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Handling Stress
Memoirs of a Recovering Drug Addicted Nurse
Freedom for those trapped in drug abuse.
BY DEDE DWYER, RNC-E
Drug addiction? That could never happen to me!
I wish that were the truth. I’m a nurse, and I certainly never thought I was vulnerable.
Not all nurses will develop the disease of addiction. But for many nurses, addiction is real. Substance abuse in the nursing population is believed to parallel or be slightly higher than that in the general population: approximately 10%. And it very often begins with a legal prescription for a legitimate medical problem. That’s how it started for me, anyway.
A Migraine of Problems
When Stadol first came on the market (1991), it was not considered or marketed as a controlled substance, so I wasn’t concerned about my Stadol nasal spray prescription for the migraines I suffer. Two years after using Stadol as prescribed, I had major abdominal surgery. Three weeks following that surgery, I found out my abdominal wounds weren’t healing and my incision opened in four separate areas, exposing my abdominal wall.
The next two years were very difficult. In order to encourage healing of these deep wounds, I had to “heal by granulation.” I had to keep the wounds irritated, cleaning them with medicated soaps and rough gauze 2-3 times a day. My doctor prescribed Stadol nasal spray for my dressing changes; it still hurt, but the Stadol made it more tolerable.
No one knew Stadol was addictive and should be treated as a controlled substance. Stadol was usually ordered for short term pain relief in recovery rooms of hospitals, so it was considered perfect for my dressing changes. I wasn’t getting high on it. The drug just made the pain go away.
As I healed, I continued using Stadol for the dressing changes as prescribed; I’m not exactly sure when the physical pain actually ended and my fear of being in the pain began to drive my continued use.
The Drug Becomes Master
My abdominal healing took two years. During that time, Stadol slowly gained control of my life. Scientific research has found that actual chemical changes occur in the pleasure/reward area of the brain with repeated use of narcotics. This area is also responsible for human survival instincts. Pretty soon my brain was telling me: “Eat, sleep, take Stadol, drink water, take Stadol, hit the washroom, take Stadol.” I believed I truly needed it to survive.
You don’t really notice when the transition happens. However, when you haven’t taken the drug, you experience withdrawal symptoms, such as itching, diarrhea, intense muscle cramps, sweating, anxiety, or as in my case, shakes and nausea. Then you take the drug, and the pain goes away. After all, we’re taught, that’s what it’s there for, right? Nurses see instant relief—both physical and emotional--in their patients’ when pain medication is given.
Diversion Begins
When I was working in Labor and Delivery, the dose of Stadol required for our patients was half of what was available in the vial. This meant that we would have partial vials of Stadol leftover. As we rushed to clean up after a delivery, the vial(s) would end up in our pockets--and often the process of properly discarding them was overlooked.
One day after arriving home and having a headache, I found my nasal spray was empty. I had a vial of injectable Stadol in my pocket, and I wondered, If I put this in a nasal spray bottle, will it work? It didn’t. Because I’m diabetic I had syringes, and without thinking I injected myself intravenously; like many nurses, I was skilled in starting IVs.
During this time, I didn’t/couldn’t see anything wrong with taking the leftover vials from the hospital. I rationalized that I would have tossed them out otherwise, and it saved me a trip to the pharmacy.
One thing led to another. Eventually I was taking full vials home and injecting Stadol on a daily basis. When I was medicating a patient, I would often take out two bottles: one for them, and one for me. And as I later learned in treatment, my usage increased as my tolerance increased; soon I needed more and more.
Eye Opening Intervention
Desperate, I began to use a coworker’s code for the Pyxis system. The pharmacy started asking questions when they realized my coworker was signing out a lot of medication-- even when she wasn’t on duty and sometimes for patients no longer at the hospital but still in the system. Because of me, she was fully investigated; I can’t imagine how horrible that must have been for her. My drug use caused me to act and function outside my “normal” moral behavior: typical addict behavior.
Around this time I finally realized that I was really sick, that I had become addicted to Stadol. But where could I go? Who was going to help me? I felt an overwhelming amount of shame, guilt, and humiliation: I’m a nurse, I should know better. I’m supposed to be helping people.
Once I realized what was going on, I firmly believe the healthier part of my brain started making mistakes on purpose so I would get caught. During their investigation, state drug control agents installed surveillance cameras over each of the three Pyxis systems on our floor. Once they had enough evidence, I was confronted. I was physically ill when I saw the still shots from the video cameras. The day I was confronted was the worst and best day of my life; I no longer had to hide my illness, and I could stop lying, especially to myself.
