COVER STORY

Beware the dark side of pharmacy life

One for you, two for me. Selfish, but harmless child's play, right? Wrong. It's one of many ruses used by pharmacists when they dispense drugs in order to satisfy their drug addiction.

While drug addiction among pharmacists is certainly not a new phenomenon, experts report that the number of pharmacists in treatment has increased. Why are R.Ph.s turning to drugs? Which drugs are they abusing? What are the telltale signs of addiction? What rehabilitation programs are available to help impaired pharmacists recover and return to work?

Dave Marley, Pharm.D., RAS (registered addiction specialist), executive director of the North Carolina Pharmacist Recovery Network Inc., Winston-Salem, said that the program has treated 135 pharmacists for addiction since 1995. "Our case load has consistently increased—from five in '95 to 25 in '98 to 30 a year since 2001," said Marley.

Tim Benedict, R.Ph., assistant executive director, Ohio State Board of Pharmacy, has seen a surge in the past 10 years in the number of R.Ph.s in Ohio who have drug addiction problems. "I spent the early '80s in the field and investigated six or seven pharmacists with addiction problems," he said. In 1986, when he became compliance and enforcement administrator for the board, he investigated a couple of cases a year.

"We now investigate 20 to 30 pharmacists a year in Ohio for drug addiction problems, and that doesn't include drug trafficking and doesn't count technicians," said Benedict. "We're doing at least as many cases with techs in the past few years as we are with pharmacists. Some of the technicians are addicted, but most are stealing for resale in the streets."

Merrill Norton, R.Ph., NCAC-II (Nationally Certified Addictions Counselor), CCS (Certified Clinical Supervisor), is director of the Recovering Pharmacists Program at the Talbott Recovery Campus, a private facility in Atlanta. "We have treated close to 1,000 pharmacists since 1974 when the program began," he said. "The numbers have increased drastically, and the demographics are changing. Now we're seeing younger males. That has to do with some early interventions by states with pharmacist recovery networks."

Norton pointed out that the average pharmacist the facility treats has severe problems and has been to treatment two or three times. "We see patients who have been to treatment several times and have not done well. Most pharmacists stay 16 to 17 weeks. Now 55% of those pharmacists on initial discharge will be put on some type of psychotropic medication for depression, anxiety, or personality disorder," he said.

Norton is concerned that there may be female R.Ph.s who need treatment for drug addiction. "About 55% of the pharmacy graduates are women. We're seeing only a small percentage of those women in treatment. I see 95% men and 5% women. I think there are more women out there in need of treatment," he said.

Norton explained that women who receive treatment at Talbott have more complicated personal issues to deal with than men, including childhood traumas and being involved in abusive relationships. They may also have a strong genetic history for depression, anxiety, or addiction.

Why is the number of pharmacists needing treatment on an upward trajectory? Increased stress in the workplace is largely to blame. "A lot of them are not happy with the profession because it never met their professional expectations," said Norton. "Many had expectations of becoming doctors and did not meet that goal. Even though pharmacy can be a wonderful career, most pharmacists end up doing work a tech can do." On top of all that, he said, the average pharmacist he sees works more than 60 hours a week.

The confines of the workplace also contribute to increased stress. "The average pharmacist works in an area that's about 12 ft. by 60 ft. They are locked in there; they can't eat; they can't use the restroom as necessary—they have to cheat their employer in order to take a break," said Norton.

Another culprit is the physical strain of the job, which requires R.Ph.s to be on their feet most of the day. Many pharmacists develop hip, back, and leg problems, and, because drugs are so accessible, they begin to self-medicate their pains.

Marley provided a scenario to illustrate how increased stress and the physical demands of the job lead R.Ph.s to self-medicate and eventually develop drug dependency: "Ten years ago, a pharmacist filled 100 Rxs a day. He has a bad back and can't get relief help. All day, he dispenses Vicodin and ibuprofen. He thinks, 'I'll take a couple of these to get through the day.' He does, and the back pain goes away.

"Move forward 10 years," Marley continued. "That R.Ph. is filling 500 Rxs a day, with the same bad back and even more stress. A couple of Vicodins help the back pain and the stress of phones ringing, the people giving you looks, and the manager complaining about your fill rates. Tomorrow, his back might not hurt, but he remembers the stress was less when he took the pills. In 13 years of doing this work, I never met a pharmacist who set out to be a drug addict. It's just one of those things that happen."

Yet another reason pharmacists succumb to addiction is many of them believe that because they are knowledgeable about drugs, they are immune from harm. "We hear this from everybody, 'I'm a pharmacist. I know how the drugs work. I can control them.' Garbage. They are the same as everybody else. They cannot control the drugs," insisted Benedict.

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