Substance use disorders are related to alcohol, tobacco, cannabis, stimulants, hallucinogens, and opioids. Terms such as 'abuse' and 'dependence' are no longer used to describe the condition. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), “Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home." A diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.1 

For Jeff Young, RPh, addiction began in the early 1980’s. A few years into his career, working in pharmacies, he started substance use with just a few teaspoonfuls of hydrocodone/homatropine syrup. Within one month, he was unable to stop. At his lowest point, as he described, he was using up to 4 pints on some days. He acquired the medication without a prescription, but he always paid for the amount he took from his pharmacy. Mr. Young compares the worst days of his addiction to taking 400 Vicodin tablets in one day. However, he never took the Vicodin tablets because he was worried about the acetaminophen component.

At Mr. Young’s lowest point, he was taking the syrup just to suppress withdrawal. When he woke up in the morning, he would drink 3-4 ounces, just to stop sweating. His daily prayer was, “God, please don’t let me be without drugs,” he said. He recalled an awful time, when the warehouse was out of generic hydrocodone/homatropine syrup and instead sent a brand alternative. The syrup came in a glass bottle which, to his dismay, arrived broken. Mr Young was sopping up the liquid among shattered glass, and trying to squeeze it out of paper towels, swallowing shattered glass along with the liquid. He explained that he could have died from the shattered glass, but he did not care at that time.

One day, everything caught up to him, and he was interrogated, and taken to jail. Mr. Young was able to get out of jail later that day, and immediately enter into treatment.  

In a rehabilitation facility, Mr. Young experienced the worst pain he has ever been through, he said. On the fourth night, he crawled to the nurse on his hands and knees and pleading, “I’m going to die, help me get through this.” A compassionate doctor, who was previously a pharmacist, promised him that she would get him through this soon, and that anything they added would prolong withdrawal. Sure enough, 1 or 2 days later, he had an out of body experience that felt supernatural, he said, and his withdrawal symptoms were gone. 

After 24 days in treatment, Mr. Young became involved with the Pharmacists Recovery Network. His pharmacist license was revoked for 2.5 years, during which time he volunteered with the organization to help the less fortunate. He was monitored with urine drug screens, and had to send in reports. Because of his successful participation in a rigorous, 12-step rehabilitation program, the district attorney dismissed all charges against him. 

After the 2.5 years was up, he returned to work at Eckerd Drugs. The company featured Mr. Young in their employee magazine for other pharmacists who needed help. His story was also featured in the official Texas State Board of Pharmacy Newsletter. Currently, Mr. Young is a staff pharmacist at a CVS pharmacy, and has had tremendous support from his manager, and colleagues, he said.

To this day, Mr. Young refuses to introduce any narcotics into his body. He recalled a hospital admission for severe diverticulitis, where every doctor, and nurse wanted to give him painkillers. He refused, and stayed awake all night, afraid of any IV narcotic being started. He did not even request the acetaminophen that was ordered. 

Mr. Young has made a full recovery—he has been clean, and sober since the day he was arrested in November 1990. He has done so much volunteer work in the recovery field that the Oklahoma Board of Pharmacy awarded him an honorary Doctor of Pharmacy degree. He said that he feels very grateful that the pharmacy profession welcomed him back with open arms, and feels happy, joyous, and free, being clean, sober, and working in a pharmacy. In addition to acting as a support for other pharmacists around the country, he continues to talk to recovering people and keep in touch with them almost every day. 

Mr. Young makes an excellent point that all pharmacists should remember. With the opioid crisis, we have the ability to help patients get the help they need. Mr. Young opens up to his patients, and uses himself as an example. He explained that sometimes we need to look a little deeper. For example, one patient asked him for something for a hangover. Instead of just giving a quick recommendation and moving on, Mr Young asked what was really going on, and the man started crying, and said he couldn’t stop drinking. Mr. Young helped this man get to AA meetings and on the road to recovery. He also keeps meeting schedules on hand to give out to patients who need it.

