Nurse addict?

banker321 · Aug 31, 2001

Thank you everyone for the advice you have given me, I guess I have a lot to think about. To answer misti_z question, no, we don't have any children. We are both in our late 30s and have been married for less than 2 years.

In regard to the drugs I mentioned -- lorazepam (mostly) and midazolam (once), I have another question. I've found out via the internet that both are sedatives, but are they the type of drugs a stressed out RN would want to steal? I'm very confused.

Several posters mentioned that two RN's are needed to declare a drug "waste". Is this true in all 50 states?

Thanks again for your help.

nilepoc · Aug 31, 2001

After being personally involved in three IV drug cases at work, I can say unequivically you should seek help. (Sometimes I really hate being Charge) The advice above seems sound. You alone know your wife and how she will react to any of the above situations. All I can say, is act now before something bad happens. I had the very unfortunate experience of saying goodbye to a colleage at the Pyxis at 0700. That was the last time I ever saw this nurse alive. She/He Od'd in the restroom one hour later. You will never know the depth of her problem until you confront her.

I wish you luck, and hope that things work out as best they can for you. You are in a potentially bad situation, but without action, it will only get worse. The person I mentioned above was only found to use IV drugs after they went anoxic in the employee restroom. So you may be in time to do some good.

NICU_Nurse, BSN, RN · Aug 31, 2001

Found on the Yahoo health topic:

Lorazepam (Ativan)-

Lorazepam is a benzodiazepine used to RELIEVE ANXIETY.

Pharmacology:

Studies in healthy volunteers show that in single high doses Lorazepam has a tranquilizing action on the central nervous system with no appreciable effect on the respiratory or cardiovascular systems.

Indications and Usage:

Lorazepam is indicated for the management of anxiety disorders or for the SHORT-TERM RELIEF OF THE SYMPTOMS OF ANXIETY ASSOCIATED WITH DEPRESSIVE SYMPTOMS. Injectable lorazepam is useful as an initial anticonvulsant medication for the control of status epilepticus and fpr producing sedation (sleepiness or drowsiness), relief of anxiety, and a decreased ability to recall events related to the day of surgery. It is most useful in those patients who are anxious about their surgical procedure and who would prefer to have DIMINISHED RECALL of the events of the day of surgery

Warnings:

Lorazepam is not recommended for use in patients with a primary depressive disorder or psychosis. As with all patients on CNS-acting drugs, patients receiving lorazepam should be warned not to operate dangerous machinery or motor vehicles and that their tolerance for alcohol and other CNS depressants will be diminished.

Physical And Psychological Dependence:

Withdrawal symptoms, similar in character to those noted with barbiturates and alcohol (convulsions, tremor, abdominal and muscle cramps, vomiting, and sweating), have occurred following abrupt discontinuance of lorazepam. The more severe withdrawal symptoms have usually been limited to those patients who received excessive doses over an extended period of time. Generally milder withdrawal symptoms (e.g., dysphoria and insomnia) have been reported following abrupt discontinuance of benzodiazepines taken continuously at therapeutic levels for several months. Consequently, after extended therapy, abrupt discontinuation should generally be avoided and a gradual dosage-tapering schedule followed. Addiction-prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving lorazepam or other psychotropic agents because of the predisposition of such patients to habituation and dependence.

Overdose:

In the management of overdosage with any drug, it should be kept in mind that multiple agents may have been taken.

Symptoms: Overdosage of benzodiazepines is usually

manifested by varying degrees of central nervous system

depression ranging from drowsiness to coma. In mild cases,

symptoms include drowsiness, mental confusion, and lethargy.

In more serious cases, and especially when other drugs or

alcohol were ingested, sypmtoms may include ataxia,

hypotonia, hypotension, hypnotic state, stage one (1) to three

(3) coma, and very rarely, death.

