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    Drug addiction among nurses: Confronting a quiet epidemic

    Many RNs fall prey to this hidden, potentially deadly disease.

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    YOUR COLLEAGUE on the night shift is a stellar nurse. Her background, experience, and demonstrated skills are top-notch. She is working extra shifts to help cover expenses while her husband is between jobs. While raising three young children, she also cares for her severely disabled father. You wonder how she does it all.

    This description fit Patricia Holloran, RN, whom friends and colleagues regarded as a "super nurse"—until hospital administration and the Connecticut Department of Health confronted her for drug diversion.

    Holloran was introduced to the nasal spray butorphanol (Stadol) when her doctor changed her migraine prescription. She often administered the injected form of this powerful narcotic to women in labor. When the women did not require a full dose, Holloran justified using the leftovers to help her sleep after a long night shift. It also helped her cope with the stress of taking on extra shifts, being the primary breadwinner, and caring for her three sons—along with her father, who suffered from rheumatoid arthritis. Months later, she was pocketing whole vials from the dispenser. "Stadol is not physically addictive," Holloran said. "I thought I could stop at any time. I was wrong."

    Holloran details her spiral into drug dependence and arduous path back to hospital nursing practice in her recent book, Impaired: A Nurse's Story of Addiction and Recovery (Kaplan Publishing, 2009). Her story shows that, with determination and support, nurses who suffer from addiction can recover and regain their practices.

    A nurse for more than 30 years, Holloran has returned to her favorite practice area, labor and delivery. She speaks to groups regularly about addiction, and oversees an anonymous recovery program called Nurses for Nurses. Two summers ago, Holloran stood with Connecticut Gov. M. Jodi Rell as the governor signed a bill creating the HAVEN assistance program for healthcare professionals in the state.

    STIGMATIZED DISEASE Holloran's openness about her addiction and recovery are in stark contrast to the silent, often punitive environment that surrounds the issue of nurses and drug addiction. (For the purposes of this article, the term "drug addiction" includes alcoholism.)

    Addicted individuals feel tremendous shame and guilt, and fear losing their reputations, jobs, family, and friends, said the experts interviewed for this article. Drug addiction is even more devastating for healthcare practitioners: It is a breach of professional ethics, places patients at risk, and can affect the reputations of the facilities where they work. Nurses can be particularly hard on themselves and colleagues who may be addicted.

    "The stigma that addiction is a moral failure or lack of willpower rather than a disease is embedded in U.S. society," said Jack Stem, CNA, one of two peer advisors on addiction for certified nurse anesthetists in Ohio, and founder of Peer Advocacy for Impaired Nurses LLC. This attitude, he maintains, prevents nurses from seeking help. It deters facilities from providing adequate support programs for addicted and recovering nurses, and ultimately puts patients at risk.

    "Our number-one goal is to protect patients. Our secondary goal should be helping our colleagues—as we would help any patient under our care," Stem said.

    INCIDENCE OF ADDICTION The National Institute on Drug Abuse estimates that 10% of U.S. adults abuse drugs during their lifetimes. Accurate statistics are difficult to obtain because drug abuse and addiction are often cloaked in silence.

    The American Nurses Association (ANA) says approximately 10% of nurses are dependent on drugs, making the incidence of drug abuse and addiction among nurses consistent with that of the U.S. population. With nearly 3 million RNs employed in the U.S., that means almost 300,000 RNs may be substance abusers; put another way, if you work with 10 nurses, one of them is likely to be struggling with addiction.

    Drug addiction is a major health risk among nurses and other healthcare professionals, said Stem. Of the hundreds of cases that come before the State of Ohio Board of Nursing each month, well over half of them deal with addiction, he said.

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