Many people have come to Mr. Young in tears, so grateful that they got their spouses back. He recalled a woman who came back to thank him for referring her husband for treatment. Pharmacists from other stores, and other chains often call Mr. Young for advice as well. He explained these are things we can do in a pharmacy that can’t be measured by metrics, but it makes you feel good.

Estimates show that 10-15% of healthcare professionals will misuse drugs or alcohol at some point in their career, a similar rate to the rest of the population.1 Occupational hazards unique to pharmacy involve the following risk factors—accessibility to controlled substances, stressful or unpleasant workplace issues, lack of addiction education related to the profession, and professional shame that develops with impaired pharmacists and their family members prior to treatment.

Professional shame is a huge factor with pharmacists who find themselves in this situation. Commander John Burke has more than 47 years of law enforcement experience and has seen this firsthand. He has seen too many pharmacists commit suicide. Commander Burke explained that pharmacists have a lot to lose, and often they are worried about losing their pharmacist license, and the opinion of their peers, which often prevents them from seeking help. Because he has seen many pharmacists get caught and end up with a record, his advice to pharmacists is to come forward and go through recovery anonymously, without danger to your record/reputation.

Pharmacists Recovery Network exists to help pharmacy professionals and students with substance use recovery. It is a central network of states’ information maintained by Charlie Broussard, BSPharm, MEd, FAPhA, where a pharmacist or student pharmacist can go to find their state specific program for help. 

Each state board of pharmacy has its own regulations and procedures for addressing a pharmacist suspected of substance use disorder. Impaired pharmacists can be reassured that they can get the necessary treatment through PRN. 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.

Tony Tommasello, RPh, PhD, is the former President of PEAC (Pharmacists’ Education and Advocacy Council) in Maryland. Dr. Tommasello explained that being a pharmacist does not reduce the risk of a substance use disorder; we are like “kids in a candy store.” He also notes that genetic experts believe that 50% of the risk for substance use disorder is DNA related, and combined with the environmental factors of a pharmacy, the risk will increase. This DNA exists in people of every profession, but Dr. Tommasello said he feels pharmacist rates are higher because we have access to these medications. He also says that knowledge about drugs does not protect us and can actually be a risk.

Brian Fingerson, RPh, is the President of Kentucky Professionals Recovery Network (KYPRN), which administers the recovery programs for eleven licensing Boards in Kentucky. He has over 30 years of experience in this field. Mr. Fingerson explained that substance use disorder is a disease and does not indicate moral failure—that no matter what the substance (alcohol, marijuana, opioids, etc), it works on the same reward center in the brain. He also explained that it is a chronic and progressive disease, and will only get worse. The prognosis is the person would end up in prison or dead if they don’t get help.

Pharmacists often come to Mr. Fingerson in their darkest time. His advice? If you think you have a problem, get help, you are not alone. Addiction is an equal opportunity disease and there is no limit on age, intelligence, race, etc.

Mr. Young’s advice is to take it one day at a time, not putting substances in your body. He feels that the 12-step program was a second family—AA or NA is a great place to be. He said he feels pharmacists have a big success rate of becoming sober because of the license at stake. Mr. Young recommends pharmacists reach out because there is help for everyone everywhere you go: push down your pride, surrender, and say you need help. He realizes many people will have to hit rock bottom before they come crawling back out, but it is never too late to get help and become clean and sober. He also suggests not focusing too much on the past, and to instead focus on moving forward.

Visit http://usaprn.org/ to find your state program and/or pharmacist contacts in your state.  
 
References
  1. Substance Abuse and Mental Health Services Administration. Substance use disorders. SAMHSA website. https://www.samhsa.gov/disorders/substance-use. Updated October 27, 2015. Accessed March 22, 2018
  2. Baldisseri MR. Impaired healthcare professional. Crit Care Med. 2007 Feb;35(2 Suppl):S106-16. https://www.ncbi.nlm.nih.gov/pubmed/17242598. Accessed March 22, 2018
  3. PRN Pharmacists Recovery Network http://usaprn.org/impaired-pharmacist.pdf. Accessed March 22, 2018