This week the Maine Center for Public Interest Reporting warns that over the past decade, 13 Maine pharmacists were relicensed/reinstated despite documented histories of substance abuse and theft. These numbers seem disconcerting. They’re not. If we eliminate those convicted of theft without abusing substances, we’re talking about one professional a year.
We should be more concerned with the number who didn’t get caught. It is disconcerting to consider who’s out there with easy access and a low likelihood of being caught. Should we increase our efforts to monitor every professional who works with controlled substances? That’s thousands of folks:.
Medical doctors, physician assistants, surgeons & surgical Assistants, nurse practitioners, nurses (R.N. & L.P.N.), veterinarians, pharmacists and psychiatrists are the obvious suspects. We’d then have to add in all the professionals who work directly under these folks: Certified Nursing Assistants (C.N.A.) pharmacy technicians, Certified Registered Medical Assistants (C.R.M.A.) and veterinarian techs.
We’ve already created a lot of monitoring bureaucracy – licensing & regulatory boards, state departments, and federal agencies. The cynical amongst us wonder who monitors the folks who do the monitoring. We expect individual boards of licensure to protect their own (doctors protect doctors). More bureaucracy isn’t going to help.
By the time a person is willing to jeopardize their career and risk losing their professional license, they’ve gone well beyond abusing substances and crossed the line into addiction. The prevailing dynamic is this – the addict works to keep their efforts covert and those who monitor work to expose and bring the problem out into the open. First problem – the addict is infinitely more motivated.
Second problem: the rest of us in the field stand on the sidelines. Many of us turn a blind eye and some of us (with good but misguided intentions) enable by covering the mess up.
Third problem: everyone’s worried about their liability. Those who employ us don’t want the truth to become public record. They don’t want their reputations tarnished and they don’t want the lawsuits that are likely to follow.
Prevailing stereotypes may be our biggest obstacle. We want to believe that high functioning addicts are rare. If you’re not knowledgeable about addiction it’s hard to believe that people can maintain an opiate addiction long term. It seems impossible that a person can perform in a high stress occupation while under the influence.
I learned those lessons long before I started working with recovering addicts. As a young man I worked in the restaurant business (consistently ranked at the top of drug abusing professions). I worked with guys who functioned brilliantly under the influence. When they were sober they were a mess but once they smoked, snorted, drank, or booted, we could feed an army without a hitch.
In my office today hangs a sign that says, “First we have to make it overt.” Until we bring the problem out into the open, nothing changes. Every effort we’ve made to monitor and enforce simply drives the problem further underground. If we don’t allow people to come forward and get help without having to risk losing their livelihood; we should expect that high functioning addiction will be salient in the healing and helping professions.
It’s not enough to protect our own. Lawyers, doctors, surgeons and other high paying professionals have the option of going to luxury rehabs tailored to their profession and prevailing personality types. As far as anyone knows they’re simply “on vacation.” The nurse who makes 45k/yr can’t afford to get professional help because s/he can’t risk having a diagnosis of addiction on their health care records (confidentiality is a bit of a myth in a digital world). The pharmacy tech making 20k/yr can’t afford to seek treatment at all.
Addiction requires crossing a series of lines. The illusion of control is maintained by creating a new line that won’t be crossed (rules the addict sets for themselves). As a society we want to believe that we are safe from enemies foreign and domestic. Our collective illusion is the desperate belief that government can protect us, that law enforcement can protect us, and that people who work in health care are indeed healthy.
We’re not. They can’t. The enemy is a disease that flourishes when hidden and it’s growing.
Cynicism is a lousy defense. We know that addiction is increasingly salient and our response is to become progressively desensitized. We’re no longer surprised when people fall from grace. We expect it. Yet we continue to place them on pedestals and afford them no safety net.
The World Health Organization, the American Medical Association, The Center for Disease Control & Prevention and countless other respected authorities recognize that addiction is a disease. We don’t expect people to maintain their professional duties when they’re debilitated by other diseases and we would never think of stigmatizing them. Addiction stands alone as a disease that will get you shunned and criminalized before it takes everything else from you.
Between now and the time we wake up systemically, the only reasonable response is radical use of loop holes. If addiction can flourish underground then treatment and recovery can too. Let’s take extra steps to ensure confidentiality. Let’s make use of “life coaching (can be done by trained professionals)” and “recovery coaching (often available free of charge)” and other efforts that aren’t subject to licensing and reporting. Let’s step up organizationally and as employers and provide peer recovery on site that ensure anonymity. Let’s find ways to allow for leave time for “health conditions.”
All of current efforts are designed to protect the public. Until we protect those impacted by this disease we can’t overcome. AA & NA are the real experts in these matters and as they say, “Remember that we deal with alcohol (and other drugs), cunning, baffling, powerful!