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Pharmacist on Buprenorphine Program - a Dilemma

shroompharmer

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Apr 14, 2014
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[FONT=Verdana, Arial, Tahoma, Calibri, Geneva, sans-serif]Note to the mod - I posted an identical thread in Education and Careers but then realised that it might get better exposure here. Not sure if that is a breach of rules - sorry

Ijust wanted to share my situation and see if anyone else is in asimilar position, or could give some advice. I was a registeredpharmacist in NSW, Australia up until about 3 years ago. I developedan opioid habit and soon after I voluntarily left the profession toseek treatment, letting my professional registration lapse in theprocess - I knew that what I was doing was not sustainable and Icould potentially get into a lot of trouble, not to mention possiblyOD in the process- I had FAR too much access to whatever opioid Idesired. I struggled for a long time to get a handle on my opioid useuntil recently, when I decided to finally to try to get onto Bupe. Ihave been on Bupe maintenance for a while now, and it has been veryhelpful in keeping me on the straight and narrow. [/FONT]


[FONT=Verdana, Arial, Tahoma, Calibri, Geneva, sans-serif]Thatis all well and good, but I have recently been considering gettingback into pharmacy - I enjoy the work and the pay is good. I feelthat my illicit opioid use is no longer an issue and feel confidentthat pharmaceuticals would no longer be a major temptation. I got tothe point of filling out my application for registration - only tonotice the little question on the form asking if I had "anycondition that could impede your practice - including drug abuse ordependence". Now I face a dilemma - I dont believe that I dohave a condition that could impede my practice, but the PharmacyBoard may have a different view. If I answer no to the question, Irun the risk of being turned in by a colleague (several healthworkers and pharmacists know that I am on the program) and could facelegal problems or problems with my professional insurance. If Ianswer yes tot he question, I could be denied my registration, andcould seriously affect my chances of ever becoming registered again.For all of my searching, I have not been able to find a clearprecedence, or guideline that tells me if I am allowed to beregistered while on Bupe. [/FONT]

[FONT=Verdana, Arial, Tahoma, Calibri, Geneva, sans-serif]Iam confused about what to do [/FONT]:\ [FONT=Verdana, Arial, Tahoma, Calibri, Geneva, sans-serif]Doesanyone have any advice or opinions? has anyone been in a similarsituation - in Australia, or elsewhere?[/FONT]
 
Hi shroomfarmer - welcome to bluelight.

I think the best place to go to for advice would be your state drug user organisation. Are you still in NSW? I would contact NUAA and have a chat to them. If you are in a different state, you can swing by the AIVL website and find your relevant state user organisation.
 
Hey Shroompharma,

Straight up: sorry, I have no idea what you should do, as your case is very specific and really comes down to your own ethics and judgement. Ayjay's post above is probably as much as anyone can say on the matter.

Reason for posting in response is a selfish one: pure curiosity.

I find your situation really fascinating. I've often wondered how many people in the medical/pharmaceutical field have developed addictions due to their access to a range of potent, clean drugs. If you don't mind - and I realise this is something you may not want to go into, so feel free to not answer (or PM me, haha) - could you tell me a little of the background to your addiction?

Did you use any drugs prior to becoming a pharmacist? If yes: Did that play a part in your chosen profession? (I don't think that's a completely ridiculous question, BTW)

Do you know of any other pharmacists or GPs/nurses/etc that maintained habits while working in their fields?

How easy or hard would it be to "help yourself" as a pharmacist? I mean, things like oxycodone are quite tightly regulated and monitored, right?

Apologies for not being able to help, and sorry again if these questions are far too personal or risky for you to discuss given your situation.

All the best.
 
Hey, thanks for the responses. ayjay, that is a good idea - I might get in contact with NUAA and see if they can offer any advice.

Halif, I'm happy to share my experience.

