Addicted at the bedside

It was the kind of story that gives you chills: A nurse at Abbott Northwestern Hospital in Minneapolis allegedly stole fentanyl meant for a patient undergoing a kidney procedure, telling the patient to “man up” and endure the pain.

According to news coverage last month, Sarah Casareto admitted in a criminal complaint that she has had dependency issues with narcotic pain medication.

An isolated incident? Maybe not. Earlier this month a registered nurse from Superior, Wis., pleaded guilty in federal court to taking Dilaudid, a prescription painkiller, from patients at a Twin Cities hospital. News accounts said Maria Mihalik allegedly posed as an employee to enter Mercy Hospital and used a syringe to siphon Dilaudid from patients’ IV drip bags.

The news from St. Cloud this week was more of the same: An unidentified nurse at St. Cloud Hospital was suspended after allegedly removing pain medication from patients’ IV bags and replacing it with saline or air. In the process, at least 23 patients were infected with bacteria.

As if this weren’t enough, last week’s episode of “The Mentalist” involved a drug-addicted anesthesiologist who killed a colleague by whacking him in the head with a golf club. The fictional motive: The doc was about to be outed for stealing pain meds from the hospital pharmacy and using them for herself.

The public might be excused for wondering exactly how widespread it is for health care professionals to abuse prescription drugs, especially narcotics.

Figures are hard to come by. The best estimate I could find was that about 10 to 15 percent of health care workers have substance abuse problems involving alcohol and/or prescription drugs. This level is the same as or slightly higher than the general population. It also means that 85 to 90 percent of health care professionals – in other words, the vast majority – don’t abuse drink or drugs.

But regardless of the incidence, the stakes are extremely high because of the potential for putting patients in danger.

Some of the addiction-related issues facing health care professionals are unique. For one thing, it’s far easier for them to obtain drugs, especially narcotics. This article, which appears at DrugAddictionTreatment.com, tells the story of Debbie, a 40-something nurse from Michigan who struggled with alcoholism and then turned to prescription painkillers for chronic back pain:

“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.

The fact that so many prescription drugs, especially painkillers, are commonplace in hospital, clinic and pharmacy settings also can lead some health care professionals into trying them out of curiosity, the article notes.

For nurses in particular, addiction is “an occupational hazard,” according to a paper published a few years ago in the American Journal of Nursing. The author, Patricia Maher-Brisen, spent 10 years with the Statewide Peer Assistance for Nurses program in New York. She describes some of the workplace factors that can contribute to nurses’ likelihood of becoming addicted: working night shifts or rotating shifts, working excessive overtime, working with critically ill patients, and the occupational risk of back and muscle injuries and pain. She cites research suggesting that emergency-room nurses are more than three times as likely to use marijuana or cocaine as nurses in other departments.

Maher-Brisen also makes a critical distinction: It’s not a crime to be addicted. The wrongdoing lies in putting patients at risk and engaging in unethical and criminal behavior, she writes:

Diversion is a crime, and when it occurs the police may be called in to investigate and make an arrest. Nurses have been arrested for falsifying records and forging prescriptions.

Practicing nursing while impaired by alcohol or other drugs is a form of professional misconduct. Nurses who practice while impaired report that they live in fear of being caught.

It’s often just a matter of time before a patient, colleague, or manager reports the problem to the administration.

Here are some more key facts about addiction among health care professionals: Doctors seem to be more likely than the general public to misuse prescription drugs but their overall drug of choice tends to be alcohol. Anesthesiologists are the exception; they’re more likely to abuse injected opioids, which are especially potent. Although most states provide intervention and monitoring for addicted physicians, there’s a shortage of programs for other professionals such as nurses and nurse anesthetists, with the result that many of these people are undertreated and sometimes die from their addictions.

With proper treatment, many addicted health care professionals can go back to work. Some might need to change the focus of their practice, however, and a small minority might never be fit to return to patient care.

To their credit, the three Minnesota hospitals where nurses were caught allegedly stealing drugs from patients were quick to act. They also were quick to go public and to share what they knew with patients who might have been affected. Drug misuse at this level rarely springs up overnight, however, and it makes one wonder how long these nurses continued to care for patients before their drug problems became apparent. Could – or should – someone have intervened sooner?

Maybe this is an opportunity for everyone in the health care community to take a long, hard look at how they identify, deal with and support colleagues who are addicted.

Photo: Wikimedia Commons

7 thoughts on “Addicted at the bedside

  1. This article hits home with me. I was a nurse for 13 years, and after several knee and back problems I became addicted to pain killers. I have lost so much as a result of my addiction, family, friends, jobs, and most of all my license to practice the one thing in life I have been truely blessed to do (nursing). I have indured alot of misforntune and judgement, but I can assure anyone who is reading this and finds themselves relating to my story, that life can be wonderful and rewarding again. I have found through the 12 steps of AA or NA, a sponsor, a higher power of your understanding and some hard work, life ( a better life) is obtainable. I hope my few words of encouragement reach and help someone. You are not alone and you are not unique, people make it through this and they are happy, joyous and free. God Bless You,

  2. This is more of a problem than anyone thinks. If you look at the rate of prescription drug abuse and overdoses in the past 15 years, you can see how it has dramatically risen. My wife was a nurse, and she had an addiction problem that she couldnt tell anyone about. It ultimately took her life some months ago. God rest her soul. Maybe someday I will be able to find peace, but not until I do all I can to bring this epidemic into the light.

  3. I have been on the other side; well actually I have been on both sides, but I am replying as a patient who went to the ER for debilitating, excrutiating pain from a migraine. I had taken everything at home that I could safely take, including 2 100 mg. pills of sumatriptan (imitrex) the best migraine remedy. When my pain would become that bad and out of control the only thing that would help was typically 100 mg. of demoral. First of all; I was ALWAYS treated as a drug seeking addict. Even though I brought with me a letter from my neurologist who had treated me for years; who knew and documented that I was a legitimate sufferer of migraine headaches that about once every six to twelve months could not be brought under control with traditional methods. Secondly, when I did finally receive the medication I “asked for” yes I was drug seeking—because I was in severe pain and I needed drugs, thank you to help me, not because I was looking for a “fix”. If I needed a “fix” it would have been a lot easier and certainly much quicker to go to the street. That is not my deal. I just want help like a normal person in an ER. The last time I went to the ER at Southdale Medical Center I was given demoral after 3 1/2 hours and it was as if I had been given NOTHING! When I complained to the nurse that I felt my drug had been “diverted” the MD came running in and accuse me of “how dare you accuse my nurse of taking your drugs!” In other words I was not allowed to complain. So when you ask how long this has probably gone on before these nurses get help, if they have doctors who would rather blame the patient than the nurse, then it probably goes on for a very long time! I asked for one more injection. Nothing again. I went home. I have never returned to that ER.

  4. Eddie, my heart goes out to you. Addiction is ugly and shows no mercy to any social or economic status. I don’t know what to say but I am very sorry for your loss and find a support group that will help you most. Al-non or a survivers group I suggest. You will be in my prayers tonight.

  5. Mary Cat, Don’t know what to tell you, but it is a major problem from the patients side as well as the medical staff. I have no easy answer, but maybe a Pain Clinic

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