My CRNA friends do illegal drugs

[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.

[SportyNurse]

I am so upset and outraged at some of these responses on here... oh just watch them, don't get the board involved, what they do on their own free time is their own business...

I don't think so. If anything was to ever happen to one of their patients and people knew about it and didn't say anything, then they should be just as liable for the harm done.

I am definitely far from being the perfect nurse, but if anyone ever thought that there was anything wrong with me, or I was ever impaired, then feel free to have someone check it out. I would be upset if they felt that way and didn't call the board.

We are supposed to be patient advocates, and that means making sure that all of the care that they recieve is as safe as possible. I am shocked at the number of posts on here suggesting to just let it go and not get the BON involved, because they worked so hard to get where they are.

I did some reading up on ecstasy and the research isn't totally clear yet, however chronic ecstasy use is linked with serotonin levels and impairment of cognition, mood, and memory... Now, that is someone I don't even want passing me a pill, let alone in charge of putting me out. Those who posted that the issue should be left alone should be ashamed of themselves.

[arv]

Just my opinion...

I don't usually post here very often because I am still just a student and recognize that I still have some "rosy" views of how nursing is/should be. However, this topic compelled me. I am amazed at the posters who are defending the "recreational use" of Ecstasy. To me, it all boils down to this. I was just reading last night about another nurse who posts on this site who was let go from work for being "impaired" by medicine that she has scripts for. She chooses to not take them within 12 hours of a shift for her patients safety, they are perfectly legal - yet she was (unfairly IMO according to the post) terminated because of this "impairment." So it really isn't an issue of ecstasy not being a hard drug or alcohol being worse but legal - they are all inappropriate when they CAN effect your professional decision making. I agree that I wouldn't want these CRNA's working on me - but then neither would I want someone hung over. Whatever your vice of choice, if it effects your ability to perform duties that are in your standard of care (and this is not whether YOU think it is affecting your ability, it is in the eyes of someone else, be it BON, patient, administration, Johnny Law, etc.) DON'T DO IT!!! I will leave it up to the OP as to what action to take but I would find a way to intervene. Chain of command, BON, whatever the case may be. I am sure I will be flamed, but this is what I truly believe and felt strongly enough about to actually post instead of lurking.

[introspectiveRN]

PATIENT ADVOCATE.

PATIENT ADVOCATE.

PATIENT ADVOCATE.

Courage without conscience is a wild beast.-R. G. Ingersoll

[jeroboam]

One may rationalize all one wants, but we practice in a profession that requires a level of mental agility and concentration that is extremely unforgiving of mistakes. The IOM estimate, that medical errors kill about 100,000 patients per year, is likely on the low side. Personnel who paralyze you, and then breathe for you, likely require a higher degree of mental stability and agility.

If they continue to use drugs, on their own time, it is likely that these women will harm someone, by driving their cars if not in the operating room. The data on Ecstacy is available on PubMed and anyone who believes that it doesn't cause permanent brain damage is fooling himself/herself.

So often, people do or don't do things for the wrong reasons. The RIGHT reason to report these women to the BON is that IT'S THE RIGHT THING TO DO. The OP is supposedly a friend; a friend doesn't let his friends fry their brains. Anesthesiologists have the highest rate of drug addiction in the medical profession. It won't be long before these women are stealing Fentanyl and Dilaudid, then using Fentanyl and Dilaudid in the operating room. I have seen it happen.

I would report these women in a heartbeat. I wouldn't want either one of them giving anesthesia to my friends or relatives. That's the test. If they're not good enough for you, OP (for you to trust them in the OR with your loved one), then they're not good enough for anyone else. REPORT THEM.

[TIVA2]

The American Association of Nurse Anesthetists has a website: aana.com which offers Peer Assistance to CRNAs with substance abuse/use problems. Perhaps, you could encourage your friends to access the 800 hotline. From what I gather, they are very supportive not punity.

[oneillk1]

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.

Actually I think you should do something. It is not your responsibility to try and ascertain whether they are impaired at work, or know the pharmacokinetics of the drug. The BON will have experts for that sort of thing, and one would assume that it is their responsibility to follow up on these concerns. Sure nothing may come of it, but on the other hand how would you feel if something happened when they were working one Monday morning and a patient died....

