Drug abuse among nurses is a serious issue that can affect patient care and safety, hospital budgets, and a nurse’s career.

According to a study from the American Nurses Association (ANA), about 10% of nurses become dependent on drugs, which is right in line with the incidence of drug addiction with that of the general U.S. population. Currently there are almost 3 million nurses employed in the country, which means that there are nearly 300,000 who abuse or are addicted to drugs. Of course, accurate statistics are hard to nail down, because drug and alcohol abuse and addiction often go unreported.

Some nursing specialties are at a greater risk of substance abuse because of the emotional and physical toll they take on nurses, and the accessibility of drugs common to the area. Such departments include critical care, oncology, psychiatry, and anesthesia.

Signs & Symptoms of Addiction in Nurses

Use of drugs or alcohol or other addictive substance becomes abuse when someone uses a drug or alcohol outside of how it was intended or prescribed. For example: taking non-prescription drugs beyond the purpose and/or amount indicated; taking someone else’s prescription drugs; taking your own prescription drugs beyond the amount and/or frequency indicated; increasing the concentration of an addictive substance; smoking marijuana to relax. Drinking is alcohol abuse when its effects negatively impact your college-age son’s or daughter’s academic progress, social life, or health.

Because nurses are in the medical field, and they are aware of the signs of substance abuse, they are often very good at hiding the signs and symptoms of their own use from others – sometimes for extended lengths of time. However, there are some things, physical and behavioral, that may point to a problem with substance use or abuse.

It may be easiest for coworkers of a nurse to notice signs and symptoms first. For example, if you are a fellow nurse and you dread going to work because you know that the nurse on the previous shift will leave you with charts that are incomplete and patients who are complaining about pain, that could be an indicator.

Another indication might be that a nurse you work with side-by-side has become moody, leaves for the bathroom more often than usual and no longer socializes the way he or she did before. Perhaps the nurse in question is often late for work, or his or her handwriting has become illegible when it didn’t used to be.

Of course, on the flip side of the coin, a nurse who is using substances may also be seen as the best nurse on the floor. Often being praised by patients, doctors and hospital administrators. She may frequently be the first to volunteer to work overtime and likes to work on acute-care units where narcotics are often administered.

You can see how it might be difficult to recognize when a nurse has a problem with drugs or alcohol.

Here are some additional signs and symptoms to look out for:

  • Change in personality or mood swings
  • Acting more secretive or solitary
  • Distracted or reduced job performance
  • Sleeping on the job
  • Volunteering to administer controlled drugs to patients
  • Unusually friendly relationships with doctors who prescribe medication
  • Has trouble focusing in meetings
  • Has a history of chronic pain from an injury or surgery
  • Absenteeism or tardiness
  • Prefers night shifts where there is less supervision and more access to medication
  • Eager to work overtime or extra shifts
  • Patients may complain of inadequate pain relief
  • Smells of alcohol, or uses breath mints or mouthwash excessively
  • Has pinpoint pupils or is glassy-eyed
  • Has significant family or financial problems
  • Has visible shakiness or tremors
  • Has an unsteady gait or slurred speech

 

It’s important to remember that anyone can become addicted to drugs or alcohol, whether he or she is a brand new nurse or a veteran, an LPN or and RN, or has a master’s degree or Ph.D. Addiction doesn’t discriminate.

Most Common Drugs Abused by Nurses

Use of drugs or alcohol or other addictive substance becomes abuse when someone uses a drug or alcohol outside of how it was intended or prescribed. For example: taking non-prescription drugs beyond the purpose and/or amount indicated; taking someone else’s prescription drugs; taking your own prescription drugs beyond the amount and/or frequency indicated; increasing the concentration of an addictive substance; smoking marijuana to relax. Drinking is alcohol abuse when its effects negatively impact your college-age son’s or daughter’s academic progress, social life, or health.

Nurses are subject to the same risk factors for addiction and mental health disorders as people who do not work in the medical field – genetic predisposition, childhood trauma, anxiety, depression or other mental health issue. However, these risk factors are compounded by stresses inherent in the nursing profession as well.

Most nurses think they will never fall into addiction, but they are just as vulnerable as anyone else.