Midazolam (Versed)-

Midazolam is used to produce sleepiness or drowsiness and to RELIEVE ANXIETY before surgery or certain procedures. It is also used to produce loss of consciousness before and during surgery. Midazolam is used sometimes in patients in intensive care units in hospitals to cause unconsciousness. This may allow the patients to withstand the STRESS of being in the intensive care unit and help the patients cooperate when a machine must be used to assist them with breathing. Midazolam may cause some people to feel drowsy, tired, or weak for 1 or 2 days after it has been given.

*****It may also cause problems with coordination******

***** and one's ABILITY TO THINK. ******

Therefore, do not drive, use machines, or do anything else that could be dangerous if you are not alert until the effects of the medicine have disappeared or until the day after you receive midazolam, whichever period of time is longer.

Do not drink alcoholic beverages or take other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness) for about 24 hours after you have received midazolam, unless otherwise directed by your doctor . To do so may add to the effects of the medicine. Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; other sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; medicine for seizures; and muscle relaxants.

You get the idea. My strongest prayers to you right now; the situation you are faced with is a tough one, but if you truly love your wife, you know what you have to do with this information. In Louisiana, two nurses are required to witness narcotic wastes; I agree with the above posters that while it does happen occasionally, it is HIGHLY UNLIKELY that this is an accident, especially considering that it has happened more than once (in other words, you've found it stashed around the house...you mentioned fridge and dresser?). The fact that she is hiding it rather than immediately (by the next work day) bringing it back to the hospital or even disposing of it herself at home rather than keeping it is in line with typical drug-using behavior. Nursing is an extremely intense profession; it is possible that she is experiencing emotions that she is not capable of dealing with in a healthy way. To care about someone, as unfortunate and painful as it may be sometimes, is to risk losing them; if you are afraid of making her angry at you or having her leave you or accuse you of not trusting her may scare you into INACTION. I beg of you not to do this. You care about her; otherwise you would not have been concerned to find what you've found. I suggest that before you confront her, make sure that you have evidence of your accusations and make sure that you have a plan to help her get treatment lined up. Legally, hospitals typically will provide rehabilitation and job security to drug-abusing and drug-using (but isn't it really the same thing?) employees; investigate this at once anonymously to find out if it is an option for you and your wife. She needs counseling, and possibly a change in career in the long run if it is indeed nursing that is 'driving' her to do this. Other possibilities would be trouble between the two of you (only you can examine this; I'm not judging, just suggesting...) or financial difficulties or difficulties with family. My point is that there is some issue, or more than one, somewhere, that is causing her to want to 'flee' her everyday life; it is too much for her to take, and so perhaps it is appealing to temporarily forget or relax via narcotic use. Examine all aspects carefully, know that you have people here you can talk to, and have faith that no matter what she says or does, you may be saving the life of the woman you love. Good luck to you.

bigred · Aug 31, 2001

Well Banker, good for you for coming to this post to ask other nurses what they think. I agree with the others that your wife has a problem. I understand it. She is working on a shift that she doesn't like, and she sleeps poorly. She has found help in a vial. As others have mentioned, now is the time to act before something happens to your wife. It's only a metter of time. It is far better for her if she goes to management and admit she has a problem before they go to her. Many hospitals have programs for nurses with durg and alcohol dependencies. You have a job on her hands

because she probably won't admit that she has a problem right away. And she may have a lot of denile to deal with also. Sure will be thinking of you and your wife. Please continue to keep us posted as to how you are doing.

Bigred

imn2nursing · Sep 1, 2001

This was very hard for me to read, and to comment on. Sir, I am afraid your wife has a big problem. I am a recovering nurse who was addicted. My prayers are with your family. Be supportive and get her some help. Chances are, she won't admit she has a problem. God bless!

KellyandtheBoys · Sep 1, 2001

I've brought home empty medication vials in the past (mostly non narcotics as far as I can remember). So, that would be possible. However, I think it is a warning sign that she puts them in the fridge and hides them in a drawer. Best wishes to all of you.

majic65 · Sep 1, 2001

Two things have occured to me reading this posdt. First, I honestly believe your wife has an abuse problem and wants very much for you to know about it. She is leaving clues all over the place, and usually that signals that the person with a problem wants someone to help , but does not know how to ask.