Just something to think about

[CaseManager1947]

First of all to the OP, thanks for bringing up this topic... sure as God made the sun come up this morning, this was important to be on the website. Good for you!!. Hey, DeepZ, I was merely trying to offer a comparison of effect. I am an OR survivor, helped with many cases using the drug. There was no intent to impugn your techniques as an Anesthetist. this is about MDMA and someone's real concern. Did not intend to offend. Geesh.

[Josh L.Ac.]

The data on Ecstacy is available on PubMed and anyone who believes that it doesn't cause permanent brain damage is fooling himself/herself.

Interesting conclusion, but only those that think this issue is that cut-and-dry are the ones really fooling themselves [or believe our government's "drug czar"]:

Neurotoxicity of methylenedioxyamphetamines (MDMA; ecstasy) in humans: how strong is the evidence for persistent brain damage?Gouzoulis-Mayfrank E, Daumann J.

Department of Psychiatry and Psychotherapy, University of Cologne, Germany. [email protected]

BACKGROUND: The popular dance drug ecstasy (3,4-methylenedioxymethamphetamine: MDMA and some analogues) causes selective and persistent neurotoxic damage of central serotonergic neurones in laboratory animals. Serotonin plays a role in numerous functional systems in the central nervous system (CNS). Consequently, various abnormalities including psychiatric, vegetative, neuroendocrine and cognitive disorders could be expected in humans following MDMA-induced neurotoxic brain damage. AIMS: In recent years, the question of ecstasy-induced neurotoxicity and possible functional sequelae has been addressed in several studies with drug users. The aim of this paper was to review this literature and weigh the strength of the evidence for persistent brain damage in ecstasy users. METHODS: We used Medline to view all available publications on 'ecstasy' or 'MDMA'. All available studies dealing with ecstasy users entered this analysis. FINDINGS AND CONCLUSIONS: Despite large methodological problems the bulk of evidence suggests residual alterations of serotonergic transmission in MDMA users, although at least partial restitution may occur after long-term abstinence. However, functional sequelae may persist even after longer periods of abstinence. To date, the most consistent findings associate subtle cognitive, particularly memory, impairments with heavy ecstasy use. However, the evidence cannot be considered definite and the issues of possible pre-existing traits or the effects of polydrug use are not resolved. RECOMMENDATIONS: Questions about the neurotoxic effects of ecstasy on the brain remain highly topical in light of its popularity among young people. More longitudinal and prospective studies are clearly needed in order to obtain a better understanding of the possible long-term sequelae of ecstasy use in humans.

The effects of stereotype threat on cognitive function in ecstasy users.Cole JC, Michailidou K, Jerome L, Sumnall HR.

Psychology Department, Liverpool University, Liverpool, UK. [email protected]

Stereotype threat occurs when individuals, believed to be intellectually inferior, perform badly on cognitive tests they perceive to confirm stereotypes about them. Due to the wide media coverage of studies purporting to show cognitive deficits in ecstasy users it is possible that they experience stereotype threat. This study tested ecstasy and non-ecstasy using polysubstance misusers on a variety of cognitive tests after they had been exposed to stereotype threat. This priming consisted of exposing them to information about the long-term effects of ecstasy which either stated that ecstasy caused memory loss or that it did not. Ecstasy users that had been primed that ecstasy did not cause cognitive deficits performed better than the other three groups on the delayed portion of the prose recall task from the Rivermead Behavioural Memory Test battery. There were no other statistically significant differences between any of the groups on any of the other cognitive tests used. This suggests that stereotype threat exists in ecstasy users and may be influencing their performance in experiments designed to identify cognitive deficits. In order to prevent this occurring in future studies, experimenters must be careful how they conduct their experiments and discuss their results with the media.

Ecstasy: pharmacology and neurotoxicity.Morton J.

Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge CB2 1PD, UK. [email protected]

In part because it is amphetamine derived, ecstasy has inherited some of its parent compound's reputation for being neurotoxic. However, whereas amphetamine and methamphetamine undoubtedly cause irreversible brain damage with long-term use, the jury is still out on the party drug ecstasy. The deadly reputation of ecstasy has been fuelled by the tragic fates of healthy young clubbers who have died after taking the drug. However, compared with other recreational drugs, there have been very few ecstasy-related deaths. Further, there is little evidence for short-term neurotoxicity of ecstasy at recreational doses. That is not to say that ecstasy leaves the user neutral. Chronic ecstasy use causes depletion of serotonin, which has subtle but important long-term effects on cognition and mood. Although it seems unlikely that we will be faced with a generation of party goers who suffer from premature Parkinson's disease, so little is known about the long-term effects of ecstasy on mood, emotional states and cognitive function that at present we cannot predict what impact their use of ecstasy will have on the middle-age of the average ecstasy user.

Those are the some of the abstracts in the very first screen of pubmed with the search "MDMA brain damage". I'm sure there are more, but I watching an episode of House on DVD and would like to get back to it.

[Roy Fokker, BSN, RN]

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

This "Fokker" doesn't disagree with the gist of Mr. Focker's earlier post :)

Mr. Focker --- this website lets you post polls. All one has to do is become a Premium Member! :)

[Laughing Gas]

Comparing terrorists with drug use? Lets get real here. That's insulting.

And just to clarify, just because you believe people heve the right to do what they want in their own time does not mean you condone or endorse the behavior. Many of us just believe in the right to privacy.

The fact that ecstacy is illegal does not make it any more dangerous than a legal drug like alcohol. In the right circumstance, alcohol can be just as illegal and much more dangerous than ecstacy (i.e. driving). Alcohol related deaths are in fact frequently reported... when was the last time you heard about an ecstacy related death? Want your health-care provider to work with an alcohol hang-over? No, but it's legal, and it probably happens way more often than you think. In fact, alcohol addiction is a common and unfortunate problem... ecstacy addiction? I don't think so.

Honestly, I would think very hard before I went off and tried to ruin someone's life 'cause they party on the weekend. Honestly, I'm way more afraid of alcoholics... they're everywhere, and they're well within the law to carry out their addiction. Like I said... get a grip, people.

1.The right to privacy has nothing to do with illegal drug use.

2. X is more dangerous than alcohol. I can have a beer and be 99.9% full functioning. I bet after 1 X tab I'm not so hot.

3.When was the last time I heard about an X related death? About 2 weeks ago, 3 teens died.

4.ETOH can be just as dangerous due to driving? Cell phone use and inattentive drivers are pretty darn dangerous too. So are 16 and 86 year old drivers. Any other intelligent comparisons?

5.Working with a hangover is dangerous. Working with any distraction, flu, hangover, bad gas pains:wink2: is dangerous. What's your point? CRNA's should not be coming in hungover either.

6.Ecstacy addiction, you don't think so. How long have you been researching this? Was this part of your PhD thesis? Not that it matters. But you have 2 choices; Do you select the CRNA who had a bowl of corn flakes for breakfeast and spent the weekend playing with the kids..... or the CRNA who just got a good 20 minutes of sleep between X hits this weekend? Hurry the mask is coming down on your face!

Since you think that privacy governs this area, we'll let you honor the impaired CRNA's rights by risking your life. Best of luck, you'll need it.

[jwk]

1.The right to privacy has nothing to do with illegal drug use.

2. X is more dangerous than alcohol. I can have a beer and be 99.9% full functioning. I bet after 1 X tab I'm not so hot.

3.When was the last time I heard about an X related death? About 2 weeks ago, 3 teens died.

4.ETOH can be just as dangerous due to driving? Cell phone use and inattentive drivers are pretty darn dangerous too. So are 16 and 86 year old drivers. Any other intelligent comparisons?

5.Working with a hangover is dangerous. Working with any distraction, flu, hangover, bad gas pains:wink2: is dangerous. What's your point? CRNA's should not be coming in hungover either.

6.Ecstacy addiction, you don't think so. How long have you been researching this? Was this part of your PhD thesis? Not that it matters. But you have 2 choices; Do you select the CRNA who had a bowl of corn flakes for breakfeast and spent the weekend playing with the kids..... or the CRNA who just got a good 20 minutes of sleep between X hits this weekend? Hurry the mask is coming down on your face!

Since you think that privacy governs this area, we'll let you honor the impaired CRNA's rights by risking your life. Best of luck, you'll need it.

:yelclap: :yelclap:

[RNCRNA2BE]

This is really starting to sound like my substance of choice isn't as bad as yours. Impaired is impaired!