My CRNA friends do illegal drugs

BSNtobe2009 · Oct 11, 2006

developing a physical dependence is not addiction. while it may be one of the signs of substance abuse, it is not considered a major sign or symptom of addiction.
"taking drugs may begin as a voluntary choice to seek a pleasant stimulus, but for addicts, that choice is no longer volitional, even in the face of terrible personal consequences.
physical dependence refers to the adaptations that result in withdrawal symptoms when drugs such as alcohol and heroin are discontinued. those are distinct from the adaptations that result in addiction, which refers to the loss of control over the intense urges to take the drug even at the expense of adverse consequences."
simply exposing someone to a mood altering substance for a prolonged period of time does not lead to addiction. many chronic pain sufferers will develop tolerance (reduced effect with the same dose) and physical dependence when taking opioids for prolonged periods. however, if their medication is reduced in small amounts over a period of time, withdrawal signs and symptoms will be significantly alleviated. once they have been weened from their opioids, they don't have the compulsion to find and ingest opioids despite the lengthy exposure.
even though the addict has been weened to reduce withdrawal symptoms, they continue to "crave" the drug. this compulsion will decrease over time until it's almost completely gone. however, it never goes away completely and it's quite possible the cravings can be triggered by certain sights, sounds, smells, or environment.
pet scans in addicts/alcoholics in documented, long term recovery have been most interesting. in these individuals, showing them videos, pictures, or actual "instruments" they associate with using can "light up" the reward systems deep in the brain, showing that the brain is altered for quite awhile, perhaps even permanently. this explains why someone can relapse even after decades of no use.
this disease can be kept in remission by working a solid plan of recovery everyday. there are interesting new treatment protocols and medications that may significantly improve the treatment of addictions. but first, every professional health care provider must become familiar with this disease in order to intervene as early as possible. early intervention and treatment signifiantly improves the prognosis for long term recovery.
jack

jack, in all due respect, and i know you have personally recovered (and i want to say here that i believe people can recover and if you were still licensed you could put me to sleep on any day ), but i am going to have to wholeheartedly disagree with you on this one.

what is considered to be an "addiction" has be significantly redefined over the course of the last few years. physical addiction is not even considered a necessary component to diagnose someone as an "addict" be it an illegal substance, alcohol, or certain types of destructive behaviors such as sex or Media.

what jumped out at me, in one of the original posts, is that these women are putting their careers at significant risk and refuse to even consider the fact that such an incredibly heavy drug can have an impact on their judgement during surgery. this has, in everything i have ever seen or been taught about addiction, is a sign that something is seriously wrong. it's a psychological component to addiction, because all addictions have both physical and psychological characteristics.

because we haven't been given the ability to evaluate these people or meet them, we have to go by what their friend on this thread has said. when he spoke to them about it, they refused to even consider stop taking the drug, which again, is not a good sign.

i am, with many others, are greatly disturbed of the "look the other way" advice that has been given to the original poster. this is the very thing that is wrong with the health care system today. anesthesia to me, equals the seriousness of anything a surgeon could do and a mistake in judgement can cause a patient to become brain dead, just dead, or even worse, be a victim of anesthesia awareness which is increasing in commonality.

it's a shame that we still live in a society where we have to wait until someone is dead before we react. i think about all of the school shootings we have had in the past week, yet every time they find a kid who was still in the planning stages, they just send him to counseling. try being in the "planning stages" of killing the president and see how many decades you sit in prison.

another poster hit the nail on the head when she said that walmart employees are drug tested more than hospital workers, yet healthcare professionals of any profession, have the highest rate of prescription drug use.

please report these people before they ruin the careers of themselves or ruin the lives of an innocent family.

bmoore1973 · Oct 11, 2006

looks like this has been an interesting post. the only thing i want to say is that we are supposed to be professionals and in that respect we are supposed to abide by the laws and it is illegal to take any kind of drug. that is no way around it, it is illegal and they should not be doing it and as adults who worked really hard to get where they are and have the responisiblity that they have they should know that. If you are with them when they are doing drugs, you are just as guilty even if you aren't doing it yourself.

dfk, RN, CRNA · Oct 11, 2006

Yes, I would most certainly not hang out with my best friend if he/she was using drugs.
And...I don't hang out with my own son because of his drug use. You'd better believe I worked way too hard for this license to let it hinge on other people's issues.
Do you want to go to jail?

good friend. good parent. sounds quite supportive and understanding, history notwithstanding,

i guess we are different.

enjoy your career.

nurse4theplanet, RN · Oct 11, 2006

good friend. good parent. sounds quite supportive and understanding, history notwithstanding,
i guess we are different.
enjoy your career.

