Definitions
A disease of the brain characterized by the recurrent use of substances that cause clinical and functional impairment
Substance Use Disorder
Psychological
Depression/anxiety
Low self-esteem
Low stress tolerance
Feelings of resentment
Drug Diversion Behaviors
Behavior: Consistently uses more drugs for cases than colleagues, Frequent breaks/trips to the bathroom, Drugs/syringes in pockets
Frequent volunteering to administer narcotics, relieve colleagues of casework, especially on cases where opioids are administered
Frequent breaks or trips to bathroom
Drugs and syringes in pockets
CRNA School
Question: Do any of those risk factors stand out to you as something that an SRNA might experience?
Stage in which there is a substantial loss of self-control, as indicated by compulsive substance use despite the desire to stop using
Addiction
Behavioral/Social
Maladaptive coping strategies
Trauma, isolation, abuse, lack of support system
Stressful work, home, community environment
Victim of bullying (e.g., work place, school)
Drug Diversion Signs
Anesthesia record does not reconcile with drug dispensed and administered to patient
Patient has unusually significant or uncontrolled pain after anesthesia
Higher pain score as compared to other anesthesia providers
Missing medications or prescription pads
Drugs, syringes, needles improperly stored
Signs of medication tampering, including broken vials returned to pharmacy
Reporting
Question: Can you think of any barriers to reporting? Why or why not?
The transfer of any substance from the purpose for which it is intended for any illicit use (e.g., personal use, sale)
Drug Diversion
Workplace-Specific
Heightened stress of working in high-intensity environment (e.g., operating room)
Production pressure
Fatigue and burnout
Irregular work hours
Role strain
Inadequate work-life balance
Impairment Behaviors
Frequent or unexplained tardiness, work absences, illness or physical complaints
Behavior: Elaborate excuses, Underperformance, Poorly explained errors, accidents or injuries
Difficulty with authority
Poorly explained errors, accidents or injuries
Confusion, memory loss, and difficulty concentrating or recalling details and instructions
Visibly intoxicated
Refuses drug testing
Support
Question: How would you suggest we support our colleagues in recovery who are re-entering the clinical arena?
Inability or impending inability to engage safely in professional and daily life activities as a result of use, abuse, or addiction
Impairment
Anesthesia-Specific
Possible sensitization to the effects of opioids and anesthetic agents
Access and availability of opioids, benzodiazepines, IV and inhalational anesthetics in workplace
Unregulated, readily available propofol
Impairment Signs
Physical indications (e.g., track marks, bloodshot eyes)
Deterioration in personal appearance
Significant weight loss or gain
Positivity
Question: We're out here, enjoying the sun, trying to keep an eye on the dogs lest they eat dirt. Wellness is really important for people in anesthesia school and we see that poor wellness can lead to SUD. What do you think we can do together to foster our wellness through school and after?