Addiction in Healthcare EnvironmentsNotice, Reach Out, Save a Life

The Secret Disease

• “This is a disease that tells you that you don’t have it. It’s the only disease I know that argues with you and says, look, despite all the evidence, you don’t have a problem.” ~Lawyer

• “When I was asked what could have been done to help me with my addiction, I told them, bring it out into the open, by letting people know it’s an occupational hazard. Get the secret out of the closet.” ~M.D.

What Do We Know?

• Substance Abuse: “The Nation’s #1 Health Problem.” RWJ (2001).• 8-14% struggle with substance use disorders.• More than half of all adults have an alcoholic family member.• 1 in 5 US high school students say they’ve taken a prescription drug without an

MD’s prescription. • 12-16% of health care professionals will be addicted to a prescription drug at some

point during their career and 6% use in a way that impairs prof. judgment.• Access to narcotics is an occupational hazard and a patient safety risk. • In 2007, recorded deaths associated with misuse of prescriptions surpassed those

of other illicit substances.• No healthcare facility is immune to drug diversion.

We Are Losing UMHS Employees to Addiction

Concern Around the Country

http://www.cdc.gov/injectionsafety/drugdiversion/drug-diversion-2013.html

Drug Diversion and Patient Safety

“The state Department of Health has identified 46 patients who contracted a genetically similar strain of Hepatitis-C in what is the largest unsolved outbreak of the disease in U.S. history.

And it linked all but one of the cases to Manor Care in Minot.

But, as Jim Olson reports, a lawsuit filed this week claims Trinity Health is responsible for spreading the disease to the victims.

The lawsuit filed in US District Court alleges that one person is responsible for the spread of Hepatitis-C among nearly four dozen mostly-elderly men and women.”

Consequences of Drug Diversion

“Substance Use Disorders” On a Continuum

• Substance Use: Could be non-problematic.

• Substance Misuse: Use of substances in a manner for which they were not intended.

• Substance Abuse/ Dependence: Recurrent problem use, life problems, role function affected, interpersonal conflicts, legal problems, or use in situations that are physically hazardous.

Anywhere on this continuum you could be impaired.

Impairment

“The inability to practice with reasonable skill and safety to patients by reason of physical or mental illness including alcohol or other drug dependence.”

-AMA Council on Mental Health 1972

For Cause Drug Testing Policy

• Policy Statement“It is the goal of the University of Michigan Health System (UMHS) to provide a safe patient care and employee environment. UMHS recognizes that alcohol and drug abuse problems pose a significant threat to this goal.

UMHS actively encourages identification, intervention and treatment of employees with alcohol and other drug abuse problems and assists them in voluntarily seeking help with alcohol and drug abuse problems. Any employee who believes he/she may be impaired is encouraged to self-report to the Employee Assistance Program.”

Policy Goals: Safety, Timeliness, Clarity, Consistency

• For Cause Drug Testing Memorandum of Understanding

Why Do People Use Mood Altering Substances?

• To celebrate• To mark accomplishments• To feel better about oneself• To feel pleasure• To alleviate physical and emotional pain• To cover skill deficits • To fit in• To have fun

Why do you use mood altering substances?

What is Addiction?

• Addiction is a brain disease that causes structural and functional changes.

• Drugs and alcohol “hijack” the brain’s reward systems and pleasure pathways.

• When the addiction switch is turned-on the individual no longer has control.

• It is a disease that carries stigma.• It is a disease that can be treated.• It’s a fatal disease if left untreated.

What Happens when the Brain is Hijacked?

• Denial• Minimization• Rationalization• Projection• Manipulation • Stealing• Legal Issues• Potential

Unemployment • Homelessness• Death

Judgment and insight are markedly impaired

Can Even Make This Seem Ok…

How Many of You Have Known Someone at Work or in Your Personal Life Who has Struggled with Addiction?

• What happened?• What did you do to try to help?• Did it work?• What thoughts and emotions come up for you?

It’s Important to reflect on our own pain, attitudes, beliefs and biases

Sometimes people with the disease of addiction don’t look ill…

Sometimes they look like us…

What are the Signs and Symptoms that Addiction Might be Present in the Workplace?

• Odor of alcohol or marijuana• Excessive cologne• Absences (Implausible

Excuses)• Always there• Volunteers for overtime• Comes to work when not

rescheduled • Starts early / Stays late• Frequent disappearances in

bathrooms and on breaks

• Change in upholding work standards (Errors/ Oversights)

• Emotional and/or behavioral changes: e.g. mood swings, irritability, forgetful, agitation, slurred speech

• Physical changes: e.g. lethargic, sleepiness, weight loss, pupils dilated/ glassy, eyes puffy/ can be red, unkempt, tremors

Diversion Methods

• Retrieving more controlled substances than ordered and then entering an override.

