[DrugReptoNurse]

Two of my friends who are CRNA's take recreational ecstasy almost every weekend. They will take it on Saturday night...stay up all night....and then try to sleep it off on Sunday. When Monday morning comes around they go to their contract per diem positions and perform anesthesia mostly in private practice plastic surgery clinics.

I am worried that one day they may provide anestheisa while the ecstasy is still running through their systems.

A couple of questions for those of you who are currently CRNAs.

1. How do you approach a CRNA and tell them you are worried they might harm a patient while under the influence.

2. What else would you do to make sure they don't harm anybody? Should I contact the state board or should I mind my own business? For the record I am just a nursing student.

They have both been practicing for 8 years and have never had any problems in the past. I just know I wouldn't want to be patient under their care.

[Focker]

I'm sure this will be a touchy subject.

My personal opinion: People have a right to do to themselves what they will, smoke, drink, do drugs, drive unbuckled, etc. When it impedes on someone elses's rights it becomes unnacceptable. In this case, they are not doing drugs the night before work, they are not stealing narcs from their patients, etc. (based on the info you gave) so I say no harm no foul. I don't know the pharmacodynamics/kinetics of ecstacy though. Maybe someone can clear that up for us.

Approaching the BON is not something you should take lightly, and not something I feel you even have the right to do from your position. It doesn't sound like you have firsthand knowledge of how these people practice, you are worried that "someday" they might harm someone under the influence. Before anesthesia school I went out on plenty of saturday nights and drank, slept it off sunday, and went into work monday. Do you think you would have the right to report me to the BON because you are worried that someday I might show up at work drunk? Doesn't that sound ridiculous to you? You are jumping to conclusions and in my opinion should just mind your own business.

[susswood]

I agree with Focker. People can do what they want on their own time.... also, keep in mind that many legal drugs (such as alcohol) can be much more damaging to peoples lives than occasional use of recreational drugs.

I should reinterate Fockers point that you don't have any business reporting these people to the BON.

[SKM-NURSIEPOOH]

I'm on the fence with this issue because on the one hand like Focker said...these people haven't worked under the influence; but on the other hand...they *are* taking "illegal" substances...even if it's on Friday's &/or Saturday nights.

What makes this so sticky is the fact that we all know just how hard these people worked to achieve their CRNA status. It took years of hard work & studying. Obviously, they're not stupid in a knowledge sense. However...one could say that they're being irresponsible at best & down right dangerous to themselves & others at worse. We all know that these guys/gals have a ton of student loans they've gotta pay-off...as-well-as other responsibilities. I for one don't support taking illegal substances & would have no problems with such activities being reported to the SBON if it can be substancedated...I just don't know if *I* would/could be the one to make such a report. To do so...one would absolutely had better be 110% sure of their facts & be willing to look those who they're reporting in their eyes & tell them why. If one has to sneak or report folks annoyousmously...then I think they're cowards & should watch-out...karma & all that. But on the other hand...if I was absolutely was 110% sure someone was working under the influence of some substance (legal as in prescription meds/ETOH or not as in illegal drugs or over the ETOH level) or another...then sure I would report it & would be willing to look them in the eyes. I'd probably would have no problems with looking at myself in the mirror the next day too.

Well...over a 100 have read this thread...come-on now...I know that there's gotta to be some others who could/would share their opinions on the subject. What say you all?

Cheers ,
Moe

[rn/writer]

I'm on the fence with this issue because on the one hand like Roy said...

Please note: Focker, the above poster, and Roy Fokker, the moderator, are two different people. Easy to confuse the two.

[SKM-NURSIEPOOH]

Originally Posted by rn/writer

Please note: Focker, the above poster, and Roy Fokker, the moderator, are two different people. Easy to confuse the two.

Ohhhhhhh....thx! My bad...sorry Focker

Cheers ,
Moe

[anne74]

Honestly, I wouldn't do anything unless I knew they were under the influence while working. Again - it would be interesting to know the pharmacodynamics of ecstasy.

