[pandabearchipteacup]

After 5 years of practice I became severely addicted to narcotics. I knew they would ruin not only my life but my dream. After having my license revoked I went out and blamed everyone, I pretended not to want to practice. Fortunately for me I was able to develop a support system. I have been clean for almost 4 years. I am entering into nursing again. I do plan to tell those I work with, not for sympathy or empathy, but for support. narcotic abuse is very high in our profession 6-8% of RN's suffer. If any nurse out there is having a problem get help and now! I you think a nurse you work with is, get help for them now! Don't wait!!

[jackstem]

As chair of the peer assistance and practitioner wellness committee for nurse anesthetists in Ohio, I frequently surf the net for anything dealing with substance abuse and chemical dependency in health care professionals. I receive several phone calls every week requesting information or help for nurses who have a colleague they are concerned about or themselves. The overall lack of knowledge and understanding about the disease of addiction in the medical community is appalling. Having said that, the reason this is so is due to a lack of education about the disease in nursing, medical, and pharmacy training programs.

I graduated from nursing school in 1978 and from anesthesia training in 1981. The only education I received in either program was about the adverse effects of substance abuse on the various organ systems. We were never truly educated about the disease of addiction. It's interesting to note that a survey performed by The Robert Woods Johnson Institute found that 35% of the population continue to believe the disease of addiction is a moral failing and lack of willpower. If you include those who believe it might be a disease but it's also a sign of moral weakness and lack of willpower, the number jumps to 51%!

Significant advancement in the understanding of the disease and how it affects the brain has taken place over the past 25 years, yet this information isn't being effectively disseminated to health care professionals. These studies show this disease is a combination of genetics and exposure to mood altering substances. Children who have one parent who is chemically dependent is at significantly higher risk for development of the disease than those children whose parents (or relatives) are not chemically dependent.

It's also interesting to note that 70+% of chemically dependent individuals also have a major psychiatric diagnosis as well (chronic depression, ADD, ADHD, bipolar disorder, etc.). There is strong anecdotal evidence of "self medicating" with alcohol and other mood altering substances in order to "feel normal" or "OK". This is usually discovered when an individual drinks alcohol or "uses" for the first time. The euphoric effects are so astounding that the brain registers this as "I have to do this again!" Similar descriptions are given by addicts when discussing their first high with other substances. The "potential addict's" brain appears to over respond to stimulation of the pleasure centers. This over response leaves the pleasure from natural stimuli so far behind it can only be described as one addict said, "A total body orgasm". This over response rarely happens in the non-addict brain (i.e. those with no familial history of chemical dependence).

Substance abuse and chemical dependence are preventable. The major tool for prevention is to avoid the use of mood altering substances for non-medical purposes, or as many say, "recreational" use. Unfortunately, recreational use of these chemicals have been around since the dawn of man. Our brain is "wired" for the possibility, and some brains are REALLY wired for the possibility of becoming addicted. The appropriate medical use of medications such as opioids, antianxiety agents, and sedatives when indicated poses very little risk of addiction in the general population, and a slight increase in the "addict prone" individual. It's the MISUSE of these types of chemicals...used for their euphoric effects...that get's the brain started on the physical and chemical alterations that lead to addiction. The more potent the chemical, the faster the disease progresses. For example, alcohol may take years before the changes are such that the individual can no longer function effectively. But if you look at fentanyl and sufentanil, the progress of the disease to the same level as the alcoholic can be a matter of 6 months for fentanyl and 3 months for sufentanil.

In my own case, I went from no problems with substance abuse (an occasional beer or wine) to almost dead in a little over 5 months. I had chronic back pain due to spondylolisthesis, which eventually required a semi-emergent spinal fusion (foot drop and early bladder dysfunction). I now have 13+ years clean and sober, but have chosen not to return to practice after 2 relapses.

My anesthesia colleagues suspected something was going on but chose to do nothing to intervene. Early recognition and intensive, residential treatment can not only save lives, it might also save licenses as well. The earlier treatment starts, the higher the success rate for long term sobriety. Someone in an earlier post said it wasn't the responsibility of other nurses or the institution to intervene. Nothing could be further from the truth. As health care professionals, we have an ethical and professional obligation to intervene when we recognize the signs and symptoms of a chronic, progressive, fatal disease. Even if you want to argue that the individual "did this to themselves", we still have an obligation to patients and the community to intervene when a disease puts others at risk.

