Substance Abuse in Health Care Professionals

This paper explores the issue of substance abuse among healthcare professionals and its negative impacts on patient safety and healthcare services. It defines substance abuse, discusses its scope, benefits, and challenges, and highlights its impact and implications. The paper concludes with recommendations for improved healthcare services.

Running head: Substance Abuse 1
Substance Abuse in Health Care Professionals
by
Course:
Tutor:
University:
Department:
Date:

Substance Abuse 2
Introduction
Healthcare professionals play a vital role in the society because their services have a
significant effect on both members of the community and the economic development of a
country. As a result, different level of professional conduct is expected of them (Rogers &
Ballantyne, 2010). Substance abuse among healthcare professions is likely to become risky to
them and have dire ramifications on their fitness and performance to offer quality healthcare
services. Studies have shown that incidences of substance abuse among healthcare
professionals commence at the start of their work (Jackson, Shanafelt, Hasan, Satele, &
Dyrbye, 2016). The impact of substance abuse among Canadian health care professionals
cannot be underrated. Studies have indicated that substance abuse among healthcare
professionals is slightly above (10%-15%) than in the general public and yet they are more
knowledge regarding the side effects of substance and drugs (Merlo, Trejo‐Lopez, Conwell,
& Rivenbark, 2013). Substance abuse causes cognitive impairment which makes the nurses
and other practitioners unable to make timely clinical decisions thus risking the lives
entrusted to them through misdiagnosis. 4.4% of Canadians aged 15 years and above tested
positive for substance abuse disorders (Canadian Centre on Substance Abuse, 2016). The
National Council of State Boards of Nursing (2011) approximates the misuse of drugs and
substance to be a little higher for healthcare experts. This paper aimed at exploring this issue
and make recommendations for improved healthcare services.
Background
Substance or drug abuse has become one of the leading public health issues in health over the
past decades due to the gravity of the effects which are beyond the biological limit. Drug and
substance abuse may lead to increased rates of morbimortality which results in high social
and economic costs (WH0, 2014). The effects of substance abuse are generally known both
in the public domain and the health sector. Substance abuse significantly affects working

Substance Abuse 3
associations, reduces performance and compromises workplace safety, as well as increased
absenteeism and presenteeism occurrences 1,2. Healthcare experts are generally perceived to
be the ambassadors of health habits and are typically expected to exhibit healthier lifestyles,
unlike the general population, in addition to low substance abuse and an increase of exercise
(WH0, 2014). Nevertheless, the reports by WH0 (2014) and VicHealth (2012) have indicated
that the rate of substance abuse and addiction among various health care professionals is not
that much different from the general population, and healthcare providers exhibit a higher
degree of the misuse of opioid.
These issues of substance abuse among healthcare professionals are alarming especially in a
provider population because they can result in serious issues for the patients under treatment
care of the doctors and nurses. Problematic substance use affects the cognitive functioning of
healthcare professionals and decision making and their capacity to manage stressful
circumstances. Moreover, substance abuse amongst healthcare experts contravene their
standards of ethical practice and compromises patient safety. Osmond (2011) reports that
about 20% of healthcare experts are victims of substance and drug abuse just like it is in the
general population. The Canadian Nurses Association also reported problematic substance
abuse by nurses to be one of the factors that affected the nursing profession in Canada
(Mental Health Commission of Canada, n.d.). Therefore, there is a need for emphasizing on
the substance abuse among healthcare professionals due to the negative impacts associated
with it.
Definition and Scope
Substance abuse is defined as scenarios in which the use of a substance adversely affects the
ability of an individual to practice in a safe, competent, and ethical way (Halley Grigsby,
Forster, Soto, Baezconde-Garbanati, & Unger, 2014). Problematic substance use among
Hispanic adolescents and young adults: implications for prevention efforts. Substance use &

