US Pharm. 2010;35(9):1. 

One of the most difficult things for a health care professional to do is to identify and report a colleague who is practicing while impaired due to substance abuse, which could include alcohol, prescription drugs, or illegal substances. In fact, according to a recent survey published in the Journal of the American Medical Association, more than one-third of U.S. physicians who responded to a survey said they didn't think they should always report colleagues who are incompetent or impaired because of substance abuse. This report reminded me of a situation I experienced years ago.

Back in the days when I owned and operated an independent drugstore, I noticed a few orders for a pint bottle of paregoric. If I used one pint bottle in a year it was a lot, so I immediately became suspicious that someone who had access to the order book was using the paregoric personally. Not so strangely though, when I went to look for the bottles on the shelf, I could not find any. Then one day I went to flush the toilet in the restroom, and the handle would not go down. I took the top of the toilet reservoir off only to discover a pint of paregoric sitting at the bottom of the water tank. It was not difficult for me to trace who had been ordering the bottles. It turned out to be a pharmacist who worked for us part-time. This gentleman was very affable and well liked by the staff and patients. He was the last person I would have suspected of being impaired; but, when I was certain it could be no one else, I confronted him. He looked like a kid whose hand had been caught in the cookie jar, but he never actually admitted to being addicted to paregoric (or anything else). I offered to contact the state pharmacy association and see if we could get him into a pharmacist recovery program. He denied he had a “real problem,” rejected our offer, and we parted ways. I was shocked to learn of his problem and that I had unknowingly entrusted this man to fill prescriptions and counsel patients while “under the influence.”

Because of the sensitivities involved, data about the number of impaired pharmacists is scarce, or sketchy at best. One study uncovered that most nonprescribed opioid and antianxiety drugs used by pharmacists are taken for self-diagnosed ailments, while most stimulants are taken to facilitate performance. It also showed that the majority of pharmacists who used these drugs did so after leaving college. More disturbing is the fact that 40% of pharmacists reported that they had used a prescription drug without a physician's authorization, and 20% reported that they had done so five or more times in their lifetime. How widespread substance abuse by pharmacists may be is anyone's guess. Much of the time, when it is discovered it is not reported and the pharmacist likely loses his or her job, only to take another position in another city or state where the pharmacist's reputation is unknown. My guess would be that abuse is rarely reported to the state board of pharmacy for fear that the impaired person will be expelled from the profession. And that is really too bad because virtually every state has a pharmacy recovery network (PRN). Its programs are rehabilitative in their approach and offer an alternative to board of pharmacy license sanctions. The PRN is dedicated to the early identification, intervention, and treatment of drug-affected pharmacists, pharmacy students, and technicians.

Every pharmacist has a duty to be aware of an impaired pharmacist with whom he or she might be working and to try to seek help from the state association. Not only will you be doing your fellow pharmacist a huge favor, you will also be assuring the safety of the patients your pharmacy serves. 

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