While highly publicized drug diversion incidents are frequently in the news, less is said about the healthcare worker’s road to recovery.
Some involved in diversion-related outbreaks that harm multiple patients have been imprisoned. Others are barred from returning to healthcare by licensing and public health officials. However, some addicted nurses can recover and return to work, but there are obstacles to overcome, says Indra Cidambi, MD, an addiction specialist and medical director for Center for Network Therapy treatment centers in Middlesex, NJ.
“It’s important to keep an open mind and treat addiction like any other brain disease,” she says. “If a nurse has a bipolar disorder, they are not going to tell them they can’t work as long as that person is stable and on medication.”
The addiction recovery process can stall as a nurse begins medicated-assisted treatment (MAT), which can raise red flags from employers. On the contrary, MAT is an essential part of rehabilitation, staving off cravings and providing a safety net for the return to work, Cidambi emphasizes. These nurses should be able to use MAT as part of return-to-work plan that includes random drug tests and other oversight.
“Many nurses I have treated for opiate use disorder are not allowed to come back to work after successfully engaging in substance abuse treatment, simply because they are on maintenance treatment with buprenorphine,” Cidambi says.
A partial opioid agonist, buprenorphine is widely used to address withdrawal symptoms and craving related to opioid abuse. However, some employers may see it as substituting one drug for another.
“It is a very sad thing, and I am being as open as I can be on this topic,” Cidambi says. “Nobody is really paying attention to this issue. MAT allows someone who is addicted to substances to function as a normal human being.”
Some nurses who have gone through her recovery program and been sober for more than one year have been told they cannot return to work if they are using an opioid agonist to reduce cravings, Cidambi says.
“That’s just not right,” she says. “If they are tested on a consistent basis and maintain sobriety, I don’t think they think there should be any discrimination on this.”
For example, nonaddicted nurses may work while taking appropriately prescribed pain medications. However, the policies for addicted nurses in recovery may tempt them to go off their MAT to reduce craving, setting up a scenario for a relapse.
“That is dangerous,” she says. “This is a brain disease, and relapse is part of the disease.”
Workers diverting drugs may be reluctant to seek help if they know they cannot return to work while using the MAT drugs to reduce craving.
“There is so much stigma in substance abuse treatment,” Cidambi says. “Nurses will try to hide it before they come to seek help because of problems like MAT.”