Risk recognize resolve_addiction_in_the_pharmacy_profession
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Transcript of Risk recognize resolve_addiction_in_the_pharmacy_profession
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Risk, Recognize, Resolve: Addic2on in the
Pharmacy Profession April 2 – 4, 2013
Omni Orlando Resort
at ChampionsGate
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Learning Objec2ves
• 1. Iden=fy risk factors for pharmacy professionals that may influence the development of the disease of addic=on.
• 2. Iden=fy the signs and symptoms of the disease of addic=on.
• 3. Describe the resources available to pharmacy professionals when a colleague may need assistance with addic=on or substance abuse issues.
• 4. Describe the structure of accountability added to the recovery person by monitoring with a Pharmacist Recovery Network.
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Disclosure Statement
Brian Fingerson has no financial rela=onships with proprietary en==es that produce health care goods and services.
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Brian Fingerson, RPh • President, KYPRN – Kentucky Professionals Recovery Network since 1986
• Clients/professions include: Accountants, Pharmacy, Den=stry, Physical Therapy, Veterinary Medicine, Respiratory Care, Optometry, Chiroprac=c, Social Work
• Work with these professionals through their licensing Boards
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What do you know? Self-‐Assessment Ques2ons T or F
• In a diagnosis of addic=on using DSM IV criteria, one must exhibit any two out of seven of the criteria within the past six months.
• Gene=cs is the sole determining factor as to whether someone becomes addicted to a substance or process.
• The prognosis for someone who is addicted to a substance includes these three: 1) get sober; 2) get locked up; or 3) die.
• Alcoholism, chemical addic=on, is a disease, the very nature of which renders the vic=m incapable of recognizing the severity of the symptoms, the progression of the disease, or of accep=ng any ordinary offers of help.
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And why should we learn about addic2on in pharmacy professionals?
Crit Care Med. 2007 Feb;35(2 Suppl):S106-‐16 Baldisseri MR.
Cri=cal Care Medicine, University of Pidsburgh School of Medicine, Pidsburgh, Pennsylvania, USA. OBJECTIVE: The objec1ve of the ar1cle is to present the available data from the literature on substance use disorders in healthcare professionals. Prevalence, risk factors, treatment op1ons, and reentry into clinical prac1ce are discussed.
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Crit Care Med. 2007 Feb;35(2 Suppl):S106-‐16 Baldisseri MR.
• INTRODUCTION: Impairment of a healthcare professional is the inability or impending inability to prac5ce according to accepted standards as a result of substance use, abuse, or dependency (addic5on). The term substance use disorder can be divided into substance abuse and dependence (addic1on). Substance abuse results in adverse social and professional consequences. Addic5on manifests as physiologic and behavioral symptoms related to a maladap1ve paLern of substance use.
• MAIN RESULTS: It is es1mated that approximately 10% to 15% of all healthcare professionals will misuse drugs or alcohol alcohol some 1me during their career.
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Why do people take drugs “recrea2onally” in
the first place?
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People Take Drugs To:
• Feel good (sensa2on seeking) • Feel be[er (self-‐medica2on)
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A major reason people take a psychoac2ve drug is they
like what it does to their brains
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Prolonged drug use changes
the brain in fundamental and
long-lasting ways
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Addiction is a
brain disease
Reward Pathway
Wow!!!
Opiates Alcohol Cocaine Amphetamines Marijuana
Frontal Cortex
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Young adults may be less likely to develop serious alcohol
and other drug problems if the age of first use is
delayed beyond childhood or adolescence
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AA Grapevine e-‐poll Ques2on: At what age did you have your first drink? Total Responded: 7947
0-‐11 2308 votes (29.04 %)
12-‐18 5110 votes (64.3 %)
19-‐26 420 votes (5.29 %)
27-‐40 52 votes (0.65 %)
41 or older 57 votes (0.72 %)
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Addic2on: One Defini2on • A primary, chronic, neurobiological disease, with gene2c, psychosocial, and environmental factors influencing its development and manifesta2ons. It is characterized by behaviors that include one or more of the following:
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Addic2on behaviors:
• Impaired control over drug use
• Compulsive use
• Con2nued use despite harm
• Craving
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Fr Vernon Johnson’s defini2on of addic2on
• “”Alcoholism, chemical addic2on, is a disease, the very nature of which renders the vic2m incapable of recognizing the severity of the symptoms, the progression of the disease, or of accep2ng any ordinary offers of help.”
