Pharmacy Technician Consumed 56 Codeine Tablets Daily at Work – GPhC Lifts Suspension After Evidence of Rehabilitation

Date of Decision: February 5, 2019

Registrant's Role: Pharmacy technician

Allegations:

Removed an unknown quantity of codeine tablets from the pharmacy without authority.
Removed an unknown quantity of Orlistat tablets without authority.
Did not have a valid prescription for either medication.
Consumed some or all of the removed medications.
Acted dishonestly by knowingly taking medication without permission.

Outcome: Suspension lifted; registrant’s fitness to practise no longer found to be impaired.

GPhC Standards Breached:

Standard 1 – Provide person-centred care
Standard 2 – Work in partnership with people
Standard 3 – Communicate effectively
Standard 4 – Maintain, develop and use your professional knowledge and skills
Standard 6 – Behave professionally
Standard 9 – Demonstrate leadership

Case Summary

Allegations

In a deeply concerning case for the pharmacy profession, a pharmacy technician was found to have dishonestly removed and consumed large quantities of medications—namely codeine, a controlled drug, and Orlistat, a prescription-only medicine—while at work. The misconduct occurred over several weeks between June and October 2016. The registrant had no valid prescriptions for either drug and admitted to consuming up to 56 codeine tablets daily while on duty. The allegations were fully admitted by the registrant at the initial hearing, which led to a finding of impaired fitness to practise and the imposition of a 12-month suspension.

Findings

The initial Fitness to Practise Committee (the “Principal Committee”) viewed the conduct as a serious breach of professional standards. Several aggravating factors were considered:

The misconduct was repeated over a period of weeks.
The medications taken included a controlled opioid (codeine).
High quantities were consumed while the registrant was on duty.
There was an element of dishonesty, involving deceit towards the employer.
The risk posed to public safety due to the registrant’s drug consumption while working.

Despite these serious breaches, the Principal Committee also considered mitigating factors: the registrant had reported the matter herself, cooperated fully, expressed remorse, had no prior history of misconduct, and had personal and health difficulties at the time. The misconduct was found to be for personal consumption and not for distribution, which somewhat lessened the severity.

The original decision resulted in a 12-month suspension and a requirement for review before re-entry to the register.

GPhC Determination on Impairment

At the review hearing in January 2019, the Committee evaluated whether the registrant’s fitness to practise remained impaired. The legal framework guided them to consider whether the registrant had addressed the original concerns and demonstrated insight and remediation.

The Committee received oral evidence via telephone from the registrant and found her to be open and sincere. She acknowledged the gravity of her past actions, their impact on public confidence, and the importance of professional integrity.

A particularly compelling element of her testimony was her reflection on why the public must be able to trust healthcare professionals, saying she understood that “the Council could not allow people to do what she had done.” Her testimony revealed that she had changed how she copes with stress, now relying on support from family and a supportive manager, rather than turning to medication misuse.

Additionally, her employer provided a reference showing trust in her character and judgment—most notably, she was now responsible for locking the pharmacy and securing the controlled drugs cabinet.

The Committee found that:

“The Registrant had developed a fresh approach to dealing with problems that greatly reduced the risk of further misconduct.”

They concluded that she had not only demonstrated insight but had actively changed her behaviour and support systems, reducing the risk of recurrence.

Sanction

Given the depth of reflection, insight, and positive evidence of rehabilitation, the Committee determined that the registrant’s fitness to practise was no longer impaired. As a result, they allowed the suspension to lapse on its scheduled end date of 27 February 2019, effectively restoring her ability to return to practice.

They noted that:

“She has been open with her employers… and has responded well to the trust they have placed in her.”

This marked a significant shift from the concerns of dishonesty and patient risk that had originally led to the suspension.

Key Learning Points for Pharmacy Professionals

This case is a powerful example of how serious misconduct—especially involving dishonesty and the misuse of controlled substances—can severely damage professional standing and trust. However, it also illustrates how insight, genuine remorse, and demonstrable change can lead to redemption.

Key takeaways include:

Dishonesty, even under duress or due to health problems, seriously undermines public trust and will nearly always lead to sanctions.
Controlled drug misuse while practising is a high-risk behaviour, both for patient safety and professional integrity. Consuming opioids at work is especially serious.
Insight and remediation are essential for recovery of professional standing. This includes not only reflective writing but actions—like continued work under conditions, support from employers, and changed coping mechanisms.
Openness with employers and professional bodies can significantly influence outcomes. In this case, the registrant shared all case documents with her employer and was transparent about her past.
Resilience and support systems matter. The registrant demonstrated that even under renewed personal stress (a family member’s illness), she did not relapse—proving her new coping strategies were effective.

Pharmacy professionals must remember that while regulators do allow for second chances, those are hard-earned and contingent upon compelling evidence of insight, change, and commitment to patient safety and ethical practice.

Original Case Document

The full determination transcript is available to logged in users.