Prospects Brighten for Pharmacists in Recovery

New methods help pharmacists confront drug abuse

by Carol Milano

"I used drugs all through pharmacy school, skirted the system, forged prescriptions to cover up my use and didn't get caught for 10 years," recalls Jeff Harnsberger, now pharmacy district manager for a major chain.

While Mr. Harnsberger's comeback may be outstanding, his history reflects a significant problem in the profession. "Among practicing pharmacists, 19% are occasional or regular users of controlled substances without a prescription," according to the Journal of the American Pharmaceutical Association (January-February 1998).

Larger workloads and more prescriptions have heightened the temptations in recent years. "No one goes to pharmacy school for drug access," observes Jeff Baldwin, PharmD, RPH, associate professor of pharmacy practice at the University of Nebraska Medical Center College of Pharmacy, in Omaha. "You can't keep people on their feet for 12 hours-in front of a computer, calling insurance companies, dealing with customers -- and not expect them to find ways to cope."

Favored coping methods are Schedule III narcotics or controlled substances, especially hydrocodone. Some abusers will add a stimulant, such as a diet pill, followed by benzodiazepene. These may be mixed with other medications, like acetaminophen, that are "not as tightly controlled, so you can get away with stealing more, faster, because of less federal control," says Dr. Baldwin.

Changing Attitudes

For a long time, impaired practitioners were simply dismissed. However, "the terrific shortage of pharmacists has had an impact," says Mary Ann Wagner, vice president of pharmacy regulatory affairs at the National Association of Chain Drug Stores. "Chains now look at it differently, acknowledge the problem and are becoming receptive to the idea of treatment programs. One or two chains have told me they usually make information available, by at least giving a pharmacist a number to call to get help."

Over the past decade, Ms. Wagner has seen a trend toward getting people into treatment programs and back to work. Some discover they simply cannot be around controlled substances, "but most do recover and get their jobs back. Understanding is growing on the part of chain employers; they want to keep good pharmacists. One chain found that those they helped have returned and become their most loyal employees, because someone literally saved their lives."

Kerr Drug, a Mid-Atlantic chain of 115 stores, believes it has a duty to protect the safety of its customers. "If we have a pharmacist who is impaired, we need to do something about it," asserts Gray Stewart, RPh, manager of pharmacy administration and compliance. "Most pharmacists do want to get help, but if we ask them to consider a [treatment] program and they decline, we feel it's our professional obligation to inform the Board of Pharmacy." The Board has jurisdiction over a pharmacist's license, which can be taken away if an impaired professional declines treatment. "It's a 'voluntary' program, but if you don't volunteer, you face consequences. The profession, like us, wants people to get help," Dr. Stewart says.

Once a pharmacist goes through a rehabilitation program, Kerr Drug will work with him or her. "Years ago, you wouldn't give someone a second chance, but because of the numbers of people who have addiction problems now, we do. We've been able to have people in treatment programs who can come back to their jobs," Dr. Stewart reports.

Treatment Programs

Treatment options vary among states. The Arizona Board of Pharmacy's respected program, Pharmacists Assisting Pharmacists of Arizona (PAPA), began in 1989. "As the regulatory agency, we get reports of missing drugs and controlled substances from pharmacies, and calls from internal Loss Prevention staff at different chains," explains Llyn Lloyd, the Board's executive director. "Usually, they have good evidence: someone on a hidden camera, or a pattern over several weeks when only a particular pharmacist was working. If a manager intervenes and directs the pharmacist to a program, the Board is not notified." Some pharmacists enroll themselves, when co-workers tell them that when they voluntarily join a program, the Board is not notified, so that their license isn't suspended.

Since 1995, the North Carolina Recovery Network -- America's only fully funded treatment service administered by a pharmacist -- has treated about 150 pharmacists, with more than 90% returning to work successfully. Nearly half are referred by a colleague or relative; NCRN sends a semiannual newsletter to the home of every licensed pharmacist in the state. After evaluation, NCRN makes referrals for one to three months of inpatient treatment with a qualified provider, at a cost of $10,000 to $30,000, which the pharmacist has to cover.

One major chain, which has a specific policy dealing with substance abuse, refers its pharmacists to NCRN, puts them on disability, with full benefits, and holds their jobs. For other employers, a treating physician sends a notice that a pharmacist is out of work because of a "medical disability."

On average, people return to work in about six months, checking in daily with an 800 number that tells them when to report for randomized testing. "When we send narcotics addicts back to work, they're on naltrexone, which makes it impossible to get high," says David Marley, PharmD, NCRN's executive director. "The most important factor for returning to work is a solid 12-step foundation, at either NA or AA."

One Pharmacist's Experience

Jeff Harnsberger worked full-time, as a student, at a pharmacy where drug abuse was common. "When I came in looking tired, another pharmacist said, "Try this -- it'll pep you up," and handed me a phentermine. That legitimized taking drugs for me. In the late '80s, no one noticed a few missing pills." Soon, Mr. Harnsberger was taking pills to help him sleep, study or avoid nausea. On the morning he learned he'd passed the Board, the pharmacy that had given him a scholarship fired him for taking a bottle of prescription cough syrup.

Moving to North Carolina, Mr. Harnsberger worked for major high-volume chains, and thought he was hiding his growing drug use. An employer confronted him, offering help if he'd admit to his problem. Mr. Harnsberger denied the charges -- unaware that he'd be reported to the state Board of Pharmacy.

At his next job, a Loss Prevention specialist showed him computer records of missing drugs, and advised him to call NCRN. Frightened enough to seek help, Mr. Harnsberger started a 30-day treatment program in November 1998. He lost his license for six months. Having no savings, he asked a relative for the money to pay for treatment, and worked as a warehouse clerk for $8 an hour. He had to repay his last employer for all the drugs he had taken.

A district manager he'd met at NCRN offered Mr. Harnsberger a job. "His supervisor knew he hired people in recovery, and believes they work harder because they're so grateful for a second chance," Mr. Harnsberger reflects. After 18 months, he was encouraged to apply for a promotion. Now, as district manager, he's glad to hire pharmacists who have been to NCRN, when they're ready.

"It took me 10 years from the time I lost my first job to get to the point of admitting I needed help. Now I'm involved in recovery work in the pharmacy field -- my most rewarding role. Yet, after four years, I still go to five or six NA meetings a week. Recovery never stops-it's a journey, not a destination," says a pharmacist who knows.