Deborah Brauser

December 19, 2011

December 19, 2011 (Scottsdale, Arizona) — Tailored treatment programs can help chemically dependent pharmacists not only achieve and maintain abstinence but also successfully return to a workplace that is often full of temptation, according to new research presented here at the American Academy of Addiction Psychiatry (AAAP) 22nd Annual Meeting & Symposium.

A long-term, prospective study of more than 100 pharmacists who entered a pharmacist-focused addictions treatment program showed that 87.1% of the participants had a 2-year recovery success rate.

"After 2 years of abstinence, a recovering pharmacist poses no more additional risk to potential employers than does a randomly selected member of the general population," lead author of the first study Wallace Cross, RPh, senior addictions counselor and pharmacy program coordinator at Resurrection Behavioral Health-Addiction Services in Chicago, Illinois, told Medscape Medical News.

Lisa J. Merlo, PhD, MPE, clinical psychologist and assistant professor of psychiatry at the University of Florida College of Medicine, was not involved with this research but presented two other studies at the meeting on substance-addicted healthcare professionals.

"There is so much stigma related to addiction, and it may be even worse in these professionals than in the general population," said Dr. Merlo.

"If we can change the way we talk about this problem and disseminate information about the fact that people can get help and get better and actually return to work and be more productive than they were before, that will increase the likelihood that colleagues will help by reporting what they see. Hopefully it will also help increase the number of self-referrals to treatment."

Paucity of Research

"In spite of the burgeoning attention given to other healthcare professionals struggling with addiction, there exists a paucity of literature concerning addictive disease in pharmacists," write the investigators from the first study.

This is perplexing, they note, because past research has shown that 1 in 8 pharmacists will suffer from addiction over their lifespan.

Mr. Cross and his investigative team collected data from 116 substance-addicted pharmacists (77.6% men; mean age, 40.7 years; 95.7% white) who underwent an addictions treatment program in Chicago, Illinois.

Of these, 75% were employed in retail pharmacies, 14.7 were employed in hospital settings, and 5.2% were employed in other settings such as independent pharmacies. A total of 5.2% were advanced pharmacy students.

The 8-week intensive 12-step outpatient treatment program was abstinence-based and was tailored to both the individual and the pharmacy profession. Naltrexone was prescribed to narcotic-addicted pharmacists who had no contraindicated conditions "as a condition of returning to the profession."

To assess treatment success, all participants were followed for 2 years after being discharged from the program. Treatment success was defined as abstinence documented by frequent and random urine tests for specific drug(s) of choice, The tests were conducted throughout the 2-year follow-up period by state monitoring programs.

Relapse, which was defined as use during the follow-up period of any mood altering, addictive substance except for nicotine, was also monitored.

Useful Data

Results showed that only 12.9% of the participants relapsed during the follow-up period.

Significant independent predictors of relapse, compared with those who remained abstinent, included alcohol dependence (P < .05), the presence of an Axis II dual psychiatric diagnosis (P < .05), prior treatment history (P < .05), being single with regard to marital status (P < .05), and not participating in a 12-step program during the follow-up period (P < .01).

Being female was also found to be a relapse predictor, but it was not considered statistically significant (P = .08).

The investigators write that the study findings may potentially help identify "at-risk" pharmacists, which would in turn protect public health.

"Data from this analysis could be of utility to treatment providers, state monitoring programs, employers, and boards of pharmacy to more effectively evaluate pharmacists and provide continued accuracy," note the researchers.

"The workplace itself can be high risk for these individuals. So programs need to take that into account and tailor their processes accordingly. By ensuring pharmacists' health through evidence-based treatment and intervention, both the facilitation of the healthcare system and the health of the population are improved," added Mr. Cross.

Best Chance of Success

"These results are very consistent with what we've seen in the physician recovery literature, which shows around 80% success rates typically 5 years after treatment," Dr. Merlo told Medscape Medical News when asked for comment.

Dr. Merlo, who was not involved with this study, is director of research for the Professionals Resource Network (PRN), Inc., which is designated by the state of Florida as one of its Impaired Practitioners Programs.

"In our research with pharmacists, they often bring up risk factors in their work environment. So some have opted to work in a nuclear pharmacy as opposed to a retail pharmacy, where they don't have access to the abuseable drugs," Dr, Merlo reported.

"And that can actually be part of the contract — that individuals in a professional pharmacist health program finish their treatment, participate in 12-step recovery groups, and then put themselves in a position where they'll have the best chance of success."

Dr. Merlo added that Florida has a policy whereby pharmacists with opiate dependence are treated with naltrexone in addition to their other addiction treatments.

"That can have a big impact in terms of reducing their craving and reducing their risk for relapse as well."

Addiction Risk Higher in Physicians

During a meeting symposium, Dr. Merlo presented results from two unpublished studies that examined addicted healthcare professionals.

Her first study assessed physicians (n = 101, 75.3% men) and nonphysician health professionals (n = 156, 60.3% men) with substance use disorders and comorbid psychiatric disorders. All participants were recruited from the PRN and came from 6 sites across Florida.

Results showed that the nonphysicians had significantly higher lifetime rates of use of amphetamines, opiates, cannabis, sedatives, and tobacco than the physician group.

"This was somewhat surprising, especially about the opiates. But it may have been because the nonphysician group included so many pharmacists" (n = 39), said Dr. Merlo.

Nonphysicians also had significantly higher rates of antisocial personality disorder (P < .01). There were no significant between-group rate differences for any other mental disorders.

The investigators then compared substance use rates between the physician group and 404 matched control participants from the National Epidemiologic Survey on Alcohol and Related Conditions, Wave 1.

Results from this second analysis showed that the physician group reported significantly higher rates of lifetime use of cocaine/crack, opiates, and sedatives than did the matched control participants, but the general population had higher levels of tobacco dependence.

Finally, the physician group had lower levels of specific phobias and obsessive-compulsive disorder than the matched control participants. No other differences in psychiatric disorders were found between the groups.

Varied Reasons for Addiction

In the second of Dr. Merlo's studies presented during the symposium, which is tentatively scheduled to be published in the Journal of the American Pharmacists Association in March, 110 substance-impaired healthcare professionals from the PRN participated in group interviews to discuss their reasons for misusing drugs.

The most common reason given by the 54 physicians who participated in the interviews was to manage physical pain. Other reasons were to manage emotional/psychiatric symptoms, to manage stress, recreational use, and to prevent/alleviate withdrawal.

The most common reason given by the 32 pharmacists who were interviewed was access, followed by a stressful work environment and a "look the other way" culture of tolerance. They also noted that it was difficult for them to imagine help without legal ramifications or the possibility of losing their jobs.

"Right now I think access is the primary barrier. We know that professional health programs work, and we know that monitoring is associated with really good outcomes. It's just getting people into the system that's been the challenge," said Dr. Merlo.

"And the most important reason for research into this area is that it's showing that these professionals can be helped and shouldn't just lose their license," she added.

Mr. Cross disclosed no relevant financial relationships. Dr. Merlo reported having received fellowship support from a National Institute on Drug Abuse training grant.

American Academy of Addiction Psychiatry (AAAP) 22nd Annual Meeting and Symposium: Poster Abstract 5 and Symposium 2. Presented December 9, 2011.

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