Exposure of anesthesia providers in recovery from substance abuse to potential triggering agents.

STUDY OBJECTIVE: To determine the experience, attitudes, and opinions of anesthesia providers in recovery from addiction to anesthetic agents, who subsequently undergo surgery or who require opioid analgesics for injuries or other conditions. DESIGN: Survey instrument. SETTING: Academic medical center. SUBJECTS: Physicians and nurse-anesthetists in recovery in the United States. MEASUREMENTS: A link to a survey was posted on the Anesthetists in Recovery website on January 17, 2010 and allowed to remain active for a period of one week. The survey also was distributed via email to recovering anesthesiologists in a "snowball sampling" method. Completed surveys were reviewed, and data were compiled using Survey Monkey, with categorical variables described as frequencies and percentages. MAIN RESULTS: A total of 30 surveys were returned, with 27 (90%) reporting a history of abusing anesthetics or drugs commonly found in the work environment, and 19 (65.5%) reporting abuse of recreational drugs and drugs used during the administration of anesthesia. Twenty-eight (93%) respondents reported finding themselves in a situation that necessitated they receive their former drug of choice for legitimate medical reasons while in recovery. CONCLUSIONS: Anesthesia care providers in recovery from addiction to anesthetic agents may undergo subsequent exposure to these agents due to medical necessity. Participation in a program of recovery with support from family members may decrease the risk of relapse but does not eliminate it.

Substance abuse issues in oral and maxillofacial practice.

Substance abuse has far-reaching consequences for individuals, their families, and the community. Medications with abuse potential play an important role in the management of pain and are widely prescribed by the oral and maxillofacial surgeon. Reducing the likelihood of abuse and providing appropriate pain management for the known abuser are critical aspects of perioperative patient management. Health care providers are not immune to substance abuse and may, in fact, be at an elevated risk. Identification of impaired providers is essential to help them find the appropriate treatment and counseling and to prevent harm to their patients, family, friends, or associates.

Substance use among third year medical students of Nepal.

BACKGROUND: Substance use is very rampant in a developing country like Nepal. Unfortunately, medical field is not exempt from it either. Substance use among medical students and doctors not only reduces their efficiency at present but also increases their DALY on long term. The main objectives of the study were to assess the prevalence of substance use among medical student and to find out whether substance use started before or after joining the medical school. METHODS: The study design employed for the research was descriptive cross sectional. A structured questionnaire about current use of tobacco, alcohol and marijuana was used to collect the data from third year students from eight medical and one dental college from across the country having 2006 batch. RESULTS: The overall response rate was 74.12% (N=510). Among those who responded, prevalence of substance use was 49.6%, of which 38.2% were Nepalese nationals and 11.4% were foreign nationals and 39% were male and 10.6% female. Alcohol based product users were 52.3%, tobacco based product users were 55% and marijuana users were 65.7% and all started using them after joining the medical school. CONCLUSIONS: Almost half of the respondents were involved in some sort of substance use and more than half of those using started after joining medical school. Hence if proper measures are taken to address this then its prevalence can be significantly reduced if not eliminated completely.

Physician wellness: a missing quality indicator.

When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.

Domestic violence: caring for a colleague.

Domestic abuse is a devastating social, legal, and health care problem of enormous proportions. Routine and multiple screenings by skilled health care providers, when conducted face-to-face, markedly increase the identification of physical, psychological, and sexual abuse. Patients are not the only ones who can benefit from domestic violence screening and intervention. This article describes the subtle signs of domestic abuse that might be observed in a colleague, explains how to initiate a conversation with a colleague, and suggests appropriate ways to offer support.

Substance abuse: prevalence in a sample of nursing students.

AIMS: The aim of this research was to evaluate the prevalence of substance abuse in a sample of Iranian nursing students. DESIGN AND MEASUREMENTS: Four hundred nursing students (85.25% were females and 14.25% were male) were assessed by a confidential questionnaire based on DSM-IV, which was distributed, completed by the students and collected in the same session. FINDINGS: Mean age of the females was 20.3 and of males was 22.8. Of the subjects, 27.3% (21.4% of females and 61% of males) reported usage of substance(s) once or more sometime during their lives: cigarette (25.3%), alcohol (5.8%), opium (8.5%), cocaine (1.5%), hashish (1.5%), marijuana (0.8%) and morphine (0.5%). Only 3.8% of the participants (1.8% of females and 15.3% of males) reported still using substances: cigarettes (3.3%), alcohol (1.7%), opium (0.8%), cocaine (0.5%) and marijuana (0.3%). About 11.8% of the subjects (10% of females and 22% of males) reported using of substances occasionally (at least once a month): cigarette (10.8%), alcohol (3.5%), opium (4.3%), cocaine (0.5%) and hashish (0.3%). Some used or were using more than one substance. CONCLUSIONS: Substance use was significantly related to sex: higher among males than females. Tobacco and opium were found to be the most prevalent form of substance use among students. Pleasurable purposes, habit, need (to avoid withdrawal symptoms) and tension were the major reasons for substance use. There was no report of psychedelics use. These results are, however, different from those studies carried out in the west, although there is some overlap. Cultural attitudes toward substance use quite likely affect the types and patterns of use. These findings can be considered when planning preventive and therapeutic programmes. RELEVANCE TO CLINICAL PRACTICE: Substance use can reduce scientific progress and academic achievement of nursing students; therefore, authorities of the university must be able to assess the extent of the problem, understand the contributing factors, recognize signs and symptoms, and use educational interventions in identifying and preventing substance dependency.

My name is Ellen and I'm a recovering....

Drug addiction. A unique illness. Those of us who are afflicted, live with it, refuse to acknowledge it and fail to seek a cure. My story is that of many impaired nurses who are suffering from addictions. I hope that by sharing it with you I can help you to recognize fellow nurses who may be addicted and assist them on the road to recovery.