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  1. The FDA recently noticed an increase in hospitalizations and deaths linked to using nitrite “poppers”. On June 24, 2021, the agency issued a statement warning consumers not to buy or use poppers that are typically sold on-line and in adult novelty shops. They are marketed under the brand names of Super RUSH, Jungle Juice, Extreme Formula, Quick Silver, Premium Ironhorse and Super Rush Nail Polish Remover. What Are Poppers? Poppers are usually sold as a liquid and packaged as room deodorizers or leather cleaner. They are usually packaged in 10mL to 40mL bottles that look like energy shot products. The chemicals in the liquid produce a vapor that causes vasodilation in the body when inhaled. It is actually related to the nitrate inhalation medications that are prescribed by physicians for angina attacks. Street names may include: Aimes Aimees Snapper Bold Liquid gold Rush Purple haze Buzz How Are They Used? Poppers are usually used by inhaling the vapors from the bottle. Some people dip the end of a cigarette into the bottle and inhale through the cigarette to avoid sniffing the chemicals directly from the packaging. Why Are They Used? Poppers are typically used recreationally to produce a feeling of euphoria or to enhance sexual experiences. Instant High People often use poppers for the “head rush” that is caused by the sudden increased blood flow. This can cause a euphoric feeling or instant high that general lasts only a few minutes. Some have described the rush as a “warm fuzzy” feeling that is caused by the side effects of vasodilation, including: Sudden drop in blood pressure Dizziness Increase in heart rate Lightheadedness Warm sensation throughout the body Sexual Enhancement The vasodilation effects of amyl nitrites also relax smooth muscles in the anus and vagina, making sex more comfortable and sensations more intense. Some men also take use poppers to prolong erections. Serious Side Effects The FDA released the warning against poppers based on an increase in hospitalizations and deaths with problems such as Severe headaches Dizziness Increased body temperature Shortness of breath Extreme hypotension Methemoglobinemia Brain death Here is a look at other problems people may experience when using poppers. Respiratory problems (sinus issues, respiratory infections, wheezing) Chemical burns around lips or nose Allergic reactions Increased eye pressure Heart palpitations Nausea Poor coordination Nosebleeds Lowered inhibitions Impaired judgement Dangerous With Other Drugs Poppers are often used in combination with other illegal drugs to increase the high, including, cocaine, marijuana, methamphetamines and hallucinogens. This increases the risk of both psychiatric and physiological side effects. The following medications when taken with poppers can cause a dangerously low blood pressure: Viagra Monoxidil (Rogaine) Diuretics (I.e. furosemide, hydrochlorothiazide) Beta Blockers (I.e. carvedilol, atenolol) Calcium channel blockers (I.e. diltiazem, nicardipine) Angiotensin II receptor antagonist (I.e. losartan, valsartan) Vasodilators (I.e. terazosin, apresonline) There is also research that suggests amyl nitrate can reduce the effectiveness of certain HIV medications, particularly protease inhibitors, such as indinavir, saquinavir mesylate and ritonavir. Who Uses Poppers? Amyl nitrite began being used for a recreational drug in the gay community during the 1960s. Its use became widespread throughout the 70s, 80s and 90s in the club scene. Today, people of all ages, races and sexual orientations use poppers. Are Poppers Addictive? Repeatedly using poppers can lead to a substance use disorder (SUD). This occurs when someone continues to use poppers despite health problems or issues in everyday life. Signs of a SUD including failing to meet personal responsibilities at home, work or school. A SUD be mild to severe, and an addiction would be the most severe. People who have tried to quit using inhalants may have the following withdrawal symptoms: Nausea Poor appetite Sweating Sleep problems Mood changes For more information on inhalants and addiction, visit this National Institute on Drug Abuse website. Do you have a clinical or personal experience with inhalants you are willing to share? References Is amyl nitrite safe? Who uses poppers? Nitrite ‘Poppers’: Here’s Why FDA Warned Against Their Use For Fun, Sex
