SUBSTANCE USE AND DRUG DIVERSION
Drug misuse typically refers to prescription drugs and is defined as using them for a purpose other than for which they were prescribed. Examples include taking higher doses than prescribed, taking longer than prescribed, using drugs for purposes other than prescribed, using drugs in conjunction with other medications that affect CNS or alcohol, and skipping doses or hoarding drugs. Drug diversion is defined as “any criminal act or deviation that removes a prescription drug from its intended path from the manufacturer to the patient,” including everything from outright theft of the drug to doctor shopping, prescription forging, manufacture or sales of counterfeit drugs, and international smuggling (CSTE, 2019). Diversion can occur at any point— from the manufacturer’s distribution to the wholesalers to pharmacies and, in turn, to the patient. However, some drugs are more targeted than others: (1) anti-anxiety medications and sedatives, including benzodiazepines; (2) prescription pain medications, including opioids; (3) stimulants, including those used to treat attention deficit disorder and narcolepsy; (4) sleep aids; and (5) anesthetics, such as propofol. Healthcare providers can divert medications through false documentation, scavenging wasted medications, and theft by tampering (CSTE, 2019). Behavioral changes include subtle changes in appearance, increasing isolation from colleagues, inappropriate verbal/emotional responses, and diminished alertness, confusion, or memory lapses (NCSBN, 2018). Many healthcare workers with substance use disorders are unidentified, unreported, and untreated. These individuals continue to practice where the impairment is endangering the lives of others (NCSBN, 2018). Healthcare Consideration: Misuse and abuse are distinct from medication mismanagement problems such as forgetting to take medications and confusion or lack of understanding about proper use. Medication mismanagement problems can also have serious consequences for patients, but they have different risk factors and typically require different types of interventions (SAMHSA, 2018). The impact of substance use disorder is costly not only to the healthcare worker but also to families, colleagues, and the organizations for which they work. The cost can be measured in the potential loss of jobs, loss of income, and damage to health, resulting in increased medical expenses. Substance abuse also compromises interpersonal relationships with family members and friends and professional relationships with colleagues and employers. The interpersonal cost may be evaluated regarding divorce, termination of interpersonal relationships, compromised professional collaborations, and/or loss of emotional support systems. Loss of job productivity is common among those with addictions (DrugAbuse, 2019). The effects of SUD on interpersonal relationships can be devastating. There are a number of signs that show how substance use is harming interpersonal relationships. Most relationships will not show all of the signs. However, even one of the following signs indicates that the person using drugs and/or alcohol needs help. Many arguments about substance use or issues relating to SUD (e.g., financial problems, failure to fulfill responsibilities at home) are occurring. Loved ones find themselves “covering” for someone abusing substances, such Economic impact SUD is costly for society with billions of dollars in lost work productivity, drug law enforcement, and healthcare expenses. Research shows that excessive alcohol intake costs the United States about $223 billion annually in healthcare expenses, law enforcement costs, and lost productivity (DrugAbuse.com, 2019). SUD can have a significant negative impact on society and is closely linked to poverty. Paying for an addictive substance can be expensive, regardless of the substance being used. For example, a $5 six-pack of beer consumed everyday costs
as reporting to an employer that the person using the substance is sick and cannot come to work. The substance user says they drink or use drugs to reduce stress related to arguments about substance use. Loved ones begin to consume alcohol and/or use drugs because they believe that such activities are the only ones, they can do with the person who is abusing the substance. The person with SUD begins to display violent behavior toward loved ones under the influence of drugs and/or alcohol. The person with SUD and loved ones must be drunk or high to show affection toward each other. People with SUD and loved ones avoid encounters with other friends or family members to hide the substance use problem. The effects of SUD can seriously compromise safety culture. Nurses dealing with SUD cannot provide safe and appropriate patient care if their ability to function is impaired. Healthcare organizations have an obligation to make sure that effective systems and processes are in place to prevent drug diversion and to protect patients from the safety threats that may occur as a result of impaired nurses. It is essential to maintain a drug and alcohol-free working environment. Equitable policies and procedures must be applied across the organization: ● Defining impaired work performance, how to recognize it, the consequences of working in an impaired state, the consequences of failing to report impaired colleagues, and interventions to help the impaired person recover. ● Educating all employees regarding policies and procedures and how to implement such policies and procedures correctly. ● Establishing policies and procedures that provide safeguards regarding confidentiality; it is imperative that nurses and other employees believe that they can communicate their concerns without fear of retaliation. ● Providing continuing education programs that deal with the topic of impairment and SUD. ● Establishing mandates that all employees attend continuing education programs that deal with the topic of substance use disorder; such education must be appropriate for the employees’ education, training, and roles that they fulfill. ● Explaining the resources available to help nurses and other employees who are dealing with SUD obtain the help that they need to recover. (NCSBN, 2018) There are a number of reasons nurses do not report colleagues suspected of SUD. These include the following: ● Fear that the colleagues will lose their jobs if they are reported. ● Lack of explicit policies and procedures that address SUD, impairment, addiction, and reporting of such issues. ● A work environment that lacks compassion and willingness to help impaired nurses recover. (NCSBN, 2018a, 2018b) In addition to protecting patients, employers have ethical and legal obligations to help nurses and other employees whose functioning is impaired due to substance use. State boards of nursing often have assistance programs designed to protect patients and save the lives and careers of those who are dealing with substance use disorder. Nurses must review the options offered by their respective state board of nursing. In general, these programs are designed to be confidential, nonpunitive, and therapeutic. $150 per month. That’s about $1,000 in six months. Persons using more expensive drugs such as cocaine may spend more than $10,000 annually to support their SUD and addiction (DrugAbuse.com, 2019). SUD is most expensive for vulnerable individuals. Research shows that a pack of cigarettes per day can cost 10% of their family’s monthly income (DrugAbuse.com, 2019).
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Book Code: DFL3024
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