For Pharmacists With Substance Use Disorders, Recovery Is Possible

Jake Nichols, PharmD, MBA, has been in recovery for over 14 years. His substance abuse, which kicked off while he was a student in pharmacy school, has shaped the entire trajectory of his career. During the height of his addiction, Nichols exhibited most of the typical behaviors at work that are associated with the disease: not showing up on time, staying late to catch up on his responsibilities, not showing up at all. But none of his colleagues ever caught on to the real issue—or at least never outright accused him of it.

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However, while Nichols was working in an oncology specialty pharmacy in 2010, that quickly changed. Six months into his new position, he was caught stealing controlled substances by his employer. What followed were legal issues, board of pharmacy issues, and a long, long road of recovery. After going through detox and outpatient care, Nichols entered into a 5 year program through a pharmacy recovery network in Massachusetts.

“I was kind of honestly forced into treatment,” Nichols said. “In my mind back then, it was the only path to getting my pharmacy license back. Initially, in that period, I did not acknowledge that I had an issue [or that] I had a disease. It was all focused on being able to continue to work and support my family.”

Nichols now acknowledges that he does in fact have a disease, the seeds of which he says were planted in him long ago—and he’s far from alone. Research has shown that health care workers, especially pharmacy professionals, are at an increased risk of substance use disorders. Approximately 1 in 9 pharmacists will suffer from a substance use disorder at some point in their career and 46% have reported using controlled substances without a prescription.^1,2

Why is this the case? Addiction is a complex and chronic disease where genetics play a key role. Research supported by the National Institute on Drug Abuse that probed the genomic data of over 1 million people identified genes commonly inherited across substance use disorders.³ But genes do not form the whole picture of addiction, environmental factors are also influential and are known to contribute to substance abuse in pharmacy professionals.

READ MORE: Higher Buprenorphine Doses May Reduce Health Care Utilization for OUD

A spotlight has recently been shone on the pharmacy field, due to the COVID-19 pandemic, unionization efforts at large chain pharmacies, and pharmacy benefit manager (PBM) reform legislation making its way through Congress. What all of these different factors boil down to is a toxic pharmacy work environment that is rife with burnout. Over half of pharmacists report experiencing burnout because of increased work hours, excessive workload, high patient and prescription volumes, and poor work-life balance.⁴

Burnout is defined as a “psychological response to work related stress, presenting as emotional exhaustion, increased levels of depersonalization and cynicism and reduced feeling of personal accomplishment or efficacy.”⁴ Aside from being a predictor of many physical complications like heart and cardiovascular disease, burnout is also known to negatively impact mental health and can lead to depression, anxiety and substance abuse—particularly in health care workers.⁵

“[Pharmacists have access to] multiple mind altering substances,” Nichols said. “Whether we've tried them or not before, [we] know that these can alleviate pain, whether that's emotional or physical pain. In the throes of a very stressful work environment, it can become very tempting for those of us with that genetic predisposition or an experience having tried 1 of these to take a pill here or there. That’s how it starts. One or 2 at stressful times, and then it doubles. Then you find yourself using every day not too long after that.”

For pharmacists dealing with a substance use disorder, there are numerous treatment options and it is no longer a career-ending issue. Nichols said the profession has come a long way on this topic since he went through treatment all those years ago. Many states have recovery programs now specifically for pharmacists that are sponsored by their respective Boards of Pharmacy. The programs typically include some form of recovery monitoring, which vary from state to state, as well as support and advocacy for pharmacists returning to work.

But stigma surrounding substance abuse is still very real and acts as a deterrent to seeking help for many pharmacy professionals. Sarah T. Thomason, PharmD, BCPP, BCACP, CGP, FASCP, who serves on the Virginia Opioid Abatement Authority and is the chair of Pharmacy Practice at the Gatton College of Pharmacy at East Tennessee State University, said stigma around substance abuse is particularly bad for pharmacists and other health care professionals. Thomason added that even though it's taught that substance use disorder is a disease, many are still reluctant to seek help because they feel shame or embarrassment due to the associated stigma.

“[Having a substance use disorder] is not because you're weak,” Thomason said. “It is because you have a disease. It takes treatment. It's chronic. It's relapsing. You have to understand that it's long term treatment to get into long term recovery for most people. I think education [is key], especially starting [with] student pharmacists, but also doing continuing education with our licensed pharmacists, so that they feel more comfortable if they see someone [dealing with] a substance use disorder that they help intervene and get them the treatment they need and support them, instead of making them feel that they're less than or that there's something wrong with them.”

What’s clear is that erasing stigma around substance abuse is critical for getting more pharmacy professionals to seek the assistance they need. Although there is not much data, reports have shown that when pharmacists enter treatment it works extremely well, with anecdotal data suggesting an 80% to 85% success rate.⁶ The type of treatment also seems to be of importance. One study found that pharmacists who did not go into a pharmacy assistance program were 10 times more likely to relapse than those who participated.¹ But the overall takeaway from these numbers is that recovery can be achieved—pharmacists with addiction just need to admit they have a disease and reach out for help.

“Recovery is possible,” Nichols said. “Because of the stigma, we don't hear about recovery as much as we probably should. There are millions and millions of people that are in recovery for substance use disorder [and] there are many paths to recovery. There's no one way to do it. There is no clinical definition of what recovery is. It is a very personal thing that takes a lot of work and a lot of insight to uncover what that looks like. But I promise you, if you find yourself in this situation and you do the work and you achieve recovery, it is absolutely worth it.”

READ MORE: Substance Use Disorder Resource Center

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References

1. Cross W. Addressing substance abuse in the pharmacy. Pharmacy Purchasing & Products. July 2014; Vol. 11; No. 7. https://www.pppmag.com/article/1539

2. Vivian JC. DEA Form 106 and Loss of Controlled Substances. December 14, 2015. US Pharmacist. https://www.uspharmacist.com/article/dea-form-106-and-loss-of-controlled-substances

3. Hatoum AS, Colbert SMC, Johnson EC, et al. Multivariate genome-wide association meta-analysis of over 1 million subjects identifies loci underlying multiple substance use disorders. Nat Ment Health. 2023;1(3):210-223. doi: 10.1038/s44220-023-00034-y

4. Dee J, Dhuhaibawi N, Hayden JC. A systematic review and pooled prevalence of burnout in pharmacists. Int J Clin Pharm. 2023;45(5):1027-1036. doi: 10.1007/s11096-022-01520-6

5. Elkardi S, Choujaa H, Agoub M. Burn out of health care professionals leads to addiction. Eur Psychiatry. 2023;66(Suppl 1):S466–7. doi: 10.1192/j.eurpsy.2023.1000

6. Light KE, Goodner K, Seaton VA, et al. State programs assisting pharmacy professionals with substance use disorders. J Am Pharm Assoc (2003). 2017;57(6):704-710. doi: 10.1016/j.japh.2017.07.002