14.8 Pharmaceutical Temptations for Abuse and Theft

Drug abuse is an enormous problem, not only for patients, but also for pharmacy and medical personnel who are tempted into illegal behaviors due to access. According to USA Today in April 2014, more than 100,000 healthcare practitioners are abusing legal drugs, which affects not only themselves and their families but also the quality of the care they give patients.

Drug Abuse in Health Professionals

Health professionals, like physicians, nurses, pharmacists, and others, often fall victim to drug abuse and controlled substances diversion. It is not uncommon for a pharmacy technician to succumb to the temptation to pilfer prescription drugs. It is estimated that more than 10% of healthcare professionals have a drug or alcohol abuse problem—a statistic that is similar to substance abuse in the general population. Access to controlled drugs offers a temptation to healthcare workers who are drug seekers. Some will divert and abuse these drugs for reasons such as self-medication to relieve stress or pain, improve work performance and alertness, or to sell and make money.

When the prescriber, pharmacist, or technician is caught, it can mean loss of job, license, and registration, and embarrassment to the family and profession. In addition, a drug-impaired pharmacist or technician is more likely to make medication errors and be subject to criminal prosecution.

Prevention

Criminal background checks and urine drug screening tests have become an essential component of prescreening for pharmacy technician and pharmacist education programs and employment opportunities. Due to risk of abuse and easy access to controlled drugs, pharmacies have also implemented measures to prevent drug theft, including cameras, tablet-by-tablet inventories, and staff in-service training. Such training includes recognizing the signs and symptoms of substance abuse and knowing the course of action to take if you suspect a colleague has a substance abuse problem.

Signs and Symptoms of Substance Abuse Substance abuse is difficult to spot because it is a behavior most people cleverly learn to hide. Possible signs and symptoms include changes in appearance (such as bloodshot eyes) and changes in behavior (such as abrupt mood swings, slurred speech, poor listening skills, belligerence, overconfidence, lying, absenteeism, and forgetfulness). While anyone can have a “bad day,” sudden and consistent behavioral changes may indicate a serious problem. The problem may also stem from personal or relationship issues, economic issues, health issues, stress, or other causative factors.

Course of Action If you are aware that a technician or a pharmacist has a problem, you have a legal and ethical responsibility to uphold the law and protect society. There is a natural reluctance to getting involved with a colleague’s problems. Anyone would want to avoid retribution or contributing to a technician’s termination or a pharmacist’s loss of licensure. Even so, encourage your coworker to seek professional drug treatment. By getting help for your colleague, you are protecting not only their safety and welfare but also that of the other employees and patients.

Rehabilitation

Pharmacists, pharmacy students, or pharmacy technicians who are impaired from alcohol or drug abuse can be referred (or volunteer to be admitted) to a drug rehabilitation counseling program offered through their state pharmacy organization. Most state boards of pharmacy have a Pharmacists Recovery Network (PRN) or similar organization to provide assistance and treatment for impaired colleagues without the risk of losing their license or registration. Contact information for each state may be found at https://PharmPractice7e.ParadigmEducation.com/StateContact. The successful completion of such a program may result in reinstatement of registration or license.

One commonly abused drug is a combination of hydrocodone and acetaminophen.

Prescription Drug Theft

Certainly, drug tolerance and addiction are major reasons for prescription drug abuse, but drug diversion for money, especially in challenging economic times, is also a major cause of abuse. Each dose of a prescription drug may command a high price among recreational users. Sadly, some Medicare and Medicaid patients give their legal prescriptions for narcotics to drug dealers for cash. National and regional databases share information about the prescribing and dispensing of these drugs between states to better identify drug seekers and traffickers.

Preventing Pharmacy Robberies

Retail pharmacies, due to the presence of money and especially drugs, are targets for robberies from criminals and addicts. In 2015 there were over 800 armed robberies of retail pharmacies in the United States. Hopefully, you will never encounter such an event, but if you do have such an emergency, do you know the right and wrong things to do?

Purdue Pharma, in conjunction with the National Community Pharmacists Association (NCPA), has developed a crime prevention and training program called RxPatrol. This is a collaborative effort between industry and law enforcement designed to collect, collate, analyze, and disseminate pharmacy theft information. The RxPatrol website has training videos and a security checklist to help make your pharmacy safer from robbers. There is also a national database of pharmacy robberies. If you have an incident at your pharmacy, you can report it, or you can review the robberies in your geographic area and alert other staff members.

During a robbery, the acronym to remember is REACT:

R - Remain calm, comply, and do not resist.

E - Eyewitness; remember all you can, such as age, height, weight, race, gender, body markings, and clothing.

A - Activate your panic alarm when safe.

C - Call police; describe incident, robber, and their mode and direction of travel.

T - Take charge; lock the door so the robber cannot return, protect the crime scene, keep customers calm, and have them remain in the store as witnesses when police arrive.

Prevention strategies are also important to deter potential robberies. Keep an eye on customers you do not recognize; many times they may be scoping out the pharmacy. Keep security cameras visible and functional. Have more than one panic alarm button and have an escape plan with your staff. Keep the phone number of your local police precinct readily available.

RxPatrol is an acronym for Pattern Analysis Tracking Robberies and Other Losses.

Copyright © 2013 Purdue Pharma L.P.

The National Association of Boards of Pharmacies (NABP) and the Drug Enforcement Agency (DEA) recommend that both C-II and C-III drugs be locked in a steel cabinet with access limited to the pharmacist. This is not always practical, though C-II drugs must legally be locked. To prevent night robberies, a good alarm system plus the locked cabinets is a prudent prevention strategy.