Transcript Chemical Abuse and Dependency in Nursing

Amy Tardy PhD
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Case Manger MPHP Maine Medical Association
Medical Professionals Monitor and Advocate
Certified Trainer for CPI Non-Violent Crisis Intervention
Educator & Instructor, University of Phoenix
Human Resources educator, trainer and presenter
Program Director numerous Non-Profit Maine
agencies
*Dr. Tardy is not connected with any
commercial interests nor received financial
gain or compensation for the development,
production and distribution for this educational
power point presentation.
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Gain an understanding of addiction and its
prevalence in the medical professional
population
Understand signs and symptoms of impairment
Understand the law related to substance use
by the medical professional and related board
actions
Gain an understanding of MPHP’s relationship
with the licensing boards, including protocols
and consent agreements
Learn about replacement medications and
their role in treating addiction
Addiction is a primary, chronic disease of brain
reward, motivation, memory and related circuitry.
Dysfunction in these circuits leads to characteristic
biological, psychological, social and spiritual
manifestations. This is reflected in an individual
pathologically pursuing reward and/or relief by
substance use and other behaviors.
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Approximately 45% of Americans know someone with
a substance use problem
In 2011, 6.3% of adults ages 26 and older used illicit
drugs- with the majority of this represented by adults
who used prescription-pain psychotherapies for
nonmedical purposes
54.2% of these people report they got it “for free”
from friends or family, and 18.1% reported they got it
from their doctor. The remaining population got it
from a friend/dealer or off the internet.
Males had a higher tendency to use illicit drugs;
females more likely to abuse prescription
medications.
› The U.S. is the worlds largest consumer of painkillers.
Use of opioids is the #2 cause of accidental death in the United
States. In 2009, there were 15,500 deaths that resulted
 More then 50% of the US population was considered “regular
drinkers”
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22.6% were considered “binge drinkers” at 5 or more drinks at a time, during at least 1 day of the
past 30 days. This translates to 58.3 million people ages 12 and older
Relapse rates from addiction (40 to 60%) can be compared to those suffering
from other chronic illnesses such as Type I diabetes (30 - 50%), Hypertension
(50-70%) and asthma (50 to 70%). Drug addiction should be treated like any
other chronic illness, with relapse indicating the need for renewed
intervention.
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The Lifetime prevalence of physicians
who will develop a substance use
disorder during their careers is unknown,
but estimates range from 5-15%. Best
estimate is about 8%
› Alcohol remains a drug of choice for the
majority of physicians. Up to 18% of 2nd year
medical students in one study met criteria for
alcohol abuse
› It appears that heavy drinking decreases
with age in the general population, but
increases with age in physicians
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It is estimated that approximately 11-15% of
pharmacists are confronted with alcohol/drug
dependency problems at some time in their career
› It is estimated that 46% of pharmacists have used drugs off
prescription. 62% of pharmacy students have done the
same
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In contrast, between 10-20% of nurses in the United
States have substance abuse, misuse, and/or
dependency problems.
It is estimated that approximately 14% of veterinarians
and vet techs are confronted with alcohol/drug
dependency problems at some time in their career
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The drug of choice for veterinarians: analgesics
(painkillers), sedatives/tranquilizers
The drug of choice for pharmacists: seems to be
narcotics such as Vicodin, oxycodone, and
hydrocodone. Very high rates of alcohol use.
Drug of choice for nurses: opiates such as fentanyl,
morphine, Percocet; narcotics such as Vicodin and
hydrocodone.
Anesthesiologists or CRNA’s: major opioids, IV
morphine, fentanyl, meperidine
Psychiatrists: benzodiazepines
Family Practice Physicians: opioids—codeine,
oxycodone, hydrocodone and other oral
medications
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The level of importance that is placed on work
by those in the health professions is often very
high.
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High Stress, busy practice
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Maintaining access to the drug of choice may
provide an incentive to stay on the job
› As a result, social, financial and interpersonal decay
often occur before the addiction interferes with the
job.
› Families, partners, and friends are much more likely to
have been impacted by the effects of addiction
long before it is noticed at work and they are more
likely to be reluctant to confront
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Uncontrollable craving
Secrecy
Excessive amount of money spend on
obtaining a particular substance
Weight loss
Nausea
Headache
Paranoia
Confusion
Glazed/ red eyes
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Persistent cough
Excessive energy/ fast speech
Anxiety
Mood swings
Social isolation
Poor work performance
Neglect of family responsibilities
Neglect of personal hygiene
Insomnia
Personality changes
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The list of complications that have been mentioned
in various sources for Chemical addiction includes:
Depression
Excessive Anger
Relationship and Social problems
Work problems
Physical health concerns (Drug abuse can put people at
risk for high blood pressure, diabetes, heart disease, liver
disease, cancer, depression, cardiovascular disease and
other health problems. Premature aging)
› Permanent impairment to neurological functioning
› Potential for overdose
› Death
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Therapy
› Identification of trigger mechanisms
› Development of non-chemical coping mechanisms
› Achieving balance by changing priorities
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Psychiatry and/or addictionology
Attendance in 12-step meetings (AA/NA/Al Anon)
Participation in Caduceus
Strong support system in the workplace
Professional Monitoring
medication management and pain management
contracts (if applicable)
Understanding and acceptance of disease concept
Family involvement
A full professional evaluation with a treatment plan
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Replacement therapy may be used in the treatment
of drug or alcohol addiction.
