AANA Peer Assistance Advisors' Recommendations for Re-entry of Anesthesia Professional or Students with Chemical Dependency

1. Completion of treatment and comprehensive evaluation by an ASAM board certified addictionologist according to the PAA recommendations and compliance with all treatment center recommendations for continuing care after discharge, including relapse prevention techniques.
2. Evaluation of suitability by an addictionologist for, and timing of, the return to anesthesia practice as CRNAs face unique obstacles and risks that can threaten their ability to maintain sobriety. 
• A minimum of one year out of the clinical anesthesia arena for individuals with an IV drug addiction or major opioid history. 
3. Achievement of the Talbott criteria for reentry:
   • Supportive spouse/significant other
   • No untreated psychological comorbidities
   • Acceptance of the chronicity of chemical dependency
   • Grounded in the recovery community (sponsor, etc.)
   • Supportive colleagues at the workplace familiar with history and needs for reentry
4. Commitment to monitoring program including regular toxicology screenings on a random basis through a formal program, administered by a state board of nursing or alternative program, for a minimum of five years.  Voluntary monitoring through the professional lifetime is ideal.
5. Regular attendance at recovery based meetings, and continuous follow-up and aftercare with an addictionologist.  
6. We only support abstinence based recovery and strict avoidance of opioid replacement therapy (ORT) in CRNAs and student nurse anesthetists returning to clinical practice. We support the utilization of Naltrexone where the addictionologist has deemed it appropriate. 

• Re-entry and Malpractice Insurance
• Re-entry Frequently Asked Questions (FAQs) (link to follow)
• NBCRNA CE Refresher Program
• Council on Recertification
• Recovery Maintenance Workbook for Nurses and Health Care Professionals
• Talbott Recovery Programs Medication Guide for a Safe Recovery 

Articles:

• Angres DH, Bettinardi-Angres K, Cross W. Nurses with Chemical Dependency: Promoting Successful Treatment and Reentry. J Nurs Regul. 2010
• Bryson EO, Hamza, H. The Drug Seeking Anesthesia Care Provider. International Anesthesiology Clinics. Winter 2010
• Hamza H, Bryson JO. Buprenorphine Maintenance Therapy in Opioid-Addicted Health Care Professionals Returning to Clinical Practice: A Hidden Controversy, Mayo Clin Proc. 2012: 87(3)-260-267.
• Hamza H, Bryson JO. Exposure of Anesthesia Providers in Recovery from Substance Abuse to Potential Triggering Agents, Journal of Clinical Anesthesia, November 2011.
• Hamza H, Monroe T. Reentry and Recidivism for Certified Registered Nurse Anesthetists. J Nurs Regul. 2011
• Seppala M, Oreskovich M. Opioid-Abusing Health Care Professionals: Options for Treatment and Returning to Work After Treatment, editorial in Mayo Clin Proc. 2012;87(3):213-215. (see also Buprenorphine Maintenance Therapy in Opioid-Addicted HCP)
• Wilson H, Compton M. Reentry of the Addicted Certified Registered Nurse Anesthetist: A Review of the Literature.  Journal of Addictions Nursing. December 2009
• Reentry Using Naltrexone: One anesthesia department's experience, Management Briefs, AANA Journal, August 1998. 

Additional articles and research on anesthesia professionals and chemical dependency - see the Wellness Research and Education resources