  2. On March 2nd, a former Yale nurse pleaded guilty to altering fentanyl vials intended for outpatient surgical patients. The nurse, Donna Monticone, worked at the Yale Reproductive Endocrinology and Infertility clinic in Orange, Connecticut and was responsible for ordering and stocking narcotics needed for procedures. According to the U.S. attorney’s office, the nurse began stealing fentanyl in June 2020 for her own personal use. Monticone would remove the drug from secured vials, inject herself, then replace the fentanyl with saline. No Protection from Pain When Monticone pled guilty, she confessed to actions that are in direct conflict to nursing ethics and standards. Specifically, she admitted to the following: Knowing that the fentanyl vials she replaced with saline would be used in surgical procedures as an anesthetic. Knowing patients could experience serious bodily harm without an anesthetic. Injected herself with fentanyl while working at the clinic. Eventually taking vials of fentanyl home for self injection. Refilling the empty vials at home with saline and returning them to the clinic’s fentanyl stock. Bringing around 175 vials of fentanyl vials she had taken from the clinic and discarded them in the clinic’s trash. Investigators discovered that between June and October 2020, approximately 75% of the fentanyl administered to clinic patients for surgical procedures was either diluted or consisted only of saline. “I Screamed” Patients detail the extreme pain they experienced during procedures at the Yale fertility center. One patient recalls suddenly realizing the anesthesia she’d been given during a painful egg harvesting procedure was not working. She shared her story with a local news station, stating, “It made me scream. I remember screaming in the middle of the procedure from pain”. Attorney Josh Koskoff represents four victims who had IVF procedures while in extreme pain. He describes the women as feeling betrayed and dismissed when clinic staff did nothing when they reported the pain. Koskoff also questions how the complaints continued to go on for several months without a thorough investigation by the clinic. Yale’s Response Yale’s director of university media relations released a statement about the what is being done to reassure the public and prevent this from happening again. Here is a look at what steps are being taken: The clinic informed law enforcement of the theft and notified patients about the issue. Informed patients there is no reason to believe the nurse’s actions harmed their health or treatment outcome. A combination of pain medication is used during clinic procedures and are adjusted if signs of discomfort. Making needed changes in procedures, record-keeping and storage to prevent diversion in the future. Bond and Sentencing Monticone was released on a $50,000 bond and will return for sentencing on May 25th, facing a maximum prison sentence of 10 years. Healthcare Workers at Increased Risk Nurses stealing opioids for their own personal use is nothing new and there’s no shortage of news articles reporting criminal charges for diversion. Now, the pandemic is intensifying the risk of substance abuse among healthcare workers. During COVID-19, it’s not unusual for nurses to feel like their best is not good enough and the emotional, mental and physical toll can be overwhelming. Navigating life during a pandemic is stressful already, but add to the mix the extra challenges healthcare workers have faced over the last year. For example: Long shifts and work hours Fear of being infected by the virus Fear of passing the virus on to vulnerable patients Fear of passing the virus on to loved ones Busy/chaotic work environments and unable to take time to talk to peers about stress and anxiety Loss of outlets for stress due to social distancing Financial hardships due to lay-offs and cancelled shifts during early pandemic The pandemic has only added “fuel to the fire” in healthcare workers who are already at risk for substance use disorders. What Do You Think? Donna Monticone surrendered her nursing license and went to rehab. I do believe she should face the consequences of her actions. But, I also think the stigma and shame of being a nurse with an addiction prevents too many from seeking help. What do you think… is there a bigger picture than what the news reports?
  3. OyWithThePoodles

    Under the Influence Assessment

    Alright y'all. I tried searching, promise. And I could not find a previous post on this even though I know they're there. I am at a high school now (working with Mr. Poodles!!) and I am unfamiliar with how to assess the students if they're suspected to be under the influence. I was brought one yesterday: Upon entering I first checked smell, through my mask of course. No smell of alcohol or marijuana noted. I check her pupils, gait, speech, how she reacted when I said was going to call mom (about an actual medical concern). I found nothing of concern. The SRO came in after and said his findings were the same. My question is: Is there anything else I should've done? Do you all make them do almost like a sobriety test (I.e. walk a straight line, nose to finger, etc.)? I want to make sure I am doing everything I can do detect an abnormality if it's there, I've been in elementary the last 6 years, and thankfully, I never had this issue. My 9 years in the hospital dealing with DT patients yields some assistance, but I want advice from my "co-workers". Miss y'all. Covid is taking up so much of our time I know we aren't on here as much.
