Recognizing and Reporting Employee Substance Abuse and Diversion

RELATED LINKS 

For additional resources to support pharmacy controlled substance distribution and losses compliance click HERE. 

FULL ARTICLE: 

Substance abuse and addiction are serious concerns within the pharmacy profession. Due to access to controlled substances, pharmacy personnel may be at increased risk for misuse and diversion. Creating a culture of awareness, accountability, and support is essential to protecting patients, staff, and the integrity of the pharmacy. 

Pharmacies should encourage early recognition of concerning behaviors and promote timely reporting while also supporting employees in seeking help. 

Supporting Employees Seeking Help 

Pharmacy staff experiencing substance misuse or addiction are encouraged to seek professional assistance as early as possible. 

• Many state boards of pharmacy offer confidential recovery and monitoring programs  
• Employee assistance programs (EAPs) and healthcare providers can also offer support  
• Early intervention can protect both the individual and patient safety  

Promoting a supportive environment helps reduce stigma and encourages individuals to get help before issues escalate. 

Workplace Expectations 

Pharmacy staff are expected to report to work fit for duty. 

• Reporting to work under the influence of drugs or alcohol is strictly prohibited  
• Violations are subject to disciplinary action in accordance with company policies and employment agreements  

Maintaining a safe and professional workplace is critical in a healthcare setting. 

Recognizing Signs of Possible Diversion or Substance Abuse 

Identifying early warning signs can help prevent harm. While no single behavior confirms misuse or diversion, patterns or combinations of the following may indicate a concern: 

Workplace Behavior 

• Frequent absenteeism  
• Repeated or unexplained disappearances from the pharmacy  
• Excessively long or frequent bathroom breaks  
• Spending unusual amounts of time near drug storage areas  
• Missed deadlines or unreliable performance  

Cognitive and Performance Changes 

• Confusion or memory loss  
• Difficulty concentrating  
• Slowed task completion or decreased productivity  
• Increased errors or declining work quality  

Physical and Personal Indicators 

• Noticeable decline in personal appearance or hygiene  
• Signs of fatigue or impairment  

Interpersonal and Behavioral Changes 

• Mood swings, anxiety, or depression  
• Social withdrawal or isolation  
• Complaints from coworkers or patients about behavior  

These signs should be evaluated carefully and objectively—avoid assumptions, but do not ignore patterns. 

Reporting Concerns 

If there is suspicion of medication diversion, theft, or substance abuse: 

• Report concerns immediately through the appropriate internal channels (e.g., pharmacist-in-charge, supervisor, or compliance officer)  
• Follow all applicable state-specific reporting requirements  
• Provide factual, objective observations (not assumptions or diagnoses)  

Timely reporting is critical to: 

• Protect patient safety  
• Prevent further diversion  
• Ensure appropriate investigation and intervention  

Best Practices for a Safe and Supportive Environment 

• Train all staff to recognize warning signs of diversion and substance misuse  
• Encourage a “see something, say something” culture  
• Maintain clear reporting pathways and confidentiality where appropriate  
• Document concerns thoroughly and objectively  
• Balance accountability with compassion and support for recovery  

Pharmacy teams play a vital role in safeguarding controlled substances. Awareness, early recognition, and appropriate action are key to preventing diversion and supporting colleagues in need. 

Disclaimer: These tools and templates are intended for general informational purposes and are provided by Montana Family Pharmacies as a service to pharmacies. While we try to keep the information timely and accurate, we make no guarantees. These tools and templates are not a substitute for legal, regulatory, or professional advice. 

Policies and procedure, templates, checklists, and other tools should be customized to fit the specific needs and regulatory requirements of your pharmacy. 

Montana Family Pharmacies disclaims any liability for any damages, losses, or other consequences arising from the use or reliance on the tools or policy templates.