and professional life. The majority of PRN treatment programs function with a multidisciplinary staff trained to deal with substance abuse. Although they do not provide substance abuse treatment, PRNs make treatment referrals, monitor recovery, and offer support.8 Often these programs include required (sometimes optional) monitoring for the remainder of the pharmacists' professional life.3
Impaired pharmacists can be discovered in a variety of ways. Sometimes their state board of pharmacy or another health care professional discovers them. This can occur during a site inspection by the state board of pharmacy, often prompted by reports of drug diversion. Pharmacy technicians who work closely with a pharmacist may prompt management to intervene. Others are discovered by law enforcement when either caught abusing a substance or engaging in a related illegal activity. Still other pharmacists are able to recognize that they have a problem and choose to report themselves.
In practically all cases, a state pharmacy board will prohibit a pharmacist from practicing pharmacy if it determines that there is a substance abuse problem that must be addressed. Each state pharmacy board has its own procedures for addressing the pharmacist suspected of substance abuse. For a state board to consider reinstating an impaired pharmacist, the pharmacist will be required to obtain a baseline clinical assessment then enroll in a PRN program to begin recovery from their addiction. It has been reported that the success rate for pharmacists enrolled in PRN programs is very high.9 However, in order to successfully participate in a PRN program the pharmacist must adhere to treatment plans set forth by the PRN and not vary from them.
Once a pharmacist has demonstrated a commitment to recovery and a substance-free lifestyle, reinstatement with a state pharmacy board to practice pharmacy may commence. See table 1 for principles that are important for an impaired pharmacist to adopt. In most cases, the state pharmacy board will require the pharmacist to maintain regular contact with an assigned counselor, submit to random drug testing, and participate in support group meetings on a regular basis. In addition, a pharmacy board will very likely place pharmacy practice restrictions on the pharmacist as well as require remedial training and reporting, depending on how long the pharmacist has been separated from the pharmacy profession and professional practice.
Impaired pharmacists need long-term support to reduce the likelihood of a relapse. Pharmacists overcoming substance abuse have numerous resources available to them to assist themselves in this regard. Such resources may include help from family, friends, peers, and support networks. Recovery is heightened when the affected pharmacist makes a commitment to therapy. According to documentation in 1989, 20% or less of pharmacist who utilize a PRN relapsed.9 Through proper intervention, it is possible for an impaired pharmacist to once again be a responsible health care professional and to achieve a productive life with dignity and without substance abuse.
Pharmacists are highly respected health care professionals charged with caring for patients and helping them through their disease states, including at times, a patient's own substance abuse issues. Pharmacists are uniquely poised to recognize that there are resources available for treatments for either themselves or an affected coworker who is at risk. Pharmacists who have placed their professional career in jeopardy should be prepared to seek recovery and submit to the requirements of their state pharmacy board prior to reinstatement to practice pharmacy again. Table 2 provides examples of requirements for an impaired pharmacist to return to the work force. Additionally, state-specific pharmacy associations can be a valuable resource for recovering pharmacists.
Insert 2
It wasn't until I sobered up that I realized the kind of danger I had been putting my patients (and myself) in for years. Even though technically I was not drinking alcohol on the job, the amounts I would consume every day for nearly 10 years would leave me in a fog/hangover most of the time. From my own experience, the fog doesn't really lift until several months of abstinence from alcohol. Don't get me wrong. I love my job and the patients I care for – even generally got high praise for going above and beyond. I just wasn't fully aware for most of it. Imagine the hypocrite I was for telling my patients to drink less alcohol and lecture upon the various health risks it posed meanwhile counting the minutes until I could speed home and make myself a drink (I even had to make sure to beat my spouse home so he wouldn't know how much I consumed during the week). I didn't seek help because I had lost my job or gotten pulled over while intoxicated – I was simply lost and luckily found myself guided to a 12-step meeting. In my sobriety, I do have to face the shame of my previous performance and become able to forgive myself. Without the support of a 12-step program and sponsor, I would not be able to maintain my sobriety. I am grateful to be given an opportunity to amend my past behaviors and am thankful every day for the chance to be the best person I can be.
-Anonymous recovering pharmacist 2