  4. Meriwhen

    Addictions Nursing

    Overview Addictions Nursing (often referred to as substance abuse nursing) deals with the nursing care of individuals suffering from one or more addictions. Addictions Nursing is considered a subspecialty of Psychiatric Nursing. Patients may be suffering from the addiction alone or may have one or more co-occurring psychiatric diagnoses: this is termed dual- or multiple-diagnosis. People often think of addictions only in terms of alcohol, painkillers, or street drugs such as heroin. In addition to the aforementioned, addictions can also include: methadone benzodiazepines such as Valium and Xanax ADHD/amphetamine medications non-opiate pain medications other prescription medications OTC medications such as: cough medications inhalants nicotine caffeine Also, addictions are not limited to drugs only. Patients may also be suffering from addictions to sex, gambling, or shopping. In addition, eating disorders fall under addiction medicine. Addictions Nursing is one of the more "medical" psychiatric nursing subspecialties, in that patients experience physiological as well as psychological addiction to a substance or behavior. Eating disorders have numerous physiological sequelae, many of which are severe or even fatal. Cessation of the addictive substance or behavior (detox) often causes physiological complications, some of which are fatal. Duties therapeutic communication rapid, comprehensive assessment pain management development of nursing diagnoses and plans of care administration of medication patient education crisis intervention family support Addictions nurses care for patients during detox/withdrawal as well as during their recovery. In addition to the physiological complications of withdrawal, patients frequently have medical comorbidities that will also require nursing care. Practice Settings When it comes to where addictions nurses can work, most people probably think first of places like the Betty Ford Center. That is just one of many places an Addictions nurse can practice. Addictions nurses are found in a variety of settings such as: freestanding psychiatric hospitals psychiatric units in mental hospitals intensive outpatient and partial hospitalization programs residential (short- or long-term) treatment centers mental health clinics private practices public schools community agencies Professional Organizations The main professional organization for Addiction nurses is the International Nurses Society on Addictions (IntNSA). Membership is open to RNs, however, Licensed Practical/Vocational Nurses (LPN/LVN) and non-nurses may join as associate or affiliate members, though they may not vote or hold office. Since addictions nursing is related to psychiatric nursing, addiction nurses may also be interested in joining the American Psychiatric Nurses Association (APNA) and the International Society of Psychiatric-Mental Health Nurses (ISPN). Nurses can also join the American Society of Addiction Medicine (ASAM). It is, "a professional medical society representing over 6,000 physicians, clinicians and associated professionals in the field of addiction medicine". The Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency within the U.S. Department of Health and Human Services (HHS). This agency, "leads public health efforts to advance the behavioral health of the nation and to improve the lives of individuals living with mental and substance use disorders, and their families". Educational Requirements Graduate from an accredited Practical/Vocational Nursing (LPN/LVN) program or Registered Nursing (RN) program LPN/LVN: certificate, diploma or degree RN: Diploma, ADN, BSN, or MSN Successfully pass the NCLEX-PN or NCLEX-RN Current, unencumbered LPN/LVN or RN license in U.S. state of practice Nurses can work in addictions as an RN or an LPN/LVN. Other countries may have additional requirements for practicing as an Addictions nurse. Certification International Nurses Society on Addictions (IntNSA) The following addictions nurse certifications are available for the RN and the Advanced Practice Nurse (APN): Certified Addiction Registered Nurse (CARN) Certified Addiction Registered Nurse – Advanced Practice (CARN-AP) The Addictions Nursing Certification Board (ANCB) offers the certifications supported by the IntNSA. The certifications are available for RNs or advanced-practice RNs only and are valid for 4 years. CARN eligibility (not all-inclusive) Current, unencumbered RN license in U.S. state of practice 30 hours of continuing education credits Evidence of 2000 hours with experience in addictions nursing within the last 3 years CARN-AP eligibility (not all-inclusive) Current, unencumbered RN license as an RN in U.S. state of practice Master of Science in Nursing (MSN) degree or higher 45 hours of continuing education Minimum 500 supervised hours in addictions and 1500 hours of nursing experience in addictions as an Advanced Practice Nurse (APN) within the last 3 years practice in addictions American Nurses Credentialing Center (ANCC) RNs and Nurse Practitioners (NP) may also apply for the following certifications by the ANCC*: Psychiatric-Mental Health Nursing Certification (RN-BC) {for the Registered Nurse} Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC) {for the Nurse Practitioner} *LPNs/LVNs are not eligible for these certifications Psychiatric-Mental Health Nursing Certification (RN-BC): eligibility (not all-inclusive) Graduate from an accredited RN nursing program with a Diploma, ADN, or BSN degree or higher and successfully passed NCLEX-RN Current, unencumbered RN license in U.S. state or territory or hold the legally recognized equivalent in another country 2 years full-time as an RN Minimum 2,000 hours clinical practice in psychiatric–mental health nursing within last 3 years Completed 30 hours of continuing education in psychiatric–mental health nursing within last 3 years Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC): eligibility (not all-inclusive) Current, unencumbered RN license in U.S. state or territory or the legally recognized equivalent in another country and successfully passed NCLEX-RN Master of Science in Nursing (MSN), post-graduate, or nursing doctoral degree from an accredited psychiatric-mental health NP Program Minimum 500 faculty-supervised clinical hours must be included in the psychiatric-mental health NP Program Salary (2020) According to salary.com, the average hourly wage for an Addictions Nurse in the U.S. is $34 and falls between $31 and $38. According to ZipRecruiter, the average annual pay in the U.S. is $62,104 a year with salaries as high as $132,000 and as low as $22,000, depending on education, experience, and location. If You Are