Story of a Recovering Drug-Addicted Nurse: Help is waiting

Story of a Recovering Drug-Addicted Nurse:

Help is waiting

BY DEDE DWYER, RNC-E, LNC

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.

The sad truth, though, for me and for many other nurses, is that addiction is very real. Substance abuse among nurses is believed to be slightly higher than in the general population: approximately 10%. It often begins with a legal prescription for a legitimate medical problem, but once the brain is “primed," addiction has laid down its tracks. That’s how it started for me, anyway.

A Migraine of Problems

Stadol first came on the market in 1991, and it was not marketed as a controlled substance or considered addictive. So, I wasn’t concerned about my Stadol nasal spray prescription for migraines. Two years following my first Stadol exposure, I had major abdominal surgery. Three weeks post-op, my abdominal wounds weren’t healing and my incision opened and collapsed in 4 separate areas, exposing my abdominal wall.

The next two years were horrific; healing by granulation is an arduously slow and painful process. Healing these wounds was a full time job, cleansing them with medicated soaps and irrigating them with rough gauze 2-3 times a day. My doctor prescribed Stadol nasal spray for my dressing changes. Nothing took all the pain away, Stadol just made it more tolerable.

No one knew Stadol was addictive and should have been treated as a controlled substance. Stadol was approved for short term pain relief in hospital settings; it was perfect for my dressing changes. I wasn’t getting high; the drug just made the pain go away. As I healed I continued to use the Stadol as prescribed. I’m not sure exactly when the physical pain actually ended and my fear of being in the pain began to drive my continued use.

The Drug Becomes Master

The healing process took two years, and Stadol slowly gained control of my life. Research has shown that with this kind of continued use, chemical changes occur at the cellular level in the brain, in the pleasure/reward center -- a primitive part of the brain concerned with basic survival. Before long, my brain directed me: “Eat, sleep, take Stadol, drink water, take Stadol, take Stadol, take Stadol.” Every part of my being told me Stadol was a basic survival need.

You don’t really notice as the addiction process gradually takes hold. However, when you haven’t taken the drug for a while, you start to experience withdrawal symptoms. There can be itching, diarrhea, muscle cramps, sweating, and anxiety. For me, I especially remember the shakes, and the nausea. Then, you take the drug, and the pain goes away. And we are taught, that’s what the drug is there for, right? Relief from pain is a good thing, isn't it?

In some ways, our education as nurses may even make us more vulnerable to addiction. We have seen the instant relief in our patients when pain meds are given -- relief from both physical and emotional pain. Perhaps this makes relying on medication seem more normal. Or, we may feel that we know enough to manage these issues, and somehow our actions are outside of the addiction process that everyday people are subject to. In any case, there is no doubt that nurses can use their own forms of "denial" just as much as anyone else. 

Diversion Begins

Stadol was the “drug of choice” in Labor and Delivery for pain management, and the dose ordered was half of the contents of a vial. As staff rushed to prepare for the next delivery, partial vial(s) would end up in warm-up jacket pockets and the process of properly discarding was overlooked.

One day after arriving home, and having a headache I found my nasal spray was empty. I had a partial vial of injectable Stadol in my pocket, and I wondered, If I put this in my nasal spray bottle, will it work? It didn’t. As an insulin dependent diabetic I had syringes, and without giving it a second thought, I injected myself intravenously. Like many nurses, I was skilled in starting IVs. I did not or could not see the wrong in taking the leftover vials from the hospital. I rationalized that they were headed for the trash anyway, and it saved me a trip to the pharmacy.

Eventually, I was taking full vials home and injecting Stadol on a daily basis.
When medicating a patient, I would take out two vials: one for them, one for me.
And as I later learned in treatment, my usage increased as my tolerance increased, and soon I needed more and more.

Eye Opening Intervention

Desperate, I began using a co-worker’s Pyxis code. The pharmacy investigated and tracked the diversion. It “appeared” my coworker was signing out a lot of medication -- even when she wasn’t on duty, and for patients who were discharged but still in the system. Because of me, her character was in question, her reputation was in jeopardy. 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; in other words, it was typical addictive behavior.

In a moment of clarity I realized I was very sick, I was addicted to Stadol. But where could I go? Who could help me? I felt overwhelming shame, guilt, and humiliation: I’m a nurse, I should know better. I’m supposed to be helping people, not needing help.