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DSM IV: Diagnosis of Addic2on (3 out of 7 in past 12 months)
1. Tolerance 2. Withdrawal Loss of Control: 3. Used more and longer than planned 4. Unsuccessful a[empts to quit or control use 5. Excessive 2me spent obtaining, using, or
recovering from use 6. Important ac2vi2es given up 7. Con2nued use despite adverse consequences
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DSM-‐V
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Risk as a healthcare professional?
Don’t know of anyone yet whose reason for becoming a pharmacist was drug access. But…maybe so?
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Risk Factors • General Public = 10%
• Pharmacists and some other health care professionals = HCP = 12-‐16%
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So…Why an increased risk factor?
• Access to drugs • Stress • Knowledge • Family history = 1 parent 20-‐25% chance, 2 parents 30-‐50%
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And how can this be, you say?
• Dean Dabney in JAPhA, May/June 2001
• Vol. 41, No. 3 • Use of Mind Altering or Poten2ally Addic2ve Prescrip2on Drugs (PAPD)
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Who was asked?
• It was a random sample of licensed, prac2cing pharmacists who were members of APhA in the fall of 1996.
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And what did the study show?
• 40% indicated using PAPD without 1st obtaining an Rx
• 20% reported 5 or more life2me episodes
• 6% reported 10 or more life2me episodes
• 6% iden2fying as being drug abusers
• Drugs obtained by stealing drugs from employers or forging Rx
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DENIAL – not just a river in Egypt* Yes – it has been said before!
• Don’t • Even • Know • I • Am • Lying
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Denial from Knots by R.D. Lang
• There must be something the ma[er with him because he would not be ac2ng as he does unless there was. Therefore he is ac2ng as he is because there is something the ma[er with him.
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Denial con2nued:
• He does not think there is anything the ma[er with him because one of the things that is the ma[er with him is that he does not think that there is anything the ma[er with him.
• Therefore we have to help him realize that, the fact that he does not think there is anything the ma[er with him is one of the things that is the ma[er with him.
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HCP good at “cover up” and if confronted will deny
• Denial is not just a river in Egypt • Paranoia and irritability • Depression • Use of large quan22es of alcohol – more than normal or more than others present
• Blackouts
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Blackouts -‐ Once a person has had one
Fr Vernon Johnson • 1) You can never tell how much of the chemical it will take to put you into the blackout again.
• 2) You can never tell how long the blackout will last.
• 3) There is no connec2on between our value system and what we will do in a blackout.
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Problems seen:
• Slurred speech – frequent drunkenness
• Personal problems
• Paren2ng problems • Sexual dysfunc2on or promiscuity
• Insomnia • Having ONLY friends who like to party
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Problems con2nued:
• Frequent promises to cut back
• Avoiding social func2ons unless “altered”
• Memory problems
• Mood swings
• Blaming of behavior on others
• Withdrawal into isola2on
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Impairment signs/symptoms in the workplace:
• Changes in the manner in which pa2ents and colleagues are treated
• Deteriora2on of personal appearance and hygiene
• Loss of interest in work, or…. • “Super Pharmacist” or Super whatever
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Workplace con2nued:
• Poor record keeping • Problems with concentra2on • Med errors or whatever • Absenteeism or tardiness, esp. on day following days off
• Pa[ern of frequent job changes
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Workplace con2nued:
• Paranoia • Frequent trips to the bathroom
• Mood swings
• Periods of unemployment
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Am I an alcoholic?
• 1. Have you ever decided to stop drinking for a week or so, but only lasted for a couple of days? 2 -‐ Do you wish people would mind their own business about your drinking-‐-‐ stop telling you what to do? 3 -‐ Have you ever switched from one kind of drink to another in the hope that this would keep you from gesng drunk? 4 -‐ Have you had to have an eye-‐opener upon awakening during the past year?
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Am I an alcoholic?
• 5 -‐ Do you envy people who can drink without gesng into trouble? 6 -‐ Have you had problems connected with drinking during the past year? 7 -‐ Has your drinking caused trouble at home? 8 -‐ Do you ever try to get "extra" drinks at a party because you do not get enough?
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Am I an alcoholic?
• 9 -‐ Do you tell yourself you can stop drinking any 2me you want to, even though you keep gesng drunk when you don't mean to? 10 -‐ Have you missed days of work or school because of drinking? 11 -‐ Do you have "blackouts"? 12 -‐ Have you ever felt that your life would be be[er if you did not drink?
