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’sÂ 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