Who me? I would never get addicted to drugs!
This was probably your first response and would most likely have been that of the hundreds of nurses caught in the trap of addiction, often after a simple prescription of painkillers after an injury or surgery. There is a high incidence of abuse and addiction to prescription medications among nurses and factors that contribute to this are the high stress levels at work, long working hours, as well as the easy access to these medications in the workplace.
According to the American Nurses Association (ANA) about 1 in 10 or 10-15% of nurses may be impaired due to the abuse of drugs or alcohol. A substantial percentage of disciplinary cases brought before by state boards of nursing concern issues around substance abuse or addiction, and the problem is growing. In 2016, 73 Massachusetts nurses lost their licences either for substance abuse itself or being caught stealing a controlled substance. This was nearly three times as many as in 2015, according to data from the Department of Public Health.
The drug of choice is most often opioid painkillers. The Centers for Disease Control and Prevention state that there is an opioid addiction epidemic in the U.S. It has reported that deaths due to opioids have quadrupled between 2000 and 2014 and at least half of these deaths were due to prescription opioids.
The Trap of Substance Abuse
The term opioids refers both to natural opiates derived from the poppy seed (morphine, heroin) as well as semi-synthetic and synthetic opioids (for example codeine, fentanyl, hydrocodone and meperidine) which have the same effects on the body.
While opioids are prescribed to manage pain, they also affect the central nervous system. They can cause drowsiness, poor memory and confusion, decreased higher cognitive functioning, and impairment of neuromuscular coordination. The effects of opioids are increased when used in combination with alcohol or other psychiatric medication. Abuse of opioids, even with a single large dose, can cause severe respiratory depression which could be fatal.
Opioids are safe and effective for pain management when they are prescribed correctly for acute pain and for a short period. However, these powerful drugs are extremely addictive. There is a good chance of impairment and addiction when they are prescribed in high doses or for lengthy periods, used in higher doses than prescribed, or illegally abused.
Overuse and/or extended use of opioids and other addictive drugs, results first in tolerance, where ever higher doses are required for the same effect. The next step is physical dependence, where the person experiences withdrawal symptoms when the drug is discontinued. Tolerance and dependence require increased use of the drug and at this stage it is difficult for the person to stop using it. The addict then displays the typical compulsive behaviour in obtaining the drug at all costs – they are caught in the trap.
Many nurses start on the road to addiction after surgery or an injury, where drugs are prescribed for pain; by self-medicating a headache or insomnia; or to help them cope with a stressful situation in their personal lives or at work.
The following illustrates a typical story of a nurse caught in the trap of addiction. Married with three children, the nurse realized after surgery that the pain medication reduced the feelings of anxiety which were part of her personality. The road to her addiction began simply with some waste meds which she discovered in her pocket when she got home one day. Eventually she was faking it to steal Dilaudid until she was caught out, having stolen hundreds of vials in a matter of two weeks. She lost her job but was able to recover in a rehabilitation program as well as earn back her nursing license after three years.
Avoiding the Trap
Here are some of the ways you can avoid the trap of substance abuse:
Learn as much as you can about the potential habit-forming effects of different prescription medications, as well as how they should be used correctly. Also become informed about the physical, psychological and social risk factors that contribute to substance abuse. Awareness of these factors will serve as a warning signal and help you to avoid them.
Find healthy ways to relieve stress and unwind after a day’s work
Alcohol and drugs may provide for quick relaxation after a hard day. However, the fix is temporary and the side-effects leave you feeling worse afterwards and could eventually lead to much more stress in your life. Rather find a relaxing activity you enjoy such as reading, exercising, meditation, or creative crafts.
Get help for mental health issues
Depression, anxiety and PTSD often go hand-in-hand with substance abuse because the sufferers try to relieve the emotional pain through self-medication. It is a well-known fact that nurses tend to neglect self-care. Follow the advice you would give your patients and go for counselling or therapy if you experience mental health issues or the moment you realize that you are swallowing pills when you feel overwhelmed.
Be aware of a genetic predisposition
Substance abuse has a strong genetic link. If you know that there is a history of addiction in your family you can take extra care. It is easier to avoid addictive substances completely than to recover once you have fallen into the trap.
Keep your life balanced
Don’t allow your work to rule your life. Make time for healthy leisure activities, your family and friends, spiritual growth, and other things that make you happy. Find an outlet that you are passionate about and motivates you stay mentally and physically healthy such as a sport, a social cause, an artistic outlet, or special relationships.
Getting Out of the Trap
By getting help as soon as you realize that your drug use is getting out of control you protect your nursing license, your future, as well as your patients. Reaching out is especially important if you are tempted to or have already started resorting to compulsive behavior such as lying, cheating and stealing to get hold of on more drugs.
The majority of nurses who become addicted to prescription meds will try and hide the fact and keep using devious means to get to more and more drugs until they are eventually caught out. This usually leads to dismissal and losing their nursing licenses.
However, many nurses’ unions now have assistance programs for those who are struggling with addiction. More and more employers have employee assistance programs that allow for treatment and rehabilitation, rather than instant dismissal. Boards of Nursing are also increasingly following the alternative approach of assisting nurses to recover and return to work, with support and monitoring, without permanently losing their licenses. These programs, as an alternative to disciplinary measures, are also strongly supported by the American Nurses Association.
Addiction is an illness of the brain but there is help and you can recover. However, you need to take the first step and ask for the help:
- The Opioid Epidemic (ANA website)
- Substance Use Disorder Resources
- American Association of Nurse Anesthetists Peer Assistance Program
- Emergency Nurses Association
- International Nurses Society on Addictions