Drug Use in Health Care

Drug Use in Health Care

As anyone who’s seen the show knows, Nurse Jackie, the title character of Showtime’s new hospital drama, depends on narcotic painkillers like OxyContin, Vicodin, and Percocet to make it through each day as an ER nurse. She suffers from chronic back pain, and is seen snorting or drinking powdered versions of the drugs several times a day. While drug dependence makes for an interesting television plot, it’s also a reality in the health care field.

Drug abuse among health professionals is about the same as the general population—between 10 and 15 percent. However, it is much easier for nurses and doctors to obtain narcotics, as they deal with them every day and know exactly how they work.

Dr. Michael Brooks, director of psychiatric services at Brighton Hospital in Brighton, Michigan, told ABC News that opioid treatments, which were reserved for terminal pain 20 years ago, are now being used more frequently for chronic pain. “With that change of philosophy, there is more free use for prescription opiates for use of chronic pain. Which means more exposure for people in medical fields,” he said.

Debbie, a 45-year-old nurse who works in a Michigan hospital, told ABC that she was an alcoholic for years before sobering up and completing nursing school. She stayed clean for nine years until her brother, father, and a close friend died in a short amount of time. With the stress of her job and the multiple losses, she started drinking again. She was also prescribed painkillers for chronic back pain after having back surgery, and she soon became addicted to them.

“It’s kind of like a roller coaster ride. One isn’t enough and you’re doing two [painkillers],” Debbie said. “Before you know it, you’re having to medicate yourself just to go to sleep.”

Debbie also pointed out that exposure to drugs can be a problem for those who are predisposed to addiction genetically or have experienced addiction in the past. “If you’re an addict, eventually your drug of choice is whatever is in front of you,” she said.

In addition, some health care professionals dabble in drug use out of curiosity for what their patients feel. This is especially true for some people who work in anesthesiology, where it’s very easy to access drugs like morphine.

“They see a sense of calm that comes over a patient’s face when a medicine is administered,” said Dr. Michael Fitzsimons, an anesthesiologist and the administrative director for the Substance Abuse Prevention program at Massachusetts General Hospital. “The care provider sees their pain and anxiety being relieved. You kind of develop a sense of curiosity about it.”

“The unfortunate thing is that 10 to 20 percent of addicts in medicine will actually present dead,” said Fitzsimons. “They’re found dead in the call room or at home because they utilize these substances, not appreciating the potency.”

Besides harming themselves, health care professionals who are under the influence of drugs can also harm their patients. “No patient should ever accept the care of a person under influence,” Fitzsimons said.

But many doctors and nurses who abuse drugs are high functioning and good at hiding their habit, as seen on Nurse Jackie. Only the pharmacist with whom she’s having an affair seems to know about her drug use, as he’s the one who keeps her well stocked.

Unfortunately, colleagues sometimes enable or cover up their co-worker’s addictions. In the case of Jackie, her lover provides her with drugs because he cares about her—she also returns the favor by secretly sleeping with him every day at noon. This is also illustrated on Fox’s television show House, where everyone in the hospital knows Dr. House is addicted to painkillers (mainly Vicodin) and lets him get away with it because he’s a brilliant doctor. In one episode, the chief of medicine even perjures herself in court to keep him from going to jail.

But in Debbie’s case, an anonymous call that was placed about her drug use got her fired from the hospital and also saved her life. When she resorted to stealing drugs from her workplace to support her addiction and her behavior started to change, her colleagues started to notice her problem.

After an anonymous call was made, Debbie was given a drug test, which she failed, and was fired. She soon sank into a depressive state that culminated in a failed suicide attempt. She chose not to receive treatment and eventually returned to nursing at a different hospital.

“I had to remove myself from that environment and get to a safe place,” Debbie said. “I know in my heart of hearts that I can’t use any mind-mood-altering substances. The stimulus just starts the craving phenomenon.”

Dr. Brooks pointed out that the anonymous phone call that saved Debbie’s life may not have been possible 20 years ago. “There used to be a code of silence among medical personnel… and meant to be protective for the person who’s using, but it’s a reverse protection,” he said. “Now, the air is more that people are alert to this and the consequences are greater and we are rapid to identify and intervene in the problem.”

Source: ABC News, Radha Chitale, Edie Falco’s Nurse Jackie a Model for Hospital Drug Use? June 19, 2009

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