The opioid crisis hits hospitals and healthcare professionals the hardest

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For all the news coverage the opioid crisis has garnered over the past year, one of the most prevalent sources and at-risk groups has been significantly overlooked.

As unlikely as it sounds, the evidence suggests hospitals and healthcare professionals might be the places and people most at risk of opioid abuse and addiction.

On the surface, hospitals may seem like one of the safe havens against opioid abuse. After all, hospitals are places of healing, and no one understands the hazards of opioid abuse better than doctors, nurses and other medical professionals. But the statistics on substance abuse for healthcare professionals tell a different story: while eight to ten percent of the general population has problems with substance abuse, that number rises to an estimated ten to fifteen percent for healthcare professionals.

It may seem strange to think of healthcare professionals being more likely to abuse opioids than the general population, but this is true for the same reason that financial professionals are more likely to embezzle money than a food service professional might be — they have access, expertise, and a host of stressors that invite maladaptive responses.

When prescription drugs are diverted from their intended use and used in any other way, we call it drug diversion. It happens in a myriad of ways: pharmacists improperly filling prescriptions, anesthesiologists saving leftover sedatives or nurses retrieving unused painkillers from insufficient disposal systems.

Hospitals, more than any other facilities, store vast amounts of drugs with equally vast amounts of people accessing them. Healthcare professionals have these drugs in their hands nearly every day, something the rest of the population rarely does.

Healthcare professionals also posses unique expertise in how to administer drugs, so they can self-administer without involving another person who might report them. They are also more likely than the average person to be able to use​ ​dosing techniques that mask the cognitive effects of a particular medication and delay unwanted scrutiny of their behavior.

While healthcare professionals may have more knowledge about the dangers of opioid addiction, they are equally at risk as anyone else: They have stressful careers, prescriptions for painkillers after surgeries and significant life events that may cause a turn to substance abuse. When the abuse gets to the point of addiction for healthcare professionals, they not only have the accessibility to acquire the drugs, but because of loose accountability regulations and often inadequate systems, they also have the means.

Worse yet, when they find themselves struggling with substance use disorder, the perceived professional ramifications of seeking help deters their coming forward. This hush-hush climate incentivizes many healthcare professionals to try and beat the disease on their own — and their intimate knowledge of the drugs and its regulations allows them to acquire and hide the substance abuse better than anyone. Furthermore, employers oftentimes quietly and hastily address the issue in the interest of avoiding the publicity of staffing professionals known to be recovering addicts.

From my own career, I’ve seen firsthand the lengths to which healthcare professionals will go to divert drugs and to hide their addiction. When they don’t get help, the substance abuse only comes to light after a devastating and potentially life-threatening event. To make matters worse, healthcare professionals are not the only ones at risk. So too are patients receiving care from impaired providers.

With between ten and fifteen percent of healthcare professionals struggling with substance abuse, it’s reasonable to expect that drug diversion occurs at nearly every major medical facility across the country. The fact that this sounds so alarming illustrates just how little drug diversion is talked about. By avoiding the issue, we create an elephant-in-the-room climate for healthcare professionals to come forward and get the help they need and further perpetuate a system desperately in need of better regulations and controls. It’s time that we begin addressing it.

Medical facilities need more comprehensive policies and systems that increase accountability and prevent drug diversion — that is, policies that keep the proper drugs going to the patients and products that render leftover drugs non-retrievable. Furthermore, hospitals need better procedures for identifying drug diversion in their facilities and more sufficient solutions for helping their employees struggling with substance abuse pursue proper treatment.

Since the ways that drugs are diverted from their intended uses are always changing, there aren’t any simple solutions and any strategy must be flexible and include both prevention and treatment. But for this issue, the first part of the prescription is proper diagnosis: we need to take care of the workforce who are the caretakers of our country.

Rodrigo Garcia is a Certified Registered Nurse Anesthetist and is the CEO of Parkdale Center for Professionals, a dual diagnosis addiction treatment facility. He is also the Director of Parkdale Solutions, a program designed to assist health care facilities in managing diversion and the impaired provider.

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