"Red Flags" of Drug Diversion - page 4

Listmates, My post is intended as a way of "helping" us in our work settings to possibly identify a peer or colleague who might be actively diverting drugs. None of us wants to "rush to judgement"... Read More

  1. by   kanzi monkey
    Quote from earle58
    sue, was there supposed to be a link?

    getting junkies clean syringes is one thing.
    providing them with a legal means of supporting their habits????
    i can't make any sense out of that.
    it wouldn't make the consequences of their actions, any less disastrous.
    what am i not understanding?

    leslie
    Yeah, I totally see your point. But I think, using the same principles of harm reduction that have been the driving force behind needle exchange organizations, there is an argument to providing safe environments/safe substances for people with addictive disorders. Methadone clinics, for example, have been used for awhile. Granted, not everyone who uses these services "recovers" or even improves from their situation. But the intention is to give people the means to slowly (and safely) wean themselves from at least the chemical side of the addiction.

    I have even heard of "safe rooms"--maybe in Washington? Can't remember which state this is legal in--where people can go to use their own substances (usually heroin I think). This makes it less likey that someone will make an error in their dosage leading them to OD (and of course, there is narcan readily available), and ensures that clients are using clean works. This is definitely more of a harm reduction kind of organization--not as much about recovery. At the same time, having spent some time working at a needle exchange myself, I know that these places are readily available to help people make the connections they need if they are contemplating making changes in their lives.

    Many of the "junkies" I've met get hooked in ways that any one of us, being nurses, can understand. Chronic pain--something many of our patients, or ourselves, have--often leads to substance abuse. The cost and/or difficulty of acquiring prescription drugs may lead a person who has become addicted to use street drugs. I have not been a nurse long, and I've seen this plenty of times. A teenager with cancer who lost his prescription to OCs--taking heroin. It's crazy. It can happen to anyone.

    I applaud this thread for acknowledging the humanity and humility of addiction--and showing compassion to nurses, or to anyone, who may be suffering from these circumstances.
  2. by   leslie :-D
    Quote from Suesquatch
    The point is that people will go to extraordinary - and criminal - lengths to obtain criminalized substances. I'd rather have an amphetamine addict take an Escatrol than something they synthesized from kitty litter and sinus medicine, and I'd rather that we don't lock anyone up for synthesizing said substance. Why? To punish them for liking to be high? How is that a crime?
    it becomes a crime when tens of thousands of people could be dangerously affected.
    addiction spans all social classes.
    can you imagine the implications of having impaired cops, firefighters, dr/nurses, teachers, parents raising kids, public servants, and the list goes on...
    addictions would only worsen because the access to attain their drug of choice, has now been legalized.
    what people choose to do is their own business.
    but when it potentially affects others lives, then there's a responsibility:
    a legal, moral and ethical responsibility.
    no one will sway me otherwise.

    leslie
  3. by   leslie :-D
    Quote from kanzi monkey
    Yeah, I totally see your point. But I think, using the same principles of harm reduction that have been the driving force behind needle exchange organizations, there is an argument to providing safe environments/safe substances for people with addictive disorders. Methadone clinics, for example, have been used for awhile. Granted, not everyone who uses these services "recovers" or even improves from their situation. But the intention is to give people the means to slowly (and safely) wean themselves from at least the chemical side of the addiction.

    I have even heard of "safe rooms"--maybe in Washington? Can't remember which state this is legal in--where people can go to use their own substances (usually heroin I think). This makes it less likey that someone will make an error in their dosage leading them to OD (and of course, there is narcan readily available), and ensures that clients are using clean works. This is definitely more of a harm reduction kind of organization--not as much about recovery. At the same time, having spent some time working at a needle exchange myself, I know that these places are readily available to help people make the connections they need if they are contemplating making changes in their lives.

