Prescription for addiction

A Gonzaga University nursing student working in a local hospital this spring noticed something odd on the medication logs.

A patient who didn’t need painkillers was receiving the drugs every time a certain nurse was on shift.

“She told the nurse she was working under, and it was reported to the nurse manager,” said Lori Tochterman, chairwoman of GU’s undergraduate nursing program.

An inquiry led to suspicions of theft, and the hospital fired the nurse and reported the case to the state Nursing Care Quality Assurance Commission.

The case is among dozens involving suspected drug abuse brought before the commission and underscores a problem along the frontlines of medicine: The work can be hard and stressful, and nurses have easy access to powerful painkillers.

The medical community and regulators acknowledge that difficulty and have often worked to treat drug abuse among health care workers rather than seek criminal prosecution.

“(Addiction) is a chronic, progressive illness. It’s an illness just like any other, such as rheumatoid arthritis or diabetes,” said John Furman, director of Washington Health Professional Services, a drug treatment program for health care workers.

At any given time, 500 medical workers are being monitored through the program and, generally, 75 percent are employed in nursing – the largest group of health care professionals in the state.

“Of course it’s a concern in terms of health professionals that may be practicing, and it’s imperative they receive appropriate treatment just like anyone else receive treatment,” Furman said.

Between July 2012 and May 2013, the commission reviewed 1,547 complaints. The most common involve patient care, such as leaving a patient unattended for too long or causing harm. The second-most-common charge is substance abuse, state officials said, whether that’s prescription painkillers, alcohol or a combination of both.

Washington has about 100,000 nurses of all levels of certification.

Nurses become addicted for the same reasons other people do – they’ve been prescribed pain medication for a medical condition and become dependent on it, or have struggled with depression or addiction their entire lives, said Furman. And many have ready access to addictive prescription drugs.

“All the professionals in our program have been diagnosed with a substance-use disorder that requires treatment just like anyone in the general public,” Furman said.

Washington was one of the first states to establish a program, and now similar options exist in most states.

Studies vary on the prevalence of substance abuse among nurses; some say it’s about the same level as the general public while others estimate it’s almost twice as high. The problem is one that health professionals have recognized for more than a century. It wasn’t until the 1980s, however, that states began considering alternative-to-discipline approaches to treat nurses, according to the Journal of Addictions Nursing.

Without alternatives, national surveys indicated, fewer nurses reported substance-abuse issues involving themselves or co-workers because the stakes were too high – acknowledging a problem could end their career or someone else’s. That approach put patients’ lives at risk, national nursing organizations said.

The vast majority of nurses and other health professionals who go through the Washington program “go on and have successful, productive careers,” Furman said.

Many of the rest voluntarily give up their licenses to pursue other careers or for other reasons.

One national study found that nurses who enter treatment programs complete them at rates as high as 91 percent.

The right path

Opiates, such as OxyContin, morphine and Vicodin, are the most commonly abused medications among nurses.

Sometimes the drugs are stolen from work, depending on what the nurse has access to, and other times nurses go “doctor-shopping” and have multiple prescriptions, Furman said.

There have also been cases where prescription pads have been stolen, state officials said.

A nurse in Grant County illegally obtained more than 100 prescriptions over several months using other nurses’ names and a doctor’s drug identification number, according to a Washington Department of Health document.

In Spokane a nurse took an elderly patient’s liquid morphine and replaced it with water.

Another case describes a nurse using OxyContin and sedatives while undergoing substance-abuse treatment and submitting someone else’s urine for her own test.

Dr. Kim Thorburn, the former director of the Spokane Regional Health District, spent most of her career in public health and has researched chemical dependency. She said approaching substance abuse as illness is the correct model.

“There are clearly biologic aspects, and that is clearly what people need to think about in approaching addiction, not victim-blaming,” she said.

She added, “If you think of medical personnel, and nurses in particular, the environmental risks are huge, their exposure and their knowledge. They have access.”

Nurses also are subject to enormous stress at work, said Tochterman, of Gonzaga’s nursing school.

In her nearly 27 years as a nurse, patient case loads have increased, there are more medications and more methods of medication delivery, and sicker patients are on the general floors rather than in intensive care, she said.

“We are asking nurses to do so much … . Any nurse that isn’t absolutely on top of their game every day they walk in – the potential for an error is increased hugely,” Tochterman said.

Officials at Providence Sacred Heart Medical Center and Deaconess Hospital declined to comment on substance abuse among nurses.

Five-year program

Health care workers can be referred to the Washington Health Professional Services treatment program by themselves, their employers, co-workers, friends, family, or professional associations.

A client first has a chemical dependency evaluation by the Department of Social and Health Services, said Furman, the program’s executive director. If they do have a substance-abuse diagnosis, they are offered treatment services and must enter into a contract with the program.

Based on the diagnosis, a recommended level of service is prescribed. Required treatment, including inpatient and outpatient programs, can be done at approved facilities near where a client lives.

In addition to counseling, the health professional has to participate in self-help groups and peer-support groups multiple times per week.

“They are required to take random drug screening,” Furman said. “They call in or log in (to a website) each day to find out if they need to be tested. Generally, it’s urine, but sometimes it’s hair or blood or nails.”

Additionally, they must notify their employer or school that they’re going through the program.

Generally, the treatment program lasts five years.

If the health professional has a job, they can continue to work while in the program, but there are restrictions on access to medications and other work conditions.

Although employment is a requirement for graduation from the program, Furman admits that once a health professional is diagnosed with a substance-abuse illness, it’s tough to find a new job in health care. The state’s program does not offer any assistance in job placement.

“Some health agencies won’t hire people who’ve had substance-abuse issues,” Furman said. “So, that’s tough. As part of the recovery, and self-esteem, you really have to work.”

Said Thorburn: “One of the reasons we want to do it with doctors and nurses is the societal investment in that individual. It’s a person with many, many years of training. If we can save that person in the profession and keep that person in the profession, that’s the goal.”