The approach used for this analysis was as follows:

Determine sources and relative seriousness of

the drug abuse and diversion problem • Obtain suggested approaches to dealing with

drug-related problems including:
- Increased enforcement

Continuing education
Mandatory peer review sponsored by board
Voluntary peer review as an association-
sponsored activity

Improvements in complaint review process. • Evaluate the complaint review process as a key

to better enforcement • Evaluate the joint roles and responsibilities of

boards and associations in affecting health care
professional conduct, including:

Board and association communication on
licensees
Peer review
Effective uses of professional associations

Conflicts of interest.
Inducing changes in legislation
Fostering continuing education.

The following discussion introduces the study on drug abuse and diversion. Included are the general results of the three-State field surveys.

The "sick or impaired professional" is defined in terms of incapacity due to a psychiatric disorder, including alcoholism or drug dependence, which jeopardizes both the professional's accountability to the public and the assurance of providing competent health care to the patient. The term "sick or impaired professional” pertains to the inability to practice the profession with reasonable skill and safety based upon a number of enumerated illnesses as opposed to proving injury to a patient. Health professionals interviewed in Virginia indicated that drug diversion or leakage may be attributed to the following: • Physicians who maintain drug addicts as

clients without proper authorization .. Indiscriminate prescribing by some physi

cians, especially when the proper doctorpatient relationship has not been established. Noteworthy is the fact that pharmacists, who were viewed as a possible source of drug diversion, do not appear to present a drug problem in this particular area due to enforcement efforts made by the pharmacy board.

.

(1) Drug Abuse and Diversion Problems

A major aspect of this study is an assessment of the degree to which drug abuse and diversion are considered problems by the officials of the individual State boards. • Three-State Field Survey

Health professionals interviewed in the threeState field survey indicate that:

Improper self-administration may be a problem confronting health professionals in the area of drug diversion and abuse. This problem is heightened as health professionals working in hospitals have daily access to a wide variety of controlled substances. At present, it is not possible to identify this source as a major channel for leakage or diversion of drugs.

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Of particular interest is the fact that pharmacists viewed the first two areas with concern and labeled them as serious problems. Their daily direct handling of controlled substances and increased proximity to the problem could be the reason for this finding. • Pharmacy Theft

As Table 12 shows, concerning theft of drugs from pharmacies, the majority (59 percent or 129) of respondents who answered at least one of these questions felt that such theft was either a moderate or serious problem. Not surprisingly, a relatively large number of respondents from the pharmacy profession considered drug theft to be either a serious problem, (66 percent or 41), or a moderate problem, (23 percent or 14). Forged Prescription Orders Most pharmacists, 79 percent (49), considered forged prescription orders to be a moderate or serious problem. The largest number of professionals in nursing consider it a minor problem, and over half (64 percent or 28) of the veterinarians considered it no problem at all.

• Multiple Prescription Problem

The problem of patients obtaining the same prescription order from more than one practitioner and reselling these controlled substances is not felt to be as serious by 16 percent (34) of the respondents as those of drug theft and forged prescription orders. A substantial number of the members of the medical profession (49 percent or 30) and 50 percent (31) of the pharmacy profession felt it was a moderate problem. Veterinarians were the only group where a majority (52 percent or 23) did not feel this was a problem. (See Table 14.)