I was stealing and using opioids from my patients. Now I am enlisting in an army of prevention.

In partnership with IntelliGuard Intelligent Inventory Solutions 

At the start of the COVID-19 pandemic, I, like many other doctors of the world, became a soldier. We were pulled from our typical roles and headed forth into battle. For some of us, however, the battle didn’t start the moment our days were full of intubation and revisiting medical procedures many of us hadn’t performed since residency. For some of us, war was already a familiar territory we existed within far before a deadly virus dismantled our daily routine. 

Approximately fourteen percent of general medical practitioners will have a substance abuse disorder within their duration of medical practice. While the COVID-19 pandemic has introduced an overabundance of unexpected crises into everyday life, the disaster includes but isn’t limited to, a severe toll on our health care workers. 

Studies find more than $400 million of controlled substances being diverted by hospital staff on average each year. It’s safe to say that within the next year, that average is only going to go up. With last year’s circumstances taking a major toll on the mental health of our nation’s doctors, it’s no surprise that over 24% of surveyed medical workers reported that they had started or increased substance use to cope with pandemic-related stress or emotions. 

Many medical practitioners are faced with a heightened level of stress on the job - in fact, most are. Life and death are an everyday occurance, and controlling one's level of consciousness is certainly part of the job description when dealing with anesthetic medications. While many residency programs provide a fair warning and opportunity to learn for their students regarding the dangers of narcotics and the probability of addiction, the handling of controlled substances on a daily basis, mixed with the heightened pressures and excruciating circumstances of the last year, everyone from a new interned to seasoned veterans in the operating room may be pushed towards forming the addictive habits of escapism. Diversion of controlled substances that are readily available in the workplace are often just the first step. 

I was not the only person in my hospital to have a substance abuse disorder, nor was I the first to divert drugs. Prevention starts with not only expecting to see diversion wherever controlled substances exist, but actively addressing it within those spaces as well. With that, there are several methods of diversion that medical professionals may already be aware of, but unfamiliar with, how to pinpoint and associate responsibility within the workplace regarding diversion. The evasion of talking about the pervasive and often unrelenting stress of medical professions is largely the reason for practitioners to lean into self-medication. De-stigmatizing the issue of addiction as a whole is central to combating the internal struggle among medical professionals. This starts by softening the tunnel vision that many doctors have, and instead, becoming more aware of the softer shores that exist outside of the barriers, begging to be protected from inevitable erosion. 

There are many different ways medical professionals are able to divert controlled substances. Likewise, there are many different and hospital-specific treatment options for those who are struggling. I’ve found that The American Association of Nurse Anesthetists have a very informative and helpful outline of their own, but in my experience, most common signs of diversion, addiction, and struggle within myself and other medical professionals often included what follows. 

• Moodiness and reactive behaviors: Whether it be a lack of sleep, common stress of the job, or the trauma associated with the complications of the last year, depression and poor mental health can often exist and be overlooked in the medical field. Doctors or nurses who may exhibit a change in mood are to be observed and cared for accordingly. Additionally, as tolerance to narcotics may build within an addict's system, mood swings are a common sign of dipping levels of narcotics.
  
  
• Changes in the way doctors begin choosing medications: Diversion can often occur under the disguise of most doctors’ lifelong pursuit of improving their care through the use of the most recent and innovative pharmaceutical practices. Looking out for, and being skeptical of, random shifts in the choices of medication that doctors make is a way to better pinpoint diversion methods. 
  
  
• General changes in behavior: Many addicted medical professionals, specifically doctors, will begin to request shifts and cases that are guaranteed to have less staff, thus making it easier for them to divert. A common occurrence to be aware of is a doctor that is increasingly requesting weekend or evening cases.  
  
  
• Increased pain symptoms in patients: Many diverting doctors will take out specific narcotics for a patient or case and instead mask pain symptoms with other non-narcotic drugs in order to divert. If there is a trend in a certain doctor’s patients waking up from operations in increased levels of pain, confronting the possibility of a diverting doctor struggling with some sort of substance abuse disorder is something to consider. 
  
  
• Professional behavior beginning to fall short: Between improper disposal methods and medical professionals being late for certain operations and elements of patient care, medical workers abusing narcotics will inevitably lead to a decline in patient care and professionalism. Being aware of certain signs and shifts in behavior is critical for hospitals to best support those that may be struggling within their system. 
  

There are many victims in every case of diversion: the patient who didn't receive their morphine dose, the economic toll on the bottom line of many hospitals and providers, certain clinicians who become legally responsible for diverted narcotics, the non-diverting witnesses during the disposal process, and finally and most importantly, the diverter themselves. With the last year and unavoidable decline in the mental health of medical professionals amongst a global pandemic, medicine must evolve from a culture of ‘blame the person making the mistake’ to one focused on the root cause in the processes involved in the error. Supporting healthcare professionals through employee assistance and support programs geared toward managing stress and the very clear factors of the last year that lead to substance dependency disorders.

In 2019 I participated in an anonymous article about my struggle within addiction as one of the top doctors in my field. While I started to tell my story, questions like, ‘What drives a person to steal from their employer and place a patient at risk, ultimately leading to their own shattered career and life?’ were left unturned. It is my goal to answer them. 

The past few years for me have been filled with taking recovery one day at a time. I’ve found myself returning to the job I love most, and being a better doctor than I ever have been, even before I started using. This everyday war is now mine to wage for every other provider that may not feel like they know where to turn or allied medical workers who need help navigating through the best way to combat drug diversion in the aftermath of the COVID-19 pandemic.

Join me as I discuss this further in the upcoming webinar, Healthcare Professionals: The Road from Diversion and Addiction to Prevention in partnership with IntelliGuard, sponsored by Fresenius Kabi  and other soldiers forging our path forward.