The National Institute for Occupational Safety and Health (NIOSH) has launched a study of violence against pharmacists, in a first step toward production of recommendations to reduce the dangers. "We got a number of calls from pharmacists last year that brought the problem to our attention," said Dan Hartley, NIOSH epidemiologist and director for Workplace Violence Prevention Research. "Anecdotally, we are finding that violence against pharmacists differs from violence experienced by other healthcare workers such as hospital employees."

A 2002 NIOSH report found that violence against hospital workers, including hospital pharmacists, usually comes from patients, family members, and friends who feel vulnerable, frustrated, and out of control. Violence against retail pharmacists is more often associated with robberies targeting controlled substances.

"You can limit cash on hand to $50 and lower the temptation to steal cash, but it's harder to limit supplies of OxyContin [oxycodone] or Vicodin [hydrocodone] or other controlled substances," Hartley said. NIOSH is sampling pharmacy crime reports from selected locations in Illinois, Ohio, South Carolina, Tennessee, and Wisconsin. According to a literature search made last fall, Hartley said, these five states have the highest rates of pharmacy robbery. Once the initial survey is compiled this spring, NIOSH may move on to a broad survey or begin an intervention study. "NIOSH does the study and OSHA [the Occupational Safety and Health Administration] issues guidelines and workplace standards," he said. "I would like to see a numbered NIOSH publication come out of this."

A pharmacy robbery can be troubling, even if the event is unseen and nonviolent. One of Steve Giroux's six Minnesota pharmacies was robbed by thieves who hid in a restroom before closing time. After the pharmacist locked the building for the night and went home, the thieves disabled a back-door alarm and ransacked stocks of controlled substances. "My pharmacist's father called and asked how I could guarantee his daughter's safety in the store after that. You do everything you can, but there's no good answer."

Giroux has also seen more violent events. A fraudulent prescription for a controlled substance led to a pharmacy shootout just after Labor Day, 2001. The perpetrator was killed, a police officer was hospitalized, and the store was closed for 24 hours for forensic work. The store staff was unhurt, but shaken.

When Giroux became president of the National Community Pharmacy Association (NCPA) in 2007, he helped launch Protect Your Pharmacy, a pharmacy safety and security program. The program relies on advice from RxPatrol as well as violence-prevention guidelines from OSHA. "We are seeing a tremendous increase in the number of pharmacy robberies," Conklin said. "They are looking for controlled substances. The good news is that most robbers don't want to perpetrate any violence. They want to get in and get out fast."

Criminals typically scout several pharmacies to find the easiest target. The addition of surveillance cameras and signs warning the store is being monitored deters many would-be thieves.

Giroux noted that visible surveillance cameras also cut down on shoplifting. "You may spend $1,000, $2,000 on a camera system, but you can save that much by deterring a single thief who cleans out a shelf of diabetic test strips or some other high-value item," Giroux said. "You also need cameras covering the exterior of your store to capture images of everyone coming and going, and of the parking areas. Most criminals see the cameras and move on to a more vulnerable target."