Controlled substances - page 2

Recently, a student nurse anesthetist was found dead in the on-call room of a drug overdose. People I know who work in PACU, OR say there is NO accountability for controlled substances. That pretty... Read More

  1. by   susanna
    Does anyone know why this happens exactly? High stress rate? Is anesthesia a particularly easy burn-out profession and is that why so many people turn to drugs?
  2. by   jwk
    Quote from deepz
    It seems to be getting worse. In years past the risk was said to 1:7 that an anesthesia provider would have a chemical dependency problem at some point in their career. It is a complex issue, beyond the easy availability.

    This year Diana Quinlan says the risk is currently 1 in 5.

    deepz
    That really seems high - at those rates, I should have come in contact with at least 30-40 in my career, and I just don't believe that many have that problem. I have knowledge of several, but certainly nowhere near 1 in 5 or 7.
  3. by   deepz
    Quote from jwk
    That really seems high - at those rates, I should have come in contact with at least 30-40 in my career, and I just don't believe that many have that problem. I have knowledge of several, but certainly nowhere near 1 in 5 or 7.

    Diana Quinlan is the national authority, not me. I've been surprised several times over the years to learn of addicted coworkers whom I would never have suspected.

    deepz
  4. by   jwk
    Quote from deepz
    Diana Quinlan is the national authority, not me. I've been surprised several times over the years to learn of addicted coworkers whom I would never have suspected.

    deepz
    True - the couple that I've known were a total surprise to everyone. Like I said, it just seems like an awful high number. Kinda scary if it's accurate.

    Anyone have a feel for whether tight drug control makes a difference (Pyxis or Omnicell machines, pharmacist in the OR, etc.) as far as detecting abusers?
  5. by   gaspassah
    i was discussing this just the other day. it doesnt matter how you get the drug, whether pyxis or other means. when there is noone to watch you administer the drug, then at the end you show someone a syringe with a blue label, how are they supposed to know what is in the stick? it could be saline for all they know. it really boils down to trust. some people just choose to abuse that trust.
    d
  6. by   deepz
    Quote from gaspassah
    ....some people just choose to abuse that trust...

    Yes. And if a sense of professional responsibility has not been deeply ingrained -- internalized -- during a person's anesthesia training, no external attempts at control are likely to prevent secret self-medication. Unfortunately.

    deepz
  7. by   athomas91
    i completely agree - you can place all the pyxis' etc... you want to attempt to control - but if someone wants to use that badly they WILL find a way...and it is a huge abuse of trust and power...i am surprised that there isn't some type of personality eval we had to pass prior to school in attempts to weed this out....i guess all we can do it support each other and help when we find someone who needs it..
  8. by   louloubell1
    Quote from athomas91
    i completely agree - you can place all the pyxis' etc... you want to attempt to control - but if someone wants to use that badly they WILL find a way...and it is a huge abuse of trust and power...i am surprised that there isn't some type of personality eval we had to pass prior to school in attempts to weed this out....i guess all we can do it support each other and help when we find someone who needs it..
    I don't think that a school really could try in any overt type of way to weed out people with tendencies toward addiction. Drug addiction and alcoholism is considered a disabililty and people suffering from these afflictions are protected under the Americans with Disabilities Act. To deny someone a slot in school or a job based on a personality type or even on a past history of addiction is unlawful.
  9. by   MyReign1
    Since drug abuse is such a huge problem for medical workers, why aren't there mandatory drug tests every few months. This to me would cut down on abuse. I don't know whether this is done or not, I'm currently a student. It seems like the obvious solution though.
  10. by   athomas91
    RNLou - i do not think that drug addiction is covered under the American's w/ disabilities act - it is not a disability. And i completely disagree w/ your statement - placing someone w/ a history of drug addiction in a position where it is not only readily accessible but nearly untrackable is a diservice to that individual as well as to the patients that are "supposedly" receiving that medication.
    myreign1 - i agree that intermittent/random testing would likely be a better approach.
  11. by   louloubell1
    Quote from athomas91
    RNLou - i do not think that drug addiction is covered under the American's w/ disabilities act - it is not a disability. And i completely disagree w/ your statement - placing someone w/ a history of drug addiction in a position where it is not only readily accessible but nearly untrackable is a diservice to that individual as well as to the patients that are "supposedly" receiving that medication.
    myreign1 - i agree that intermittent/random testing would likely be a better approach.
    http://www.dol.gov/elaws/asp/drugfre...s/screen13.asp