› Those commonly used: Methadone (for opiate addiction),
Suboxone (for opiate addiction), Naltrexone (for opiate
and alcohol addictions) Vivitrol (once a month injectable
for opiate and alcohol addictions),
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Problems with replacement drugs? Highly successful
but also addictive. Therefore, use must be carefully
monitored
Use of replacement medications should not be lifelong. Instead, they should be used for immediate
assistance with cravings, combined with therapy,
and tapered as soon as clinically indicated.
Talk to them or a supervisor- depends
how well you know/how closely you work
with the person
 Report to the Medical Professionals
Health Program
 Report to the Board of Licensure
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It is much more difficult to quit without
professional help. The majority of
individuals who try, fail.
 relapse usually occurs within the first 3
years
 Make the appropriate connections and
have a treatment team surrounding the
person and offering guidance to reduce
risk of relapse
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The Medical Professionals Health Program
assists medical professionals in developing
strategies for treatment, helping them return
to successful professional careers. The
MPHP does not make diagnoses or
provide treatment. The MPHP clinical
staff and committee members act as
advocates for their impaired colleagues,
providing compassionate, comprehensive
and confidential assistance.
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Who can make a referral?
Self- usually occurs earlier in illness so treatment is more
effective
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Friends and family
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Colleague or practice partner
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Employer
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Board or licensing agency- occurs later in disease after it
has affected social and/or work life
Nationally recognized PHPs are 75-90%
successful in preventing relapse
 Demonstrate to employers that you are
safe to practice (comfort)
 Establish a record to get back a
suspended license
 Required by a Board as a condition of
licensure
 Advocate with the licensing board
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What happens after referral?
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Initial intake interview, screening and initial
contract development.
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When indicated, a comprehensive
psychological evaluation will be conducted
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Determination of treatment needs and/or
eligibility to be part of the program
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What does monitoring entail? The MPHP
generally offers a 5 year monitoring contract (case manager will consider
many factors of the illness- such as symptomology and years in recoverybefore setting contract length)
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Monthly Self Reports
AA and Caduceus (or approved alternative such as SMART recovery) selfhelp group attendance
Worksite monitor reports
Treatment provider reports - therapist, addictionist, psychiatrist, chronic
pain specialist, primary care physician
Medication reports
Daily call-ins for selections
Random toxicology testing
April 5, 2013- MPHP held the first annual
Health and Wellness conference for
physicians; conference coming up on
April 17, 2015 in Portland
 Developed a web-based mentorship
training curriculum
 Mentorship program
 Community education and outreach
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“I reflected on what gifts MPHP has brought to
me: Caduceus and the friendships I have built
there; integration of my identity as a physician
and as a person in recovery; recognition that I
had shame about having addiction, and the
ability to transform shame into neutral
acceptance of having the disease of
addiction”
“Sobriety has let me forgive and go easier on
myself. Now I can be easier on others. I am
grateful to be asked to work rather then asked
not to work. My sobriety isn’t just about me, it
has affected everyone around me”
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Law: Diagnosable substance use may be
grounds to deny a pharmacy license, refuse to
renew a license, or impose other disciplinary
conditions
› Example of Unprofessional Conduct (Pharmacy rule):
“Being unable to practice pharmacy with
reasonable skill and safety by reason of illness, use of
drugs, narcotics, chemicals, or any other type of
material, or as a result of any mental or physical
condition. A pharmacist affected under this
subsection shall at reasonable intervals be afforded
an opportunity to demonstrate that the pharmacist
can resume the competent practice of pharmacy
with reasonable skill and safety to patients.”
› Applies even when patient harm has not occurred
Consent agreements are documents
that may be issued to a professional who
the board would not otherwise license.
 Consent agreements impose restrictions
upon the professional license. Each
licensing board has different “standards”
for their consent agreements.
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Example 1:
____________shall completely abstain from the ingestion of alcohol.
 ____________shall comply with the terms of her January 6,2012
contract with the Maine Medical Professional Health Program which
she shall forward forthwith to the Board with any future
amendments.
 ____________shall work as a pharmacist no more than 40 hours per
week. She shall immediately inform Kelly McLaughlin, Senior
Consumer Assistant Specialist of any employment as a pharmacist
during the duration of the MMPHP contract. Ms. Davis may petition
the Board in person to change this restriction which shall remain in
effect until at least January 1,2014.