    Many of the "junkies" I've met get hooked in ways that any one of us, being nurses, can understand. Chronic pain--something many of our patients, or ourselves, have--often leads to substance abuse. The cost and/or difficulty of acquiring prescription drugs may lead a person who has become addicted to use street drugs. I have not been a nurse long, and I've seen this plenty of times. A teenager with cancer who lost his prescription to OCs--taking heroin. It's crazy. It can happen to anyone.

    I applaud this thread for acknowledging the humanity and humility of addiction--and showing compassion to nurses, or to anyone, who may be suffering from these circumstances.
    you're right.
    for some, there would be a reduction of harm.
    however, for more, there would be danger.
    please refer to above post.

    leslie
  4. by   withasmilelpn
    When I think about some of my wild teenage days, I can't help but think,"there by the grace of god go I" to have come out unscathed and unaddicted. I refuse to judge anyone for that reason. (And would never call them an idiot, etc.) It is my sincere hope that should this list help identify a colleague, it also helps to put them on a path to wellness!
  5. by   kanzi monkey
    Quote from earle58
    you're right.
    for some, there would be a reduction of harm.
    however, for more, there would be danger.
    please refer to above post.

    leslie
    I see what you're saying in the above post, but you are forgetting one of the basic aspects about what is known about addictive disorders--that not everyone who uses a known addictive substance will become psychologically dependent on it. We've all probably seen patients with high tolerance to pain meds--this, more often than not, is a reflection of the quality and quantity of pain they have endured over an extended period of time. With healing and weaning, these people can eventually completely stop using pain medication, and will feel better for it.

    People who actually become addicted to substances to a point where they alter their behavior in order to GET their drug (ie, lying--to others and to themselves, stealing, using street drugs, etc) are those who have an underlying addictive disorder. Those who suffer from psychological illness (bipolar, depression, schizophrenia, etc) or who are having difficulty coping with the challenges in their lives are more likely to end up altering their behavior to get their drug--they're truly "self-medicating."

    So I disagree that implementing programs of harm reduction like the ones I mentioned above would necessarily put everyone and their families at risk for becoming addicted themselves, or putting others in harm's way by providing public services while under the influence. Take alcohol for example--many of us like to drink sometimes. Sometimes we get drunk--it can be fun. But for those of us who do not suffer from alcoholism, we don't have to think twice about staying sober at work. That's a given. As long as we're not stupid enough to drive and we keep a few of our wits, we can use alcohol safely.

    Programs of harm reduction aren't trying to open opium dens or anything. They are usually regulated by DPH, publicly funded, and work in conjunction with state health officials. They aren't unpleasant places to be, but they aren't party houses. And they certainly aren't inviting in people who aren't in need of addictive disorder services.

    So, I don't think opening the door to increasing harm reduction services in the context of health care would in any way increase risks or dangers to anyone.
  6. by   finn11707
    This a real and current concern where I work. One of our most liked, trusted colleagues was fired for diverting from a patient home setting. It is painful for all our staff. Management has facilitated no address due to "confidentiality" issues. One among us is a 'rehabed diverter' and is in great pain about the firing instead of rehabing. Another peer has sadly exhibited on the job drug use and possible diversion behavior for over a year, while heartfelt reports to management have been met with coldness. "it is not a mandatory reporting issue..." In my research, it is everyone's responsibility to help to protect the intregrity of our profession and to report concerns related to safety of patients and staff.
  7. by   Iam46yearsold
    Quote from Cattitude
    Oh I've been used to that for years already. My head is not in the sand. But if anyone continues to use offensive terms like "idiots" than I'm going to speak up.

    As far as TIME magazine, I haven't read the article, maybe I'll check it out. But I can say this of the above quote, anyone that views it as a voluntary behavior DOES have their head in the sand. WHO voluntarily signs up for this sickness? WHO volunteers to be so sick as to turn to desperate measures for their drug/drink, WHO?? No one I know. No addict wants to be an addict.

