Issues and Data Associated With Addictive Disease in Pharmacists

1. Issues and Data Associated With Addictive Disease in Pharmacists Wally Cross, R. Ph.¹ Stephanie Bologeorges, B.A.¹ & Daniel Angres, M.D.¹ ¹ Resurrection Behavioral Health-Addiction Services • Discussion • The present investigation found the two-year recovery success rate for pharmacists to be 87.1%. This demonstrates that chemically dependent pharmacists who complete a tailored treatment program experience a high rate of recovery; after 2 years of abstinence, a recovering pharmacist poses no additional risk to a potential employer than does a randomly selected member of the general population. • Data from this study suggest the effectiveness of tailoring treatment to the factors that predict relapse. Treatment of this population must also be tailored to the pharmacy profession and include collaboration with employers and assistance programs, advocacy with the licensing board of pharmacy, follow-up monitoring of substance use, treatment and management of dual diagnoses, be 12-step oriented, and provide the patient with a comprehensive aftercare contract. • Treatment must also address return-to-work issues, as the workplace itself is high risk. For narcotic addicted pharmacists seeking to return to work, naltrexone seems to be an effective adjunctive treatment option to aid in the ease and safety of doing so. • Findings also highlight critical warning signs and triggers of addiction within the workplace itself (e.g. diverting), which may aid others in the identification of the “at risk” pharmacist and assisting them into treatment. • Implications for relapse prevention programming emphasize the importance of 12-step programs, enhancing social/marital support, and learning effective coping strategies to manage workplace stress. • Treatment of the addicted pharmacist helps maintain public health. Pharmacists have been noted as among the most accessible health care providers, and by ensuring their health through evidence-based treatment and intervention, both the facilitation of the health care system and the health of the population are improved. • Strengths of this investigation include its prospective and longitudinal design, the use of clearly defined and objective outcome measurement, and use of a tailored treatment program with components similar to those recommended in prior studies of other health professionals (e.g. Baldissari, 2007; Skipper, 1997; Long et al., 2006). • Outcomes from this study both extend the extant research and clinical literature and can also be of utility to treatment providers, state monitoring programs, employers, and boards of pharmacy to more effectively evaluate pharmacists and provide them with continued support and advocacy in their recovery. • Measures • Longitudinal Sobriety Outcome: Participants were classified as either abstinent or relapsed at the end of the 2-year follow-up interval. Abstinence was defined as the absence of use of any addictive substance (except nicotine) for 2 years post-treatment. Relapse was defined as any use of an addictive substance in the 2 year interval. Outcome determination was based on documentation from frequent and random urine toxicologies specific to drug(s) of choice conducted by state monitoring programs. The determination was corroborated by observational and interview clinician reports at periodic follow-up visits and through ongoing collaborative agreements with referral sources and monitoring programs. • Drug(s) of Choice: Drug(s) of choice had to meet the full DSM-IV criteria for dependence for inclusion. Drugs were classified into the following categories: oral stimulant, oral narcotic, parenteral narcotic, alcohol, illegal (e.g. marijuana, cocaine), and other (e.g. benzodiazepines) • Dual Diagnosis: Assessed at intake by psychiatrist in conjunction with clinician report, and had to meet DSM-IV criteria for inclusion. Data were coded in binary by diagnostic axis. • Other variables assessed included binary classifications of the presence of legal charges, pharmacy board involvement, job status (terminated or not), prior relapse history, known family history, diverting from the workplace, 12-step involvement in follow-up interval, and naltrexone prescribed as a condition of returning to work. • Introduction • 1 in 8 pharmacists will suffer from addiction over the lifespan (Baldwin, 2009) • The rate of addiction in pharmacists is no greater than in other health professions (Kenna & Wood, 2004), yet in spite of the burgeoning attention given to other health care professionals with addictions, there exists a paucity of literature concerning addictive disease in pharmacists. • Extant research on this population has focused on