Have you ever worked with a colleague who diverted drugs to feed an addiction?
Chances are you have, though you may not have known it, since drug diversion and addiction are often very secretive issues. Most put nurses' drug and alcohol misuse at around 6% to 10%, or about one in 10 nurses.
This makes it highly likely that at some point in your career you'll encounter a colleague or staff member who is, or will, divert and misuse drugs.
Yet, diversion and addiction are still misunderstood, said Laura Wright, PhD, CRNA, associate professor in the Department of Acute, Chronic, and Continuing Care at The University of Alabama at Birmingham, School of Nursing.
"Addiction is a disease, it's not a moral defect," she said. "But, when I talk about addiction, I still get people asking me, 'Why would they ever do that? That's an awful thing. How could they do that to their children?'"
Here are five things Wright, who is a member of the American Association of Nurse Anesthetists Peer Assistance Advisors Committee (), wants nurses to know about drug diversion and addiction.
1. Addiction is a disease.
Wright describes addiction as a "." What does this mean? I shared with her that I once had a colleague who, after going to a new employer, was caught diverting drugs.
When I worked with this nurse, they had sustained injuries from a car accident and had been prescribed prescription pain medication. Eventually, the nurse started mentioning that the medication wasn't helping with the physical pain anymore.
"Tolerance builds and they need more," Wright explained. "The brain has been rewired so that the drug becomes necessary for survival on a very unconscious level."
This rewiring interrupts their ability to make proper choices and, biologically, addicts become unable to "just say no."
2. Know the signs and behaviors of impairment.
There are often red flags that there is a problem with diversion and addiction well before the narcotics counts are "off."
A nurse may become forgetful, unpredictable, or lack concentration. He or she may have frequent illnesses, physical complaints, and elaborate excuses for things. They may pick-up extra on-call shifts, have a labile mood with unexplained anger and overreaction to criticism, or have an increase in unexplained tardiness or absenteeism.
"When it gets to the point, when nurses are diverting, where it's noticeable on audits and in the Pyxis, it's way out of control," Wright said of addiction.
3. Turning a blind-eye helps no one.
Colleagues who notice signs and behaviors of drug diversion and addiction are often hesitant to raise their concerns.
"The people who love them know that they're a great nurse, and they don't want to get them in trouble... because they're worried that they're going to be the one that causes somebody to lose their job," Wright said.
But inaction can lead to permanent harm and even death. Creating policies that incorporate rehabilitation and reentry into practice versus automatic termination could help peers feel more comfortable speaking up when they notice something is suspicious, she said.
4. Screen for the right drugs.
Some medications, such as fentanyl, may not be part of the panel on a standard drug screen.
Managers need to know what a typical drug panel entails and, if it is not included, have the drug suspected of being diverted added to the laboratory tests.
5. When confronting diversion, do not leave the person alone.
Nurses caught diverting drugs are at high risk for suicide, Wright said.
"They often have the means. They've got the drug, and now their whole life has just fallen apart," she said. "A lot of policies say, 'You're out of here, empty your locker,' and security escorts you to the door."
Rather than immediately severing ties with drug diverters, organizations should instead have policies that ensure the nurse is under direct watch until a family member can come to get them, or they can be taken someplace safe, such as a treatment center.
For more on drug diversion and addiction, join Laura Wright, PhD, CRNA, associate professor in the Department of Acute, Chronic, and Continuing Care at The University of Alabama at Birmingham, School of Nursing, and member of the Peer Advisors Committee at the American Association of Nurse Anesthetists for the HealthLeaders Media webcast, on October 13 from 1:00 to 2:00pm ET.
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