Myth busters: Drug abuse no different in HCWs
Watch for changes in behavior, absenteeism
Common wisdom suggests the drug-addicted doctor is different from the drug-addicted sales rep or homeless person. Along with other health care professionals, physicians begin using drugs later in life and for different reasons than the man or woman down the street, or so the health care community has theorized for decades.
It is an interesting theory, seemingly supported by decades of studies that showed physicians were more likely to abuse prescription drugs than people in non-health care professions. The trouble is that the theory is wrong: Researchers recently asked doctors and other health care professionals when they first used substances, including tobacco and alcohol.
They discovered to their surprise that initiation into substance use began long before they became doctors or even entered college.1
"Health care professionals with addiction are just like everyone else," says Lisa Merlo, PhD, MPE, assistant professor of psychiatry at the University of Florida in Gainesville. "They started off like any other teenager, wanting to try drugs to get high at a party or to participate in the general social scene, and they continued using because they were having fun."
The fine line between abuse and addition is eventually crossed.
"They get addicted and experience withdrawal symptoms if they stop," she says. "They find that drugs help with stress and the reasons for substance use continue through their careers."
These findings suggest that hospital employee health programs could do more to identify workers with substance abuse problems and make inroads toward prevention.
Many health care workers identified with substance abuse problems are found because of drug diversion or problematic workplace behaviors, says Jay D. Harper, MD, MBA, MPH, employee health services medical director at the University of Pittsburgh Medical Center in Pittsburgh, PA. (See related story, p. 79.)
"Technology makes it easier to catch people diverting drugs," Harper notes. "There’s a given range of people making mistakes, but if you see something going on outside the norm, then you have a suspicion."
Behavior that should raise red flags includes employees having financial problems, missing work more frequently, or showing up for work but not being fully mentally present, he explains.
"An employee could go into a rage or just not act like themselves," he says. "Falling asleep at work is another sign."
Patient safety at risk
With patient safety at risk, health systems need efficient ways to screen for substance abuse problems. The small percentage of health care workers identified through current practices might be the tip of the proverbial iceberg.
Data show that health care employees have a substance use rate that is similar to the general population, which means roughly one in 10 has a substance abuse problem, says John Furman, PhD, MSN, executive director of Washington Health Professional Services in Olympia, WA.
"Health professionals have a higher rate of prescription drug misuse, but the general rate is the same," Furman adds. "The American Nurses Association estimates that 6 to 8 percent of nurses at some time in their career misuse substances to the extent that their practice may be impaired."
Programs like Washington Health Professional Services that offer follow-up care to these individuals are referred a tiny portion of the estimated workers with the problem, Furman says. "We have about 525 active clients — who are mostly nurses — at any given time, and we average 700 clients a year," he says."
There are some 100,000 nurses in Washington, meaning there may be as many as 10,000 who are misusing substances like alcohol or other drugs, he notes. Complicating the issue, marijuana is legal now in Washington, so it’s handled the same way as alcohol in terms of substance abuse, Furman says.
Physicians and HC professionals who misuse prescription medications often started taking pain killers legally because of chronic pain or some medical problem. Like non-health care addicts, however, they abused other substances before prescription drugs.
"We found initial use was like any other teenager: their friends were doing it or they were curious," Merlo explains.
"Some 80 to 90 percent of the [addicted] health care professionals started substance use before they went to college," she adds. "We were not seeing a different pattern from the general population."
Merlo and co-investigators recruited participants from attendees at a conference for health care workers in recovery, asking them to complete a questionnaire. They found that more than 60% of participants first smoked tobacco before they were high school graduates. Also, their average age of first drinking alcohol was 16 years and they were drinking regularly by the time they were 21. Marijuana was the third drug tried for most participants, followed by cocaine.1
One major statistical difference between health care workers who abuse substances and other people with addictions is that the long-term recovery rate is much greater for medical employees, Merlo notes.
"We know that physicians who participate in monitoring programs do really well, with 80 percent of them having five years of abstinence," she says. "This is in comparison to individuals in the general population who may go to rehab and don’t have follow-up care; their relapse rates are extremely high — even one year after treatment you’re lucky to have half of them who are clean and sober."
Merlo attributes this difference to hospitals having better after-care programs than those available to the general public.
"Why don’t we provide everyone with addiction access to the same treatment? We know it works," Merlo says.
Specifically, Merlo refers to hospital health programs that require random drug and alcohol testing for a five-year follow-up period.
Washington Health Professionals Services provides a follow-up substance use program as an alternative to discipline for HC professionals, Furman says. When nurses are identified with a substance abuse disorder and there has been no patient harm, they are often given the option of going into such programs, he explains.
"We provide substance abuse monitoring services," he says. "Substance abuse disorder is considered by our legislature and department of health as a chronic illness, like diabetes or cardiovascular disease."
- Merlo LJ, Trejo-Lopez J, Conwell T, et al. Patterns of substance use initiation among healthcare professionals in recovery. Am J Addict 2013;22:605-612.