Prescription drug diversion among substance-impaired pharmacists.

BACKGROUND AND OBJECTIVES: Prescription drug addiction is a significant problem affecting healthcare professionals. The purpose of the present study was to identify common mechanisms of prescription drug diversion by pharmacists, in order to facilitate the development of effective prevention programs and policies for this high-risk group. METHODS: A total of 32 pharmacists (71% male) who were being monitored by their State professional health program (PHP) due to substance-related impairment participated in anonymous guided group discussions. RESULTS: Participants documented six primary methods of drug diversion by pharmacists: (1) taking expired drugs that can no longer be sold by the pharmacy and are awaiting disposal; (2) assuming responsibility for managing the pharmacy inventory and/or changing inventory records to prevent detection of missing drugs; (3) forging prescriptions for themselves, family members, friends, or customers in order to gain access to the drugs; (4) using "sleight of hand" techniques to acquire drugs while filling prescriptions or shelving products; (5) blatantly stealing drugs from the pharmacy, even in front of coworkers or video cameras, and (6) collecting patients' unused medications and keeping them. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Efforts to address the problem of prescription drug abuse and diversion by pharmacists should be expanded in order to safeguard pharmacies and the patients they serve. Future research should extend this study to larger samples and assess best practices for decreasing prescription drug diversion by pharmacists with addiction.

Recovering substance-impaired pharmacists' views regarding occupational risks for addiction.

OBJECTIVE: To better understand the occupational risks for substance use disorders among pharmacists and possibilities for improved prevention. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: A southeastern state from December 2008 to April 2009. PARTICIPANTS: 32 participants (72.7% men) from the impaired professionals monitoring groups in the geographic regions within the state that had the greatest number of physicians, pharmacists, and allied health professionals currently under monitoring contracts for substance use disorders. INTERVENTION: Guided group discussions regarding substance use among health care providers. MAIN OUTCOME MEASURES: Persistent occupational risks for development of a substance use disorder among pharmacists. RESULTS: Several occupational hazards unique to the pharmacy profession might contribute to the problem of substance use disorders among some members of this population, including increased access to potent drugs of abuse, a stressful/unpleasant working environment, a culture that unofficially condones medication diversion, lack of education related to addiction, and lack of support for individuals seeking treatment. CONCLUSION: These results have important implications for the education of student pharmacists, the continuing education of licensed pharmacists, and the management of pharmacies in which these individuals work. Given the potential occupational risks for substance abuse associated with the pharmacy profession, additional training, monitoring, changes to the work environment, and increased confidential access to treatment may be needed to safeguard pharmacy professionals and the communities they serve.

Reasons for misuse of prescription medication among physicians undergoing monitoring by a physician health program.

OBJECTIVES: Substance-related impairment of physicians is a small but serious problem, with significant consequences for patient safety and public health. The purpose of this study was to identify reasons for prescription drug misuse among physicians referred to a physician health program for monitoring because of substance-related impairment, to develop better mechanisms for prevention and intervention. METHODS: A total of 55 physicians (94.5% male) who were being monitored by their State physician health program because of substance-related impairment participated in guided focus group discussions. Participation was anonymous. Discussions were transcribed from 9 separate focus groups, lasting 60 to 90 minutes each. Qualitative analyses were conducted to examine themes. RESULTS: All participants were diagnosed with substance dependence, and 69.1% of them endorsed a history of misusing prescription drugs. Participants documented the following 5 primary reasons for prescription drug misuse: (1) to manage physical pain, (2) to manage emotional/psychiatric distress, (3) to manage stressful situations, (4) to serve recreational purposes, and (5) to avoid withdrawal symptoms. CONCLUSIONS: Our results emphasize the importance of self-medication as a leading reason for misusing prescription medications, although recreational use was also an important factor. Prevention efforts targeting prescription drug misuse among physicians should be initiated during medical training, with continuing education requirements throughout the physicians' careers.

Injury, pain, and prescription opioid use among former National Football League (NFL) players.

BACKGROUND: Athletes with injury-related pain, especially National Football League (NFL) players, are at increased risk for opioid use and misuse which may result in medical, psychiatric and social problems. This is the first study to evaluate the intersection of sports pain and opioid use and misuse among former NFL players. METHODS: A telephone survey of 644 retired NFL players from the 2009 Retired Players Association Directory was conducted (53.4% completion rate) from March to August 2010. RESULTS: Over half (52%) used opioids during their NFL career with 71% reporting misuse. Additionally, 15% of NFL misusers currently misused vs. 5% among players who used just as prescribed during their NFL career. Prevalence of current opioid use was 7%-3 times the rate of the general population. Multivariate analyses indicated that significant NFL pain increased the adjusted odds (AOR) of any current opioid use vs. non-use (AOR 6.76, 95%CI 2.88-15.87), as did moderate to severe mental impairment (AOR 1.88, 95%CI 1.19-2.98) and heavy drinking in the past week (AOR 2.15, 95%CI 1.17-3.98). Undiagnosed concussions singly predicted current misuse vs. use just as prescribed (AOR 4.25, 95%CI 1.12-16.22). Three variables predicted current misuse vs. non-use: significant pain (AOR 8.33, 95%CI 1.98-35.04), undiagnosed concussions (AOR 3.51, 95%CI 1.98-35.04) and heavy drinking (AOR 3.48, 95%CI 1.63-7.41). CONCLUSIONS: Players who misused during their NFL career were most likely to misuse currently compared to others. Current misuse was associated with more NFL pain, undiagnosed concussions and heavy drinking. Longitudinal studies are needed to determine the long term effects of opioid misuse among athletes.