What to look for inside the hospital

1. Addicts sign out ever-increasing quantities of narcotics.

2. Addicts frequently have unusual changes in behavior such as wide mood swings, periods of depression, anger, and irritability alternating with periods of euphoria.

3. Charting becomes increasingly sloppy and unreadable.

4. Addicts often sign out narcotics in inappropriately high doses for the operation being performed.

5. They refuse lunch and coffee relief.

6. Addicts like to work alone in order to use anesthetic techniques without narcotics, falsify records, and divert drugs for personal use.

7. They volunteer for extra cases, often where large amounts of narcotics are available (e.g., cardiac cases).

8. They frequently relieve others.

9. They are often at the hospital when off-duty, staying close to their drug supply to prevent withdrawal.

10. They volunteer frequently for extra call.

11. They are often difficult to find between cases; they are taking short naps after using.

12. Addicted anesthesia personnel may insist on personally administering narcotics in the recovery room.

13. Addicts make frequent requests for bathroom relief. This is usually where they use drugs.

14. Addicts may wear long-sleeved gowns to hide needle tracks and also to combat the subjective feeling of cold they experience when using narcotics.

15. Narcotic addicts often have pinpoint pupils.

16. An addict’s patients may come into the recovery room complaining of pain out of proportion to the amount of narcotic charted on the anesthesia record.

17. Weight loss and pale skin also are common signs of addiction.

18. Addicts may be seen injecting drugs.

19. Untreated addicts are found comatose.

20. Undetected addicts are found dead.

Source: Excerpted from Chemical Dependence in Anesthesiologists: What You Need to Know When You Need to Know it. American Society of Anesthesiologists. A copy of the full text can be obtained from ASA, 520 N. Northwest Highway, Park Ridge, IL 60068-2573. Web: www.ASAhq.org/ProfInfo/chemical.html. This table is adapted from Farley WJ, Arnold WP. Videotape: Unmasking Addiction: Chemical Dependency in Anesthesiology. Produced by Davids Productions, Parsippany, NJ, funded by Janssen Pharmaceutica, Piscataway, NJ. 1991.