CRNA Drug Addiction - page 3

I have heard from alot of sources that the addiction rate among CRNA's is higher than other nursing specialities. Why is this? I realize availability of drugs, etc. plays a part, but in short I... Read More

  1. by   TrudyRN
    Quote from paindoc
    In a prior career as an anesthesiologist, I saw 2 CRNAs become addicted to fentanyl. One quit practice immediately, one went through a drug addiction program requiring monitoring for one year with naltrexone being given orally (witnessed) daily. Within a month after the year probation, the CRNA relapsed sadly again, and quit practice. He was a friend of mine and I was very distraught at his demise. I have seen anesthesia residents addicted to fentanyl, halothane, sufentanil, ketamine, and demerol. One resident that had been on probation once already for substance abuse (fentanyl) had a positive urine drug screen for ketamine 2 days before the end of residency. He never practiced anesthesiology thereafter.
    Many who became addicted were the thrill seekers...the base jumpers, mountain climbers, mountain bikers, downhill skiiers....those that like a little living on the edge. But some were quiet and had rather bland lives....
    Addiction is a very sad reality of our profession that can bite any of us at any time. Many feel stressed as the inciting cause, turning to fentanyl, an easily accessable drug, thinking they can control their use. But rapid escalation is the rule, and within a few weeks to a few months, most have escalated their doses to massive amounts, sometimes up to 20-50cc per day IV.
    You can help...take note of those that are dissheveled, frequently late or unreliable, frequently early (when the obtain the drugs), staying late, seem preoccupied, pinpoint pupils, withdraw from social groups or engagements, and are less conversant than previously. Their charting may become sloppy or abbreviated. Their patients arrive in the PACU screaming in pain and require much higher doses of narcotics in the PACU than do those of other providers. If you notice these signs, don't just chalk it up to too much hard work or study...by notifying your program director, you may save their life. We lost two lives over the past 10 years by not noticing soon enough....don't make the same mistake or think someone else will file a report...everyone else is thinking the same thing and nothing gets reported.
    This is good to know. Thanks, paindoc.
  2. by   jackstem
    Quote from SFCardiacRN
    I'm not sure that the addiction rate is higher for CRNA's. I've worked for many years in many OR's and have heard of a many anesthesiologists, OR RN's & Techs, PACU RN's, EMT's and med/surg/re-hab/LTC RN's but NEVER a CRNA. Perhaps the numbers are so small that it doesn't take many to skew the percentage rate.
    The rate of addiction in society and specific groups (nurses, anesthesia providers, pharmacists, attorneys, pilots, etc.) is difficult to determine accuratley. The stigma (they did this to themselves, they deserve whatever happens to them) associated with this disease means most people are unwilling to disclose they are addicted or have received treatment and are now in recovery.

    The rate of addiction in anesthesia providers (anesthesiologist or CRNA) is indeed higher than in other health care professionals. I'm a recovering addict, former CRNA, and now chair and senior advisor for the Ohio State Association of Nurse Anesthetists Peer Advocacy for Practitioner Wellness Committee. Substance abuse and addiction is the number one health risk associated with the practice of anesthesia. According to the American Association of Nurse Anesthetists past president Terry Wicks, CRNA, MHS,
    Every anesthesia provider, irrespective of credentials, experience, or responsibilities, can become a victim of chemical dependency when they experience unmanageable physical or emotional pain, unrelenting stress, or other life experiences that increase their vulnerability.
    The Farley Center and The Talbott Treatment Campus have treatment programs spefically for health care professionals. Multiple risk factors for addictive behavior have been identified for the anesthesia provider.
    Farley and Talbott commented on certain similarities among the anesthesiologists and nurse anesthetists treated in the Medical Association of Georgia's Impaired Physician Program which they labeled "anesthesiology trigger mechanisms. The 5 most common triggers are:

    • Ease of drug availability
    • Prior experimentation with mood-altering drugs
    • Job-related stress of highly specialized vocation
    • Respect not equivalent to responsibility
    • Intimate knowledge of the power of drugs

    More specific stress-related risk factors include life and death decision making, long working hours, and altered sleep patterns associated with call. Depression may also manifest itself in the professional due to fatigue, stress, the death of a patient, and the juggling of a family/social life with a demanding career.

