Pharmacy culture condones R.Ph. self-medication


Pharmacy needs to teach pharmacists about drug addiction, according to a researcher who found that 40% of R.Ph.s have taken potentially addictive Rx drugs without a script.



Pharmacy culture condones R.Ph. self-medication

Pharmacy has an attitude problem, according to a Georgia State University researcher who found that pharmacists who condone self-medication are more likely to illegally take potentially addictive pharmaceuticals without a prescription.

Pharmacy culture sends the message that it's OK for pharmacists to self-prescribe medications because, after all, they are the drug experts and know more than physicians about pharmaceuticals. That's one conclusion reached by Dean Dabney, Ph.D., an assistant professor, in GSU's criminal justice department, who conducted a study on the illegal use of mind-altering or potentially addictive pharmaceuticals among dispensing pharmacists. Questionnaires were mailed to 2,025 dispensing pharmacists who are members of the American Pharmaceutical Association; 1,016 surveys were returned. His study results were recently published in APhA's professional journal.

Forty-two percent of the pharmacists surveyed said they had witnessed illicit use of potentially addictive pharmaceutical drugs (PAPDs) among co-workers, and 65% had worked with an R.Ph. who condoned self-medication. Dabney also found that 30% of the pharmacists personally approved of self-medication.

"Drug use in pharmacy has a couple of faces," Dabney said. "Some pharmacists engage in self-medication as a fringe-benefit type of behavior—sort of like other employees taking home pens and paper from the job. In addition, pharmacists who self-medicate see themselves as drug experts, and they resent asking a doctor. This creates a culture of tolerance. Pharmacists who develop a drug habit can rationalize their behavior by saying, 'I can handle it. Junkies are out on the street.' "

Nearly 40% of the R.Ph.s Dabney surveyed said they had engaged in illicit use of mind-altering or PAPDs on at least one occasion. Of those, 20% reported five or more episodes and 6% reported more than 10 episodes. Almost 6% identified themselves as being drug abusers at some point during their pharmacy careers. Among the users, 61% had stolen drugs from pharmacy stock and 7.5% had forged scripts.

While self-medication is technically illegal, most pharmacists can rationalize such behavior, agreed Jeffrey Baldwin, Pharm.D., associate professor of pharmacy practice at the University of Nebraska Medical Center. "Most pharmacists probably feel that the doctors are too busy to be bothered. Pharmacists are too busy trying to get prescriptions filled and contacting third-party payers to go to the doctor, and they know what the doctor will prescribe anyway, so why not save everyone the trouble?" he added.

Pharmacists generally begin to illegally use PAPDs after they start their pharmacy training, Dabney found. Among those who had used PAPDs, approximately 24% started during college, and 64% were out in the workforce when they started self-medicating with such drugs.

The self-medication mystique is a problem, agreed officials who manage state programs for impaired pharmacists. David Marley, Pharm.D., executive director of the North Carolina Pharmacist Recovery Network Inc., estimated that more than 95% of R.Ph.s. have self-medicated at some point in their careers. "Unfortunately, self-medication is being reinforced by preceptors to students," he added. "For example, have a fever, take a Zithromax; hurt your back, take a T&C#3; eat too many chicken wings, take a Prilosec."

While some in pharmacy might be upset about negative coverage generated by Dabney's study, a little more media attention to drug use among pharmacists might be a good thing, according to Marley. "Maybe then the other states, associations, and pharmacy schools would take the issue more seriously," he said. "We still have far too many states struggling with volunteer [pharmacist recovery] programs, which only inhibits effective promotion of the issue."

Since self-medication seems to be influenced, at least in part, by day-to-day interactions with colleagues that outweigh the influence of teachers or supervisors, pharmacy's leadership has a tough job, Dabney said. Formal efforts to reduce drug usage by educators, employers, or national leaders may not be effective; instead the focus should be on long-term, grassroots efforts to eliminate the climate of tolerance.

Going to the grass roots is good, but it's going to take more than local, informal efforts to overcome pharmacy's culture of self-medication, said Baldwin. "It must be grass roots to treetops; that is, from practitioner to academia to national leadership to employers to lawmakers," he said.

Carol Ukens


Carol Ukens. Pharmacy culture condones R.Ph. self-medication.

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