The Anesthetic Agent Substance The Anesthetic Agent Substance Abusing ProviderAbusing Provider

Poonam Agarwal, RN, BSN, SRNAPoonam Agarwal, RN, BSN, SRNA

Valentyna Groelle, RN, BSN, SRNAValentyna Groelle, RN, BSN, SRNA

York College of PennsylvaniaYork College of Pennsylvania

Nurse Anesthetist ProgramNurse Anesthetist Program

ObjectivesObjectives

Discuss statistics and risk factors for anesthetic agent and substance abuse among Nurse Anesthetists and Anesthesiologists.

Identify currently abused anesthetic agents, in addition to patterns of behavior of the addicted provider.

Discuss legal issues regarding reporting impaired provider.

Examine current treatment and recovery programs, as well as options for reentry into the workforce.

PrevalencePrevalence

Risk FactorsRisk Factors

Factors Contributing to Factors Contributing to Development of Chemical Development of Chemical

DependencyDependency

OccupationalOccupational ExposureExposure(Gold et al., 2006)(Gold et al., 2006)

Occupational ExposureOccupational Exposure(Gold et al., 2006)(Gold et al., 2006)

Neurobiological FactorsNeurobiological Factors

Adapted from Volkow et al., Neuropharmacology, 2004.

DriveSaliency

Memory

Control

Non-Addicted Brain

NO GO

Addicted Brain

Drive

Memory

Control

GOSaliency

Why Can’t Addicts Just Quit?

Because Addiction Changes Brain CircuitsBecause Addiction Changes Brain Circuits

Most Commonly Abused Most Commonly Abused SubstancesSubstances

PropofolPropofol

Patterns of BehaviorPatterns of Behavior

Education and Education and PreventionPrevention

Legal IssuesLegal Issues

Legal Issues and OptionsLegal Issues and Options

TreatmentTreatment

Challenges of ReentryChallenges of Reentry

Challenges of ReentryChallenges of Reentry

Attitudes of ReentryAttitudes of Reentry

ReferencesReferences

Bryson, E. O., & Silverstein, J. H. (2008). Addiction and Substance Abuse in Anesthesiology. Anesthesiology, 109(5), 905-917.

Collins, G. B., McAllister, M. S., Jensen, M., & Gooden, T. A. (2005). Chemical dependency treatment outcomes of residents in anesthesiology: Results of a survey. Anesthesia and Analgesia, 101, 1457-1462.

Fitzsimmons, M. G., Baker, K. H., Lowenstein, E., & Zapol, W. M. (2008). Random drug testing to reduce the incidence of addiction in anesthesia residents: Preliminary results from one program. Anesthesia and Analgesia, 107, 630-635.

Garcia-Guasch, R., Roige, J., & Padros, J. (2012). Substance Abuse in Anaesthetists. Anesthesiology, 25(2), 204-209.

Gold, M. S., Melker, R. J., Dennis, D. M., Morey, T. E., Bajpai, L. K., Pomm, R., & Frost-Pineda, K. (2006). Fentanyl Abuse and Dependence: Further Evidence for Second Hand Exposure Hypothesis. Journal of Addictive Diseases, 25(1), 15-21.

Jungerman, F. S., Alves, H. N., Carmona, M. J., Conti, N. B., & Malbergier, A. (2012). Anesthetic Drug Abuse by Anesthesiologists. Revista Brasilieira de Anestesiologia, 62(3), 375-386.

McHugh, M., Papastrat, K., & Ashton, K. C. (2011). Assisting the drug addicted nurse: Information for the legal nurse consultant. Journal of Legal Nurse Consulting, 22(3), 11-14.

National Institute Of Drug Abuse (2008, July). Addiction Science: From Molecules to Managed Care. Retrieved February 1, 2013, from http://www.drugabuse.gov/publications/addiction-science/drug-use-changes-brain/exposure-to-some-drugs-abuse-can-change-structure-neurons-in-brain

Quinlan, D. (2001). Peer Assistance: A Historical Perspective. Retrieved January 20, 2013, from http://www.aana.com/peer/historical.asp

Skipper, G. E., Campbell, M. D., & DuPont, R. L. (2009). Anesthesiologists with substance use disorders: A 5-year outcome study from 16 state physician health programs. Anesthesia and Analgesia, 109(3), 891-896.

Stocks, G. (2011). Abuse of Propofol by Anesthesia Providers: the Case for Re-Classification as a Control Substance. Journal of Addictions Nursing, 22(1), 57-62.

Tetzlaff, J., Collins, G. B., Brown, D. L., Pollack, G., & Popa, D. (2010). A strategy to prevent substance abuse in an academic anesthesiology department. Journal of Clinical Anesthesia, 22, 143-150.

Wilson, H., & Compton, M. (2009). Reentry of the addicted certified registered nurse anesthetist: A review of the literature. Journal of Addictions Nursing, 20, 177-184.

Wright, E. L., McGuiness, T., Moneyham, L., Schumacher, J. E., Zwerling, A., & Stullenbarger, N. E. (2012). Opioid Abuse Among Nurse Anesthetists and Anesthesiologists. AANA Journal, 80(2), 120-128.