By Dave Marley, Pharm.D., Former Executive Director North Carolina P.R.N.
The profession of pharmacy has evolved through the years from one of apprenticeship, to now requiring a six-year Doctorate degree for entry into the profession. We have come from a role that was once primarily of prescription compounder and seller of product, to one of dispensing necessary drug/health care information. One area of practice though that has remained consistent is our false believe that we as pharmacists can somehow diagnose and treat our own illnesses.
So as not to offend anyone, I will say that not all pharmacists are guilty of self-medication. When I speak of self-medication though, I’m not just talking about controlled substances. I mean all drugs that contain the federal legend on the stock bottle, which states, “Federal law prohibits dispensing without a prescription.”
First and foremost, self-medication is irresponsible, unethical, and dangerous pharmacy practice. Our colleagues in the field of medicine would say that “a doctor who treats himself has a fool for a patient, and even bigger fool for a doctor.” It is important to also note that we pharmacists do not possess the legal ability to diagnose and dispense, making self-medication a felonious offense.
This combination of knowledge and drug availability can lead health care professionals to a false sense of confidence. It has been said that this is a “paradox of familiarity” where pharmaceutical knowledge, minus an accurate understanding of the risks, leads to the belief of immunity from prescription drug abuse. In most pharmacies it is only a couple of inches difference between reaching for 800mg of ibuprofen (also a legend drug), and if that doesn’t work for whatever ails you, then grabbing the hydrocodone products.
To date, I have not seen a study that addresses the issue of self-medication as a whole. When it comes to addressing self-medication with controlled substances, this issue first appeared in an 1888 issue of The Apothecary, which stated, “the bane of drug clerks (today known as staff pharmacists) is a tendency to have two great besetting vices - tippling, and opium eating.”
In 1987, McAuliffe et al’s study, “Use and Abuse of Controlled Substances by Pharmacists and Pharmacy Students,” looked at 312 pharmacists and 278 pharmacy students. Their results showed that 46% of the pharmacists, and 62% of the students had reported using a controlled substance at some time without a prescription.; 19% and 41% , respectively, used one within the previous year. One has to ask if this many pharmacists and students are willing to violate the federal Controlled Substances Act (CSA), how many more are willing to violate the federal Food Drug and Cosmetic Act? While both are federal crimes, the CSA generally has more serious punishment.
The purpose for making self-medication an issue is two-fold. First, is the very serious potential for bad outcomes when one is involved in diagnosing and treating one’s own illnesses. The other is to hallmark an important point that is often missed when addressing addiction within the profession, this being that self-medication is a choice, while addiction is a disease.
I have yet to meet an addict who has consciously chosen to “become an addict.” Many pharmacists make a choice to experiment or self-medicate. If McAuliffe’s numbers are correct, almost half of the profession of pharmacy has chosen to take a controlled substance without authorization. If that person happens to have the genetic predisposition to addiction, then any choice about addiction is lost. They have no more control over becoming an addict than the diabetic has over becoming diabetic.
This now raises a couple of questions: 1. Do we punish someone for having a disease? I think not 2. Do we punish someone for breaking the law? What we as a profession need to do is first recognize that self-medication is a problem. Addressing this issue in the schools of pharmacy is part of the solution. Boards of Pharmacy also need to take action when the self-medication is discovered. Self-medication by itself is easy enough to reprimand.
Recognizing that there may be a concomitant disease process (addiction) also occurring requires action as well. Society’s approach to criminalizing drug use is outdated, ineffective and doesn’t address the underlying pathology. Mandating treatment in lieu of prosecution is an approach that is having success. Many jurisdictions are now implementing drug courts, rather than traditional jail time.
If we are serious about addressing impairment within the profession of pharmacy, we need more states to implement fully funded impairment programs. But we also need the schools of pharmacy, the professional societies, and Boards of Pharmacy to start talking about self-medication as well.
Reprinted with permission :North Carolina PRN Journal, Volume 3, Issue