Some of the risk factors that are common for nurses are:

Attitudes about Drugs and Drug Use

There are several attitudes about drugs that can affect a nurse’s likelihood to use or abuse drugs. The first is when substance use is seen as an acceptable means of coping with life’s problems and facilitates enjoyment, comfort and getting along. The second is when nurses are trained to develop a faith in drugs as a means of promoting healing or as a result of witnessing the positive effects of drugs on patients. The third attitude is a sense of entitlement by a nurse that they need to continue to work and can lead to a rationalization of substance use as a means to an end. The fourth attitude deals with the special status of health care providers as being invulnerable to the illnesses of their patients. Finally, the last attitude is when professional training about medications is used to self-diagnose and self-medicate physical pain or stress in order to enable the nurse to continue to work.

Long Work Hours

Schedule annual medical visits. Use these as an opportunity to ask your child about drug use. Standardized screening tools help pediatricians, dentists, emergency room doctors, psychiatrists, and other clinicians determine an adolescent’s use of such substances as: tobacco, alcohol, and illicit and nonmedical prescription drug s. Identified use helps the health care provider assess substance use severity and provide a brief intervention or refer the adolescent to a substance abuse treatment program. Regular medical checkups as part of your son’s or daughter’s healthcare can put your mind to rest as a parents or flag new use and nip it in the bud..

Patient Care

Taking care of patients can be very rewarding, but also very stressful. Having to deal with difficult or non-compliant patients, negative medical outcomes, failure to be able to relieve pain, and even death, can cause anxiety and depression. Most nurses do not receive adequate training to deal with these aspects of the field.

Easy Access to Medication

Nurses work around addictive drugs on a daily basis. They are familiar with the dosages and effects of the medications and often feel that they can “manage” their use. That, combined with the fact that they work with doctors who can prescribe medication for them (or they do so themselves fraudulently), can lead to abuse.

Lack of Education Regarding Addiction

A lack of education about the addictive process and how to recognize the signs and symptoms remains one of the more profound risk factors for nurses.

Failure to Report

Even when a colleague suspects that a nurse is abusing drugs or alcohol, the likelihood of him or her reporting it is low, even though they have a professional responsibility to do so. This failure to report may be seen as a professional “courtesy,” but it only perpetuates the problem putting patients at risk of improper care, and the nurse who is using at risk of losing licensure, lawsuits, and even criminal charges.

Reasons Nurses Use Drugs

Use of drugs or alcohol or other addictive substance becomes abuse when someone uses a drug or alcohol outside of how it was intended or prescribed. For example: taking non-prescription drugs beyond the purpose and/or amount indicated; taking someone else’s prescription drugs; taking your own prescription drugs beyond the amount and/or frequency indicated; increasing the concentration of an addictive substance; smoking marijuana to relax. Drinking is alcohol abuse when its effects negatively impact your college-age son’s or daughter’s academic progress, social life, or health.

The rate of substance abuse for nurses is similar to the general population’s, but not by type. Dependence on prescription medication is much higher for nurses, and use of and addiction to illicit drugs, like cocaine and marijuana is much lower. According to the ANA, nurses most frequently abuse alcohol, followed by amphetamines, opiates, sedatives, tranquilizers and inhalants.

Alcohol Abuse

Nurses abuse alcohol more than any other substance, just as the general population does. Reasons for alcohol abuse are varied, but the most common for nurses is as a way to relax and relieve anxiety. Many nurses also use alcohol to “help” with insomnia, chronic pain, and stress. It is also common for nurses who work with critical or terminal patients to drink to distance themselves emotionally from negative medical outcomes. Alcohol is likely the most common abused substance because it is easily obtainable, legal, and socially acceptable to use.

Alcohol abuse can have significant health consequences. People who drink heavily have a greater risk of liver disease, heart disease, sleep disorders, depression, stroke, bleeding from the stomach, and several types of cancer. They may have problems managing diabetes, high blood pressure, and other existing conditions.

Prescription Medications

The following are the prescription medications most commonly abused by nurses:
Substance Commercial Names How Administered Effects and Health Risks
Amphetamines Biphetamine, Dexadrine, Adderall injected, swallowed, smoked, snorted

Increased heart rate and blood pressure, feelings of exhilaration, increased energy and mental alertness, reduced appetite, weight loss.