After this moment of clarity, I believe the healthier part of my brain caused me to make mistakes so I would get caught. State drug-control agents installed surveillance cameras over the Pyxis units, and 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 could get help. I could stop lying, especially to myself.

I wasn’t arrested or jailed. I didn’t lose my son. I wasn’t fired. I was lucky.
I was presented before the State Board of Examiners for Nursing and my license was disciplined in a public forum, in front of students and nurse educators. Probation lasted four-years; the first year was no access to narcotics. Co-workers had to medicate my patients. For all four years, my nurse manager and therapist had to submit monthly reports regarding my ability to practice safely. I had to submit to 18 months of weekly, followed by twice-monthly urine drug screens, and I had to attend support group meetings.

Alternative to Discipline

Each state has its own disciplinary practices, governed by the Department of Public Health or other licensing body. This type of disciplinary process is public and punitive: Imagine having heart disease and being punished for it in a public forum. Only four states now lack an alternative-to-discipline program. I wish such a program had been available in my state at the time of my intervention. The Connecticut Nurses’ Association fought for over 20 years to develop an alternative-to-discipline program for nurses; I broke my anonymity at every level to advocate and support the effort. Unfortunately, nurses alone were unable to push the legislation through. Finally, in 2007, there was a breakthrough, based on a dynamic, two-year effort by a coalition comprised of the five major healthcare professions (CT State Medical Society, CT Nurses’ Association, CT State Dental Association, CT Veterinary Medicine Association and the CT Association of Physician’s Assistants). P.A. 07-103 was signed into law, and the birth of HAVEN was realized. (HAVEN stands for the Health Assessment Intervention Education Network, and it is an alternative-to-discipline program for all healthcare professionals, not just nurses.)

An alternative-to-discipline program recognizes drug addiction as a disease and an occupational hazard for healthcare professionals. It provides an avenue for getting help while maintaining integrity, dignity, and job status after rehabilitation.

There is a process for self-referral, or facility or coworker referral. The program addresses each situation individually. When necessary, the healthcare professional may need to refrain from practice and enter treatment and recovery while maintaining confidentiality. Their ability to practice with skill and safety is assessed, and safeguards are in place before return to practice. Case management is utilized and trained addiction and mental health specialists conduct all monitoring.

Studies show that the recidivism (relapse) rates for healthcare professionals (especially nurses who engage in a formal alternative-to-discipline program) are low -- less then 8-10%. (The relapse rate among the general population is > 50%).

And now?

I’m not a bad person, and I wasn’t a bad person back then. I used a drug prescribed to me that was marketed as non-addictive. That use became a disease, and 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 eleven years, and I still hold an active nursing license. My son is 15 ½, and he knows my story and respects my advocacy for others in recovery; he is wonderful. I went back to school and earned a DARC (Drug/Alcohol Recovery Counseling) degree in 2005. I am very active in the recovering nurse community and am an advocate for all recovering individuals. I am also an active member of Nurses for Nurses, Connecticut’s only peer support group for nurses. As mentioned previously, I was involved with CNA for eight (8) years, including various stages in the development of the alternative-to-discipline program for CT healthcare professionals. I currently function as a Case Manager in the HAVEN program.

Addiction doesn’t discriminate. It doesn’t care what you own, what your profession is, or what your position in society is. It’s an equal opportunity disease. It’s chronic, it's progressive, and it can be fatal. So, if you find yourself or a friend in this situation, reach out. Don’t let your shame consume paralyze you. Does your state have an alternative-to-discipline program? Use it! Are there nurse support groups available? Go! You cannot do this alone.

And it doesn’t matter how the drugs got into your body, how the problem came to be. Addiction is addiction, and it is a disease of the body, the mind and the soul. A better life is waiting – recovery provides strength and hope for anyone willing to believe in themselves. Believe.

My email address is dede58@sbcglobal.net

For Nurses for Nurses meeting information in CT please call 203-238-1207 ext 21.
For on line peer support join Nurses in Recovery (NIR)
For information on alternative to discipline programs go online to National Organization of Alternative Programs (NOAP)
A link to each states’ Board of Nursing log on to National Council of State Boards of Nursing (NCSBN) for information related to state alternative-to-discipline programs and or nurse peer support groups available in your state.