[pickledpepperRN]

I certainly don’t think that status as a student should preclude making a report.
Our board advises that a complaint should be filed by anyone who believes that a licensee of the Board has engaged in illegal activities which are related to his/her professional responsibilities.
http://www.rn.ca.gov/enf/complaint.htm#who

They also have a diversion program which is offered to any RN who self reports or is reported. A nurse using illegal recreational drugs could potentially harm a patient.
I would be partly at fault if I knew of the possibility but did nothing. I have reported a physician for drinking alcohol on duty and an RN who pre-charted for the entire shift. He added up the I&O and everything!

That said, perhaps you may want to help your friends. If they are routinely engaging in potentially unsafe activities such as taking pills of unknown content and dosage they could harm themselves as well as patients. If they are really friends you should be able to have a conversation with you expressing your concerns.
This conversation may help you decide.

I agree that it is a big deal reporting someone to the BRN. It is not to be done on a whim or dishonestly.

Alabama BON:
http://www.abn.state.al.us/welcome.html

http://www.abn.state.al.us/main/down...%20610-X-8.doc

http://www.abn.state.al.us/main/down...%20Nursing.doc

Medical information regarding the illegal drug(s) called “ecstasy” http://epe.lac-bac.gc.ca/100/201/300...sue-7/0917.asp

[nurse4theplanet]

Sorry to say, I disagree with you all. While I acknowledge these people have worked extremely hard for their license, and it is possible they have never been "impaired" during a case...it is not certain. The sheer fact that they can use, and rationalize the use, of illegal designer drugs shows poor judgement. It is impossible to know whether they are minimizing the effects of the drug abuse to make others feel as though it has no impact on their performance during anesthesia. I feel as if the right thing to do would be to confront your friend in a firm, yet non judgemental manner and insist that they have a drug problem and should seek immediate help. And the consequences for refusing to help will force you to speak to their employer. I would not take it to the BON. This is my opinion, how I would handle it, and I don't expect anyone to agree with me. Just my two cents.

[DrugReptoNurse]

Thanks for the advice. I've already spoken to both of them previously and told them I think they have a problem. They disagree and wouldn't consider any form of intervention or rehabilitation. I think I'll keep this matter between us and keep the BON out of it. I've known both of these women for 5 years and hope they know what they are doing. For the record....they do not practice in Alabama. They practice in California.

Here is the only pharmacodynamic information I could find on ecstasy.


ABSTRACT
3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) is a synthetic amphetamine derivative commonly abused by young people. There are only limited data about its pharmacokinetics and pharmacological effects under controlled conditions in humans. A series of studies were carried out to determine the pharmacokinetic and pharmacodynamics of MDMA. All studies were placebo-controlled, randomized, double blind and cross-over. Twenty-seven healthy male recreational MDMA users were included. They received a single oral dose of MDMA (doses ranged from 50 to 150 mg). Physiological parameters (blood pressure, heart rate, temperature, pupil diameter), psychomotor performance (DSST and simple reaction time), and subjective effects were measured. Blood samples were obtained to determine MDMA and metabolites, and hormones (prolactin and cortisol). MDMA administration induced dose-related significant changes in blood pressure, heart rate, pupillary diameter and oral temperature. Performance measures were slightly impaired after 125 and 150 mg. MDMA induced euphoria and well-being feelings, slight changes in perceptions (sounds, lights) but no hallucinations. MDMA produced a marked increase in cortisol and prolactin plasma concentrations. A parallelism was observed between blood levels and pharmacological effects. Peak plasma concentrations were obtained at 2 hours, elimination half-life was about 8-9 hours. Cmax and AUC increased in a non-proportional way in relation to dose administered, suggesting a possible non-linear pharmacokinetics of MDMA.

Supported by grants: FIS 97/1198 and 98/0081, CIRIT 1997SGR00077, ISC-III 97-98/4344 and PNSD.