    Similar risk factors exist for the nurse anesthesia student, the most predominant being stress. Students have high expectations of their own performance in both the classroom and the clinical arena. Perception of poor performance, be it accurate or not may put them at risk because of decreased self-esteem. Other factors for students may be related to increasing financial problems, decreasing time for self/family, lack of coping skills, and depression from being overwhelmed by the association demands.
    Statistics are gathered from a variety sources including hospital admissions, ER visits, addiction treatment facilities, police records, and death certificates. But addiction and substance abuse aren't always included in these records for a variety of reasons (another topic for another thread).

    The AANA has chosen to face this issue in their membership head on. They formed an ad hoc committe in 1983 which has evolved into the Peer Assistance and Wellness Committee. They have endorsed and encourage state associations to form their own committees and employ peer assistance advisors. The following are suggested functions for the state peer assistance advisor position:
    • Attend an orientation training program, where available.
    • Serve as a resource and support for nurse anesthetists and students with impairment issues.
    • Regularly communicate and network with state peer assistance programs, the board of nursing peer assistance programs, and professional alternative discipline programs.
    • Monitor state legislative and regulatory activities regarding chemical dependency in nursing and other health professional groups.
    • Familiarity with treatment programs located in the state, particularly those with a focus on health professional programs.
    • Act as a resource for the state nurse anesthetists association and other entities in developing or providing educational programs
    • Advocate for funding by your state association and other appropriate sources for support of peer assistance activities.
    • Request to be part of the business agenda at state association meetings to update the Board of Directors and members on state peer assistance activities
    • Collaborate with other groups in developing or supporting initiatives in the state that advance improvements in the area of professional well-being, substance misuse and chemical dependency.
    • Submit items for the state newsletter and request that the AANA Hotline, the AANA Web site information, and the Anesthetists in Recovery Hotline (AIR) be published. State peer assistance contact numbers should be listed in each issue.
    • Share information as appropriate with the Peer Assistance Advisors Group. Such information may include:

      o Reports of state activities and/or state newsletter articles
      o Suggested content for the focus sessions during the AANA Annual Meetings
      o Suggested areas for student research
      o Suggested postings on website.

    Developed by the AANA Peer Assistance Advisors Committee, October 2006
    Addiction is a chronic, progressive, unnecessarily fatal disease and must be treated in the same manner as other chronic diseases (diabetes, CAD, asthma, emphysema, etc.). With the significant increase in knowledge about the epidemiology, pathophysiology, psychology, and relapse triggers, evidence based treatment protocols are being developed which significantly increase the success of treatment and long term recovery. We can't expect society to change it's views about addiction if the health care community won't change theirs.

    Addiction isn't a moral weakness or a lack of willpower. It's a chronic brain disease that destroys a person mentally, emotionally, physically, and spiritual while disrupting families, businesses, and society at large.

    The impaired anesthesia provider: The manager's role

    Frequently Asked Questions About AANA Peer Assistance

    Key Concepts


    Peer Assistance, An Historical Perspective

    American Nurses Association (ANA) Resolution 2002

    AANA State Peer Assistance Advisors Locator

    ANA Impaired Nurse Resource Center

    National Council of State Boards of Nursing Alternative Programs

    Jack
  3. by   tfleuter
    All very interesting and so sad at the same time. I am actually quite surprised to hear about this. I used to work as a vet tech and was handling many of these same drugs (Ketamine, Propofal, Fentanyl) I knew these drugs could be dangerous/addicitive, but never really saw anything tempting about them. I guess it was more difficult to relate to the effects they had on animals then it would on a fellow human being. At the same time, I've heard of vet techs and veterinarians abusing these drugs too.
  4. by   jackstem
    Quote from tfleuter
    All very interesting and so sad at the same time. I am actually quite surprised to hear about this. I used to work as a vet tech and was handling many of these same drugs (Ketamine, Propofal, Fentanyl) I knew these drugs could be dangerous/addicitive, but never really saw anything tempting about them. I guess it was more difficult to relate to the effects they had on animals then it would on a fellow human being. At the same time, I've heard of vet techs and veterinarians abusing these drugs too.
    Addiction is a disease that affects smart people, dumb people and every one in between. It's a bio-psycho-social disease with strong evidence of a genetic basis. Exposure to the right substance, in the right amount, for the right amount of time, in the right person, leads to addiction. No one ever drinks or uses mood altering substances intending to become an addict. In 10 - 20% of the population who "use", the disease will become active. In 80 - 90% it won't. Unfortunately, a majority of the 80 - 90% think if they can decide when enough is enough, then anyone should be able to do the same. Sadly, that's not accurate. There is a wealth of information available explaining the pathophysiology of this disease process. The problem is, very few health care providers read it. And the information that is taught in many nursing programs isn't up to date. If the health care system managed other chronic, progressive, potentially fatal diseases the way substance abuse and addiction are managed, there would be a huge outcry and something would actually be done to change the system. But since people don't understand the disease, they find it very easy to ignore the folks who have the disease. Education is a major component of the American Association of Nurse Anesthetists Peer Assistance/Wellness program. They have accepted the reality that this is the #1 health risk associated with the profession and are taking the steps necessary to bring awareness to the profession. I feel blessed that I am able to be a small part of that effort.

