Substance Abuse Poses Challenges in Pharmacies

JULY 22, 2019
Ned Milenkovich, PharmD, JD
EDITOR’S NOTE: The characters in this article are a work of fiction. Names, characters, businesses, places, events, locales, and incidents either are the products of the author’s imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental
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People across all professions can fall victim to substance abuse, and pharmacists are no exception. The repercussions within the pharmacy profession are destructive and serious. It goes without saying that an impaired pharmacist’s performance deteriorates and can put patients at risk. Bob, a congenial and conscientious neighborhood pharmacist, is the proprietor of Bob’s Pharmacy in Small Town, USA. Bob and his wife, Sally, who is also a pharmacist, enjoy a solid reputation in their community. Bob attended a meeting of the local small business association, where he met Sparky, a fellow pharmacist who had been running his own pharmacy on the other end of town for decades. He was usually cheerful and outgoing, but Sparky looked distracted. He asked Bob whether they could speak privately for a moment. Bob motioned for Sparky to step off to the side of the meeting room. “I hired a new pharmacist a few months ago,” Sparky said. “How is he working out?” Bob asked. “Not well. Smelled alcohol on his breath a few times during business hours, but I let it go,” Sparky said. “Maybe he had a drink at lunch. I don’t know, so I didn’t say anything. But he’s been late for work on a number of occasions. And―” “Maybe it’s time you sit him down and give him a talking-to,” Bob said. “But that’s not the end of it,” Sparky said. “He came up short several times on his controlled substance inventory count.” “Oh, I see,” said Bob.

GETTING HELP
Individual states have acknowledged that substance abuse affects the pharmacy profession just as it does the general population, so they responded with pharmacists recovery networks (PRNs). A PRN is a confidential program that offers treatment for pharmacists who suffer from substance abuse. Most PRN programs comprise a psychiatrist, a psychologist, a social worker, and other addiction specialists. In many cases, a pharmacist’s addiction comes to light when either a fellow health care professional or a state board of pharmacy is made aware of it. In other cases, instances of substance abuse are identified when impaired pharmacists are apprehended by law enforcement officials. 

CONSEQUENCES
​​​​​​A state pharmacy board generally does not allow a pharmacist to resume practicing if evidence shows that the individual in question has been involved in substance abuse. State pharmacy boards have their own regulations for disciplining a pharmacist who is a proven substance abuser and cannot consider reinstatement to the practice pharmacy until the offending pharmacist undergoes a clinical assessment. The pharmacist must then enroll in a PRN program to begin rehabilitation. The success rate for pharmacists who enter a PRN program varies widely. The recovering pharmacist must diligently follow the PRN’s treatment program to successfully complete the recovery process.

REINSTATEMENT
When a pharmacist provides proof of recovery as well as a renewed commitment to a substance-free lifestyle, the state pharmacy board may initiate the reinstatement process. Typically, the board requires that the pharmacist attend regular sessions with a designated counselor and support group meetings and be available for random drug testing. A pharmacy board can also impose fixed, short-term limitations on the pharmacist’s practice as well as additional reporting requirements and remedial training, all of which are contingent on the pharmacist’s length of absence from the practice of pharmacy.


RESOURCES AND RECOVERY
Pharmacists are highly esteemed health care professionals who treat patients by guiding them through the process of treating and, in many instances, curing a disease—and substance abuse is itself a disease. As such, pharmacists are in a better position than others to be aware of the resources available to either an impaired coworker or themselves.

Many resources are available to impaired pharmacists, who need long-term support to reduce the chances of an unwelcome relapse. Colleagues, family, friends, and support groups are well positioned to provide such support, though successful rehabilitation depends ultimately on the pharmacist’s own commitment to therapy. An impaired pharmacist can return to being a responsible health care professional and enjoy a dignified and productive personal and professional life free of substance abuse.

EPILOGUE
Bob saw Sparky again a few weeks later at the golf course. Sparky was his old self again. Soon their conversation turned to the troubled pharmacist Sparky had hired.
“Did you work things out with your pharmacist?” Bob asked.
“Sure did,” Sparky said.
“Maybe he can get back on track,” Bob said.
“Maybe he can, but then maybe he can’t. After he came up short on his controlled substance inventory count, I knew I couldn’t take any more chances,” Sparky said. “I suggested he enroll in a PRN. He couldn’t say no.”
“So are you manning the fort all by yourself?” Bob asked.
“Until I hire someone new. But, hey, that’s the right problem to have,” Sparky said.

Pharmacists can more information about PRNs from state pharmacy boards and state-specific pharmacy associations.
 
Ned Milenkovich, PharmD, JD, is chairman of the health care law practice at Much Shelist PC in Chicago, Illinois, and the former vice chairman of the Illinois State Board of Pharmacy.

 

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