Addiction And Nurses

A Minneapolis nurse was accused of stealing pain medicine from a patient.  She had a fentanyl habit to feed, and didn’t seem to mind that it left her patient in substantial pain. Unfortunately for her, the patient was a Dakota County Sheriff’s Deputy.

Some women just make bad choices.

The reason I bring this up is not to wonder about if this woman is guilty or not.  I can tell you that I share one opinion with the judge — that people who ask for a lot of continuances may be getting everyone angry.

In all these years I’ve been involved with medicines, I have only worked with nurses who abuse controlled substances as part of their rehabilitation — working with nursing boards to get these people insight and understanding and whatever supervision they need to get back on track.

I have never worked with nurses who have been actively abusing for one very simple reason. Nobody would be terribly interested in the few kinds of drugs a psychiatrist might stock.  I mean, modern antidepressants are tame and safe, and most antipsychotics have little or few side effects.  Even the mood stabilizers used for bipolars are not particularly sedating.

Benzodiazepines are the only controlled substances used routinely in psychiatry (mainly as anxiety drugs), and they definitely are quickly addictive. An abuser rapidly requires increased doses to get what might be considered even a minimal effect. However, many shrinks (including yours truly) choose not to deal with these drugs – there are safer and more effective ways to treat anxiety.

Many years ago I do recall working with a nurse who pulverized powdered Benadryl (diphenhydramine) and mixed it with water and shot it into the veins in her legs.  Let me give you a free medical opinion – This is absolutely the silliest way to get high and one of the silliest drugs to abuse.  There’s just not much thrill there.

I was one of four or five doctors who had seen her and her actions made little pharmacological sense, but we did what we could.  In those days, not much was available in the way of treatment other than twelve-step progams, which I hyped mainly as a support system for this somewhat obese woman’s overwhelming loneliness.

Most nurses who have this problem tend to be in constant contact with hard-core painkillers – most of which are controlled substances — like the Fentanyl  the above-mentioned Minneapolis nurse was accused of stealing.

These are mostly found in intensive care or anesthesiology or some place where such drugs are manipulated within the scope of work. Not surprisingly, alcohol is a common problem, too.

I am not picking on nurses.  Narcotic addiction has been a problem for physicians for a long time.

This 1958 article citing of 92% recovery rate in physicians may be a period piece, since the author seems to think all doctors are male.  Still, one central point predominates — medicine may well be a lifestyle instead of a profession, and the “club” of getting that status removed can force people to do things.  

It has been the same with the nurses I have monitored.  Frankly, with the amount of schooling and experience required to be in a healthcare profession, nobody wants to throw it all away and try to figure out how to make money in some other way, some time in midlife.  

A powerful club.

I am no big fan of soap operas, although I did watch them for a while in Spanish to assist with my self-education in that language.  The only time I had watched them before had been pre-school, when I would sit by my grandmother of blessed memory.  Many characters were physicians, and one was afflicted by a substance problem, and was suspended by the hospital.  He found employment as a cocktail lounge pianist, something that stretched even my grandmother’s credulity, and brought (rare) belly-laughs from my father, a Harvard trained musical composer and arranger.

But back to nurses.

With “Nurse Jackie” the substance-abusing nurse has become humanized.

The competent nurse who must deal with her own appetites and humanity as well as the senseless goings-on around her, where life and limb seem to be the daily currency of events, handled dispassionately.  Here is a pretty good summary of what is really going on.

Curiously, these folks do list psychiatry as one of the high-emotionality fields that may foster drug dependency.  I remember hearing it as having been associated with all kinds of morbidity in physicians for that reason — everything from suicide to abbreviated marriages.

Healthcare in the 21st century simply means processing lots of people quickly, who have — what is at least in their perception — crises.

Only the made-of-steel are immune.  They may be very helpful to patients in a nuts and bolts way, but for the crying hoards who need empathy and a hug at least as badly as they need nuts-and bolts intervention — well, I can testify to the fact that it takes a toll.

I have told my dear and loving husband more than once that without him as an emotional rock, I would be pretty darned fragile.

The above article tells signs to look for in an impaired colleague — everything from falling asleep on the job, to making errors, and the like. It also cites excessive use of breath mints or mouthwash.

Of course, we must be judicial with our suspicions, as there are many legitimate uses of mints and Lavoris.  I recently had some oral surgery, and the regimen my surgeon ordered could put me squarely within the criteria for mouthwash addict — for at least the time being.

The point is that false accusations might be possible, too — as in so many places in life.  

The great American adversarial justice system is not the worst thing in the world. The greatest risk seems to be with people who start with bona fide illnesses, such as chronic pain.

Frankly, the suboptimal treatment of anything chronic seems to be significant in this country, although emergency treatment of acute situations is wildly impressive to me.  

I suspect this is a problem, although it is not discussed in the article. It is virtually impossible for me to imagine anyone turning herself (or himself) in and I have certainly never heard of any nurse doing this.  There is support and plenty of it — from hospitals themselves, nursing boards, and the like.  But the support is often invisible and seemingly unavailable to those still in denial, whether out of shame or out of the illness itself, of which denial seems at least initially to be an integral part of the process.

There is another factor we almost dare not mention, but which I will since I have been part of it.  When large numbers of women work together, there is a sense of competition.  Some older analyst once told me it was left over from a primordial competition for mates — however, I believe sisterhood to be powerful enough that we have come a long way since then.  

I can still see, for example, some resentment by a nurse who needs to handle controlled substances for a colleague who is not yet authorized to do so. Notice I chose the word “yet.” Every nurse I ever worked with who had this problem seemed to comply with the recommendations of the board and do just fine.

Although I have always hoped that addiction treatment would move beyond 12 step with a simple psychosocial model into biochemical treatments used regularly and effectively, everyone known to me has somehow found her way.

I do not feel this is something created by a nursing shortage and political or economic pressures alone.  It is something that for every nurse I have known to have been through this has been some kind of a wake-up call to life, the quality of which improved.  

The road back is a real road, and it is navigable.  

I wish there were a way to remove the guilt and stigma associated with addiction for someone who must deal daily with the object of that addiction.

For a while, I wondered if addiction were a career-change choice for my medical colleagues, since everyone I knew with an addiction problem seemed to add “addictionology” to their list of credentials.  I no longer believe that, believing instead that the problem is as real as its solution.

I guess.