He was always willing to help out, covering an extra shift here and there, offering to work till closing alone, and always just so darn helpful. It wasn’t long before I began to notice the dark side, however. The nervous reaction when a pharmacist or tech approached him while he was working alone, escalating offers that would allow him to be alone in the pharmacy, and an underlying sense of dishonesty, all led to suspicions of misbehavior. Then product started disappearing. When alerting management of my suspicions,I was advised not to schedule this pharmacist for coverage shifts any longer, effectively terminating his part-time employment with us. I know now that this was the wrong thing to do. He was never allowed back in that pharmacy.

Months later he started showing up at the clinic and the pharmacy. He brought treats for the nurses and the pharmacy staff. He tried so hard to ingratiate himself into our good graces. I could still see the dark side, however. The offers to send myself or the staff pharmacist home early and he would close up for us, resumed. Even off the clock! I detected the furtive glances trying to see how much hydrocodone we had on the shelf. I could feel the desperation.

Despite what management had told me, I felt that I must intervene, so I took this young pharmacist to my office and discussed his obvious substance problem. At first he denied it all, of course, but as I expressed empathy and pointed out the obvious addictive behaviors, he told me the whole story. Like many patients with substance abuse disorders, it began with a legitimate prescription for pain management of an acute injury. This pharmacist had be in a grievous accident, involving multiple fractures and significant pain. The slippery slope was too much for him to overcome. In a familiar progression of events, he started augmenting his regular prescriptions with Rxs from other prescribers, taking a tablet or two during his works shifts at one of his three part-time jobs, to eventually stealing entire stock bottles as his addiction took control of his life.

Fortunately, he was able to break the cycle of addiction and get the help he needed. He admitted his addiction to his parents and referred himself to the board of pharmacy and into the PAPA program. All of this happened over a decade ago and that pharmacist is now rehabilitated and working in the profession.

Over the years I have had more opportunities to see the scope of this problem. It has many different faces. A doctor friend whom I played racquetball with on a regular basis, had been ordering a hydrocodone cough syrup at increasing frequency from our pharmacy “for office use,” a former student was caught on tape accessing the narcotic cabinet during non-business hours and removing product, I was asked to go to a pharmacy as quickly as possible because there would be no pharmacist there and arrived in time to see the pharmacist being “perp walked” out of the facility, I was nearly physically assaulted when a call from a technician required me to go and ask the pharmacist for his keys and terminate his employment as he was obviously drunk, and belligerent, on duty. The scary stories are endless.

Most of us enjoy the thrills we get from a scary movie, whether it be an evil clown peeking out of a sewer or mysterious creatures from an upside-down world right next to ours. In real life, not only our patients are affected, the problems of substance abuse permeate our profession. Pharmacists are not unlike our patients and have substance abuse disorders at about the same rate as the general population, somewhere around 12%. The problem is scary and all too real.

This is why I became a part of the Arizona Pharmacy Foundation which provides critical support for the PAPA program as well as providing education for pharmacists and the community to prevent, recognize and understand treatments of substance abuse disorders. It’s rewarding to be a small part of an effective solution.

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