By: Katie McQueen, MD
Prescription drug misuse and dependence is on the rise. In the most recent data available from the Centers for Disease Control, drug overdoses in the United States caused 36,450 deaths. Opiate pain relievers were involved in 14,800 deaths (73.8%) of the 20,044 prescription drug overdose deaths. Prescription drugs are now involved in more overdose deaths than heroin and cocaine combined. According to the Substance Abuse and Mental Health Services Administration the overall rate of substance abuse treatment admissions among those aged 12 and older in the U.S. has remained nearly the same from 1999 to 2009, but there has been a dramatic rise (430 percent) in the rate of treatment admissions for the abuse of prescription pain relievers during this period. Addiction to prescription drugs now exceeds addiction to cocaine, hallucinogens, inhalants, and heroin combined.
These disturbing trends affect health care professionals (HPs) in multiple ways. There is emotional stress associated with determining which patients are appropriate candidates for opiate analgesics or benzodiazepines for anxiety. It is challenging to treat patients who have become addicted to their medication. Perhaps most disturbing, is the increasing trend in the number of HPs finding themselves addicted to prescription medication.
Roy, a nurse seeking treatment sums it up well, “I was more vulnerable. I thought because I was educated I would be able to use the medication appropriately.” His story is repeated too many times. A back injury left him in pain and presented difficulty with his job as a registered nurse. He was started on hydrocodone. When that stopped working he was placed on oxycodone and less than one year later his license is in jeopardy for stealing a patient’s medication and now he is in treatment. In a study of 479 HPs, the risk factors for addiction included moderate or more frequent use of alcohol, being in situations when offered alcohol or other drugs, feeling immune to the addictive effects of drugs (pharmaceutical invincibility) and socializing with others who misuse substances. Compounding the problem is the lack of education most HPs receive about alcohol and drug problems.
Estimates on the prevalence of addiction in HPs vary widely. It appears that addiction is as common in doctors, nurses, and other HPs as in the general population – 9% point prevalence and 15% lifetime. The difference lies in the substances most commonly leading to treatment and the treatment outcomes. Alcohol and prescription medication dependence are more common. The social acceptability of alcohol and the routine exposure to opiates and sedatives contribute to this difference. Long term recovery rates when in a monitoring program are reported as high as 90%.
Signs that you or a colleague may be experiencing a problem include worsening relationships at home, decreasing personal hygiene, increasing missed calls or late callbacks, frequent job changes, poor concentration, and worsening sleep problems. HPs often experience problems outside of the workplace first, which means that by the time a colleague suspects impairment the disorder may have been present for many months or years. Intervention by a caring colleague or a work sponsored interventionist can assist HPs in finding treatment and in considering voluntary reporting to the appropriate peer support program. Voluntary programs assist individuals in getting the treatment they need often without resulting in license revocation or suspension. Unfortunately studies show that only about half of all HPs will intervene when they suspect a colleague has a drug or alcohol problem.
The purpose of a structured monitoring program is to promote the HPs own health and well-being and to ensure patient safety. The largest review of physician monitoring was published in The Journal of Substance Abuse Treatment. The authors surveyed a sample of 904 physicians consecutively admitted to 16 state Physicians’ Health Programs (PHPs) for at least 5 years. Seventy-eight percent of participants had no positive test for either alcohol or drugs over the 5-year period, and 72% were continuing to practice medicine. Most monitoring programs include a primary treatment which may range from 30 to 90 days, regular attendance at peer support meetings, and random urine testing for alcohol and drugs. Most programs do not require relapse prevention medication. Vivitrol, a monthly depot formulation of the opiate antagonist naltrexone does provide a therapeutic option for HPs returning to high risk areas or specialties.
In summary, alcohol and drug problems are as common among HPs as the general population, but the vulnerability to the misuse of prescription medications is higher because of access and other factors. Monitoring programs represent an important option for recovery but these programs can be expensive and onerous. The lack of education surrounding these issues makes caring for patients more challenging and represents an important opportunity for preventing further increases in healthcare professional impairment.
- (800) 880-1640 Committee on Physician Health and Rehabilitation
- (800) 288-5528 Texas Peer Assistance Program for Nurses
- (800)727-5152 Peer Assistance Network (pharmacy professionals)