I didnt really get into any drug use until part way through doing my pharmacy degree. Before then, I had used alcohol and smoked a little bit of pot. having access to drugs wasn't a motivating factor in choosing pharmacy, in fact the very idea of using pharmaceuticals obtained through my workplace would have seemed morally repugnant to me at that point.

During my 4 years at Uni, I gradually was introduced to MDMA, speed, coke, LSD and Shrooms, and party drugs became a pretty important part of my social life - as they did for other students I studied with. During my final year of Uni, some friends (also bpharm students) and me become curious about pharmaceuticals and we experimented with benzos and opioids that we obtained at the university, and through various student placement workplaces. This didnt become a regular thing, but thats when I first realised that I loved opioids in particular. During the final two years of uni I also developed depression that has continued to follow me right through till now -though with medication and managing my substance use, Im now in a pretty good place mentally.

After Uni, I spent a year doing an internship at a community pharmacy in a small town. It was then that my use of pharmaceuticals really ramped up. I realised that although it was difficult to get my hands on s8 medication in the pharmacy's stock, I could keep an eye on medication that was returned to the pharmacy when someone passed away, or changed medication or whatever. S8s that were returned to be destroyed were supposed to be written into a register and then destroyed under supervision - but i realised that if I just threw them out in the drug bins with the other s4 meds, I could retrieve them when no one was looking. So pretty soon after getting my hands on my first big supply of morphine, I had my first experience with opioid dependence. I managed to get through my internship and board exams despite using benzos and opioids throughout my intern year, and my opioid use continued for several years as I continued to exploit the same crack in the system to get morphine, oxys, fentanyl, dilaudids - pretty much what ever i wanted, i could get by waiting long enough and keeping my eye out. I even figured out a way to hide that fact that my pupils were pinned. Buuuut eventually, my habit got the better of me and I realised that I had to quit pharmacy, before I was found out. So I did.

As far as I know, I am the only one from my original group of curious students that actually developed an ongoing habit.

And now, after over two years away from it, and now finally on an OTP, I want to get back in. I reckon I have left my pharmaceutical use behind - I just want to be a legit pharmacist now.
 
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Thank you very, very much for that reply:)

With that kind of experience on both sides of the fence, and the honesty with which you're revealing this, I think you deserve to re-enter work as a pharmacist. So many times I have thought (and written on here) how much different - for the better - the world of medicine would be if the people who prescribe or dispense medications had some first hand experience with the allure and pitfalls of potent substances like opioids and benzodiazepines.

My experience has suggested that there is a serious empathy deficit amongst GPs, psychiatrists, and pharmacists. The few really human people I've met working in those professions were so impressive and inspirational to me, however, that I remember them well and appreciate their sincere efforts in their work to actually help and understand people. Perhaps you could be one of "the good guys".

I hope it works out for you, and thank you again for your candid response.
 
Thanks for the words of support. In the last couple of years, I have tried to make the most of my situation and have been working as a drug and alcohol case worker for a non-government D&A service. While I think my time working in the D&A field has been an awesome experience, and I have learned so much, ultimately it is not what I am trained to do, and it isn't my passion. I just hope the pharmacy board will see things from my perspective. I am leaning towards being honest and gathering supporting character references and evidence of my ongoing treatment to tender with my application.
 
^ Great post Halif, I agree - and kudos for sharing that with us Shroompharma. Thank you. Love the clever screen name too.

I can only begin to imagine the impact of going from a rewarding professional career (that I'm sure you worked extremely hard to attain) to losing it and finding yourself in this complicated bind must have had on your life.
I'm no stranger to nightmarish scenarios playing out in my day to day life, but I'm guessing you took a bit of a tumble and getting back on track has been pretty damn hard.
A complete role reversal - from dispensing medicine to being dependent on someone doing the same for you?

I have a couple of thoughts, but I'm not sure how helpful I could be.

