| FYI |
| https://www.drugabuse.gov/ |
| Search stimulants |
Many stimulants like cocaine, amphetamines, and methamphetamines increase alertness, attention, and energy. Amphetamine, a synthetic compound, can be used legally for weight loss as an appetite suppressant and occasionally for ADHD. They can also be diverted for illegal use. For more information, see the course Methamphetamine Use: What You Need to Know.
Cocaine (coke, blow) is derived from a plant. It can be snorted up the nose or mixed with water for injection use. It can also be heated and smoked in a glass pipe. Cocaine can give a person energy and make a user restless, scared, and/or even angry. Stimulants can also increase your blood pressure and heart rate. Mood changes from happy and excited to crashing and being sad and/or tired can occur when the drug wears off.
Common signs of stimulant use disorder include:
Pain Medication
| FYI |
| https://www.drugabuse.gov/ |
| Search opioid use disorder |
There are several opioids: Morphine, OxyContin, Percocet, Vicodin, Hydrocodone, Oxycodone, which are often prescribed for pain relief and are sold illegally, heroin being commonly available on the black market.
Opioids give you a rush of good feelings, make you sleepy. Addiction is common when used for recreational use.
It is estimated 1.9 million people had an opioid use disorder related to prescription pain medications in 2014. Another estimated 586,000 people had an opioid use disorder using heroin.
Substance abuse among nurses was first documented in the 1980s. Luurila et al (2022) report the use by nurses to range from 5% to 20%. Besides the effect on the individual nurse, use of pains medications and other controlled substance can jeopardize patient care and outcomes.
Risk factors for nurses substance abuse include the following:
According to Salani (2022) the following areas have some of the highest misuse of prescription drugs by nurses:
| FYI |
| https://www.drugabuse.gov/ |
| CDC Opioid guidelines |
On March 18, 2016, the CDC published new guidelines for prescribing opioids for chronic pain in the US. Opioid prescriptions should be carried out for cancer pain symptoms and palliative/hospice care patients but limited for patients with chronic pain. According to the CDC, there is an alarming increase in prescription opioids for patients with chronic pain (Becker et al., 2008). While no patients should receive less than adequate pain control, long-term use of opioids, considered to be more than 3 months, increases the risk of addiction, which carries a 1 in 32 death rates from overdoses. Opioids have also been referred to as gateway drugs to heroin use (Dasgupta et al., 2014; Compton et al., 2016).
Symptoms of opioid use disorders include the following:
Subjective effects of opioids |
|
Phase |
Description |
Rush |
Initial rapid onset of euphoria (intravenous) |
High |
Perception of joy and ease (ingestion) |
Nod |
Sedation |
Straight |
The period between craving, pleasant feelings |
Withdrawal |
Irritability, restlessness, dysphoria |
Most nurses using opioids may have difficulty admitting they have a problem. Initially, they often believed that the use of opioids is temporary, justified and that they have everything under control. Regardless of the type of substance, it is helpful to be aware of signs to look for that might suggest a SUD
According to Salani (2022) the American Association of Nurse Anesthesiology, the National Council of State Boards of Nursing, the Drug Enforcement Administration, and the state of Florida have all independently called on nurses to act on suspicions of impairment in their colleagues and have identified the following behaviors and visible signs an impaired nurse may exhibit the following:
Other issues that might indicate impairment include the following:
Signs of drug diversion include the following:
Nurses’ stories
One afternoon when I was interviewing a patient in an ICU after she was recovering from an unconscious state, she commented about her pain medication. She noticed that when one particular nurse was on duty, her pain medication did not seem to relieve her pain. That happened only when this particular nurse was on duty. She also asked me not to say anything to this nurse because she did not want to get into trouble with the staff.
In the writings about signs and symptoms of drug diversion by nurses there is not much written about patients being afraid to report the incidences of low or no pain relief. It is important to recognize that patients feel vulnerable. They need to be reassured and protected from any negative actions by staff.
Another nurses story
D.K. was a nurse working in an ED in a Boston hospital when he became addicted to opioids. Initially, his use of opioids helped him cope with stress at home and work. His early sources of opioids were from diversion of leftover ‘waste’ narcotics. Eventually that supply wasn’t sufficient, so he got another nurse’s password using her credentials to sign out medications.
D.K. went from infrequent use to injecting morphine into his leg every few days to help him cope with long days. His use then became a dose every morning, then the middle of his shift, getting medications wherever possible. He was soon found out. He was terminated from his position and entered the five-year Substance Abuse Rehabilitation Program (SARP) for nurses in Massachusetts. After completing that program, D.K. was allowed to maintain his nursing license. Instead, he chose to talk about his experiences and advocate for more outreach for nurses who suffer from addiction and divert drugs (Brigham Bulletin, 2020)
Instant Feedback:
Which of the following are signs of drug diversion?
References
Becker, et al. (2008). Non-medical use, abuse and dependence on prescription opioids among U.S. adults: psychiatric, medical and substance use correlates. Drug Alcohol Depend. 94, 38-47. Brigham Bulletin. (2020. It Can Happen to Anyone:' Nurse Shares Story of Opioid Addiction. https://give.brighamandwomens.org/opioid-addiction/.
Brummond, P.W. et al. (2017). ASHP Guidelines on Preventing Diversion of Controlled Substances. American Journal of Health-System Pharmacy 74 (5), 325-348.
Centers for Disease Control and Prevention (CDC). (2022, September 6). Illicit Drug Use. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/drug-useillicit.htm
Compton, W. M., Jones, C. & Baldwin, G. (2016). Relationship between nonmedical prescription-opioid use and Heroin use. N Engl J Med, 374, 154-163.
Dasgupta, N., Creppage, K., Austin, A., Ringwalt, C., Sanford, C. & Proescholdbell, S.K. (2014). Observed transition from opioid analgesic deaths toward heroin. Drug Alcohol Depend. 145, 238-41.
Luurila, K., Kangasniemi, M. & Häggman-Laitila, A. (2022). An Integrative Review of Programs for Managing Nurses' Substance Use Disorder in the Workplace. J Addict Nurs. 33(4), 280-298.
Salani, D., Goldin, D., Valdes, B., & McKay, M. (2022). The impaired nurse. AJN, American Journal of Nursing, 122(10), 32-40.
©RnCeus.com