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.
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.
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.