Ajay's tips are pretty fucking spot on regarding legal advice and the sorts of organisations he's referring to - i'm sure there is a wealth of information to be had from people familiar with these kinds of clauses in contracts/registration applications - seems like the best way to approach this; seek advise from people who - above all - won't judge you...and go from there.
Actually - maybe that's bluelight? Well - good choice ;)

If not legal aid or other drug advocacy group affiliated lawyer/clued up paralegal folk - perhaps if you can afford (and are prepared) to pay for legal advice from a lawyer that specialises in this field (I'm not sure if it would be relating to medical law, contract law, industrial law?) these advocacy groups - or people in their legal teams - would presumably be able to point you in the right direction, refer you to somebody with experience in providing similar legal support.

I wouldn't be surprised if situations like this happen all the time; I'm sure that there are a number of professional organisations and industries that seek to preclude drug dependent individuals from joining their ranks.
And we all know that addiction doesn't discriminate according to profession, or other minor details. Actually - yours is more like a potential occupational hazard for people with a taste for altered states of consciousness.
...and that's kind of what makes this whole question somewhat complicated.

At this point I'm sure it is clear I have the credentials to give you an opinion that's worth sweet fuck all - but my BA in English Literature (ha ha ha) leads me to think that your best bet in this situation (apart from the really good point above about getting some really glowing professional and personal references from any impressive sounding people you might know well enough to trust they'll be as complimentary in their appraisal as you'd want) is to volunteer as much personal - potentially compromising private information about yourself as you have to no more...no less - (within reason, of course)

I think lying on the registration application (though very tempting) would be very unwise and could get you in a bit of hot water....but it depends on how this question is worded, exactly - how how one could reasonably interpret it. I different interpretation - and a less forthcoming response - could be a matter of how you read the question, rather than a deliberate attempt to distort truth.
It's all a bit "close to home" for comfort i'm sure. Jesus.

Id also like to add that if I were you I would be really careful from here on in about posting any potentially identity-revealing information relating to yourself - be it age, location, preferred brand of socks, taste in music, automobiles, the schools you' e attended - anything even slightly, personal really.
Call me paranoid, but I'd probably go back and edit my first post (mentioning your home state etc).

This may sound crazy or overly cautious, but a certain degree of anonymity is sought by most people on forums devoted to uh, stuff of questionable legality - and what you've disclosed above, in terms of reapplying for your registration as a Pharmacist - along with your (commendably eco-friendly) way of finding a new home for neglected drugs - would be almost as damning as inclosing a massive sack of empty s8 pill bottles and blister packs (each scripted to a different name; none of them yours) with your application for re-registration.

That it could cast an unfavourable shadow on your application, to say the least - should it come to the attention of anyone assessing it. Extremely unlikely (and maybe obvious) as that is, I thought it worth mentioning.
Not that many members here would think any less of you Hopefully you'll stick around this online community and and tell us all about yourself if - nay - when you get back into your career. A Pharmacist would be an amazing asset to this sub-forum (in terms of discussion and knowledge, not anything that would contravene the law or the BLUA) and you'd be in good company in Bluelight overall.

But - let me not digress too much.... The tale of how you got into this predicament is irrelevant to the issue at hand - the sticky question about anything that could potentially impede your practice - I am assuming you are quoting the form verbatim - or the key points at least.
Now...We have established that lying about being on maintenance could have a range of bad repercussions, but you feel no conflict in saying "no, I don't abuse drugs" - in response to a question with two rather vague terms as part of a related, and encompassing supposition. It is the vague - to an anti-prohibition, hair-splitting language pedant such as myself, this is where I would be seeking out as many (similarly enlightened - but qualified to give advice on the legal - or at least technical - finer points of signing what sounds like a pretty formal document).