• Tampering with controlled substance by removing portions.• Tampering with items disposed of in the sharps container. • Taking patches off of patients.• Disposing of wasted medication improperly. • Pattern of holding waste until the end of the shift.• Recurrent removal of controlled substances near the end of

the shift.• Removal of oral and injectable opioids at the same time.• Withdrawal from the PCA.

Diversion Methods

• Removal for discharged patients.• Using a colleague’s password.• Removal of duplicate doses.• Giving less than ordered. • Replacing the diverted medication with a substitute. • Inaccurate charting of medication administered.• Falsifying medications ordered by phone.• Request to care for certain patients. • Patients reporting ineffective pain control.• Picking the same people to waste with.• Finding paraphernalia where it shouldn’t be.

Why is it We Don’t Speak Up?

• We don’t see it• We are fearful of what will happen• We make excuses which blind us to the possibility that our

colleague may be struggling• We are fearful that we may be wrong• We believe it’s none of our business• We are uncomfortable with the stigma associated with

addiction• We are uncomfortable with our own and our culture’s

relationship to drugs and alcohol

What Should a Concerned Leader and/or Colleague Do?

• Notice.• Remember that addiction is a disease and follow with

compassion.• Become knowledgeable of the signs and symptoms of addiction.• Express concern to the individual, if you notice performance,

physical or behavioral changes.• Report a suspected problem.• Comply with all policies/ standards and report suspected

violations. • Recognize enabling such as covering for impaired performance.• Ask for help if you are the one struggling.

Speak Up

70% of patients at Hazleton Treatment Center went into treatment because a family member, friend, or coworker had the courage to speak up.

• Know Your Policies: • Drug Free Workplace: UMHS Policy 04-06-036 • For Cause Drug Testing: UMHS Policy 04-06-037• Fitness for Duty: UMHS Policy 201.15

• Employee Assistance Program (EAP)• Confidential counseling and consultation service – early

intervention – 24 hour availability – (734) 763-5409

• Director, Mgr., Supervisor, Dept. Head, Chair, Office of Clinical Safety, Office of Clinical Affairs

• Compliance Hotline: 866-990-0111

Who Do You Turn to for Guidance?

• Health Professionals Recovery Program (HPRP)• Confidential program designed to encourage health

professionals to seek treatment before their impairment harms a patient or damages their careers through disciplinary or regulatory action – 1-800-543-3784

• Michigan Public Health Code• Licensed/registered health professionals are required to

make good faith reports of suspected violations of the Code to the Department of Community Health, Bureau of Health Professions.

• “A licensee or registrant who has reasonable cause to believe that a licensee, registrant or applicant is impaired shall report that fact to the department (DCH-BHP).”

Who Do You Turn to For Guidance?

Know The Professional and Personal Risk Factors

• Family history• Chronic health conditions• Trauma history• Stress• Role Strain• Grief / Compassion Fatigue• Injuries and Chronic Pain• Availability/ Access• Participating in high risk

practices with alcohol and drugs

• Self-prescribing/ self-medicating

• Knowledge / Sense of Control

• Difficulty asking for help• Lack of education about

the disease • Defining lifestyle

shortcuts as virtues and not harmful to overall health and well-being

Engage In Positive Self Care as a Prevention Strategy

• Set appropriate boundaries at work and home• Routinely sleep 7 hours a night• Eat a healthy diet• Exercise• Consume on average 1 or 0 alcoholic beverages per day• Seek fellowship• Engage in spiritual and/or meditative practices• Participate in activities that bring you inspiration• Laugh• Show compassion towards self and others

Key Points

• Addiction is a public health and clinical safety issue.• Addiction is a treatable disease with behavioral symptoms

that lead to stigma. • Addiction is an occupational hazard for healthcare workers. • Healthcare workers are at high risk for addiction due to

stress and accessibility to drugs. • Healthcare workers need to be aware of signs and

symptoms of substance use in their colleagues and in themselves.

• Healthcare workers with substance use disorders can face serious health, professional and legal consequences.

Key Points

• When we view addiction as a disease, it allows us to see addicted employees/ colleagues as individuals who need treatment and to see intervention/ reporting as an act of compassion.

• Early detection and treatment leads to best outcomes and prevention of impairment.

• Diagnoses of addiction does not, per se, establish impairment.

• Any healthcare facility which houses controlled substances is at risk for diversion.

• As leaders, you have an obligation to ensure patient safety and honor the Michigan Public Health Code.

Speaking Up Can Save a Life

“Above all, do no harm.”

“Healing cannot occur until the secret is broken.”

“Timely identification, diagnosis, and intervention may save a life and a career.”

“Untreated substance use disorders and related disorders can lead to disability and/or death.”

“Recovery is a lifelong process that works.”

“Lives can be transformed.”

What questions or thoughts do you have?