Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, February 5, 1995 TAG: 9502060061
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: SARAH HUNTLEY STAFF WRITER
DATELINE: LENGTH: Long
The envelope arrived via certified mail, as Jeff Eller was on his way out the door.
It was May 10, and Eller had planned to ride his motorcycle down Bent Mountain Road to watch the Tour DuPont bikers pedal by. It was also two days before he was scheduled to appear before the Board of Pharmacy to respond to accusations that he had pilfered and used prescription drugs while working as a Revco pharmacist in September 1993.
Eller looked at the return address - the commonwealth of Virginia - put down his gear and tore the envelope open.
Inside he found a damning document, a 43-page investigative report that detailed his on-the-job drug use and included a transcript of his night-shift activity, as recorded by the store's hidden camera. In addition to serving customers and maintaining pharmacy records, Eller was videotaped taking and swallowing pills. Lots of pills, lots of times.
``Seeing the frequency was what destroyed me,'' he said. ``It was every 15 or 20 minutes.''
That investigative report triggered a sequence of events that changed Eller's life.
``They had all this evidence. I couldn't sit there and say it didn't happen,'' he said. ``I'd been planning to show up at the hearing in boots and jeans. I read that and went to my closet to find something nice to wear.''
Two days later, Eller appeared before the board in Richmond and his pharmacist's license was revoked. When he returned to Roanoke, he was arrested by local police on three felony counts of fraudulently obtaining drugs.
``It took me reading that report to understand what I am,'' he said.
Jeff Eller, 42, is a recovering drug addict. He is also a health care professional, and that combination is not uncommon. Although doctors, dentists, anesthesiologists, pharmacists and nurses are highly educated about the effects of drugs, they are not immune to chemical dependency.
Substance-abuse experts estimate that 10 percent to 12 percent of the U.S. population is predisposed to addiction. Chemical dependency affects Americans from all walks of life: teachers, laborers, lawyers - and health care professionals. (Amy took out; sarah Ok'd)The numbers of medical professionals addicted to drugs and alcohol closely mirror the overall national estimates.
``There are about 4,000 licensed pharmacists in the state,'' said Johnny Moore, chairman of the Virginia Pharmacists Assisting Pharmacists Program. ``We figured ... that could mean as many as 400 pharmacists in Virginia are either addicted or have the predilection toward addiction. We have a responsibility to them and to the public.''
Health care professionals have a direct impact on other people's lives. They are responsible for what goes on in the operating rooms, doctors' offices, nursing homes and emergency rooms. And with public safety at stake, the problem takes on new dimensions.
Virginia courts have handled cases in which addicted nurses and pharmacists have given patients placebos instead of painkillers, keeping the more potent drugs for their own use. But more often, Moore said, patients are affected in a more subtle way.
``Usually you take things in such quantities that there's no way you could nickel or dime a person's prescription,'' said pharmacist Moore, who himself is a recovering drug addict. ``People could be affected, though, because you are not thinking as well as you should be. You aren't clear-headed.''
He has been clean for more than 10 years, but Moore remembers the days of his addiction well - all 3,652 of them - and the risks he took then trouble him still.
``It scares me to death that I filled prescriptions while on amphetamines,'' he said. ``As far as I know, I didn't hurt anybody and I guess I did a pretty good job, but it scares me to know I was that impaired.''
Moore took his first amphetamine to counteract exhaustion from staying up the previous night. One upper was all it took.
``I spent 10 years of my life chasing after amphetamines. Even today, there are urges and cravings, believe you me. Every time I pull an amphetamine out of the drawer I think about that,'' he said.
If addicted health care professionals face their problem, like Moore did, they respond well to treatment. Groups that monitor and support addicted doctors, nurses and pharmacists boast success rates in the 90 percent to 92 percent range, well above the national average. But it isn't easy.
Treating health care professionals poses special challenges. Easy access to medications, highly stressful working conditions and deeply ingrained denial are just a few of the hurdles these users face.
Health care professionals who are predisposed toward chemical dependency don't have to lurk in darkened alleys and cavort with dealers to get a fix. They are, in a very real sense, the keepers of the candy jar.
``I'm not any different from other drug addicts or alcoholics in that I was born with this disease and I'd probably have become an addict no matter what, but by golly, I had some pretty powerful stuff at my fingertips,'' Moore said.
Tablets, capsules, elixirs, pharmaceutical samples: All of them are seductive to someone who is chemically dependent.
In addition, health care providers work under demanding, life-and-death conditions. To cope, they are trained to shut off their emotions while working and take solace in their medical know-how.
Therein lies the greatest paradox. These are highly trained individuals, all of whom know the dangers of drugs. Yet, rather than steer clear, they use.
``We know a lot about drugs and how they work. There tends to be an attitude that the knowledge confers an immunity,'' explained Rebecca Mason, legislative coordinator for Virginia's Peer Assistance for Chemically Dependent Nurses. ``Since we know about drugs, we can't get hooked on them, but it's simply not true.''
Once health care professionals start using, the denial follows quite naturally.
``Doctors are basically taught to deny in order to survive. A physician who gets emotionally involved with every patient he comes across wouldn't function very effectively,'' said Ernie LeClerc, who works for the Farley Institute in Hampton. The institute is one of several in-patient recovery facilities along the East Coast that specializes in helping health care professionals.
``Not all health care professionals become addicted, but those who do have a really difficult time realizing they have no control over their addictions. They control everything else in their lives. Why not that, too?'' LeClerc said.
During Jeff Eller's 18 years of addiction to painkillers and tranquilizers, there were plenty of warning signs and classic examples of dependent behavior, but he didn't recognize them.