Substance Abuse 4
misuse, 49(8), 1025-1038. In some instances, drug and substance abuse among healthcare
experts can degenerate to substance use disorder (SUD) which is a disease that can advance
further to higher chronic levels if not promptly treated. The issue substance abuse can be
dated back to the 1970s when it was recognized as ‘habits of intemperance,’ and no official
policy was developed by the American Medical Association by then to address the issue.
However, since then there has been increasing incidences of prescription and substance abuse
addiction among healthcare professionals more so for anesthetic and pain relievers across the
world (Merlo, Trejo‐Lopez, Conwell, & Rivenbark, 2013; Merlo, & Gold, 2008). The study
by Merlo et al.( 2013)carried out in the U.S have indicated that 10%-15% of healthcare
experts will abuse substances during their lifetime with the incidences of misuse in drug
prescriptions and addiction being five times higher among nurses and doctors than in the
general population especially for benzodiazepine and opioid abuse (Merlo et al., 2013; Merlo,
& Gold, 2008).
The commonly abused substances in Canada are alcohol, opioid pain treatment, and cannabis.
These substances are used in multiple places such as for leisure, but the impact can still be
felt at home, workplace performance and safety. Some of the risk factors associated with
substance abuse among nurses in Canada include easy access to alcohol and other substances,
stress, boredom, isolation, fatigue, job dissatisfaction, overworking, shift work, lack of
managerial supervision, and lack of appreciation (Mental Health Commission of Canada,
n.d.).
The Canadian Community Health Survey (CCHS) surveyed in 2012 and found out that 4.4%
of Canadians aged 15 years and above and which represents about 1.3 million people fulfilled
the tests for substance abuse disorder (Canadian Centre on Substance Abuse, 2016). This
trend is likely to be experienced at the workplace according to The Mental Health

Substance Abuse 5
Commission of Canada (2017). The National Council of State Boards of Nursing (2011)
approximates the misuse of drugs and substance to be a little higher for healthcare experts.
One out ten nurses is likely to be addicted to Substance Abuse (College of Registered Nurses
of British Columbia, 2011).
Bettinardi-Angres, Pickett, and Patrick (2012) elucidate that Alcohol abuse is predominantly
abused by the general public, but narcotics are mostly abused by nurses. Healthcare
professionals are knowledgeable regarding medications and are confident that they can self-
medicate without being addicted. Most of the healthcare experts have ease of access and are
highly exposed to controlled drugs and substances at their workplace. The College of
Registered Nurses of Nova Scotia (2016) defines drug diversion as the unlawful misdirection
or misapplication of any medication. Stealing and meddling with controlled drugs and
substances are critical kinds of a professional misdemeanor which makes one liable for
investigation and fines under the Criminal Code and the Controlled Drugs and Substances
Act (1996). For instance, a nurse hiding a section of the patient’s dose for himself or herself
or requesting a colleague to co-sign for drug wastage falsely. Studies have indicated that
Alcohol or drug use can impede discernment, understanding and decision making, weaken
cognitive and motor function and can negatively influence how one reacts to stressful
circumstances (Bernardin, Maheut-Bosser, & Paille, 2014). This compromises patient safety.
Benefits and Challenges
Healthcare providers face multiple challenges associated with substance abuse. Most of these
challenges are risk factors that predispose them to the misuse of drugs. Most of the
healthcare professionals have easy access to alcohol and controlled drugs in their workplace.
This makes it difficult to avoid the use of the drugs even if one had no intention of misusing
it.

Substance Abuse 6
Additionally, healthcare professionals such as pharmacists and nurses are the ones that
mostly administer drugs to the patient. This increases the possibility of them reserving some
other medications for their use especially when there is no close supervision. Kenna and
Lewis (2008) examined risk factors for substance abuse among healthcare professionals and
found out that drug access at the workplace influenced most of the nurses to commence drug
misuse.
Another challenge faced by the healthcare professionals that exposes them to drug misuse is
increased stress at the workplace due to overworking and fatigue. The duties of healthcare
providers are beyond mere medication but also involves intimate association and relationship
building. This makes their work demanding thus increasing tension levels especially when
they work for more hours. Studies have indicated the nursing profession is one of the leading
stressful professions with high rates of resignations and career change (Aiken, Sloane,
Bruyneel, Van den Heede, & Sermeus, 2013). As a result, nurses resort to drug medications
such as anesthetic to minimize stress levels. Continual use of pain relievers increases their
dependency until they become addicted (Groh & Rouen, 2014).
Long hours and shift work are some of the challenges faced by healthcare professionals and
which exposes them to substance use. Long hours and shift work mainly in the nursing
profession has been associated to fatigue and job dissatisfaction thus making employees
resort to the use of pain relievers which they easily access while at the hospital (Er, &
Sökmen, 2018). Research has also shown that nurses are overworked by the system of shift
work and long hours at work (Caruso, 2014). As a result, they divert drugs meant for patients
to their use so that they can remain active while on duty, an act if done continuously might
lead to addiction (Mental Health Commission of Canada, n.d.).