First the supposition; pretty standard on a lot of job applications at the moment - "any condition that could impede your practice" - sometimes you see other examples listed as "conditions that could impede your [work] - such as injuries, claims for workers' compensation - the sorts of things that employers may ask as a matter of thoroughness (on the surface) - but I always feel it is veiling a slightly more personal line of questioning, perhaps not strictly pertaining to your wellbeing - but (in the case of compo claims, for instance) my impression is that they are digging for any indication that you will either be a trouble-maker, someone that will be a liability or likely to cost them a lot of money.
That way (in the sort of jobs that have asked this sort of question) if you flare up an existing - or old - injury, for example, the employer could potentially use your failure to report it in the application to deny any compensation claims, if it emerges that you did, in fact have an injury several years earlier.
...and if you do answer with full honesty - in an application for a specific job (which is just my frame of reference; I'm afraid) - then anything you do say feels like you are voluntarily putting a black mark against your name in the field of applicants.

The context with this seems quite different though.
Do you need to renew your professional registration annually?
I take it that the "condition" in question here (condition generally taken to mean illness (physical or mental...?) or perhaps a set of circumstances that may render someone wholly inappropriate for a Pharmacist's professional registration.
I refer to this as a supposition because in the few words you quoted from this section of the form there is a fairly transparent causal link made between "drug abuse" (which seems to be almost universally understood to refer to "illegal drugs") - and "of dependence".
Now...this is the tricky bit. Having such broadly described drug use - one person's "drug abuse" may be taking a couple more codeine or whatever) pills than prescribed to feel a little more than the analgesic effect. Other people may think of "taking LSD" (at any time) to mean "drug abuse".
But "drug dependence" - well, without brewing up a cup of coffee each morning, I will get a pounding headache, maybe some nausea; I might even vomit. But does being "drug dependent" in this sense "impede my work?" I would say that it absolutely does not.

So the question I would be asking people well informed in these matters - is the question really asking if you have
"any condition that could impede your practice"
^^ as the main question, with -
including drug abuse or dependence
as examples? If this is the case, your "drug dependence" could be omitted - as you don't feel it would adversely affect your professional conduct.

Or should the question be read in terms of the examples - and the outcome - being one in the same?
To use a really basic example; "do you have any past injuries that could impede your work - including tendon damage or back problem?

I don't know how open these things are to interpretation in a professional registration to practice - whether any sort of inquiries would be made - say, for example - is there a drug addict register for people on opioid maintenance programs?

Would it be a breach of confidentiality, or could you possibly be discovered this way - and if so; would it be fair to argue that rather than being "drug dependent", you are being treated for a previous drug habit in the accepted medical fashion?

In this instance, I think you would be far less likely to be impulsive when given opportunistic access to drugs - as you were previously, as cravings would be reduced (I imagine) - not to mention buprenorphine's blocking effect.
I was considering asking if you would detox prior to submitting this (in order to avoid that question) but doing so - surrounded, potentially by easily accessible triggers (or relapses handed to you for safe disposal...!) could be a setback you really don't need in your life.

A final consideration; perhaps i am way off the mark and the question asking something other than these interpretations - something more along the lines of "are you a drug taker?" (in general) - with the implication maybe being that people who take drugs shouldn't be - or won't be (if they admit to it...) considered appropriate to be registered Pharmacists?

Hmmm....I may have just confused myself.
Good luck, regardless of how you approach this. Here's a song especial for you, Mr Pharmacist !

(fuck I didn't plan on writing a dissertation...sorry about the enormity of this post).
 
Would it be wrong to lie on your application, do they check your medical history? Im not suggesting you lie BUT should a past "mistake" cost you your career? also if you can show that you have your addiction under control is it possible that it wouldnt have a baring on you resuming your career? you obviously took positive and responsible steps to remove yourself from the situation and seek help.

I used to work in a hospital where drugs of dependence used to regularly go missing from the locked medical cabinet that only doctors and selected nurses had access to, also a doctor was found dead on the toilet with a needle sticking in his arm.

Given the access to drugs your profession gives you, Id hazard a guess you are one of many that had/has an addiction.
 
I used to work in a hospital where drugs of dependence used to regularly go missing from the locked medical cabinet that only doctors and selected nurses had access to, also a doctor was found dead on the toilet with a needle sticking in his arm.