    Jack
  5. by   loveanesthesia
    Quote from jackstem
    In 10 - 20% of the population who "use", the disease will become active. In 80 - 90% it won't.
    These numbers may be accurate for substances such as alcohol, but I don't think so for the drugs that anesthesia providers have access to. I don't think that 80-90% of CRNAs who "use" anesthetic agents such as fentanyl or propofol can avoid addiction, my impression is that almost all will become addicted and very quickly. Or am I wrong in this? I imagine that everyone thinks before that first time they take a little fentanyl that it won't be a problem, that they won't become an addict.
  6. by   jackstem
    Quote from loveanesthesia
    These numbers may be accurate for substances such as alcohol, but I don't think so for the drugs that anesthesia providers have access to. I don't think that 80-90% of CRNAs who "use" anesthetic agents such as fentanyl or propofol can avoid addiction, my impression is that almost all will become addicted and very quickly. Or am I wrong in this? I imagine that everyone thinks before that first time they take a little fentanyl that it won't be a problem, that they won't become an addict.
    We have no truly accurate numbers for the rate of dependency in any population. Not all incidences of abuse and dependency are accurately recorded due to stigma and fear of backlash by colleagues and society in general. The most common sign there may be a problem is finding the provider unconscious or dead. The numbers that are available are generally considered to be lower than the actual rate. The addiction rate for ALL anesthesia providers is listed as 10 - 20%. We're talking all providers, not just CRNAs. Also, that rate isn't just those who have "tried" the drugs...it's for the entire profession (MDA, CRNA, AA). I'd agree that of those who choose to "experiment" or use it for pain control, sleep, etc., the rate of addiction is well over 20%. There are those who think it's lower, but in my experience over the past 18 years, it's well over 10%...closer to 17+%.

    Read "Substance Abuse Policies for Anesthesia". It's the most current and complete source of information available.
  7. by   loveanesthesia
    I guess my point is that the rate of addiction-often quoted at 10-20% of anesthesia providers- is different than saying that only 10-20% of those that try it will become addicted. Most anesthesia providers never try fentanyl or propofol, so do not become addicted. But of those that do divert the drugs I think the evidence shows that the vast majority will develop an addiction. It is dangerous to think that you only have a 10-20% chance of getting into trouble if you take some fentanyl. Taking the drug the first time is a choice, after that it may not be, but you do have control that first time. I believe education can help prevent experimentation and/or self medication.
  8. by   jackstem
    Quote from loveanesthesia
    I guess my point is that the rate of addiction-often quoted at 10-20% of anesthesia providers- is different than saying that only 10-20% of those that try it will become addicted. Most anesthesia providers never try fentanyl or propofol, so do not become addicted. But of those that do divert the drugs I think the evidence shows that the vast majority will develop an addiction. It is dangerous to think that you only have a 10-20% chance of getting into trouble if you take some fentanyl. Taking the drug the first time is a choice, after that it may not be, but you do have control that first time. I believe education can help prevent experimentation and/or self medication.
    You're correct...the rate of 10 - 20% is for ALL anesthesia providers, not of those who "try" fentanyl, sufentanil, propofol, etc. If my original post wasn't clear I apologize. You would be surprised at the number of individuals who don't believe the number is as high as 10%.

    Unfortunately we live in a society that enjoys the use of mood altering substances, activities, etc. The age for first use of alcohol is getting lower (11 -12). For the person who has the genetic predisposition for chemical dependence (around 10 - 12% of the population), avoiding the use of alcohol and other substances can prevent the disease from ocurring. Many anesthesia providers have substance abuse and chemical dependence before they enter the profession. A large number of people (in and out of the profession) don't believe chemical dependence is a disease, they believe it's a lack of willpower or moral weakness. Pretty tough to get people to avoid exposure to ETOH, marijuana, etc. if they don't believe dependence will happen to them. That's why a major focus of the Peer Assistance Advisors Committee and the State Peer Advisors is on recognizing the signs and symptoms in a colleague and having polices and procedures in place to help get that colleague into treatment at the earliest possible moment. The lack of education and the stigma associated with the disease make it difficult to get the profession to change the way they deal with this issue. We're doing our best to get things changed.
  9. by   alterego33
    I would highly recommend that you go to www.aana.com, and look for the link called AIR (anesthetists in recovery). You will get some valuable information there and maybe meet people who have personal knowledge about the topic.
  10. by   NRSKarenRN
  11. by   ProspectiveMDC
    Wow! This thread is over 7 years old and still kicking.