Amphetamines: rapid breathing, hallucinations, tremors, loss of coordination, anxiousness, restlessness delirium, panic, paranoia, impulsivity, aggressiveness, addiction.

Methamphetamine: aggression, violence, psychosis, memory loss, neurological and cardiac damage, addiction

Methylphenidate: increase or decrease in blood pressure, psychosis, digestive problems, loss of appetite, addiction

Methamphetamine Desoxyn injected, swallowed, smoked, snorted
Methylphenidate Ritalin injected, swallowed, snorted
Codeine Empirin with codeine, Fiorinal with codeine, Robitussin A-C, Tylenol with codeine injected, swallowed

Pain relief, euphoria, drowsiness, respiratory depression or arrest, nausea, confusion, constipation, sedation, unconsciousness, coma, addiction

Fentanyl Actiq, Duragesic, Sublimaze injected, smoked, snorted
Morphine Roxanol, Duramorph injected, swallowed, smoked
Opium Laudanum swallowed, smoked
Opioid Pain Relievers Tylox, OxyContin, Percodan, Percocet, Demerol, Dilaudid, Vicodin, Lortab, Lorcet, Darvon, Darvocet swallowed, injected, suppositories, chewed, crushed, snorted
Barbiturates Amytal, Seconal, Nembutal, Phenobarbital injected, swallowed

Reduced pain, reduced anxiety, feeling of well-being, lowered inhibitions, slowed heart rate and breathing, decreased blood pressure, lowered concentration, confusion, fatigue, impaired coordination and judgement, respiratory depression and arrest, addiction.

Barbiturates: sedation, drowsiness, unusual excitement, fever, irritability, slurred speech, dizziness.

Benzodiazepines: sedation, drowsiness, dizziness.

Flunitrazepam: visual and gastrointestinal problems, urinary retention, memory loss

Benzodiazepines Ativan, Halcion, Librium, Valium, Xanax swallowed
Flunitrazepam Rohypnol swallowed, snorted
Ketamine Ketalar SV injected, snorted, smoked

Increased heart rate and blood pressure, impaired motor function, memory loss, numbness, nausea, vomiting.

Ketamine at high doses: delirium, depression, respiratory depression and arrest

(Source, National Council of State Board of Nursing)

Most of the prescription medication that are abused by nurses are controlled substances and are closely monitored in the hospital setting, so obtaining them isn’t easy. Some nurses may ask doctors to write them a prescription, or they may forge a prescription themselves. They may also divert prescription medications meant for patients. They may do this by:

  • administering only a partial dose to a patient and keeping the rest for themselves
  • asking a colleague to cosign records saying that a medication was wasted without witnessing the disposal
  • signing out drugs for patients who have transferred to another unit
  • obtaining as-needed medications for patients who have refused or not used them

Substance abuse is an occupational hazard for medical professionals. The general population doesn’t have constant access to drugs as nurses, doctors, pharmacists, and others do.

Addiction and Other Risks of Substance Abuse for Nurses

The biggest risk of substance abuse for anyone, not just nurses, is addiction. While there are some potentially dangerous, even life-threatening, consequences that can occur with even one use of a substance, most negative consequences happen through prolonged abuse and dependence. Addiction isn’t usually something that happens in the blink of an eye. Generally, it follows a progressive pattern of use, abuse, and addiction. The length of time it takes to get from use to addiction varies for each individual depending on factors like genetic predisposition, environmental factors, and accessibility.

These are the phases of drug or alcohol use:

Sobriety

This is the period before a person has even tried the substance. The individual has no issues with staying away from the drug.

Recreational Use

Most commonly associated with social drinking or using; a moderate consumption. During this phase, a person will likely see using as something natural, or something used to “help” with issues like: pain, insomnia, depression, anxiety, or stress. It is likely that during this phase use will continue to increase, and in turn, tolerance will increase.

Dependence, or Addiction

At some point, a recreational or moderate user crosses the line to dependence (physical or psychological) on a substance after increased use. It is extremely difficult for someone in this phase to walk away from the drug or alcohol without help. Continues use of the substance despite negative consequences (behavioral, emotional, physical, and spiritual) is an addiction.


In addition to addiction, there are other risks that come along with substance abuse.

How Do Nurses Obtain Drugs in the Healthcare Setting?

