Nurses Aren't Immune to Prescription Drug Abuse

There's been a rash of headlines involving healthcare workers abusing—and sometimes overdosing and dying from—prescription drugs. Can you spot the addicted nurses in your organization?

In December, a cardiovascular ICU nurse was found dead in the bathroom of a University of Michigan hospital. Months later, The Ann Arbor News reported that she died from an overdose of the opiate fentanyl and the benzodiazepine midazolam, two sedatives that are used for surgical patients.

Prescription painkiller abuse is a huge and growing problem in the United States. In January, Vermont Governor Peter Shumlin (D) devoted his entire state of the state address to the Green State's drug addiction crisis, which he said, "started as an Oxycontin and prescription drug addiction problem… [and] has now grown into a full-blown heroin crisis."

The problem is so prevalent in our culture that even the title character on the Showtime series Nurse Jackie, who works at a New York City hospital, is an addict.

According to the CDC, drug overdose rates have more than tripled since 1990. More than 36,000 people died from drug overdoses in 2008, and most of these deaths were caused by prescription drugs. And prescription painkillers specifically were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined, the CDC says.

Nurses and other healthcare providers are not immune to addiction, as a scan of recent headlines reveals. There's been a steady stream of news lately about nurses charged with stealing pain meds, like this one about a theft from a labor and delivery unit and this one from a nursing home.

Endangering Patients
Kathleen Russell, JD, MN, RN, Associate in the Nursing Regulations Division at the National Council of State Boards of Nursing, cites research from 1998 showing that although "substance use among nurses occurred at rates comparable to rates in general population, use of prescriptions type drugs was higher among nurses."

And when healthcare providers abuse drugs, they're not just harming themselves; they're also potentially harming their patients. From caring for patients while impaired, to stealing medications meant for patients, to actually infecting patients with using dirty syringes, the safety ramifications of prescription drug abuse among healthcare workers are far-reaching. Not to mention the fact that healthcare workers also have unique access to prescription drugs.

A Tough Problem, Too Easily Ignored
Despite the potentially devastating consequences, prescription drug abuse seems to be a difficult topic for the healthcare community to address. Russell tells me via email that "Fear of losing their jobs, licenses, and livelihoods" are among the barriers to nursing getting help for their addiction.

"Another major factor is that addiction causes chemical and physical changes in the brain that lead many addicts to think they are in control," she says.

I reached out to both the ANA and the International Nurses Society on Addictions, but neither organization had comments for me. (The ANA did point me to its Code of Ethics, including Provision 3.5 Acting on Questionable Practice).

Moreover, a USA TODAY review released this month found that "Disciplinary action for drug abuse by healthcare providers, such as suspension of a license to practice, is rare and often doesn't occur until a practitioner has committed multiple transgressions."

Although random drug testing is routine in the airline and other industries, drug testing for healthcare workers isn't common practice. However, there is a renewed call for drug testing among healthcare workers.

A Call for Mandatory Testing
HHS inspector general Daniel R. Levinson and special agent Erika T. Broadhurst recently authored a New York Times op-ed piece arguing that "All healthcare workers with access to drugs, including medical doctors, nurses, nurse practitioners, radiological technicians and surgical assistants, should be subject to mandatory drug testing."

Earlier this year, New Hampshire (where a medical technician started a deadly hepatitis C outbreak) took steps to do just that, when the state's House passed legislation requiring "licensed health care facilities and providers to adopt a policy establishing procedures for prevention, detection, and resolution of substance abuse, misuse, or diversion in the workplace." That includes requiring:

• Education of healthcare workers.
• Procedures for monitoring storage, distribution, and procurement of inventory if controlled substances are stored, dispensed, or administered at the health care setting.
• Procedures for voluntary self-referral by addicted employees.
• Procedures for co-worker reporting.
• Procedures for drug testing which shall include, at a minimum, testing where reasonable suspicion exists.
• Procedures for employee assistance.
• Provisions for confidentiality.
• A process for the investigation, reporting, and resolution of drug misuse or diversion.
• Consequences for violation of the drug misuse and diversion prevention policy.

Although I cannot possibly address every facet of this complex issue in this space, there are steps nurse managers can take to recognize and help nurses with substance abuse problems.

"NCSBN recently developed a brochure for Nurse Managers about Substance Abuse which will be out soon," Russell says. "Additionally, we recently developed a video and a continuing education course on Nurse Manager Guidelines for Substance Use Disorder."