It seems one has two choices: making said persons accountable or enabling the behavior.

Not wanting to report illegal illicit drug use by a licensed professional, a direct violation of that licensure, because they are a friend is quite juvenile.

dfk, RN, CRNA · Oct 11, 2006

It seems one has two choices: making said persons accountable or enabling the behavior.
Not wanting to report illegal illicit drug use by a licensed professional, a direct violation of that licensure, because they are a friend is quite juvenile.

sorry wife, et. al.,

but this might have been taken out of context.. i agree with the professional aspect of it all.. but if my best friend has a problem, or my kid for that matter, you can be sure i won't turn my back. it's easier to give up, but very difficult to deal with.. trust me, i know first hand. and as for the enabling, apparently you have never had to experience that issue, as i have. so, until you or anyone walks in the same shoes, i wouldn't be too judgemental on people's personal issues that may or may not have been dealt with/dealing with.

and yes, this is a free to post forum, so post ad nauseum....

nurse4theplanet, RN · Oct 11, 2006

sorry wife, et. al.,
but this might have been taken out of context.. i agree with the professional aspect of it all.. but if my best friend has a problem, or my kid for that matter, you can be sure i won't turn my back. it's easier to give up, but very difficult to deal with.. trust me, i know first hand. and as for the enabling, apparently you have never had to experience that issue, as i have. so, until you or anyone walks in the same shoes, i wouldn't be too judgemental on people's personal issues that may or may not have been dealt with/dealing with.
and yes, this is a free to post forum, so post ad nauseum....

I never implied that one should turn their back without first intervening to hold that person accountable for their own actions and consequences. I made it very clear within my posts throughout this thread that the appropriate first steps would be to approach these professionals and direct them towards a resource for help. It matters not if these professionals are close friends, relatives, or even your own children...they must be accountable for their actions and accept the consequences of violating the terms of their licensure. Anything less would be enabling.

This is my stance on the issue and is not specifically addressed at you personally. Please do not assume that I have not been in said situation....professionally no, personally yes. Unfortunately, taking responsibility for one's drug habit is a personal choice that many addicts refuse to make. At that time, we have to realize as family members or friends that setting a standard for behavior and turning our back on our loved ones are NOT the same thing.

jackstem · Oct 12, 2006

Jack, in all due respect, and I know you have personally recovered (and I want to say here that I believe people can recover and if you were still licensed you could put me to sleep on any day ), but I am going to have to wholeheartedly disagree with you on this one.
What is considered to be an "addiction" has be significantly redefined over the course of the last few years. Physical addiction is not even considered a necessary component to diagnose someone as an "addict" be it an illegal substance, alcohol, or certain types of destructive behaviors such as sex or Media.
What jumped out at me, in one of the original posts, is that these women are putting their careers at significant risk and refuse to even consider the fact that such an incredibly heavy drug can have an impact on their judgement during surgery. This has, in everything I have ever seen or been taught about addiction, is a sign that something is seriously wrong. It's a psychological component to addiction, because all addictions have both physical and psychological characteristics.
Because we haven't been given the ability to evaluate these people or meet them, we have to go by what their friend on this thread has said. When he spoke to them about it, they refused to even consider stop taking the drug, which again, is not a good sign.
I am, with many others, are greatly disturbed of the "look the other way" advice that has been given to the original poster. This is the very thing that is wrong with the health care system today. Anesthesia to me, equals the seriousness of anything a surgeon could do and a mistake in judgement can cause a patient to become brain dead, just dead, or even worse, be a victim of anesthesia awareness which is INCREASING in commonality.
It's a shame that we still live in a society where we have to wait until someone is dead before we react. I think about all of the school shootings we have had in the past week, yet every time they find a kid who was still in the planning stages, they just send him to counseling. Try being in the "planning stages" of killing the President and see how many decades you sit in prison.
Another poster hit the nail on the head when she said that Walmart employees are drug tested more than hospital workers, yet healthcare professionals of any profession, have the highest rate of prescription drug use.
Please report these people before they ruin the careers of themselves or ruin the lives of an innocent family.