Substance Abuse 7
Impact and Implications
Substance abuse has severe impacts on nurses and the nursing system. Drug diversion can
lead to severe legal and ethical consequences. Diversion of prescribed drugs can lead to fines
and even imprisonment, revocation of practicing license, job loss and poor health or even
death (Berge, Dillon, Sikkink, Taylor, & Lanier, 2012).
Misuse of drugs can also lead to cognitive impairment which will affect the process of
decision making which is very critical in offering treatment services. This implies that
healthcare experts will not provide quality care services and their miss-judgment is likely to
increase the patient’s risk of misdiagnosis. Nibbelink and Brewer (2018) examined critical
decision making in nursing practice and elucidated that nurses were always involved in acute
care which demands different decision-making skills for effective healthcare services. A
study conducted by Harker Burnhams, Dada, Linda, Myers, and Parry (2013) on the effect of
drug abuse on workplaces found out that alcohol addiction hurt employee performance at
work due to cognitive impairment and poor decision-making process.
Drug abuse among health professionals increases patient risk of complications and even death
due to the poor healthcare services provided by nurses or physicians while under drugs.
Cares, Pace, Denious, and Crane (2015) surveyed nurses and assessed the use of drugs and
associated mental disorders and hindrances to medication. The authors indicated that mental
illness was present among nurses addicted to substance abuse and they could not seek
medical assistance for fear of losing their practicing license. This aspect further exposed the
patients to poor healthcare services because the nurses were not deemed to be in a proper
mental state to offer treatment even though they were still practicing. Poor quality health
services as a result of substance misuse among healthcare professionals impact the healthcare
system by causing a negative reputation. Practicing nurses found to be addicts to substance

Substance Abuse 8
abuse causes disrepute to the licensing body, thus affecting the entire health system (Abuse &
Office of the Surgeon General, 2016).
Substance abuse in health professionals will affect human resource management as well. Poor
quality healthcare services due to substance abuse which impairs cognitive functioning
(Bernardin et al., 2014) is likely to lead to job loss. Research has already indicated that most
of the healthcare providers are affected by substance abuse more than the general population
(Merlo et al., 2013). This suggests that healthcare providers will become few, increased
workplace absenteeism and turnover.
Recommendations
Treatment programs for Addiction and Substance Abuse
As much as there exists programs of promoting patient safety, healthcare professionals
affected by substance abuse are still under-assessed and unattended to for substance misuse
and addiction (Merlo, & Gold, 2008) because of their reluctance, in addition to their
workmates and families to report such cases for fear of the possible legal, ethical, and
financial effects (Merlo, & Gold, 2008; (Research Update Buttler, Centre for Research,
2015). There is a need for treatment programs for healthcare professionals who misuse drugs
because the Canadian State medical board expects enhanced treatment levels for quality
healthcare (Merlo., 2013). The healthcare providers that abuse opioids are more likely to
suffer from relapse unlike the general population (Bowen et al., 2014), thus calling for
advanced post-treatment approach and sustained recovery plans. The victims should be
treated away from their medical community by physicians and counselors whom they are not
familiar with (Merlo, & Gold, 2008). This will help to minimize any risk of bias during the
intervention (DuPont, McLellan, Carr, Gendel, & Skipper, 2009. The treatment approach
utilized by McLellan, Skipper, Campbell, and DuPont (2008) showed that 81% of the patients
who were enrolled in the treatment programs demonstrated improvements for five years. The

Substance Abuse 9
treated healthcare experts can be checked for abstinence by undertaking random drug tests
once the treatment has been found to be effective. Random drug testing was found to be more
effective (96%) unlike those not exposed to mandatory testing (64%) (Research Update
Buttler, Centre for Research, 2015).
Education intervention and Awareness
According to Osmond (2011), lack of education on substance and drug abuse and fear for the
consequences of substance abuse are the two main hindrances to effective intervention for the
increased substance abuse among healthcare professionals. The different healthcare centers in
Canada can offer a free education and intervention and awareness program to equip
healthcare experts across Canada. The curriculum should be developed by experts in
healthcare and psychology experienced in drug policy and the prevention and management of
substance addiction (Soares, Vargas, & Formigoni, 2013). This education and awareness
programme will aim to equip healthcare professionals on fundamental knowledge regarding
substance abuse. The specific subjects to be covered include warning signs of addiction,
information on the effects of substance and drugs on cognitive function, on relationships and
work performance. The education and awareness programme will also deal with approaches
on how to identify colleagues who have been addicted to drugs and the most appropriate way
or reporting. The awareness program can be done by placing posters at designated places
with warnings on substance abuse. Seminars can also be conducted twice to thrice a month
based on the need. Experts on a different subject should be invited to give lectures on the
same.
Studies have shown that education and awareness campaigns are most effective in addressing
drug addictions. Johnston, Miech, O’Malley, Bachman, and Schulenberg (2015) carried out a
study and found out that relevant campaign awareness and education on drug abuse led to
significant reductions in the use of drugs. I agree with the above approaches of addressing