 ___________and her employer shall both report any misfills in writing
to the Board. Ms. Davis and/or her employer may petition the Board
in person to change this restriction which shall remain in effect until
at least January 1, 2014.
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Example 2:
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2011·PHA~7823
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______________admits that she should have disclosed the convictions and acknowledges that her conduct
could be found by the Board to constitute grounds for disciplining her pursuant to 10 M.R.S. § 8003(5A)(A)(I). In re: __________ Consent Agreement
As discipline for the conduct in paragraph 3, __________agrees to pay a fine in the amount of five hundred
dollars ($500.00).
The Board grants ________ her Certification of Administration of Drugs and Immunizations and the renewal
of her license to practice pharmacy. As conditions of licensure, _______, agrees to the following, which
shall remain in effect for a period of five (5) years unless otherwise an1ended by the Board:
Maintain her contract with the MMPHP; however, after two years, ________ may request that the Board
amend this Consent Agreement. The Board, acting in good faith, shall have sole discretion to amend the
Consent Agreement to reduce the length of the Agreement.
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Follow all recommendations of the MMPHP.
This Consent Agreement shall resolve finally any complaints or matters for failure to disclose information to the
Board.
Violation of any of the terms or conditions of this Consent Agreement by _______ shall constitute grounds
for discipline, including but not limited to modification, suspension, or revocation of licensure or the denial
of licensure or re-licensure.
This Consent Agreement is ~10t appealable and is effective until modified or rescinded by the parties hereto.
The Board and the Office of the Attorney General may communicate and cooperate regarding any
matter related to this Consent Agreement.
This Consent Agreement is a public record within the meaning of 1 M,RS. § 402 and will be available for
inspection and copying by the public pursuant to 1 M.R.S. § 408.
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Employers are starting to take a different
perspective as those with substance use
disorders. This is evidenced by our caseload of
pharmacists… on 9/10/13 we had 10
pharmacists and pharmacy techs in the MPHP
program. 7 are actively employed in their
professional field. At this time last year, only 3
of them were employed.
Starting to view substance use as a chronic
disease, but treatable.
Witnessed some strong structure and mentoring
in the workplace that has aided professionals
returning to the field.
Al-Anon and Alateen (www.alanon.alateen.org)
 Alcoholics Anonymous (www.aa.org)
 American Society of Addiction Medicine
(www.asam.org)
 International Doctors in AA
(www.idaa.org)
 National Institute on drug Abuse
(www.nida.nih.gov)
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Bangor Regional Caduceus Osprey Room at Acadia Hospital, Bangor
Mondays at 7:00 p.m. George (603)781-3088
Central Maine Caduceus (L/A) Lobby Conference Room, St. Mary's
Hospital
New wing, Campus Avenue, Lewiston, Maine. Tuesdays at 7:00 p.m.
Julie (207)784-2985
Central Maine Caduceus (Manchester) Manchester Community Church,
Manchester
Corner of Rte. 17 and 202, enter church through
door that faces the parking lot that has 3 steps. Meeting is held upstairs.
Thursdays at 7:00 p.m. Jack (207) 578-0232
Eastern Maine Caduceus 15 Palmer Street, Calais
Thursdays at 7:15 p.m. Bob (207) 595-0512
Northern Maine Caduceus The Aroostook Medical Center, Presque Isle
Thursdays at 7:30 p.m. Nat (207)551-2171
Southern Maine Caduceus Mercy Hospital, Portland
Meeting is on B2 the upper auditorium-which is actually in the basement
Wednesdays at 7:00 p.m. Bill (207) 653-4729
Portsmouth, New Hampshire Portsmouth Ballroom, Portsmouth, NH
Mondays at 7:30 p.m. Laura (603) 534-2372
Lani Graham, MD, MPH, Director
Heidi LaMonica, Administrative Assistant
Margaret Palmer, PhD, Senior Clinical Associate
Amy Tardy, PhD, Case Manager
Cathryn Stratton, Systems Manager
Andrew MacLean, Esq., Legal Counsel
Robert W. Chagrasulis, MD, Chair
Ibra “Chip”Ridley, CRNA, MSNA
Crissa Evans, RN
Jerr Roberts, DDS
Earl Freeman, DO
Paul Rouleau, RN
Christopher Guido, RPh
Michael Sloan, DDS
Patricia Kelley, Associate Dean, UNE
Gordon Smith, Esq.
Bill Nugent, Esq.,Ex-Officio
Jenie Smith, MD
John Murray, RPh, co-chair
William Sullivan, MD
Mark Publicker, MD
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True or False: Substance use is a problem that affects the medical
professional population
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True or False: One possible reason for abuse is the perception from society of
the level of importance placed on the medical professional’s job
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True or False: We believe that the medical professional can easily quit use on
their own without a treatment team and strategy
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True or False: The professional licensing boards don’t care about substance
use history as long as it has not resulted in patient harm.