descriptive and precipitating factors: • Caucasian males have been cited as most vulnerable to dependence (Bissell, 1989). • Oral narcotics have higher rates of use in pharmacists than in other health professionals (Kenna & Wood, 2004; Bissell et al., 1989). • Contributing factors specific to addiction in pharmacists include: a lack of effective education regarding addiction, the “paradox of familiarity” with addictive drugs, the genetic nature of addiction, high levels of workplace stress, the pharmacy culture of tolerance regarding self-medication, and workplace exposure and access to addicting drugs (Kenna & Wood, 2004; Dabney, 2001). • Prior outcome research pharmacists has been limited to retrospective, self-report data, often wherein dependence criteria have been loosely defined and outcomes have not been linked to engagement in a formal treatment program. No studies to date have disseminated prospective and longitudinal recovery rate findings for pharmacists seeking addictions treatment. • Adjunctive pharmacologic treatment with the opioid antagonist naltrexone has been approved in the treatment of narcotic addiction, as its high affinity for the opioid receptors blocks the effects of narcotics. Research has yet to report on the use of naltrexone for recovering pharmacists. • Aims of the Present Investigation • To determine the efficacy of addictions treatment tailored to both the individual and the pharmacy profession with ongoing abstinence two years post-treatment • To describe characteristics of addicted pharmacists to better identify those “at risk” • To identify factors differentially associated with relapse to improve treatment outcomes • To enhance existing knowledge of the effectiveness of naltrexone as an adjunctive treatment for narcotic addicted pharmacists returning to the workplace • Results • 87.1% of chemically dependent pharmacists had remained abstinent at the end of the two-year follow-up interval (12.9% had relapsed). • Between group Analyses of Variance (ANOVA) analyses were performed to determine which factors differentiated the relapse group from the group that maintained sobriety. The following independent predictors of relapse were found: • Alcohol dependence: p < .05 • Presence of a dual diagnosis on Axis 2 (personality disorder): p < .05 • Prior relapse history: p < .05 • Lack of 12-step involvement in follow-up interval: p < .01 • Single Marital Status: p < .05 • Female Gender: p = .08 • Methods • Participants • The study sample consisted of 116 chemically dependent pharmacists who entered a professionals addictions treatment program in Chicago, IL. 77.6% were male, 22.4% female. Mean age was 40 years, 7 months. 95.7% were Caucasian, 4.3% Asian. 40.5% reported their marital status as single, 59.5% reported being married or in a domestic partnership. 75.0% were employed in retail pharmacies, 14.7% in hospital settings, 5.2% were advanced pharmacy students, and 5.2% were employed in other settings (e.g. industry). • Procedure • Data were collected prospectively from pharmacists entering treatment over a 14 year period. • Chemically dependent pharmacists completed a partial hospital program that was 12-step, abstinence based, and tailored to both the individual and the pharmacy profession. Treatment length of stay averaged 8 weeks in duration. • For narcotic addicted pharmacists returning to a high risk work setting and who had no contra-indicated conditions, naltrexone was prescribed as a condition of returning to the profession. • Pharmacists were followed for 2 years post-discharge from treatment to determine longitudinal sobriety outcome • Data were entered and analyzed using SPSS version 18.0. References Baldissari, M. R. (2007). Impaired healthcare professional. Critical Care Medicine, 35 (2 Suppl): S106-116. Baldwin, J. N. (2009). The addicts among us. American Journal of Pharmaceutical Education, 73(7): 124. Bissell, L., Haberman, P. W., Williams, R. L. (1989). Pharmacists recovering from alcohol and other drug addictions: an interview study. American Pharmacy, NS29(6): 19-30. Dabney, D. A. (2001). Onset of illegal use of mind-altering or potentially addictive prescription drugs among pharmacists. Journal American Pharmaceutical Association, 41(3): 392-400. Kenna, G. A. & Wood, M. D. (2004). Prevalence of substance use by pharmacists and other health professionals. Journal of the American Pharmacists Association, 44(6): 684-693. Long, M. W., Cassidy, B. A., Sucher, M., Stoehr, J. D. (2006). Prevention of relapse in the recovery of Arizona health care providers. Journal of Addictive Diseases, 25(1): 65-72. Skipper, G. E. (1997). Treating the chemically dependent health professional. Journal of Addictive Diseases, 16(3): 67-73.