CRNA Drug Addiction

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.

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.

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.

AANA links:
Peer Assistance Homepage

Anesthetists in Recovery (AIR)

Anesthetists in Recovery, Chemical Dependency in the Profession

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