Second--I believe that almost every state has a program run thru the State Board of Nursing for addicted professionals. If she contacts this program, she will be steered into treatment, which is desperately needs, and if she completes it, will not lose her license, tho she will be restricted for a while.

If you can, you must confront her about this, very matter-of-factly, after you research what help is available thru the nursing Board. If necessary, make the arrangements and use the intervention approach. It s important that you do not ask if she is using, or ask if she has a problem, or become argumentative. You need to state, factually, that you know of her problem and you want to work with her to solve it. I would be willing to bet she will be relieved that you are acknowledging her problem and are willing to help her without judging or blaming.

I hope you will act on this immediatley, because an impaired nurse is dangerous not only to herself but to her patients. And sooner or later-probably sooner--her co-workers or supervisor will become aware of this. If she takes the first steps voluntarily, she will feel more empowered and will not risk losing everything.

Please let us know what happens--this could be any of us.

tonchitoRN · Sep 1, 2001

I think everyone is in aggreement that your wife has a problem. Next time you really look at your wife look at her skin. She is injecting somewhere and leaving track marks. Ask her about them. :cool:

misti_z · Sep 1, 2001

Good point, Tonchito.

Charles S. Smith, RN, MS · Sep 1, 2001

Great support from all the colleagues on this post. This is the type of support we might give to all of our nursing buddies, not just the ones in trouble...

As a legal note...any removal of any part of a scheduled/controlled pharmaceutical from its source (hospital, clinic, etc) is legally classified as diversion, accidental or otherwise. Diversion is a serious crime in all 50 states and the sanctions are severe. At the very least, Banker, get your wife to understand the serious consequences of her "accidental" actions. At the most, intervene now before she ends of like of my former employees, dead in a housekeeping closet with over 200 mgs of Demerol and 100 mgs of Morphine injected...My prayers for you.

chas

banker321 · Sep 2, 2001

Thank you again, everyone, for your thoughtful advice. I've decided to speak to my wife about this problem tomorrow. The final blow being when I checked her sock draw again today I found another, almost empty vile of lorazepam and a sizeable bag of marijuana. She smokes pot everyday, drinks alcohol most days, and takes over-the-counter benadryl to help her sleep. I also found an empty container for an individual tablet of Tylenol 3, also from the hospital.

We live in New York State and I was hoping that someone with a New York State RN license might be able to answer a few questions for me. Is it state law that all drugs declared "waste" must be disposed of in front of a witness or is it up to the discretion of the individual hospital? Is just having lorazepam, morphine and midazolam in your home without a prescription, and taken from the hospital in which you work a violation of state law (even if you don't use it)?

I ask these questions because I want to know the truth if she tries to lie to me about the situation (or downplay it), which I'm almost sure she will. After all, I haven't seen her actually use these drugs or found used syringes anywhere. In addition, most of the drugs I found in her sock draw have been there, unused for at least a month. And no, I haven't seen any injection sites on her body, but then again I haven't really looked.

I've done some research and learned that the New York State Department of Education has a Professional Assistance Program for professionals who have substance abuse problems, but who have not harmed patients. I'm going to suggest this, without being confrontational. I'm also preparing myself for her accusation that I was snooping in her personal possessions, which indeed I did. I feel justified in what I did because of the huge ramifications of all involved; mostly her health and career, but also I feel guilty about any of her patients not getting the drugs they need. I wish I knew if she got this stuff via waste or if she took it from a patient.

I will keep you up to date on how things transpire. I'm thankful that there are so many wonderful nurses out there trying to keep the standards of the profession so high. God bless you all.

misti_z · Sep 2, 2001

You're doing the right thing, you're trying to help.

It's going to be hard. You both are in my thoughts.

Good luck :)