Substance Abuse 10
substance abuse because they are useful and reduce the effect of risk factors that prone the
users to drug misuse.
Conclusion
Healthcare experts have a primary role of care to the patients entrusted to them hence the
reason for the high expectations for professional care. It is alarming that the rate of drug and
substance abuse amongst the nurses and physicians is slightly higher than that reported in the
general public, and yet these medical practitioners are more knowledgeable on the effects of
substance misuse. The increasing cases of substance abuse amongst healthcare professionals
compromise their duty leading to legal, ethical and economic costs. There, therefore, need for
treatments to addicted individuals to alleviate the current condition and an education and
awareness intervention to help prevent future occurrence of the problem

Substance Abuse 11
References
Abuse, S., US, M. H. S. A., & Office of the Surgeon General (US. (2016). Health Care
Systems And Substance Use Disorders.
Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Sermeus, W., & Rn4cast
Consortium. (2013). Nurses’ reports of working conditions and hospital quality of
care in 12 countries in Europe. International journal of nursing studies, 50(2), 143-
153.
Berge, K. H., Dillon, K. R., Sikkink, K. M., Taylor, T. K., & Lanier, W. L. (2012, July).
Diversion of drugs within health care facilities, a multiple-victim crime: patterns of
diversion, scope, consequences, detection, and prevention. In Mayo Clinic
Proceedings (Vol. 87, No. 7, pp. 674-682). Elsevier.
Bernardin, F., Maheut-Bosser, A., & Paille, F. (2014). Cognitive impairments in alcohol-
dependent subjects. Frontiers in psychiatry, 5, 78.
Bettinardi-Angres, K., Pickett, J., & Patrick, D. (2012). Substance use disorders and
accessing alternative-to-discipline programs. Journal of Nursing Regulation, 3(2), 16-
23.
Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., ... & Larimer,
M. E. (2014). Relative efficacy of mindfulness-based relapse prevention, standard
relapse prevention, and treatment as usual for substance use disorders: a randomized
clinical trial. JAMA psychiatry, 71(5), 547-556.
Canadian Centre on Substance Abuse. (2016). Addiction recovery. Retrieved from

Substance Abuse 12
http://ccsa.ca/Eng/topics/addiction-recovery/Pages/default.aspx
Cares, A., Pace, E., Denious, J., & Crane, L. A. (2015). Substance use and mental illness
among nurses: workplace warning signs and barriers to seeking assistance. Substance
abuse, 36(1), 59-66.
Caruso, C. C. (2014). Negative impacts of shiftwork and long work hours. Rehabilitation
Nursing, 39(1), 16-25.
College of Registered Nurses of British Columbia. (2011). Early intervention program
health. Vancouver, BC: Author.
College of Registered Nurses of Nova Scotia. (2016). Problematic substance use in the
workplace: Practice guideline. Halifax, NS: Author.
DuPont, R. L., McLellan, A. T., Carr, G., Gendel, M., & Skipper, G. E. (2009). How are
addicted physicians treated? A national survey of physician health programs. Journal
of Substance Abuse Treatment, 37(1), 1-7.
Er, F., & Sökmen, S. (2018). Investigation of the working conditions of nurses in public
hospitals on the basis of nurse-friendly hospital criteria. International Journal of
Nursing Sciences, 5(2), 206-212.
Groh, D. C., & Rouen, P. (2014). The prevalence and patterns of substance abuse among
nurse anesthesia students. AANA journal, 82(4), 277.
Halley Grigsby, T. J., Forster, M., Soto, D. W., Baezconde-Garbanati, L., & Unger, J. B.

