Signs and Behaviors of Impaired Colleagues 

If You See Something, Do Something

Early identification of the signs and behaviors associated with substance use disorder and drug diversion reduces the risk of harm to patients and providers. Co-workers play an important role by recognizing and reporting suspicion to supervisors/appropriate chain of command. As Ira P. Gunn, CRNA, MSL, FAAN said in a 1986 editorial, "until there are better methods for preventing, controlling, and treating chemical dependency, we must remember that we all are our colleagues' keepers and, as such, are in the best position to protect the patients we all serve."  

If signs and behaviors are noticed or you have questions or concerns, assistance is available at (800) 654-5167 or Getting Help

Signs and Behaviors: If You See Something, Do Something flyer 

Signs and Behaviors associated with substance use disorder and drug diversion



  • Severe mood swings, personality changes
  • Frequent or unexplained tardiness, work absences, illness or physical complaints
  • Elaborate excuses
  • Underperformance
  • Difficulty with authority 
  • Poorly explained errors, accidents or injuries
  • Wearing longs sleeves when inappropriate
  • Confusion, memory loss, and difficulty concentrating or recalling details and instructions
  • Visibly intoxicated
  • Refuses drug testing
  • Ordinary tasks require greater effort and consume more time
  • Unreliability in keeping appointments and meeting deadlines
  • Relationship discord (e.g., professional, familial, marital, platonic)


  • Physical indications (e.g., track marks, bloodshot eyes)
  • Signs indicative of drug diversion* (see right column)
  • Deterioration in personal appearance
  • Significant weight loss or gain
  • Discovered comatose or dead

Drug Diversion


  • Consistently uses more drugs for cases than colleagues
  • Frequent volunteering to administer narcotics, relieve colleagues of casework, especially on cases where opioids are administered
  • Consistently arrives early, stays late, or frequently volunteers for overtime
  • Frequent breaks or trips to bathroom
  • Heavy wastage of drugs
  • Drugs and syringes in pockets


  • Anesthesia record does not reconcile with drug dispensed and administered to patient
  • Patient has unusually significant or uncontrolled pain after anesthesia
  • Higher pain score as compared to other anesthesia providers
  • Times of cases do not correlate when provider dispenses drug from automated dispenser
  • Inappropriate drug choices and doses for patients
  • Missing medications or prescription pads
  • Drugs, syringes, needles improperly stored
  • Signs of medication tampering, including broken vials returned to pharmacy

Source: Addressing Substance Use Disorder for Anesthesia Professionals position statement and policy considerations

Reporting Impaired Colleagues 

Ideally, the anesthesia professional will acknowledge his or her condition, seek help voluntarily, and not require intervention. However, this is often not the case due to denial of condition, stigma, fear of job loss, and other ramifications. Therefore, colleagues play an important role in helping the impaired provider get into treatment by reporting suspicion to a supervisor or the appropriate chain of command. Colleagues are often reluctant to report suspicion for a variety of reasons, such as believing someone else is addressing the issue, it is not their responsibility, the individual will be punished excessively; fear of retribution and being responsible for their colleague’s loss of job or license; or lacking knowledge of how to properly report or intervene. 

The AANA Peer Assistance Helpline (800) 654-5167 is available for administrator or colleague concerns and questions related to the safe handling an individual struggling with substance use disorder. 

Colleagues may have certain legal responsibilities in identifying and reporting providers to their supervisor or appropriate chain of command. States may have reporting laws which hold colleagues responsible for harm to patients if they fail to report a coworker in whom substance use disorder is suspected. Does your facility policy outline proper steps to help guide informants on how to report an impaired colleague, ensure confidentiality of the informant, and offer guidance for investigating and evaluating the credibility of the allegation? If not, see Getting Help to contact your State Peer Advisor for state specific information. 

For help creating a workplace policy, see Substance Use Disorder Workplace Resources.