ASHP Statement on the Pharmacist's Role in Substance Abuse Prevention, Education, and Assistance
Posted 11/06/2003
The American Society of Health-System Pharmacists (ASHP) believes that pharmacists have the unique knowledge, skills, and responsibilities for assuming an important role in substance abuse prevention, education, and assistance. Pharmacists, as health care providers, should be actively involved in reducing the negative effects that substance abuse has on society, health systems, and the pharmacy profession. Further, ASHP supports efforts to rehabilitate pharmacists and other health-system employees whose mental or physical impairments are caused by dependency on psychoactive drugs.
Background
The term "substance abuse," as used in this Statement, includes those diseases described by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) criteria as "psychoactive substance use disorders."[1] Psychoactive substances are abused primarily to depress, stimulate, or distort brain activity. Examples include alcohol, tobacco, "street" drugs (e.g., marijuana, lysergic acid diethylamide [LSD], cocaine, methamphetamine, inhalants, methylenedioxymethamphetamine [MDMA], gammahydroxybutyrate [GHB], heroin), and the nonmedical use or the overuse of psychoactive and other prescription and nonprescription drugs (e.g., oxycodone, ketamine, methadone, and dextromethorphan).
Substance abuse is a major societal problem. The 2000 National Household Survey on Drug Abuse, a primary source of statistical information on the use of illegal drugs by the U.S. population, estimated that (a) 4.3 million Americans (or 1.9% ofthe total population) ages 12 years or older were current illicit drug users, (b) 7.1 million Americans (or 3.2%of the total population) were dependent on illicit drugs or alcohol, and (c) 5.1 million Americans (or 2.3%of the total population) were dependent on alcohol.[2] A study of psychiatric disorders in America suggested a lifetime prevalence of substance abuse disorders of 16.4%, of alcohol abuse or dependency of 13.3%, and of other drug abuse or dependency of 5.9%.[3] Studies suggest that the prevalence of drug abuse among health professionals appears to be similar to that in the general population.[4-6] Given their access, however, health professionals abuse prescription drugs more often and "street" drugs less often than does the general population.
Substance abuse frequently coexists with and complicates other psychiatric disorders, and it is a common and often unrecognized cause of physical morbidity. Intravenous drug abuse is a major factor in the spread of HIV and hepatitis. Alcohol is a major factor in cirrhosis of the liver, and tobacco is a key contributor to emphysema and lung cancer. Collectively, substance abuse contributes significantly to morbidity and mortality in our population and to the cost of health care.
Substance abuse is also a serious workplace problem. The Substance Abuse and Mental Health Services Administration reported that approximately 70% of those reporting illicit drug use within the past month were currently employed full-time and that 1 in 12 full-time employees reports current use of illicit drugs.[7] Substance abuse by employees of health care organizations leads to reduced productivity, increased absenteeism, drug diversion, and, almost certainly, increased accidents and medication misadventures. Consequently, it affects the quality of patient care, liability, and operational and health care costs.
Pharmacists have unique, comprehensive knowledge about the safe and effective use of medications and about the adverse effects of their inappropriate use. The provision of pharmaceutical care to individual patients involves pharmacists assessing the appropriateness of pharmacotherapy, counseling, and monitoring medication-use outcomes. Health-system pharmacists have organizational responsibilities for contributing to the (a) development of the health care organization's medication-use policies, including input into the decisions of the pharmacy and therapeutics committee, (b) development of clinical care plans and other types of protocols, and (c) investigation and prevention of adverse medication events. Furthermore, pharmacists have legal and organizational responsibilities for medication distribution and control across the continuum of practice settings within health care organizations. With this combination of knowledge and organizational responsibilities, pharmacists are prepared to serve in leadership and service roles in substance abuse prevention and education and assist in a variety of patient care, employee health, and community activities.