I wasn’t thrown in prison. They didn’t take away my son. I wasn’t fired. But I did have to go before the State Board of Examiners for Nursing and my nursing license was disciplined. My probation lasted four-years, which certainly wasn’t a cake walk. During the first year I didn’t have access to narcotics, which required co-workers to medicate my patients. And during all four years, both my nurse manager and therapist had to submit monthly reports regarding my ability to practice safely. I also had to submit to weekly and then twice monthly urine drug screens and attend support group meetings.
Alternative to Discipline
Each state has its own disciplinary practices, often governed by the Department of Public Health or other licensing body. This type of disciplinary process is public and punitive. Can you imagine having heart disease and being punished in a public forum? There are only about four states that do not have an alternative-to-discipline program. I wish that an alternative-to-discipline program had been instilled in my state at the time of my intervention; that’s why I’ve been fighting for it publicly ever since.
An alternative-to-discipline program recognizes that drug addiction is a disease and an occupational hazard for nurses. It provides them an avenue for getting help while maintaining their integrity, dignity, and job status after rehabilitation.
You can self-refer yourself, or a facility or coworker can refer you. There are mechanisms within the program to address those referrals and get nurses out of practice and into treatment and recovery without impacting their confidentiality or their ability to practice safely once they are proven fit to work. It functions within a case management system; therefore, trained addiction specialists conduct all monitoring. The process begins immediately, without the Department of Public Health’s involvement.
And Now?
I’m not a bad person, and I wasn’t then. I used a drug prescribed to me that was unknown to be addictive. But it turned into a disease. Without knowing it, I was putting other people in jeopardy—mainly because I was afraid of what would happen if I looked for help.
I’ve been clean for ten years, and I continue to hold an active nursing license which has been unencumbered since 2001. My son is 14, knows his mom is in recovery, advocates for other nurses, and provides tremendous support. I went back to school and earned a DARC (Drug/Alcohol Recovery Counselor) degree in 2005.
I am very active in the recovering nurse community and am an advocate for all recovering individuals. I have helped co-author legislation for an alternative-to-discipline program for Connecticut nurses in the past; now that Connecticut has passed a law allowing such a program, I am involved in its development. I am also an active member of Nurses for Nurses--Connecticut’s peer support group for nurses.
Nurses suffering from addiction are no different from anyone else suffering with a chronic and progressive disease. Addiction doesn’t discriminate or care what you have or what your status is in society. They say it’s an equal opportunity disease.
So, if you find yourself or a friend in this situation, find out if your state has an alternative-to-discipline program – and use it. Also locate the nurse support groups available. Remember: You don’t have to do this alone. It doesn’t matter if you’re taking pills or injecting; addiction is addiction, and you need freedom from it.
All nurses work extremely hard to become a nurse, but what’s most important: your license or your life? The opportunity for a better life is there. Take it.
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November 21st, 2007 at 11:21 pm
Thank you for this article. I am an RN in Maine. I am going through basically the same thing right now. I go before the board on Dec 5th. Any advice? Also, do you know if maine has a program in place? Thank you so much. This article has helped me tremendously. I am grateful.
November 22nd, 2007 at 4:49 am
Discipline is difficult for anywhere in healthcare. I am not familiar with the alternatives-to-discipline processes but they seem very similar to the philosophy of putting drug addicted offenders in hospital rather than in prison.
As an employer: would you want to take that risk of having someone with a disease that has implications for the unit and the patients working for you? It may be discriminatory, but if it went wrong, it would also leave the employer in a predicament of having “allowed” it to happen.
For a nursing board I believe the contrary is more applicable, although they also require a meaure of ‘public safety’ in their decision making. Generally tho, I find that nursing boards/councils/bodies nurses try to look after nurses.
I work with many staff who find their anger levels increase because of the nature of the clients we work with (mentally disordered offenders many with anti-social personality traits). As a supervisor, I try to cut both these items into the same decision making process - ie recognise the causality of the job in affecting staff behaviour but also maintain a line that should not be crossed.
When behaviour becomes illegal, compromises patient care or impacts on the wider service, then there is imperative need to address the matter.
In this instance; theft of drugs for personal use is illegal and also impacts on the finances of the hospital or patient paying for them. The addictive nature of the substance makes a requirement for ongoing monitoring and for nursing boards to ensure the support to remediate the issue is available and taken. It did not seem to directly impact on patient care so I would be inclined to agree with the action of the board and employer to essentially understand the issue, but also draw a line on the tolerance that was afforded.
Nothwithstanding, I hope that the nurses’ changing attitudes towards people with drug addictions spills over into the understanding of patients who are just the same - and require support to effect change rather than the ‘discipline’ of prison life or being told to “go away’ and stop wasting the healthcare services time with your problems.
November 22nd, 2007 at 8:32 am
Heather-
First of all, take a deep breathe; everything will be ok. I’m so glad my article was helpful, I’m very glad you reached out, that’s a huge step.