the One in Recovery ... Psychiatric nursing tends to attract a lot of nurses recovering from their own addictions issues, and Addictions Nursing seems like it would be a natural fit for the recovering nurse. However, you do NOT need to be in recovery (I.e., have your own addiction problem) in order to be an addictions nurse. Nor does being a recovering addict ensure that you will be good at addictions nursing. You will, however, need to self-assess to determine your own beliefs about and attitudes towards addiction, so that you can provide competent patient-centered care. Recovering Nurses that Tend to Do Well in Addictions Nursing Those who have a good handle on their own recovery. They have been clean/sober for at least a year, if not more. They are able to keep their own recovery separate from their patient's recovery. They do not try to impose their own values, beliefs, or "this is what I would do" on the patient. They are also cognizant of boundaries: while some may choose to share their own addiction and recovery experience (keep in mind that a nurse is NEVER required to share this), they always keep the focus on the patient and the patient's recovery. They are aware of what could trigger a relapse and work to avoid or mitigate these triggers. Recovering Nurses that Do Not Do Well in Addictions Nursing Those who are newly in recovery, having been clean/sober only for a few months and are still finding their own path. They are looking to Addictions nursing to take the place of therapy or to meet unfulfilled needs. They tend to see the patient in terms of their own (the nurse's) recovery, and have a hard time understanding or even just accepting a patient's decisions or actions. Instead, they may try to impose their own beliefs and choices on the patient. In short, the nurse can make the patient's recovery about themselves and not about the patient. Or, they can be at risk of having their own relapse triggered by their working environment. Only you can decide if you are able to work in Addictions Nursing as a recovering nurse. Choosing a Specialty but not sure which one is best for you? Download Nursing Specialties Guide!
  5. In the recovery community, you will lose people you love. At first, you will be shocked when you hear news of a friend’s overdose, suicide or accident. You will grieve, attend funerals and lean on others for comfort and support. You may even struggle with your own sobriety. Your drug of choice may begin tapping your shoulder, saying “I can help you to escape the pain of grief”. The Purpose of the Recovery Community In the past few months, I have lost several friends to addiction and am feeling the weight of cumulative grief. I have been in recovery for alcoholism for over 3 years and am a member of a large recovery community. I benefit from other nurses and am able to relate to their experiences. A “recovery community” is a group of people supporting each other as they do the hard work of getting clean/sober and the hard work of staying clean/sober. I participate in several recovery groups (Alcoholics Anonymous, Nurse Support Group, Caduceus, and others). After 3 years of sobriety, I stay connected with my recovery group for 2 reasons: To stay sober and avoid relapse, and To be an example, support others and give back Having a support system of others, that you can relate to, is important for anyone in recovery. For nurses, it also helps in working through the shame and guilt experienced from a professional standpoint. We Do Recover Many people, just like myself, do recover and rebuild joyful lives. This is the most important reality of addiction. The likelihood of long-term sobriety increases with each consecutive year spent in sobriety. I am writing this article because of the pain that comes with losing someone you love to substance abuse. “Losing someone” refers to more than just a death. It starts with the loss we experience because of the behaviors, choices and insanity that comes with addiction. I don’t want to paint a “hopeless” picture, there is always hope and it is absolutely obtainable. What Does It Mean to Relapse? Relapse is when someone starts to use or drink again after a period of sobriety. Relapse usually begins with cravings or increased thoughts about a substance of choice. People in recovery often return to substance abuse because it is a familiar (although ineffective), coping mechanism. When someone relapses, it is a way to for them to learn more about what is needed to experience long-term sobriety. Relapse Statistics Setbacks and relapse often occur in recovery, although relapse it is not necessary in order to maintain sobriety over a long period of time. Between 40 and 60 percent of people with an alcohol or drug addiction will relapse. A relapse on opioids (prescription pain medications and heroin) carries more risk because they suppress the central nervous system and slow breathing. No One Is Immune Addiction and death related to substance abuse can happen to anyone. It is non-discriminatory across age, gender, race, social status, and occupation. Here is a glimpse at a few individuals I have lost in my recovery community. A new first-time grandparent and business manager. Died from a heroin overdose after multiple months of sobriety. A nurse with 10+ years’ experience. Overdosed on a mix of opioids and benzodiazepines. A 20-something college student. Died from a head injury (fall) while intoxicated after 2 years sobriety. Why So Dangerous? When someone has been substance-free for a period of time, they’re at risk of overdose increases. This is true regardless of how sobriety was achieved, through formal treatment or other methods (“cold-turkey”, imprisonment, ect.) This is because their tolerance level is not what is was when they were in active addiction. I have often heard the words “it went bad so fast and was much worse” from someone who is describing their substance use following a period of abstinence. A dose that was once habit, may now be fatal. Where to Start? The issues, frustration and grief surrounding substance abuse can easily become overwhelming. It can be hard finding a “starting point” when trying to personally make a difference. Educating yourself on the issues affecting you is a great first step. Here are some resources you can check out: Online Training Series for Health Providers Applying CDC's Guideline for Prescribing Opioids Free CEUs sponsored by CDC Understanding Substance Use Disorder in Nursing National Council of State Boards of Nursing Free CEUs sponsored by NCSBN Alcohol Withdrawal, Relapse and Prevention NIH - National Institute on Alcohol Abuse and Alcoholism Have you experienced grief with the relapse of a patient or someone close to you?
