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Rx Drug Abuse: Stigma Often Prevents Abusers From Seeking Treatment

Editor’s Note: This article is part of a series produced by the Southwest Times Record in Fort Smith. The entire series will be published online at www.lonokedemocrat.com. Next: Prescription drug prosecutions more frequent locally than meth, marijuana crimes.

FORT SMITH — Prescription drug abuse is a disease that can affect people of all walks of life, yet many people do not seek help because of the stigma and possible consequences associated with it.

Those who work in the health-care industry can be especially adverse to seeking treatment, said Dr. Kim Light, pharmacology professor at the University of Arkansas for Medical Science’s College of Pharmacy.

Light said he tells students that prescription drug abuse can be a real problem for aspiring pharmacists.

“Ten to 15 percent tends to be what you hear (nationally). Health-care professionals can be more at risk, and they certainly have more exposure and more access,” Light said. “They tend to be extremely intelligent and extremely capable, and able to hide their use more effectively. It diminishes the chances of being detected until the disease is sufficiently advanced, until their cleverness can’t keep it under wraps anymore.”

Sebastian County Drug Court coordinator Shirl Page said she could recall a few nurses being in her court over the years.

“I haven’t had a health-care worker in maybe a couple of years, but I’ve had lots of nurses. Some of them gave up their license,” Page said. “I’ve had maybe three or four who went through the nursing board, and they have a system that they have to test them in order for them to keep their license … . I’ve had several who were able to go back into nursing.”

Page said she could recall two cases of people who ended up staying with their employer, but in positions that didn’t require handling drugs.

Cpl. Paul Smith of the Fort Smith Police Department’s Narcotic Unit agreed that his office seldom has to investigate cases of prescription drug abuse among local hospital staff, recalling only a handful of cases within the last year at the area’s three major hospitals, Mercy Fort Smith and Sparks Regional Medical Center in Fort Smith and Summit Medical Center in Van Buren.

“(The hospitals) have internal mechanisms to help them if they’ve got an abuse problem,” Smith said. “Usually once it comes to their attention that they’ve got an abuse problem, unless they self-report, they’re either going to be terminated or investigated by us, at which point they’ll go into the criminal system.”

William Trice, attorney for the Arkansas State Medical Board, said instances of drug diversion are an inevitable problem given how many doctors and physicians practice in the state.

“We deal with it one or two cases a board meeting, but you can see there’s a variation of what you’re dealing with,” Trice said. “We have some 10,000 docs, so when you work in the candy store, there’s a lot of ways to mess up.”

Arkansas has seen fewer cases of physicians diverting drugs within the last few years than in many other states, but if the board does catch a doctor, Trice said, he or she likely will not commit the same offense again.

“We’ve been very fortunate — and we keep track of this, obviously — when we do tag a doc for different issues, we don’t have a lot of recidivism,” Trice said. “That second hearing goes down pretty hard.”

Robert Freeman, human resources director at Sparks, said the Fort Smith hospital has a procedure in place if a staff member is suspected of stealing or abusing prescription narcotics.

“If we found out about it, anyone in the organization, they would notify HR, and we’d notify administration. … We’d pull that person off the job immediately and get them out of the environment,” Freeman said. “We’d do a drug screen and we would suspend them until we get the results of the drug screen.

“While they’re doing that drug screen, it also gives us an opportunity to investigate the situation that led to this,” he said. “Through our investigation, we can often determine that a diversion, as we will call it, did or did not occur, just based on the evidence and testimony of folks around the situation and looking at logs from our system that tracks narcotics.”

The hospital uses two machines, called Pyxis and AcuDose, to sort, track and store records of any prescription medications at the facility, Freeman said.

John Kirtley, executive director of the Arkansas State Board of Pharmacy, said the public needs to understand that anyone is susceptible to prescription drug abuse — health-care professionals or otherwise.

“The downfall of trying to say it happens in health care — with pharmacists or nurses or anything else — is that people are almost aghast at that,” Kirtley said. “Then you go, ‘Wait a minute.’ The problem is you really need to recognize the fact that the rates of drug dependence, drug addiction and drug abuse are across the line. They don’t pull health-care professionals out of that; they don’t pull police officers or elected officials.”

Light said prescription drug abuse needs to be treated for what it is — a disease.

“Addiction is the only disease for which a relapse tends to be interpreted as if treatment and recovery don’t work,” Light said. “Asthma, diabetes type 2 and hypertension all have the same relapse rates as addiction, about 40-60 percent. But if an asthmatic has an asthma attack, we don’t say, ‘See? Asthma treatment doesn’t work.’”

Treatment methods and attitudes regarding prescription drug abuse need to adjust as the disease becomes more prevalent, Light said.

“There’s still a stigma of, ‘Well, the individual brought it upon themselves.’ You know, I understand that. It seems like, ‘Why can’t they just stop?’” Light said. “But it’s only because people don’t really understand what’s going on in the brain: the neurobiology of addiction. There’s not anybody who’s an addict who really thinks, ‘This is really just the greatest thing in the world and I want to keep it up.’”

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