I checked all my sources and Maine does not have an alternative to disciplne program as yet. I might suggest that when you go before the board, have legal council. Most nursing board actions are administrative in nature but you still have rights and should take advantage, not because you have anything to hide but to protect your best interest. Most important is that you be honest before the board, I would guess if Maine is like most states, you won’t be the first nurse before them with this disease and they usually know when folks are not honest.
If you can, put the emphasis on what you’ve done (hopefully you’ve gone to treatment and are in early recovery) since you were confronted (caught). If you’re allowed, bring copies of all documents that prove you have gone to treatment, are building a support network (support letters from sponsor, family, co-workers). Write a letter to the board expalaining what you know about why you became addicted and what you’ve learned from this experience. If you feel remorse say so, explain any shame & guilt you have, don’t whine, just the heartfelt facts. Let the board know you are human and hold your head up, if you had diabetes would you feel less than???
As difficult as this time is, getting into recovery offers you a chance to be healthy and live a more sane life. It isn’t easy to get past the shame and guilt, we all have it and it’s a process to move through it. You have been ill and need to manage this disease like any other, ill does not equal BAD. You can do it.
You will be in my thoughts and prayers
December 30th, 2007 at 4:30 pm
Hi,
I am in recovery and have been looking for the nurses for nurses number to call, so I may find a meeting to attend. I’m a Certified Surgical Tech with a few classes to go for my RN. I’ve been recovering for 6 months (with a relapse) and could use more help.
Thanks
December 30th, 2007 at 11:13 pm
aol39
Please email me directly (I will give the editor permission to send it to you) I can help you out if you live in CT. Most states have some type of peer recovery group for professionals in recovery. This type of information might be found on the state’s nursing board website or nurse’s association site.
February 6th, 2008 at 9:14 pm
Hi Heather,I am also from Maine. I surrendered my liecense almost 3 years ago, but admitted my guilt to the D.A. and received a felon. Do you live near Portland? There is a meeting for health care professionals at Mercy Hospital Wed. nights (in the basement, of course!)
February 10th, 2008 at 10:08 am
Kim-
It’s great to see other nurses in recovery reaching out. This is the behaviour that can only benefit our colleagues.
Thanks
February 21st, 2008 at 1:32 pm
Dear Dede,
It was great to stumble on your article. Thank you for writing this. I could use some advice on a family situation. My sister is a practicing LPN. She has become addicted to prescrition drugs, mainly oxycodone, oxycontin and zanax. She also mixes this with some drinking. Her life is a mess but she is holding on to her job. She was recently arrested for possessing paraphenalia in her car two straws and for DUI, though the breathalyzer did not register an alcohol level. She faces mis demeanor charges for both of these counts. It looks as if she can get out of this as they did not find any illegal drugs in her an dshe had a prescription for all the drugs she possessed. She lives far away from me. I did finally call her lawyer and he told me he is fed up with her as she has not been following through or paying him. He told me that he feels she is very addicted to drugs and that she is in rough shape. He said if I were you I would report her to the nursing board. I am not sure what to do. Her job is one of the last things she has left. She does not even have a home anymore. I realize she could be putting people in harms way and I do not know why I hesitate to report her. How willthey do anything if she has a prescription to these drugs? At the place she works do they not see that she is a bit messed up? I am assuming she limits the pills while she is at work but it still must affect her. What should I do? I know this is a family disease and I do not want to contribute and be co dependent and I want to do the right thing. What would you suggest? I will look into if the state she is in has a alternative to discipline. I will try on line to find that out. Please if you have any suggestions they would be so welcome. I just hope that my sister can find her way out of this like you did. She is in deep denial and I do not know how to affect that denial. Thank you very much. Lilly
March 30th, 2008 at 8:46 pm
nice article but in healthcare today, there is little to no compassion for nurses in a recovery program. My suggestion is to find another profession. I am tired of living life in a monitoring program to the point participants can’t even drink water, eat a cookie, or even go to the dentist with out first obtaing “permission” for the higher power!!!
May 15th, 2008 at 11:35 am
I too am a recovering addict who has been a nurse for 19 years. After 3 years of sobriety and thousand’s of meetings and a stiff 2 years of daily observation by TPAPN- I have slipped. The persecution that the law puts on you is nothing compared to the guilt and self loathing you feel. Your employer doesn’t want you on their staff- and no one wants to hire you with stipulations. This is a disease. No one says when I grow up I am going to be an addict. All my life I wanted to be a nurse. In rehab they teach the crack addicts to stay away from the crack houses- how do you teach nurses to stay away from prescription drugs? We touch them every day. I am thinking of leaving the profession all together. My addiction is to demerol- I can’t be around it, our my drug seeking patients that the doctor’s so freely dishes it out to. I love my profession and feel it’s a God given gift. But I am spiritually drained from my failure.