A doctor OD'd?! Wow... shit, dude.

I suppose I shouldn't be that surprised. Just goes to show how ultimately unpredictable it is when shooting things up your arm. Or just doing potent drugs in general.

I'm sure there are a significant minority of doctors out there who maintain habits, and probably a much smaller number who have some real whopper habits. But that's just based on anecdotal things I've heard, and this is why I find the subject of addictions occurring inside the medical field fascinating.. like the ultimate taboo or something.

My mother was a nurse for nearly 30 years and like what Mister posted, she had a fair few stories of things going missing or not adding up. Usually those stories involved people who were covering shifts. I can't remember the proper name, but just like in many workplaces sometimes you have an 'outsider' come in to cover someone for a day or a week or whatever.

Disclaimer: my mother was not an addict and never stole anything. I love my mama!
 
I read about an anesthetologist (spelling) who maintained for a long time before being caught out. Problem in his case was, he was reuising his dirty needles on the patients and the reason he got caught is because someone died on the table while he was shooting himself up. It's actually common in that field of medicine, unfortunately. Imagine if there was no stigma attached to opioid addicts, they could do their jobs without jeopardising the health and safety of others.
 
Thankyou all for sharing your thoughts and advice - particularly spacejunk, you have gone to quite some length in exploring the issues involved - I have been thinking about many of the very things that you have discussed here, though your laying out of the issues has helped me in organise my thoughts. Your point regarding my anonymity is something that I had not really considered, but you make a good point - I will have to be careful not to identify myself here.

A doctor OD'd?! Wow... shit, dude.

I think that there are probably many health professionals that struggle with drug addiction - If you browse through the pharmacy board records, you can find many cases where pharmacists have be caught stealing or self administering drugs. I suspect the same would be true of nurses, doctors, dentists, vets etc. Actually, I recall an issue of 'users news' late last year that had a column about a support network for Australian doctors with drug and alcohol issues. The author claimed that half the members were alcoholics, while a large proportion of the remainder used pethidine.

There has been a bit of a development in my story- I spoke briefly today to a solicitor who deals mainly with industrial relations cases. His advise was to be completely open and honest with my application. He says that if I provide some good evidence to support my application - such as proof that I am receiving ongoing professional treatment for my issues and some character references, that I have a very good chance of having my registration restored - possibly with some temporary restrictions. He also indicated that if my application was outright rejected, despite providing said evidence, that I would have grounds to launch an appeals process, possibly on the basis of anti-discrimination legislation. So I found this very encouraging. On the other hand, if I lied to the board, and was then found out, I could have my registration cancelled - without many options for recourse. Additionally, lying could void my professional indemnity insurance - which could be financially devastating if I ever made a dispensing error or something.

I will continue to investigate options, and will keep this thread updated on progress. Thanks again for everybody for their thoughts
 
Interesting thread, and I too am interested in hearing about how it turns out.

A few thoughts:

Have you tried getting in touch with your insurer from when you were registered, or another insurer? Pharmaceutical Defense Limited seem to provide professional indemnity insurance to most pharmacists, perhaps they could give some information about what to expect. An anonymous call could work here.

You could also just try an anonymous call to AHPRA or whoever the appropriate regulators are, and ask them about the situation and what to expect.

The PSA runs a free service, the "Pharmacists' Support Service", which is probably more focused on mental health issues than this particular situation, but I thought it would be worth mentioning nonetheless. You can find some info at http://www.psa.org.au/membership/pharmacist-support-service

Another thing you could do is browse through the listing of registered health practitioners, and see if you can find any with restrictions on their practice. It might give you some clue as to what to expect.