Substance Abuse 13
(2014). Problematic substance use among hispanic adolescents and young adults:
implications for prevention efforts. Substance use & misuse, 49(8), 1025-1038.
Harker Burnhams, N., Dada, S., Linda, B., Myers, B., & Parry, C. (2013). The extent of
problematic alcohol and other drug use within selected South African
workplaces. SAMJ: South African Medical Journal, 103(11), 845-847.
Jackson, E. R., Shanafelt, T. D., Hasan, O., Satele, D. V., & Dyrbye, L. N. (2016). Burnout
and alcohol abuse/dependence among US medical students. Academic
Medicine, 91(9), 1251-1256.
Johnston, L. D., Miech, R. A., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2015).
Use of ecstasy, heroin, synthetic marijuana, alcohol, cigarettes declined among US
teens in 2015. Ann Arbor.
Kenna, G. A., & Lewis, D. C. (2008). Risk factors for alcohol and other drug use by
healthcare professionals. Substance Abuse Treatment, Prevention, and Policy, 3(1), 3.
McLellan, A. T., Skipper, G. S., Campbell, M., & DuPont, R. L. (2008). Five year outcomes
in a cohort study of physicians treated for substance use disorders in the United
States. Bmj, 337, a2038.
Mental Health Commission of Canada (2017). Problematic substance use in the workplace.
Retrieved from https://www.mentalhealthcommission.ca/English/catalyst-april-2017-
problematic-substance-use-workplace
Mental Health Commission of Canada. Canadian Centre on Substance Abuse, & the

Substance Abuse 14
Conference Board of Canada. (n.d.). Start the conversation: Problematic substance
use and the workplace. Retrieved from
file:///C:/Users/Admin/Downloads/Documents/PSUW%20Brochure.pdf
Merlo, L. J., & Gold, M. S. (2008). Prescription opioid abuse and dependence among
physicians: hypotheses and treatment. Harvard Review of Psychiatry, 16(3), 181-194.
Merlo, L. J., Trejo‐Lopez, J., Conwell, T., & Rivenbark, J. (2013). Patterns of substance use
among healthcare professionals in recovery. The American journal on
addictions, 22(6), 605-612.
National Council of States Boards of Nursing. (2011). Substance use disorder in nursing: A
resource manual and guidelines for alternative and disciplinary monitoring
programs. Chicago, IL: Author.
Nibbelink, C. W., & Brewer, B. B. (2018). Decision‐making in nursing practice: An
integrative literature review. Journal of clinical nursing, 27(5-6), 917-928.
Osmond, M. (2011). Regulatory notes: Substance abuse in the workplace: Recognizing the
signs and symptoms in your RN colleague. Access, 32(3), 16-17.
Research Update Buttler, Centre for Research. (2015). Health Care Professionals: Addiction
and Treatment.
file:///C:/Users/Admin/Downloads/Documents/BCRHealthCareProfessionalsJune201
5.pdf
Rogers, W., & Ballantyne, A. (2010). Towards a practical definition of professional
behaviour. Journal of medical ethics, 36(4), 250-254.

Substance Abuse 15
Soares, J., Vargas, D. D., & Formigoni, M. L. O. D. S. (2013). Knowledge and attitudes of
nurses towards alcohol and related problems: the impact of an educational
intervention. Revista da Escola de Enfermagem da USP, 47(5), 1172-1179.
Victorian Health Promotion Foundation (VicHealth). (2012). Reducing alcohol-related harm
in the workplace: an evidence review: summary report, Melbourne, Australia:
VicHealth. Retrieved from https://www.google.com/search?
ei=nUoDXNCKPIGa1fAP8NiBqAM&q=Victorian+Health+Promotion+Foundation+
%28VicHealth%29.+Reducing+alcohol-
related+harm+in+the+workplace&oq=Victorian+Health+Promotion+Foundation+
%28VicHealth%29.+Reducing+alcohol-related+harm+in+the+workplace&gs_l=psy-
ab.3...195752.195752..196499...0.0..0.329.329.3-1......0....1j2..gws-
wiz.......0i71.bKkpxeOL4nw
World Health Organization. (2014). Global status report on alcohol and health 2014.
Geneva: WHO; 2014. Retrieved from
http://apps.who.int/iris/bitstream/handle/10665/112736/9789240692763_eng.pdf;jsess
ionid=BEEE53921C7E5BA1601876064AFEC1BE?sequence=1