From pariah to patient

November 19, 2007

While boards of pharmacy are becoming less punitive in punishing addicted pharmacists, treatment options still vary from state to state.

Perhaps one of the most significant improvements for impaired pharmacists over the past 25 years has been the development of pharmacy recovery network (PRN) programs that recognize the unique challenges recovering pharmacists face. In the past, it was either "sober up, get locked up, or cover it up," explained Brian Fingerson, R.Ph., of the Kentucky Professionals Recovery Network. Now, according to Fingerson and other PRN leaders, specially designed programs can help get addicted pharmacists on the road to recovery faster. As a result of these programs, PRN and pharmacy board officials report that most pharmacists successfully return to practice and do not relapse.

Still, not every state has a PRN and only a handful receive support from the board of pharmacy. In fact, in most cases, PRNs are informal organizations created by dedicated volunteers with little formal structure. "Each state is different," explained Charles Broussard, R.Ph., editor of http://usaprn.org/, an on-line catalogue of resources for chemically dependent pharmacists and treatment professionals. "People are not making a lot of money at this."

Drug dependency as a disease

According to the National Institute on Drug Abuse (NIDA), a division of the National Institutes of Health, drug addiction is a "complex brain disease" characterized by drug craving and seeking, and use may be compulsive despite the risk of negative consequences.

Some studies now indicate there may be a genetic component to substance abuse. One study that looked at marijuana and cocaine abuse and addiction among twins in Virginia found that genetics played a significant role in the progression from drug use to dependence. Other studies are now focusing on identifying genes that may impact alcohol and drug dependency. Last year, NIDA researchers found gene-tic variations clustered around 51 chromosomal regions that may play roles in alcohol addiction. A growing body of research has made it increasingly evident that a family history of alcoholism, drug abuse, or other addictions is a significant risk factor for developing substance abuse.

Additional research also indicates strong correlations between alcohol and drug dependency and psychiatric problems, especially among children. According to Merrill Norton, clinical assistant professor of pharmacy at the University of Georgia College of Pharmacy, family histories of depression, suicide, or substance abuse are also important risk factors.

As researchers develop a greater understanding of the medical basis of substance abuse, more medications are being used to help patients kick the habit. Some patients now receive selective serotonin reuptake inhibitors (SSRIs) to help stabilize the brain's chemistry, especially during the detoxification period. Sleep medications are also frequently used. "It may take up to five to seven years for the brain to stabilize without any medications," explained Norton. Just as important, he added, the use of psychiatric medications to stabilize chemical or mood imbalances has dramatically lowered the chance of relapse.

Studies sponsored by NIDA also indicate a link between post-traumatic stress disorder (PTSD) and substance abuse. While the stress of working as a pharmacist falls far short in most cases of PTSD, some experts worry that on-the-job stress represents another risk factor. "We have a high-stress profession," insisted Norton. "Stress leads to two things: mental illness and substance abuse."