    True no one wants to be an addict. But for whatever reason, they did choose to take that first drink or drug. So there is at least a portion of addiction that is voluntary.
  8. by   lpnflorida
    Quote from Iam46yearsold
    True no one wants to be an addict. But for whatever reason, they did choose to take that first drink or drug. So there is at least a portion of addiction that is voluntary.
    The disease of addiction is not one of choice. No one choses to be addicted to anything, just as no one choses to get diabetes.

    However the only choice one who is addicted has is whether or not while clean and sober is to not pick up that first drink, to not swallow that pill. nor to shoot up.

    I just wanted to clarify. As I think that might have been what you meant.
  9. by   finn11707
    I know I am still adding to a very old thread. But new issues have arisen in our office. An RN let go for diverting patient meds and another suspected. Administration is being very hush about it --except for being privately admonishing towards the staff member who first reported the diversion and somewhat cool toward other staff who have stated concerns about another team member who, for the past year, has worked ill and obviously loaded--for a while in office, also out to see patients. I understand confidentiality laws, but is it not also management's responsibility to assure staff that concerns are being addressed somehow? and acknowledge the need to process all--perhaps even review guidelines to staff in a safety inservice; or offer a support group for staff to discuss the topic of concern. The team needs something to process this and heal/move on. I know how difficult it must be to heal this problem- to effectively repair trust and rapport when these issues arise---But I don't think total silence around it helps anything except to protect the unhealthiest parts of nursing culture. I know that in our unit, ther is a mixture of unhealthy and unproductive feelings---betrayal both by the nurse who betrayed the integrity of the work we do, and by our managers who remain silent about the dismissed nurse yet dismissive about the other; saddness at the loss of a loved part of our team; confusion/anger at the harshness of dismissal of one and long tolerance of the other (who is also loved).
    I have spent much researching diversion online, in an effort to understand. ANA refers to Nursing Code of Ethics to guide us--Provision 2 sections 3.5 and 3.6 clearly give guideline to us that it is "...everyone's responsibility"...to "act on and address impaired practice"-- to protect safety and the integrity of our profession. The Board of Registered Nursing guides employeers that this is not a mandatory reporting area. Further it is an honor system-- (after rehabing without report to the State Board). So very easy to get back into easy narcotic access areas of nursing. I have worked intermittently for years with a terrific nurse who diverted many yrs ago. She notes, in her career after diversion and rehab, a difficulty with peer trust and rapport when working with peers who know her history; and difficulty with staying clean while working where the history is not known and hiding that history. I would love more perspective on this. I think it is a catch 22 in high risk areas where the nurse is often using unmonitored narcotics. How can we best supported rehabed nurses, patients and the integrity of our profession???
  10. by   withasmilelpn
    How do you know that the person with the illness isn't takeing prescription drugs? Perhaps that is why they can't intervene.
  11. by   finn11707
    Quote from withasmilelpn
    How do you know that the person with the illness isn't takeing prescription drugs? Perhaps that is why they can't intervene.
    I am sure prescription meds were in use. Does it change the intervention guidelines if prescription meds are being used? Is'nt it still practicing while impaired?
  12. by   lpnflorida
    One way of handling the situation you are talking about/

    I would bring it up to the nurse themselves. Be direct, but not nonjudgemental. Tell them what you observe. I am not one to run to management as a first line for my concerns. I always try and deal with the person I have concerns about in regards to anything.

    Had a staff member years ago, who during report, could not help but smell a strong odor of alcohol on their breathe. When report finished, I caught them in the hallway. First words, I am smelling alcohol on your breathe. Are you safe to be working today?

    Now eventually this person ended up in treatment. It did take sometime though.
  13. by   withasmilelpn
    Could the nurse in question function without the prescription drugs? Maybe a dosage adjustment? It probably would be difficult to prove that someone is impaired if they are taking the meds as prescribed. I don't think that they would be able to dismiss her as easily either, it would have to be a job performance issue with plenty of documentation involved. Stinks for that nurse as well, being sick, I'm sure she is struggling with work as it is. I would bet she wouldn't work if she could. Probably she can't switch to something a little less patient oriented either due to losing her insurance. The whole situation sounds very sad to me.

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