Let’s face it; no one wants to think about a surgeon in a hospital who is questioning their own decisions and ability while providing your care. It’s an uncomfortable thought to imagine an anesthesiologist responsible for keeping you alive who won’t pay attention to your vitals and commit to calculating necessary adjustments in dosing. How about a pharmacist who is more concerned with getting yelled at by a physician than speaking out when they’ve caught a medication error in the prescription? We need each of these professionals to be a little “Type A” and have a bit of a “Superiority Self-Concept” to be good at what they do. Confidence is paramount to them being effective and their absolute best. None-the-less, each of these can create a sense of anxiety and fear among the patient who is in the care of these providers in a hospital setting. The National Institute of Health says that 1 in 10 doctors struggles with an addiction disorder1. My intent with this article is to open your eyes towards the internal struggle of maintaining a career with such extreme expectation and high risk of catastrophic events while be surrounded by legal opiates.
I was a therapist for medical professionals
Before entering the recovery industry, I was in private practice as the sole provider of mental and behavioral health services to a hospital network of more than 2600 employees. More than 75% of my clientele were direct patient care providers (physicians, nurses, pharmacists, etc.) in hospitals and clinics. I primarily worked with these individuals through counseling and therapeutic interventions. At times they were referred to me due to being caught or suspected of stealing and abusing prescription medication while at work. What I learned during this time was insight and empathy for the toll the addiction and psychological needs would have on their lives as a whole. For the remainder of this article, I would like to focus on one health professionals struggle with opiate addiction. Let’s just call him Vincent (not his real name). It will be most effective if we focus on a few areas that Vincent struggled with: stigma, accessibility, and justification.
No one sets out to develop an addiction
We’ve all known doctors with a god-like view of their knowledge and abilities. As a medical professional, Vincent was no different. However, like many people, Vincent lived with physical pain due to an injury and was legally prescribed prescription narcotics to maintain the pain. Mental and emotional pain can be equally as debilitating to a physician who is likely to quietly self-medicate as well. Vincent’s body (like anyone’s) was just as capable of building tolerance and dependence on opioids during this time. Chronic issues of pain flair-ups lead to his continual use of low dose opiates to manage the discomfort before it became a debilitating pain.
Medicating for pain soon became an addiction to opiates
Over time, the low dose was not as effective, increases in usage began, and a tolerance developed. Vincent couldn’t accept that his use of opiates had taken control and was beyond his power. This meant admitting that he was not in control of his health. How could he take care of others and fix their health if he couldn’t manage his own? How would his family see him? What would the hospital or his partners think of him professionally? What would the community do to him once they found out? This became very problematic to his sense of self and disruptive to his view of career and life success.
The stigma of opioid addiction
Doctors are expected to be healthy, stable and in control, if they are to be able to take care of our needs. The fear of public knowledge and punitive actions drive a professional to hide and justify all actions to protect their career and their family’s livelihood. It becomes a spiraling issue and self-feeding beast.
Accessibility
Very few addicts have a career that requires them to daily handle their drug of choice. In healthcare, however, professionals are expected to maintain the highest level of function without reservation. The beast of opiate addiction does not care that Vincent’s job requires him to handle controlled drugs for his patients. Again, no other addict is required by their career to work with their drug of choice in a legally licensed career as is a surgeon, pharmacist, anesthesiologist or med nurse. Imagine the struggle of knowing the person you are providing care for needs the drug you are handling for them but craving it for yourself.
Justification
Now consider the skill set that Vincent, like most all addicts, has developed and the ability to justify his actions. If a nurse, physician, anesthesiologist, pharmacist (or any other healthcare provider with access to prescription meds) is responsible for discarding or “wasting” the remaining dose or prescription in a hospital setting; it could easily be justified (completely irrationally of course) that the drug has already been paid for and is going to be flushed or destroyed. What does it matter if Vincent uses it for his own “pain?” Seem unreasonable that this would happen much? Every surgery has pain medications dosed out in locked containers for procedures. When an injection is drawn for the narcotic and dosed in increments into an IV, there will likely be leftover medication in the syringe post-operatively. This syringe and its contents are to be returned to the pharmacy or in some cases would be flushed into a drain or placed in a sharps container. For Vincent to inject it into his own body and then refill the syringe with saline or some other solution becomes an unfortunately common practice. However, the pharmacy can test the contents of the syringe and make certain that it is in fact, the remaining prescription and not a filler. This justification and means for stealing a drug that has already been paid for and would be wasted is an unfortunate but common occurrence for addicts working in healthcare. It should also be noted Vincent justified his use of these prescription drugs rather than feeding his addiction with street drugs. His mind told him this is healthier as the dosing is accurate and the product cleaner than elicit or street-acquired opioids.
The difficulty for a doctor addicted to drugs of asking for help
I feel it necessary to reiterate that healthcare providers (like Vincent or so many others) live under a stigma that unfortunately does NOT allow many to experience grace or the freedom to come straight out and seek help. These individuals did not wake up one day and make the decision, “I think I will start using illegally acquired pain medication today, become an addict, and risk my health as well as my family, friends, career and, well-being.” They’re tempted and threatened by the beast of their addiction to opiates on a weekly and often daily basis while at work as they handle these prescriptions for the very people they are there to heal. The justification is unfortunately simple due to the access and necessity of these medications for their career. Asking for help can put their job at risk. Telling your friends and family can be difficult as society expects medical professionals to give help, not need help. Yet they must ask for help to protect their health and their careers.
Getting the help they need
Fortunately, there are addiction professionals that are specifically trained to work with health professionals who are suffering from addiction disorders. Many states have programs that protect doctors’ privacy and allow them to remain licensed if they complete treatment and stay in recovery. Treatment programs do exist that deal with the specific issues pertinent to a doctor addicted to drugs or alcohol. Love first and intervene with grace. All addicts can recover and live prosperous lives. References: 1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704134/