June 25th, 2008 at 4:54 pm
I am grateful for your story. I am an addict and in hiding. I don’t dare tell anyone about my problem because of the profession I’m in. I’ve never stolen medicine from work or anywhere like that, but I buy it illegally and use it and I’m very scared of getting caught. This didn’t start with nursing, I had a few problems when I was a teenager. I quit for a long time and started again after my divorce a few years ago. I don’t know how to talk to anyone or what to do. I don’t know how to quit either. One day seems like a million years without anything. How did you overcome that feeling of wanting to take something??
June 30th, 2008 at 9:23 pm
Manda
Recovery is a process - no one just falls into it,, just like no one just gets addicted.
I fully understand how afraid you’re feeling, that’s so normal and at the same time fear may be preventing you from getting the help you need.
If you are using and working as a nurse, you are placing your patients in jeopardy - it may not seem like it BUT if you’re using your judgement is most likely impaired.
Take a leave of abcense and enter treatment - be proactive to take care of yourself ASAP. You need to stop working so your patients are protected.
I know it’s difficult but it’s far better for you to get help before you hurt someone,,,,or die.
I have asked the site to give you my email address in case you want to talk more.
Manda - you don’t have to do this alone, there is help and support available.
dede
July 7th, 2008 at 9:53 pm
I was so inspired by your article. I am an RN in MD. I obtained my license in PA. I was a Nurse for 8 years when my husband of 21 years and I moved to WVA and built a dream house. I never even took a Tylenol from a patients med drawer. After 1 year of living there, he wanted to move back to PA. I was confused. My youngest daughter moved to WVA to be close to us while living on College campus and everything was going so good. After months of hounding me, I conceded and agreed to move back to PA. We had a week between house settlements and took our 2 daughters to OBX. The second day there, I found out my husband was having an affair (not the first time). I was devestated. I left him (as I had threatened to do if this ever happened again). In one swift blow, my family broke up, my daughters were unconsolable, and I literally think I lost my mind. That was 8/5/05. I went back to working in PA at the hospital I left. My best friend called me one night, and we fought over my choice to leave my husband. I was in so much physical, emotional and mental anquish, I did it. I took narcotics and injected. It was like I was on the outside looking in. I wasn’t good at it, because I soon got caught. I enrolled in the PA drug program and kept my license. However, I went back to WVA 3 days a week, without telling them about PA, and was working. I started injecting there. My life was hell. I soon got caught again. I was living in Baltimore with my parents at the time. WVA suspended my license and I then let them expire because I knew I wouldn’t be using it there again. I then got a job in MD because I did not have any marks on my PA license because I was active in their program. I worked 8 months without using,…then my divorse papers came. I starting using again and again got caught. That was July 2007. I haven’t worked for a year. The Nursing board finally caught up with me. I have to go before the board soon…I am embarrassed and humiliated. But, I want to keep my license. I have been clean for a year, but not in a program. Im not sure what to do. I called the Board of Nursing and left a message for the Substance Abuse person to call me back, and she never did. Where do I go from here? Should I obtain a Lawyer to take with me? I need help. Any advice would be greatly appreciated.
Thank You
Catherine
July 7th, 2008 at 11:12 pm
Catherine
I’m glad you wrote, you have been through so much.
Our disease of addiction makes us act outside our moral selves and even though we try to stop we can’t without help.
You don’t mention going to treatment, that’s where our new lives can really begin. We need education related to what has happened us, our bodies, our brains. We need the help of professionals because most of us are ignorant about addiction.
In an attempt to make everything right for everyone else we lose sight of our own needs and make bad choices that we can’t control. Begin with the first step of entering treatment - if your board action comes up while you’re in treatment ask for a continuance, perhaps you need the advise of a lawyer if you were in CT I’d say absolutely.
Embarrassment, humiliation and shame are so normal and thankfully temporary - this is a process not an event - so do the next right thing and hold your head up, you have a disease and you need to manage it with the help of professionals - would you hang your head in shame if your disease was diabetes???? No one will ever judge us harder than we judge ourselves.
I have asked the site to give you my personal email in the event you want to ‘talk’ more.
Email me
dede
July 9th, 2008 at 3:07 pm
Hello. I am not an RN. I am asking this question in regard to my niece, who is an RN. I found out something by accident while surfing the web. I have known for some time that my niece is a recreational pot user. I do not approve, but she is an adult and has to make her own choices, right or wrong. I found out that she tested positve during a random drug screen at the hospital she is working in. I am heart sick. I feel like slapping her and hugging her at the same time. She is living in another state but would like to come back to her home town some day. She is such a good nurse! I had the oppurtunity to see her work as she flew home during the holidays to give hospice care to a family member. Does this disiplainary action mean she will not be able to get her license back in her home state? Thanks