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CAGE-‐AID
• Cut down • Annoyed • Guilty • Eye opener
JAMA 252:1905-1907, 1984 Am J Med 82:231-235, 1987
CAGE-AID: CAGE Questions Adapted to Include Other Drugs
p9
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CAGE-‐AID 1. Have you felt you ought to cut down on your drinking or drug use?
2. Have people annoyed you by cri=cizing your drinking or drug use?
3. Have you felt bad or guilty about your drinking or drug use?
4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves, get rid of a hangover, or get the day started? Screen posi5ve score = 1+or 2+
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CRAFFT Ques2ons 5. Have you ever ridden in a CAR driven by someone
(including yourself) who was “high” or had been using alcohol or drugs?
6. Do you ever use alcohol or drugs to RELAX, feel beder about yourself, or fit in?
7. Do you ever use alcohol/drugs while you are by yourself, ALONE?
8. Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
9. Do you ever FORGET things you did while you were using alcohol or drugs?
10. Have you goden into TROUBLE while you were using alcohol or drugs? Screen posi5ve score = 2+
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But I can’t be one!!!!!!!!!!
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If…then three courses of ac2on:
• Sober up • Get locked up • Get covered up = PUAD
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Do they have to reach this level?
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It is this serious folks!
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To whom do I turn for help? Do you call the professional’s licensing Board?
Board balances regula2on with compassion
Is it a bad person in need of punishment or an ill person in need of care?
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There is an op2on in some states
You could call your state’s recovery program
I publish my office/home phone number
The website www.usaprn.org has a directory of state programs
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Referral by: • Board • Self • Colleague or employer
• Family
• Interven2on • ***anonymous
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Why do they ask for help?
• Liver • Lover • Livelihood • Law
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Then what happens?
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Evalua2on
• KYPRN uses addic2ons psychiatrists and some2mes a residen2al 3-‐5 day assessment
• Results of evalua2ons will determine to a large extent what type of treatment. It may be AA/NA, IOP, Long-‐term residen2al or other or a combina2on
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Yes…Rehab does work!
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Goals of Addic2on Therapy:
• Reduc2on or elimina2on of denial • Increased self care • Treatment of medical and psychiatric problems
• Treatment of co-‐morbid family
• Educa2on to protect himself or herself from substance abuse disease
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Contracts
• For a specific length of 2me – usually 5 yrs
• Shared with employer – if per2nent
• May limit number of hours worked
• Approved prac2ce site or type • CAPTASA, U of Utah, SE PRN
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Other things
• Mee2ng documenta2on forms
• Medica2on use lists
• Monthly self-‐report form
• Urine Drug Screens
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Pharmacist may have:
• Modifica2on of prac2ce type • Prac2ce monitoring by peers/others
• Protocols for required mood-‐altering drugs for a legi2mate medical problem
• Consequences should she return to substance use
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Conclusion
• Substance abuse by HCP is a condi2on that has become increasingly recognized over the past 20+ years. We’ve worked hard to develop treatment protocols and support programs.
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Treatment does work!
The vast majority of Pharmacists who successfully complete treatment and par2cipate in a{ercare monitoring CAN and DO successfully return to prac2ce.
HIRE THE RECOVERING PROFESSIONAL
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“The alcoholic is like a tornado roaring through the lives of others.” page 82
From the book: “Alcoholics Anonymous”
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Page 82 also says: “Hearts are broken.” Our goal is: Recovery From the book: “Alcoholics Anonymous”
Recovery: by Mike Vye
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Not this:
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True or False
• “Alcoholism, chemical addic2on, is a disease, the very nature of which renders the vic2m incapable of recognizing the severity of the symptoms, the progression of the disease, or of accep2ng any ordinary offers of help.”
• TRUE
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True or False
• In a diagnosis of addic2on using DSM IV criteria, one must exhibit any 2 out of 7 of the criteria within the past 6 months.
• FALSE
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True or False
• Gene2cs is the sole determining factor as to whether someone becomes addicted to a substance or process.
• FALSE
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True or False
• The prognosis for someone who is addicted to a substance includes these three: 1) get sober; 2) get locked up; or 3) DIE
• TRUE
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Have you ever wondered?
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Ques2ons? • Brian Fingerson, RPh • 202 Bellemeade Road • Louisville, KY 40222-‐4502
• 502-‐749-‐8385 • Email = kyprn@a[.net
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Thank you
Thank you Thank you Thank you