Although the issue of substance abuse among pharmacists is seldom discussed, it is an issue of fundamental significance that can negatively impact the pharmacy profession. In addition, it can hinder the work performance of the affected pharmacists, thus compromising both the integrity and the quality of patient care. Substance abuse touches individuals in various health care fields. According to the National Institute on Drug Abuse, it is estimated that 8% to 12% of health care workers have substance abuse problems.¹ Furthermore, 11% to 15% of pharmacists, at some time in their career, are confronted with alcohol and/or drug dependency problems, and the median age of recovering pharmacists is 43 years.²

In 1982, the American Pharmacists Association acknowledged that substance abuse was an issue within the profession of pharmacy, which resulted in the establishment of the Pharmacy Recovery Network (PRN).^3,4 The PRN is a confidential program which provides assistance in the early recognition, intervention, and treatment of substance abuse among affected pharmacists, pharmacy students, and pharmacy technicians.⁴ In addition, many states have formed intervention and recovery treatment programs that are typically available 24 hours a day to assist pharmacists afflicted with substance abuse problems. The majority of treatment programs function with a multidisciplinary staff that can include a psychiatrist, a social worker, and a psychologist, as well as those trained in medication addiction.³ Some of those working in the PRN programs are in recovery themselves.³

Approximately two thirds of impaired pharmacists in recovery treatment programs were discovered by their local state board of pharmacy, a peer, or another health care professional.⁴ Studies suggest that certain factors may predispose pharmacists to the development of a substance abuse problem; for example, stress associated with working conditions or the demands of working long shifts, personal issues, or the belief that their knowledge of medicines will somehow prevent them from becoming addicted.³ The abuse of alcohol and other drugs in the work setting has been found to be the single largest contributing factor to the problem of employee impairment and lost productivity.⁵ Results from a study published by McAuliffe et al showed that 46% of pharmacists and 62% of pharmacy students reported using a prescription drug without an authorized prescription.^3,6 In addition, 20% of the pharmacists surveyed reported that they had used a prescription drug without an authorized prescription at least 5 or more times in their lifetime.⁴

Characteristics of Substance Abuse

Many pharmacists with substance abuse problems initially think that their trained knowledge of drugs will somehow eliminate the potential for substance abuse. They seem to function normally in their daily pharmacy practice, despite the substance abuse; however, these individuals may exhibit behavioral characteristics that can alert others to the problem. Examples of signs and symptoms of substance abuse include:⁴

• Personality changes or mood swings
• Frequent absences from work
• Volunteering to check in narcotics or do inventory on them
• Long or frequent disappearances from the work station
• Increase in medication errors
• Changes in physical appearance (eg, weight loss or poor hygiene)
• Showing signs of forgetfulness, irritability, and tardiness
• Decrease in work performance
• Excessive ordering of certain drugs
• Overreaction to criticism
• Increased complaints from patients

The Road to Recovery

When pharmacists have been identified as having a substance abuse issue, they are not allowed to practice pharmacy until the problem is resolved.⁴ Each state board of pharmacy has its own regulations and procedures for addressing the issue of a pharmacist suspected of substance abuse.³ Impaired pharmacists can be reassured that, with the assistance of PRN programs, they can face their addictions and get necessary treatment. The success rate for many of the PRN programs is as high as 85%.^1,6 It is imperative for impaired pharmacists to adhere to treatment plans and comply with the terms of returning to the practice of pharmacy in order to remain in good standing with their local boards of pharmacy. Pharmacists who participate in these programs are generally required to sign a contract that obligates them to adhere to certain rules and regulations that require them to maintain routine contact with an assigned counselor, submit to random drug testing, and attend regularly scheduled support group meetings.¹ Impaired pharmacists need long-term care and follow-up to reduce the likelihood of a relapse, as well as assistance from family, peers, and support networks.

Conclusion

Pharmacists facing the challenge of overcoming an addiction have many resources at their disposal. Recovery is a realistic goal when the affected pharmacist makes a commitment to therapy. Recognizing the signs and symptoms of a substance abuse problem and acknowledging that the problem exists are the most crucial steps on the road to recovery. Through proper intervention and treatment, it is possible for impaired pharmacists to once again achieve a better quality of life that is productive and free of substance abuse and function once again as a responsible health care professional. Early recognition of a substance abuse problem can prevent impaired pharmacists from compromising patient care and avert serious consequences that may involve medication errors.

Pharmacists are often considered some of the most trusted and respected health care professionals. It is the fundamental responsibility of the pharmacist to assist others affected by substance abuse; therefore, it is essential for all pharmacists to be knowledgeable about substance abuse and to know how to identify its characteristics. They should also be aware of the resources available for treatments for either themselves or an affected coworker. For more information on the various pharmacy recovery programs available, contact your local state board of pharmacy or your state pharmacy association.

Resources

For more information, please visit the following Web sites:

• American Pharmacists Association Addiction Practitioner Interest Group at www.aphanet.org
• American Society of Addiction Medicine at www.asam.org
• International Pharmacists Anonymous at mywebpages. comcast.net/ipa/ipapage.htm
• National Institute on Drug Abuse at www.nida.nih.gov
• USA Pharmacist Recovery Network at usaprn.org

Ms. Terrie is a clinical pharmacy writer based in Haymarket,Va.

For a list of references, send a stamped, self-addressed envelope to: References Department, Attn. A. Rybovic, Pharmacy Times, Ascend Media Healthcare, 103 College Road East, Princeton, NJ 08540; or send an email request to: arybovic@ascendmedia.com.