Drug addicted nurses - page 15

I am a nursing student and in one of my classes we have recently talked about nurses and substance abuse. I think that it is hard for me to wrap my brain around the issue. My questions are: 1.... Read More

  1. by   nursemichelle2
    Hello, I am still looking for a non patient care job to go back too as I am in the State of California Diversion Program for alcohol addiction. I have been sober for over eight months now and was allowed to return to work in a non patient care position but having no luck finding a job. Does anyone know what is out there? I have applied for case management but they want experience. I was not allowed to return to advice nurse job as night shifts required. What else is available...money is a big issue.
  2. by   jodidax
    did that post go thru
  3. by   nursemichelle2
    I just wanted to update. I returned to work in mid March and have been working in Aesthetic medicine. Doing botox and restylane injections and I love it. The pay is okay and the work is fun. I have been sober for a year on the 25th and am 100% compliant in the diversion program. I just wanted everyone to know that people do recover. I don't think I will go back to bedside nursing in ICU as the stress led to the alcohol addiction. I like what I am doing now and am happy.
  4. by   Blackcat99
    nursemichelle-That's wonderful news!!!!!:spin: Congratulations on your great recovery!!!!
  5. by   Lowell
    I'm in a situation that's got me really nervous- I'm even nervous about posting here! J

    Within the past year, I moved from one state to another, and applied for compact licensure in the new state. Now that I've completed my application for compact licensure in the new state, I was asked to appear before the BON personally and I think it's because:

    About twenty years ago I was diagnosed as having Generalized Anxiety Disorder/Panic Disorder. Since the SSRI's weren't even on the market then, benzo's and beta-blockers were the treatment of choice. I was prescribed Xanax 1 mg QID, and Inderal LA 120mg in the morning. About two years into that treatment I changed to an equivalent dose of Klonopin (6mg total), just for convenience in dosing (I could take it all at bedtime), and my internist changed the beta-blocker to Atenolol.

    Within a couple of years I wasn't having to see a psychiatrist any more, so my internist just took over prescribing the Klonopin and Atenolol, and this went on for several years. Then in 1999, the medical director of the mental health HMO I was under at the time demanded that I go see an "addictionologist" (I don't even know if he was board certified) to get off the Klonopin. I went along with everything this doctor tried to do, except that as I was taking less and less Klonopin, I found that I was having difficulty getting to sleep. When I called the "addictionologist" about this, all he had to say is that it would be like that for up to a year. To me that was like, "tough bananas, buddy", because he didn't seem to care at all that I was having trouble sleeping. My own perception was, and still is, that I am more impaired by anxiety, insomnia, and depression than by the benzo, so I just went to a different psychiatrist, someone that I had known for years and who had pretty much impeccable credentials, and he said "If it's not broke, don't fix it". My internist, who also has impeccable credentials, agreed entirely, and actually verbalized the same thing-"if it's not broke, don't fix it". So I went back on the Klonopin at the same dose. My marriage eventually crashed, but not because of that, and then my ex relocated my son 1500 miles away from where I had lived for 27 years, and I followed as soon as I could, because I knew my son needed me to be closer to him than that and have a more "normal" relationship with him from that. (My son's teacher told me in sort of a subtle way that this was exactly what my son needed, because he had been having measurable signs of emotional distress from being so far away from me, and these signs pretty much disappeared after I was here for about a month.)

    With about a month after I arrived here in the new state, I had a really bad stress reaction, with insomnia, anxiety, and depression. I think having had a stress reaction after spending a year in court over my son's relocation, losing that, and then having moved 1500 miles- I think a stress reaction under those circumstances is understandable, and I had known full well that moving to this new state would eventuate in a tapering and withdrawal of the Klonopin.

    But during the time I lived in the "former" state, I worked with that state's Department of Health in the Developmental Disablities Division, and the employer knew full well that I was taking benzo's, and there was ready access to lots of benzo's, for temporal lobe siezure, behavior, and spasticity. I also worked at the state's largest maximum security prison, and those people knew that I was taking benzo's and didn't have a problem with it, even though in that setting I was exposed to some pretty incredible amounts of controlled substances. Signing all that stuff out really got old fast, but I was never even tempted to divert.

    So I began therapy for the depression and anxiety, and am now taking 300mg of doxepin every night, and I have begun the taper of the benzo, and am now at about half (3 -1/2 mg qhs) of the original dose. I'm sleeping ok, but still a little bit depressed, and having some inappropriate anxiety.

    This morning I saw the psychiatrist who is both prescribing the doxepin and monitoring the withdrawal from the Klonopin (and actually increasing my "inventory" of Klonopin because of the downward titration of the dose requiring different dosages of the pills), and he said that he had sought legal advice about whether or not he was required to update the BON on my status, apparently because he doesn't want to incur liability if I'm impaired. I should point out that this psychiatrist has already made one report to the BON about three months ago, regarding my status then, at the BON's request. It was in apparent response to that report that the BON wanted me to make a personal appearance regarding my "competency and fitness to practice", based on the information that the psychiatrist supplied to them, which he had shared with me before he sent it.