    I read every post so far, and i'm surprised that with so many professionals in specialized health field no has mentioned "second-hand environmental exposure ." In other words perhaps it's the exposure as said" Environmental exposure may explain the high rates of addiction among anesthesiologists and why recovery for anesthesiologists often necessitates giving up their work in operating rooms and even changing medical specialties"

    Also, http://www.anesthesiologynews.com/in...rticle_id=7579

    My question was based on the two said articles were based on anesthesiologists which did not mention CRNAs. Are CRNA's also at risk in environmental exposure?

    If so, then this is a very dangerous field. Because, if one takes these substances without knowledge of it, one could become addicted by accident. Then, it would not matter the person type. It could happen to the best of the best.

    Or, could this happen to anyone or everyone in the OR?
  12. by   jackstem
    Quote from ProspectiveMDC
    Wow! This thread is over 7 years old and still kicking.

    I read every post so far, and i'm surprised that with so many professionals in specialized health field no has mentioned "second-hand environmental exposure ." In other words perhaps it's the exposure as said" Environmental exposure may explain the high rates of addiction among anesthesiologists and why recovery for anesthesiologists often necessitates giving up their work in operating rooms and even changing medical specialties"

    Also, http://www.anesthesiologynews.com/in...rticle_id=7579

    My question was based on the two said articles were based on anesthesiologists which did not mention CRNAs. Are CRNA's also at risk in environmental exposure?

    If so, then this is a very dangerous field. Because, if one takes these substances without knowledge of it, one could become addicted by accident. Then, it would not matter the person type. It could happen to the best of the best.

    Or, could this happen to anyone or everyone in the OR?
    If chronic exposure to mood altering substances alone caused addiction, then we would have millions and millions more addicts. I have cared for people with chronic pain as a result of both cancer and non-cancer causes, requiring large doses of opioids in order to control their pain. In the people who were lucky enough to have remission or cure of the problem causing the pain, very few developed addiction. They all had physical dependence which is not the same thing as cancer. You'd be surprised at the number of health care professionals don't know that. But if exposure (especially large doses for long periods) caused addiction, then most would actually become addicted.

    Evidence is continuing to point to genetics as a major (if not key) player in the development of addiction. Under the right circumstances, with the right substance in the right person...you get addiction. I 'm a good example of this. I got drunk twice...the night of high school graduation (that's long enough ago that the drinking age in my areas was 18...ANCIENT!), and 5 years later at a bachelor party. I got so sick both times that I rarely drank alcohol after that. I'd have an occasional beer with a pizza or steak, but that's it. I have never tried marijuana, ever. I've never tried cocaine. I've received benzodiazepines, opioids (my drug of choice), barbiturates (for induction of anesthesia and as a "sleeper" the night before and the day of surgery (yes, I really am that old). I've received opioids for the treatment of postoperative (T&A, septoplasty, medial meniscectomy (before scopes), and post-trauma pain relief (high school football injuries to knees, nose, arm, back, etc.). So there is my exposure. I found out (after I was in treatment) I had and have numerous relatives who are addicts (my cousin and family doctor died in the mid-60's from alcoholism...he fell off a step ladder (drinking at the time) and hit his head leading to a slow subdural bleed which killed him.

    I had spondylolisthesis which caused off and on back pain. I finally had a fusion...but not before my addiction developed. Being a CRNA with access to all sorts of opioids...well, addiction and anesthesia don't mix. I certainly don't fit the stereotype of the "typical" drug addict. But I do fit the model that has, and continues to develop as a result of the research over the past 25 years. As I tell the folks I deal with as a peer advisor...we aren't bad people trying to become good. We have a chronic, progressive, potentially fatal disease...and we're trying to become well.

    I think there could be something to the passive exposure theory, but it's still too new to know for sure if it's accurate. But it certainly gives us something to consider when designing new OR's and anesthesia equipment.

    Jack

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