How do employees act when drug-impaired?

[Editor’s note: In this second part of a two-part series on addictions, we discuss the characteristics of drug-impaired employees and give you resources for helping them. In last month’s issue, we gave you suggestions on how to avoid employee theft of narcotics.]

Drug-impaired staff members typically are the first ones at work, and they may be the last ones to go home, says Art Zwerling, CRNA, MS, MSN, PA-C, FAAPM, program director of the Pennsylvania Hospital School of Nurse Anesthesia in Philadelphia. Zwerling is coordinator of Anesthetists in Recovery and a member of the American Association of Nurse Anesthetists’ Peer Assistance Advisors Committee.

"Often, people who are opioid-dependent are always looking to do extra time and overtime to keep themselves in close proximity to their drug of choice," Zwerling says. "They often request to do longer, more painful procedures that require a fair amount of narcotics."

Impaired staff may become addicted to the point that they’re wearing long sleeves to hide track marks, "but we’ve had people snort it and put under their tongue for sublingual absorption," he says.

Addicted staff may show irritability, unexplained sleepiness, and mood swings from euphoric to dysphoric, Zwerling says.

Other signs include poor attendance, sloppy job performance, changes in behavior and work performance, plus physical or psychological signs of intoxication or withdrawal, says David Horvath, PhD, RN, CD, clinical services coordinator for National Health Care Associates in Lynbrook, NY, and president of Blaine, WA-based Consortium of Behavioral Health Nurses and Associates.

"That would depend on the drug itself and anything else they may be using," Horvath says. "Typically, most formulary drugs are sedatives, hypnotics, and analgesics, so you would most likely see slurred speech, drowsiness, lethargy, mental clouding, and pupillary constriction."

What are the primary characteristics? Inconsistency in behavior, Horvath says.

"This inconsistency, coupled with the discovery of an eventual discrepancy in the narcotic/ med count, will lead you to suspect diversion/ use," he says.

Resources for helping drug-impaired employees

For information on helping impaired staff, contact:

• Barbara McGill, National Organization of Alternative Programs, P.O. Box 5918, No. 167, Metairie, LA 70009. Telephone: (504) 838-5412. Fax: (504) 838-5382. E-mail: The organization’s mission is to promote public safety through participation of impaired health care professionals monitoring, rehabilitation, and recovery in alternative programs, emphasizing fitness to practice and retention of competent professionals in health care, and working in cooperation with regulatory and professional organizations.

Practitioners Guide for Medications in Alcohol and Drug Dependence is intended to serve as a resource for the recovering chemically dependent person and the medical professional prescribing treatment. This resource is available free on-line at the web site for the American Association of Nurse Anesthetists. Web:

ATOD [Alcohol, Tobacco, and Other Drugs] Resource Guide: Healthcare Providers is available free through the Indiana Prevention Resource Center at Indiana University. Web:

The National Clearinghouse for Alcohol and Drug Information has several resources, including Drug Testing, a 22-minute video that costs $6.50 for the employer version and $6.50 for the employee version; and a free package titled Making Your Workplace Drug Free: A Kit for Employers. To order, contact: The National Clearinghouse for Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20847-2345. Telephone: (800) 729-6686. Web: