Substance Use Disorder in the Anesthesia Provider: Pharmacology, Pathophysiology, and Observed Behaviors
On Monday, Aug. 12, from 8 - 9 a.m., Nancy L. Sweet-Fitzgibbon, MSN, CRNA, APRN, will speak about the risk factors and behaviors specifically associated with anesthesia provider addiction-related impairment and diversion. AANA Congress Daily staff spoke with Sweet-Fitzgibbon about the signs of addiction, helping anesthesia providers who are impaired, and maintaining patient safety.
Congress Daily: You point out in your session’s description online that substance use disorder (SUD) “remains a disease denied disease status by many otherwise scientifically minded CRNAs.” Why do you think there is such a stigma, even among CRNAs, about substance use disorder?
Nancy Sweet-Fitzgibbon: Control. We as CRNAs strive to appear in control at all times; the cool head in the room while everyone else falls apart. Substance abuse stems from the provider losing control, not by choice or character defect, but because the brain develops a disease that prevents healthy control. This loss of control, I believe, is what non-addicted CRNAs see and judge as disgraceful rather than seeing a person who is ill and needs treatment. It's an invisible disease until it isn’t.
Congress Daily: It’s difficult enough to deal with admitting to having an addiction, seeking help, and initiating and maintaining recovery and sobriety. To have to also battle stigma, especially from those in the same profession, creates another roadblock to success. How can those scientifically minded CRNAs be persuaded that SUD is, in fact, a real disease?
Sweet-Fitzgibbon: Come to my lecture (smiles). Seriously, I try to summarize the concepts of neuroplasticity (the ability of the brain’s neurocircuitry to change) and addiction pathophysiology. This summary explains why a person cannot just “quit.” A body of research exists which details how a brain’s anatomy and physiology changes, much like the pancreas changes with a diabetic or the lungs change with a patient with COPD. The brain of a person with SUD has restructured to need the drug as much as you and I need air, food, or water. I compare anyone who denies the reality of SUD as a disease to the mockers in the 1800s who told Lister that germs didn’t really exist.
Congress Daily: What are some of the signs that point to an anesthesia professional being impaired with SUD?
Sweet-Fitzgibbon: Great question. The AANA published an excellent summary of signs and behaviors. Alcoholism and drug diversion share some signs, yet are different in some ways. Changes in appearance and behaviors as well as changes in patient outcomes will eventually become obvious. Withdrawal makes an individual extremely irritable and on edge. Wherever the substance of use is, that is where the impaired provider wants to be. Therefore, if it is alcohol, absenteeism increases, as alcohol is more readily available at home. However, if one uses an anesthetic medication, then being at work is optimal. Drug diversion requires access; so the provider takes much more call, offers breaks, needs more breaks (to use diverted drugs), and increases the medication on a patient’s chart.
Congress Daily: Before an impaired anesthesia professional is either discovered or seeks help, patients can be at risk. How can an anesthesia department or team come together to help minimize risk to patients? Does having a plan in place help to mitigate patient risk?
Sweet-Fitzgibbon: Failure to plan is planning to fail. Yes, patients are at risk, a significant number. Many recommendations exist such as random sampling of wasted medications and random urine drug screening. Again, the AANA Peer Assistance webpages share invaluable resources for workplace policy development. Denial as a community must be overcome to protect the patient. I believe we underestimate how many patients are at risk. On average, three months pass from the first misuse of an anesthetic drug to discovery of the provider’s SUD. Three patients per day x 5 days per week x 12 weeks = 180 patients at risk. Multiply that figure by the number of our CRNA colleagues being impaired at any given time. Thousands of patients at any given time may be at risk. We must fight the denial and stigma for our patients and our future.
Congress Daily: Is there anything else you would like our members to know?
Sweet-Fitzgibbon: If you see something, do something. If you don’t know what to do, call 1-800-654-5167. Save your colleague, save their patients.
This session will be held Monday, Aug. 12, from 8 - 9 a.m., in the Regency Ballroom C, Ballroom Level, West Tower, Hyatt Regency Chicago hotel. Please double check all room assignments in the AANA Meetings app.