The notion that addicts deserve whatever happens to them is not only morally repugnant, it is outside the ethical and professional duties of a licensed health care provider. Our code of conduct requires us to treat individuals with respect and dignity regardless of their diagnosis. We don't treat other individuals with diseases or dysfunctions that are "self-induced". Lung cancer, COPD, and bronchitis patients who have a long history of smoking aren't treated like addicts. Adult onset diabetes can be induced by overeating and lack of exercise. We don't tell them, you did this to yourself! What did you expect!?

Look at the advertising in our society. They push alcohol as well as "energy" drinks. While I have no problem with a responsible adult drinking either one of these concoctions, 10 - 20% will become chemically dependent. Any non-medically indicated, chronic exposure to mood altering substances in a susceptible individual (i.e., with a genetic predisposition) has a high probability of leading to addiction. Who are these individuals? Those with a family history of substance abuse and chemical dependence are the most likely candidates. But because alcoholism and addiction carry a huge social stigma, families don't talk about it. This means Johnny or Janey, heading off to college, may be at risk and not know it. After I entered treatment I discovered I had an uncle, 2 cousins, and a grandfather who were, and are, alcoholics. Now I also discover that substance abuse and chemical dependency are the major health hazards for the profession of anesthesia. Would knowing this 18 years ago have prevented me from becoming an addict? I'll never know. But I DO know that educating my colleagues about the risks gives them a better chance than I had.

Finally. the notion that health care professionals are somehow less likely to develop chemical dependency because of our training is as ridiculous as expecting oncologists to never get cancer or protects cardiologists from developing heart disease.

Chemical dependency is a disease that affects the brain and is expressed in abnormal behaviors and emotions. Evidence based treatments work and the recovery rate for chemical dependency is equal to recovery rates for other chronic, progressive, fatal if untreated diseases. Few people are aware that long term recovery happens because those in long term recovery won't talk about it for fear of the stigma society places on those suffering with the disease of addiction. Until this changes, the rates of substance abuse and chemical dependency will continue to rise.

I realize there will be many on this bulletin board who won't agree with what I've posted. There were many who didn't agree that the earth was round either. WE must change the current paradigm of chemical dependency as a moral weakness to the scientifically supported paradigm of a chronic but treatable disease. We have seen the failure of the interdiction/punishment policies. It's time we treat this disease medically.

Jack Stem
Peer Assistance Advisor
OSANA

[subee]

Jack, Thank you for taking the time give such an eloquent response here.I perceive that people are getting more educated about the subject of addiction, but having said that, I feel like hitting my head on the wall when I'm confronted with ignorance from nurses. However, its simple-minded for me to expect that everyone has evolved from their own experiences with addiction. Most people don't have the emotional equipment or the insight to evaluate their reaction to the problem of addiction. I try to show people that addiction just IS and we have to accept it. If we can accept it in others without making moral judgements THEN and ONLY THEN, will healing be possible. I'm sorry it took two relapses for you to get out of anesthesia and I'm sorry for your loss of profession. But I'm delighted that you're giving back to others what you've learned the hardest way possible.

[Tweety]

Jack what an awesome post. Thanks for sharing.

Moving to the recovery forum, which as started after this thread was originally posted.

[GreatnurseFL]

Pyxis is not the complete safeguard you may think. Many times narcotics come in unit doses and some must be wasted. While a 2nd nurse is required, and is supposed to witness the disposal of the excess, when it busy this doesn't always happen, which makes it easy for an addict to keep the excess either for their personal use, or to sell to someone else.

[Tweety]

Originally Posted by GreatnurseFL

Pyxis is not the complete safeguard you may think. Many times narcotics come in unit doses and some must be wasted. While a 2nd nurse is required, and is supposed to witness the disposal of the excess, when it busy this doesn't always happen, which makes it easy for an addict to keep the excess either for their personal use, or to sell to someone else.

When there's a will, there's a way. Addicts can be very clever in what lengths they are willing to go to feed their addiction.