    So, in order to be honest with the BON in regards to the health questions they asked on the compact licensure application, I told them that I had a history of Generalized Anxiety Disorder/Panic Disorder for which I was being treated with benzo's, I had recently had a major depressive episode for which I was being treated with doxepin (good for sleep, good for anxiety, worked in the past), and that the taper of the Klonopin was in progress.

    I guess I'm just really anxious over this appearance before the BON and whether or not they will give me a license just because I have had a history of being treated with benzo's. I never increased the dose, never cheated, never engaged in "seeking" behaviors, never diverted, never wrote my own scripts, none of that. It was all in accordance with a valid prescription from an internist with very good credentials, and a psychiatrist with very good credentials.

    And I never went to work "impaired" by the Klonopin, because I took it all at bedtime. Even when I was called in to do a night shift after having taken the Klonopin, I found that a little extra coffee had me wide awake and paying attention to what I was doing.

    So I guess my question is, should I even be nervous about this appearance before the BON? If I put myself in their place, having to decide whether a guy who has just been through a nasty depression and some pretty stressful experiences, and has been taking benzo's for twenty years- I guess I would want to meet this guy personally too, just to be on the safe side. Waiting six more weeks is a drag, but I can understand it.

    I know that there are people that are diverting morphine and shooting it up in the bathroom, people who come to work drunk, and so forth, but nothing like that has ever happened with me. I won't even dwell on that. I think my situation is more like an insulin-dependent diabetic nurse, or a nurse with a seizure disorder.

    So maybe I'm just overreacting to the psychiatrist raising the question of whether or not he needs to give updated information to the BON, apparently to cover himself for liability. Of course I have an anxiety disorder, so I might be inclined to overreact anxiously, but I'm really having trouble getting this in perspective. I've never gone to work impaired, and I've never diverted. I would imagine that, besides nurses that unfortunately do go to work impaired, and divert, that there are nurses with insulin-dependent diabetes and seizure disorder that go to work every day. I think my issue with benzo's is really small potatoes compared to that, but, since I've gotten used to bad things happening to me (my marriage crashing and my ex relocating my son), like all good anxiety neurotics do, I have a negative and anxious anticipation of what will happen with my licensure too, and I hope you all can help me place this in context and help me get some perspective. I mean, how does this stack up against nurses who take Xanax, or insulin-dependent nurses, or nurses with seizure disorder? Thanks.
    Last edit by Lowell on Jun 21, '06
  6. by   ERRNJunkie
    Wow, I'm amazed at some of the stories. Its nice to see some of you coming forward and admitting an addiction and the recovery process. I have never had an addiction to a drug, other than nicotine and caffeine. I have worked with some nurses, and even reported a nurse for taking out the same narcotics she took out 10 min prior. I have heard even more stories. I couldn't ever do it. I would be afraid to even try to do my job under any influence. I know thats the disease, but still. I have heard stories of nurses taking meds out of PCAs and it being tracked back to them. It must be hard to work so hard for something, and then loose it due to an addiction. Hats off to those of you who have beat your addictions.
  7. by   troutfishinEMT

    I for one, totally support you - we all know the benzos are addicting and can see where they might raise a flag - but 27 years (I believe you said?) of never being reported or suspected of diverting or abusing anything or being "under the influence" while on the clock sounds to me exactly like you said - no different than an insulin dependent or nurse on seizure meds. Speaking of sz meds, I think I'd RATHER have someone who took a klonopin the night before taking care of me than someone who just took depakote two hours before - that stuff seems to wonk some people out pretty bad.

    Hang in there, man - if your condition is really bad with the anxiety, I personally would have no problem with you taking anxiolytics - if the BON seems like they ARE going to have a problem with it, maybe look into the newer stuff?

    Good luck with everything!
  8. by   Lowell
    Thanks, TF-

    "The newer stuff", by my observation and research, is not all it's cracked up to be- and you may have overlooked where I mention that I'm taking doxepin for the depression, which has the added benefit of being used as an antianxiety antidepressant as well, just like the SSRI's which supposedly work for GAD and PD. I have heard, and experienced, that some of the SSRI's cause emotional "flatness" and "blunting", so I'm not so sure I'd want to be taken care of by a nurse that couldn't feel appropriate emotions, like concern. I took Lexapro for one night with this last depressive episode, and I woke up according to the pattern, and noticed that I just had no emotions. Give me the weight gain and constipation that go with the older ones any day.

    I just hope the BON sees it that way too. Part of what I'm looking to find out is what Boards of Nursing do with insulin-dependent diabetic nurses and nurses with seizure disorder.

    And it's "only" 22 years. Sorry. And the worst mistake I've ever made (by no means a big one) was because I doubted my first instinct.
    Last edit by Lowell on Jun 21, '06
  9. by   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!!
  10. by   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
    Last edit by Tweety on May 6, '08 : Reason: Gerat post but see TOS about posting personal emails. Thanks.
  11. by   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.
  12. by   Tweety
    Jack what an awesome post. Thanks for sharing.

    Moving to the recovery forum, which as started after this thread was originally posted.
  13. 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.