    "The following is a brief outline of aspects of the ADA and the Rehabilitation Act of 1973 that are related to employees who have problems with drugs and alcohol:

    Employers may prohibit the illegal use of drugs and the use of alcohol in the workplace.
    The ADA is not violated by tests for illegal use of drugs (but remember to meet state requirements).
    Employers may discharge or deny employment to persons who currently engage in the illegal use of drugs.
    Employers may not discriminate against drug addicts who are not currently using drugs and have been rehabilitated or have a history of drug addiction.
    Employers may not discriminate against drug addicts who are currently in a rehabilitation program. (The EEOC has clarified that a rehabilitation program includes inpatient or outpatient programs, Employee Assistance Programs, or recognized self-help programs such as Narcotics Anonymous.)
    Reasonable accommodation efforts, such as allowing time off for medical care, self-help programs, etc., must be extended to rehabilitated drug addicts or individuals undergoing rehabilitation.
    A person who is an alcoholic may be an "individual with a disability" under the ADA.
    Employers may discipline, discharge or deny employment to alcoholics whose use of alcohol impairs job performance or conduct to the same extent that such conduct would result in disciplinary action for other employees.
    Employees who use drugs and alcohol may be required to meet the same standards of performance and conduct set for other employees.
    Employees may be required to follow the Drug-Free Workplace Act of 1988 and rules set by Federal agencies pertaining to alcohol and drug use in the workplace.
    The ADA does not protect casual drug users; but individuals with a record of addiction, or who are erroneously perceived as being addicts, would be covered by the guidelines."
  12. by   athomas91
    well it wouldn't be the first time i was mistaken....however.....
    it would only make LOGICAL sense that if someone was in a rehab program or was caught using that they wouldn't be placed in a position where it was readily accessible and ultimately sacrificing patient care. THAT is a lawsuit waiting to happen.
  13. by   eph432girl
    I am just a 'CRNA to be', so my perspective might be a little different than yours.... but I think there are very few institution that would hire a CRNA if the CRNA were "disabled" due to an addiction problem in their past. It is too much liability and reflects badly on the institution when the info gets out into the public. Media frenzy... Can't you just see this story on the news: "Hospital X being sued by patient CS because of awareness during surgery and did you know that her CRNA has been in drug rehab before being hired by hospital X... did the anesthesiologist steal the patient's drugs? stay tuned to channel 9....more info when we return.....".


    Also, think of this scenario: would you want your children to be supervised by a day care that employed a person who "used to have a problem" with child pornography? Even if the person has received therapy, I would still consider them as dangerous when it comes to my child. I think it is the same reasoning with hiring someone who used to have an addiction problem to dispense controlled substances in an environment relatively free of checks and balances to safeguard from substance abuse. The risk and temptations are too high. Sounds like to me that the hospital setting and stress levels are too much for SOME CRNAs/MDs/RNs without addictions to cope with and they start using. These people are not addicted when they are in school (maybe they are functional addicts - possibly)... how much more temptation will the same environment be to someone with a history of substance abuse problems?


    Lastly, using a personality trait test to justify discrimination would open the gate for litigation. I think a such test might be helpful to look at "at-risk" populations and provide information, education, counseling (say studies have shown that people with X characteristics have a higher probability to abuse), but to exclude those CRNA candidates based on a test of personality traits instead of deviant actions is not fair.

    Sounds like an idea for a future research paper........

    Christine

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