Use of drugs or alcohol or other addictive substance becomes abuse when someone uses a drug or alcohol outside of how it was intended or prescribed. For example: taking non-prescription drugs beyond the purpose and/or amount indicated; taking someone else’s prescription drugs; taking your own prescription drugs beyond the amount and/or frequency indicated; increasing the concentration of an addictive substance; smoking marijuana to relax. Drinking is alcohol abuse when its effects negatively impact your college-age son’s or daughter’s academic progress, social life, or health.

Health Problems

Nurses are no different than the general population when it comes to the health risks associated with substance abuse. There are potential health risks associated with the abuse of any type of substance, even for first time users. The risks can range from mild – changes in heart rate and blood pressure, etc. – to very serious, sometimes chronic issues, and even up to death. Because nurses work in the medical field, and they often have an attitude that medication can fix whatever is wrong, they may not be overly concerned about the possible health implications of abuse.

Injury or Harm to Patients

Of course, the greatest external risk that impaired nurses face is the possibility of harming their patients. Most nurses go into nursing because they want to help and take care of people. Substance abuse or addiction often takes away a nurse’s ability to do that with the proper standard of care. Nurses who are under the influence are not as responsive, physically able, and cognizant as they need to be to care for patients. Additionally, if they are diverting medication from their patients for their own use, it could be detrimental to the patients’ medical health and healing.

Employment, Licensing, and Legal Problems

Nurses can face serious consequences regarding their career due to substance abuse and addiction. How and to what extent a nurse is disciplined due to drug abuse varies with each individual circumstance, but it can carry career-ending outcomes. While intervention programs and rehabilitation are usually offered to nurses, license suspension, termination, and even criminal charges are possible risks depending on the seriousness of the situation, and whether any patients were harmed as a result of the nurses’ drug use.

Recovery Options for Addicted Nurses

It is crucial that medical professionals who abuse drugs or alcohol seek help and find the support they need for recovery, because the effects of their use can be even more devastating than that of others who are not in the medical field. They are caring for the health and well-being of others, and are putting their lives at risk.

The ANA considers addiction as a “chronic, progressive, and treatable” disease, and they strongly advocate for educational programs or training that teach nurses how to recognize coworkers who may be abusing substances, and ensure that nurses understand their facility’s and state board of nursing (BON) policies. The ANA also encourages training so that nursing staffs know how to support colleagues who participate in drug or alcohol rehabilitation, and seek to regain their full nursing practice.

In most cases, nurses who self-report or are confronted about their substance abuse, are offered an intervention program instead of discipline or termination (most states have these types of intervention programs). Through the program, nurses are required to participate in rehabilitation, therapy, 12-step programs, and they are required to have frequent drug tests.

If nurses have been obtaining drugs by diverting them, their employers are required to report this to drug control authorities and the state BON. Nurses may want to seek legal counsel if formal charges are brought against them. In some cases, nurses may lose their nursing license for a period of time, until progress in recovery is demonstrated. Although recovering their license is likely with successful rehabilitation, the process often takes longer and requires more supervision than a lot of nurses anticipate.

The good news is that those in medical professions who do seek help have a much higher success rate of achieving and maintaining sobriety. Medical professionals (nurses, as well as other staff) who receive treatment and participate in ongoing monitoring have a far lower rate of relapse, with over 70% still sober, licensed and employed after 5 years.

Getting Help for Addiction

If you, a loved one, or colleague are in the nursing field and are struggling with drugs or alcohol, it is imperative that you ask for help. Addiction is an illness, and it can be treated. There are nurse organizations that can help and offer support through the process, but you have to take the initiative and ask for help.

The earlier you get the help you need, the better. Don’t wait until you resort to stealing, diverting, or lying to maintain your addiction. If you are a nurse, you will likely find your supervisors and coworkers to be supportive of your efforts to recover. Additionally, the earlier you seek help, the more likely it is that you will save your nursing license and the career you take pride in and worked so hard for.

At FootPrints Behavioral Health Center we can answer your questions, address your concerns, and ensure your privacy. We have experience helping people in medical professions and will comply with monitoring, compliance, and reporting requirements. Please contact us today so we can offer you guidance in how to proceed. Let us help you begin your journey to recovery and your return to your career.