CRNA Drug Addiction

In a recent lecture by a peer assistance counseler from AANA, we were told the rate of crna drug abuse was proportional to the country. Does anyone know if this is true? I assumed yes, but have never read anything.....

And to open up another topic, what do you all think about recovered addicts returning to practice? I have a strong opinion on that, always just thinking "what if my mother was the patient" type of approach, what do you guys think?

In a recent lecture by a peer assistance counseler from AANA, we were told the rate of crna drug abuse was proportional to the country. Does anyone know if this is true? I assumed yes, but have never read anything.....

And to open up another topic, what do you all think about recovered addicts returning to practice? I have a strong opinion on that, always just thinking "what if my mother was the patient" type of approach, what do you guys think?

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.

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.

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.

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.

• 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

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.