  6. The problem is that most state Board of Nursing programs utilize a "One Size Fits all." approach that places all nurse with mental health and substance abuse impairments in the same program. The also require this approach for the one time offender who possible had a DUI or a positive test for marijuana. The current standard is Inpatient Treatment followed by Out-patient treatment, Random drug testing 4-8 times month (3 to 5 years) , Mandatory AA/NA attendance(3 to 5 years) , placed off work for up to 2 years. All of this at this paid for out of pocket by the nurse in question. The average 5 year cost to "Voluntarily" participate in these programs is between $35,000.00 to $50,000.00. I am currently working with a local legislator on a bill that would impose program limits on BONS and standardize individualized programs such as the following... Level 1 : RN/LVN with 1st time DUI and no practice issues. Mandatory AA/NA/Celebrate Recovery or other alternative to 12 step programs for 1 year with Random UDS to be preformed 2 time per month at participant cost. Participant allowed work without workplace monitor but must file monthly proof of support group meetings Level 2 : RN/LVN who failed a UDS from above level 1 or who is found to be impaired at work. Immediate suspension from practice. Assessment by a qualified addiction specialist covered by the participant's insurance and not connected with a treatment facility to avoid conflicts of interest. If found to have a diagnosis of substance abuse disorder the program is as follows. Mandatory Inpatient or out patient program as indicated by addiction specialist's assessment. AA/NA/Celebrate Recovery or other alternative to 12 step programs for 3 years with Random UDS to be performed 2 to 4 times per month at participant cost. With a fourth year of UDS monitoring 1 time per month. If all conditions are met participant may return to work after 6 months of continuous sobriety as evidence by negative UDS results with the following UDS schedule year 1: 3-4 times per month. Year 2: 2-3 times per month. Year 3: 1-2 times per month. Workplace monitor is required. Level 3 : RN/LVN who has failed above program or is found to have diverted medications from the facility they worked at or for the NP who has written fraudulent prescriptions. This participant may pose a real and present danger to public safety. As such practice shall be suspended and participant will have an assessment by a qualified addiction specialist covered by the participant's insurance and not connected with a treatment facility to avoid conflicts of interest. If found to have a diagnosis of substance abuse disorder the program is as follows. Mandatory Inpatient or out patient program as indicated by addiction specialist's assessment. AA/NA/Celebrate Recovery or other alternative to 12 step programs for 4 years with Random UDS to be performed 4 to 8 times per month at participant cost. With a fifth year of UDS monitoring 1 time per month. If all conditions are met participant may return to work after 1 year of continuous sobriety as evidenced by negative random UDS with the following UDS schedule year 1: 4 to 8 times per month. Year 2: 3 to 7 times per month. Year 3: 2 to 5 times per month. Year 4: 1 to 2 times per month. Workplace monitor is required. Level 4 : RN/LVN who has failed all the above levels or who has engaged in criminal activity related to their substance abuse to the extent that a suspension/revocation of license is warranted. Subject should also face prosecution and criminal penalty as warranted by law enforcement jurisdictions in the State/County where the resident resides. This is just a rough draft and I am looking for Input/suggestions. I know there are those here who feel a nurse who was found to be impaired should never practice again and you are entitled to your opinion - but nurses should not lose their livelihoods when they are actively trying maintain their sobriety or for a one time mistake of getting behind the wheel after having a drink. (Understand I do not condone driving under the influence and person's with DUI should deal with the criminal consequences of their behavior. ) I also need input on how to address the issue or the nurse with a mental health diagnosis who does not have a substance abuse disorder diagnosis. All replies with be kept confidential and I will not share your replies or user information with anyone outside this forum. Thank You Hppy