Anyway, ultimately I would agree with what the solicitor said - the potential costs of lying far outweigh the benefits. If you're on the buprenorphine program then it's not something that you can effectively hide, at the end of the day - the constant paranoia on its own would not be worth it. And besides, as far as drug abusers go, you are have handled this in just about the most responsible manner possible. I don't know how long you were registered for, but the Pharmacy Board of NSW used to regularly publish its disciplinary findings in "bulletins" - I managed to find one online at www.hpca.nsw.gov.au/ArticleDocuments/208/BulletinIX.pdf.aspx

Unfortunately I don't have the time to do a thorough search, but there were many of these published, and although now there is a national registration system in place, you should be able to find (perhaps on AustLII) details of how the board deals with "impaired" health professionals. From what I remember, they were generally quite lenient - I remember several cases where pharmacists were caught red-handed stealing and abusing opioids, and their license was not revoked. I suspect in your case, given that you're seeking treatment, removed yourself from practice due to concerns about your condition, etc, that they would be quite understanding.

Of course, this is just my two cents, and I'd encourage you to do as much research as possible, because a lot is on the line here. Do let us know how things work out.
 
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Im almost certain that because you may have authority to dose methadone/bupe that you could potentially get in a lot of trouble if the people in higher authority than you dont know about your meds.

Ive wanted to get into drug & alcohol work and because im still on a program(methadone) and until im off it I cant dose in a clinic :/

I would be very, very careful!
 
Firstly, fix your space bar

My personal opinion is that you shouldn't get back into that line of work, if you're serious about staying clean. You need to be honest with yourself, the problem with addiction is that it only takes about 10 seconds to fuck up and then a long time to fix yourself again. Putting yourself back into that environment, despite the perks, just seems like a bad / naive move. I'd say your chances of relapse would be approaching ~99% - giving the regular relapse rate, in your profession it would be ridiculous to think you could pull it off.

Also - if you're still on bupe maintenance then you seriously don't even know yet how difficult it is to actually get clean. Bupe makes your think you have your shit under control; particular on doses higher than 2mg.

Lastly - I strongly advise against lying on the form - just seems like a recipe for trouble that there's NO coming back from. Maybe if you tell the truth you'll ruin your chances - so be it, it's not without good reason. But if you DO have a legitimate pathway back in, it's by being honest. With yourself and your peers.
 
My personal opinion is that you shouldn't get back into that line of work, if you're serious about staying clean. You need to be honest with yourself, the problem with addiction is that it only takes about 10 seconds to fuck up and then a long time to fix yourself again. Putting yourself back into that environment, despite the perks, just seems like a bad / naive move. I'd say your chances of relapse would be approaching ~99% - giving the regular relapse rate, in your profession it would be ridiculous to think you could pull it off.

Fair enough, that's your opinion, but I think you might be projecting a lot here.

From what the OP has written it seems to me that they are being pragmatic and realistic about their situation. I don't think you can say their choices seem "naive" and that their chance of relapse would be "approaching 99%" without having some sort of incredible insight into the situation - for example you happen to know the OP personally, or you yourself have gone through the exact same experience.

There has been some good advice and suggestions given in this thread, and I feel like your post was very pessimistic - hence I suggested that you might be projecting your own internal struggle outwards. Everyone's entitled to their personal opinion, but it's a bit condescending to say that you think "it would be ridiculous to think you could pull it off".

I'd like to give the OP the benefit of the doubt here and keep thoughts positive or at least objective in this thread. I don't see the need to bring a bad attitude in when it seems clear that you don't have the experience that the OP has. I'm not meaning this to be an attack. I just thought it was a very negative post.
 
I personally think you should be given a second chance...you have already shown that you have the ability to remove yourself from the industry if things dont work out....I think there are times in our lives when we are more vulnerable to seeking an altered state of mind, I know from my own experience that when things are good, I dont chase the euphoria received from pills etc.....I dont need it.
I think it would be a good idea to reduce off the bup before you start and stabilise, just to ensure that you are clean and sober. One of the biggest problems would be the obvious issues that would arise if it became public that the industry allowed a phamacist to dispense "dangerous drugs and poisons".....we all know that you are not high etc but the ignorance of the public is what the industry would be considering........just my opinions.....good luck, !!
 
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