I'm not sure where we disagree. (Maybe I fried too many brain cells and I'm missing something).

What I posted states that physical dependence is not a sign of addiction (unfortunately far too many health care pro's STILL think physical dependence is a sign of addiction, and that's what I was responding to...the person seemed to think that physical dependence implied addiction which, it does not). We seem to agree there.

Addiction is a COMPULSION (which is psychological if I'm not mistaken) to obtain and use a substance (food, drug, Mediaography) and/or an activity (sex, gambling) in such a manner that it is detrimental to their job, relationships, and others in society. They continue to use this substance or activity despite negative consequences (including DUI, loss of driver's license, divorce, loss of money, loss of job, criminal activity, deterioration in health, etc).

The use of illegal substances (ecstasy, marijuana, cocaine, etc.) or legal substances in an illegal or abusive fashion (taking someone else's prescription, or taking your own prescription in a way other than prescribed...percocet to "unwind" at the end of the day) is also a sign of abuse or possibly addiction. So we seem to agree there as well.

It seems we agree on this point as well: We should NEVER wait until someone dies or almost dies before we do something. Prevention and early intervention are vital to maintaining a safe environment for the patient as well as the provider at risk of becoming an addict.

I'm all for random drug testing for health care providers, and so are the peer assistance advisors of the AANA. The peer advisor chairmen for the AANA and all state peer advisors have been pushing to have random drug screens of all anesthesia providers for several years. It is the non-recovering professionals (both CRNA and MDA) who have been the problem with instituting this policy (could it be they are afraid their weekend use of illegal substances might be discovered?). If it's OK for the greeter at Walmart, airline pilots, truck drivers, and others, then it certainly makes sense to randomly screen the folks who have access to drugs that can be abused.

The recovering community of CRNA's, RN's, pharmacists, and MD's want PREVENTION and EARLY DETECTION to be the norm. As the state peer assistance advisor, one of our main functions is to educate our colleagues as well as the public about the risks and dangers of addiction in the health care professional. Unfortunately, there aren't many professionals who want to hear what we have to say. They don't think it will happen to them (I know I certainly didn't think it would happen to me). I know of 3 CRNA deaths in the last 2 months. The members of their departments had seen signs of chemical abuse but chose to do nothing. Why? Here are a few of their reasons for not intervening:

"If I was wrong, I might get sued for defamation of character."

"I didn't want to be responsible for them losing their license."

"I didn't want them to get fired."

"I didn't want them to be arrested."

There is a HUGE conspiracy of silence, not only in the anesthesia community, but among health care provider's in general. This isn't likely to change until the health care community, and society at large, begin to see addiction as a chronic, progressive, and ultimately fatal disease that can be treated successfully, with recovery rates similar to other chronic diseases, instead of a moral weakness or character defect.

It is also unlikely to change if health care professionals refuse to step in when there is suspicion of a problem in a colleague. That's why there are hundreds of professionals who specialize in interventions...because the addict is rarely capable of recognizing their disease and seek appropriate assessment and treatment.

Caution must be execised when confronting the suspected addict. Attempting an intervention alone, without proper planning and documentation, can have fatal consequences. Once an intervention is planned, documentation of behaviors and specific incidents must be gathered. Colleagues who have witnessed behaviors must be interviewed and be present during the intervention if possible. Medical records (anesthesia records, nursing notes and pharmacy records) that show problems are also gathered (discrepencies in drugs administered, wasted, and not returned to the pharmacy; illegible charting, etc.).

Once this evidence is a gathered, and it's determined there is the need to intervene, an evaluation of the individual by an addictionologist is scheduled. When the individual is confronted with all the gathered information, they are presented with the option to enter a facility for a 48-72 hour evaluation. If they refuse this option, then they are informed of the consequences of their refusal. Termination with report to the state board and any other governing bodies involved (i.e., pharmacy, AANA) and possible arrest and prosecution. If they agree to the evaluation, they are taken directly to the facility where prior arrangements have been made. The person is never left alone until they have been admitted or taken into custody, since this is the most likely time for suicide.