Today, eight months into treatment, Eller can see lots of truths more clearly. He is still without his pharmacist's license and was given a three-year suspended sentence for his felony conviction. But as he sat and spoke of his experiences during a series of interviews, it appeared that the former pharmacist is in a process of constant learning.
As an undergraduate at Concord College in West Virginia in the 1960s, Eller formed a close bond with four friends, all of whom went on to pharmacy school. He applied as they did, but didn't expect to be accepted. When he was, he went.
``Why did I go? I don't know. Jesus, I knew nothing about it. I'd never been in a drugstore,'' he said. ``Looking back, I knew that a person in a white jacket was looked up to and probably made a lot of money, but I didn't really know much about it.''
Eller already had made his foray into the drug world in college. What started out as drinking and smoking pot gradually led to experimentation with more potent drugs, and the drug use continued through his graduate studies at the School of Pharmacy in Richmond.
After Eller earned his degree, he moved often, never missing the opportunity to work at new stores in new places.
``It was unusual that I worked in a store for more than 18 months, 10 to 12 maybe, but 18 months at the most,'' he said. ``I've come to realize that's called the `geographic cure.' It's very common. You say to yourself, `I'm going to leave my problem right here and I'm going to move on.'''
Except that didn't work.
``I don't think there was a night that went by that I didn't tell myself I was going to go to work and not do this,'' Eller said. ``But as soon as people cleared out and I was left on my own, the cycle would begin again.''
Eller was married twice, but both marriages ended in divorce. Her now realizes that his chemical dependency contributed to the problems between him and his wives, he said.
About five years ago, Eller took some pills as he started his drive home. On his way up Bent Mountain, he lost control of his truck, demolishing the vehicle and pinning himself inside. Police officers pulled him out and administered DUI tests, all of which he passed.
``I think they thought something was wrong with me, but I'm not sure they could figure out what,'' he said. As the officers drove him home, Eller kept his hands in his pockets, fingering the handful of pills he'd stashed there.
Eller's denial ran deep - so deep that he never once suspected he had a problem. He could recognize other pharmacists' problems with drug addictions. In fact, Eller helped authorities intervene to get help for others, but it never was his turn.
``I was a health care provider. You don't ask for help. You are a caretaker. I mean the idea that I would have to ask for help, I just don't think so.''
This kind of denial requires an intense kind of treatment, substance-abuse experts say. Recovery programs that focus on health care professionals, such as the one at Farley Institute, typically last 12 weeks, much longer than traditional 28-day in-patient care.
The treatment can be expensive - $15,000 for three months at Farley - but recovering health care professionals learn early on that staying clean has its costs, both emotional and financial.
``No matter how bad it may be for you, there is hope, but you have to be willing to do whatever it takes to get there,'' Eller said. ``That's a part of the program. It's not so much the money as it is the symbolism'' of commiting to recovery.
For Eller, who is a motorcycle aficionado, that meant selling his brand-new red Harley-Davidson to raise money for his stay at Farley.
And that was only the beginning.
Like airplane pilots and other workers whose jobs affect public safety, recovering health care professionals are monitored closely for several years. Every medical profession is governed by a regulatory board with the power to grant and revoke licenses, and most boards have developed a working relationship with profession-specific support groups.
In Virginia, there are VAPAPP, Virginia Pharmacists Assisting Pharmacists Program; PACDN, Peer Assistance for Chemically Dependent Nurses; and the Physicians' Health and Effectiveness Committee.
Trained to intervene and track recovering addicts' progress, the groups are making an impact. VAPAPP, for example, has helped nearly 250 pharmacists face their addictions and get help.
Sometimes drug users seek the assistance of the profession-specific associations themselves. More often, however, intervention is required. If VAPAPP, for example, gets a report that a pharmacist is using drugs, two trained volunteers - at least one of whom has been through recovery - will confront the person and discuss treatment options. The earlier intervention occurs, the better, Moore said.
``Let us catch someone early. Let us catch them before they have legal problems, before they hurt somebody, before they are so deep into desperation that they are near death themselves,'' he said. ``That's what we'd like to see, but it doesn't happen often. Usually the situation has to be real bad for someone to notice.''
All the groups make use of a contract, which usually lasts four or five years. After they've gone through treatment, recovering addicts pledge to undergo random urine drug screenings and attend 12-step programs and meetings of the Caduceus group, a support organization that holds sessions throughout the state for recovering health care professionals. They also are required to inform their employers of their problem and submit to quarterly workplace reports.
In return, the groups act as advocates for health care professionals who have adhered to their recovery programs, when they face board and licensing issues.
Regulatory boards who see that a health care professional is committed to treatment are more likely to give second chances - probationary periods or reactivated licenses - even when courts have handed down convictions.
``It's an incentive to continue their livelihoods,'' LeClerc said, ``and that means something. Their investment in their career is more than, say, that of a bricklayer.''
Johnny Moore, chairman of VAPAPP, has no illusions about why his group works. It's often a matter of professional survival.
``If our pharmacists go through these things, I'd say the chances are good that they'll get their licenses back. If they don't, they've lost it for good. That's our leverage,'' he said. ``If we didn't have that hammer, I don't think we'd be successful in getting as many people into treatment.''
After time, though, the rules become routine, and new habits replace the old.
``In the beginning you need the checks and balances, but in the end you wind up doing these things anyway - for yourself,'' Moore said.
Moore and others like him are living proof that there's life after recovery - good life.
``One of the best things that ever happened to me was becoming a part of this committee,'' Moore said. ``Every time I go out on an intervention, I see where I came from. I go, `Wow, I don't ever want to go back there.'''
by CNB