So I guess I'm not sure where you and I disagree. It seems we are on the same page in most instances.

Unfortunately, this topic is so frought with emotion, it can be difficult to discuss it rationally. The consequences of this disease are unlike any other in that the major signs and symptoms include illegal and immoral activities which damage the relationships of those closest to us. I've often said, if cancer patients had to resort to lying and stealing in order to obtain their chemotherapy, we would hate cancer patients as well. It's also unfortunate that the myths and misinformation about this disease are so strongly ingrained the collective minds of our society (and our profession) that many people are unable to see the addict as anything other than a moral degenerate who would stop "using" if they really loved their family or wanted to keep practicing their profession. I know, because I used to believe that as well. Then one day, I discovered it didn't matter how much I loved my family or my profession...I couldn't stop without professional, long term treatment, and a strong desire to work the program necessary to keep this disease in remission.

Perhaps the following incident says it best. My nephew asked me if I still thought about "using". I said I did, but not very often these days. Today I'm capable of playing those "using tapes" to their final conclusion instead of just remembering how great it felt. He looked at me with a puzzled expression and said, "I don't understand how you can even think about it after all that's happened in your life." My answer was simple:

"I hope you never understand, Joe. Because the day you understand is the day you'll be sitting next to me in a 12 step meeting."

grannyNan · Oct 12, 2006

I can't believe that there is really any discussion about what to do. As professionals we are obligated to report. What the BON does with the report is their issue. Not to report is the same as condoning this behavior. I have first hand knowledge of what it is like to be in this type of situation and I reported my coworker/friend. I have lost the friend for now but, I hope when she gets the help she needs she will realize I did not report her to hurt her, but to help her and to keep the public safe. We must be accountable for our actions. To think we can drink alcohol, smoke, take drugs (illegal or legal) and not affect others is a very selfish and immature way of thinking. Everything we do as humans has some effect on someone else, be it good or harmful. :twocents:

BSNtobe2009 · Oct 12, 2006

I can't believe that there is really any discussion about what to do. As professionals we are obligated to report. What the BON does with the report is their issue. Not to report is the same as condoning this behavior. I have first hand knowledge of what it is like to be in this type of situation and I reported my coworker/friend. I have lost the friend for now but, I hope when she gets the help she needs she will realize I did not report her to hurt her, but to help her and to keep the public safe. We must be accountable for our actions. To think we can drink alcohol, smoke, take drugs (illegal or legal) and not affect others is a very selfish and immature way of thinking. Everything we do as humans has some effect on someone else, be it good or harmful.

You are right, there hasn't been. I had posted earlier that I would probably report them and just not say it's me, but I have rethought that.

If it's a friend, I would probaby invite them out to dinner, and have the conversation regarding the risks, one last time. If they are very insistent about continuing to use, I would tell them they could voluntarily turn themselves in (some hospitals have policies that if you turn yourself in, instead of them catching you, you can save your job and your license), or I would report them.

CRNA's, as I have said before, the most critical personn of the surgery next to the surgeon themselves. If they are going to function at 99.9% b/c of the effects of the drug, they don't need to be practicing.

Even if you disregard the fact they are putting another patient's life at risk, if you are a friend, you could be saving the life of your friend.

BSNtobe2009 · Oct 12, 2006

Jack, you are absolutely correct...I must have misread your post and I truly apologize.

We are definately on the same page :kiss

Milenamilena · Oct 12, 2006

i think everything is for the people but in the right amount, some drugs were legal and become illegall because people were abuisng it, some are legal in on place but illegal in another. Depending on the state law. General law is simple : AS SOON AS YOU Control it and it does't impair you performance in professionall and private life, it is fine. if these women are proving themselves for past two years, I don't think they have a problem.

Anyway MDM is used to treat depression in small amouts.

deepz · Oct 12, 2006

........CRNA's, as I have said before, the most critical personn of the surgery next to the surgeon themselves. .....

Second to none, my friend!

As the man says here:

http://www.gaspasser.com/unique.html

CRNAs control the patient's physiology; surgeons, merely the anatomy.

!