Week 8 - Substance Use Disorder and Anesthesia Providers Flashcards
What are the incidence ratios of:
- personally knowing an addict
- living with an addict
- are an addicts
1: 3 people personally know an addict
1: 10 people live with an addict
1: 15 people are addicts
What are characteristics of an addict?
- Intelligent
- Top 25% of their class
- Top performers
- Well liked and respected
- Supervisors and managers
- Advanced degrees
What is the incidence of substance use disorder among anesthesia professionals?
10-15% of anesthesia professionals will misuse drugs at some point in their life
- Risk of mortality is significantly increased because of access to potent and highly addictive anesthetic agents with a NARROW THERAPEUTIC INDEX
- As compared to other healthcare professionals, anesthesia providers are more likely to to abuse drugs intravenously and alcohol.
What is the definition of drug diversion?
Defined by the AANA as “the transfer of any substance from the purpose for which it is intended for any illicit use”
What are risk factors of substance use disorder specifically in the anesthesia provider?
- Family history of addictive behaviors
- Sensation seeking or impulsive personality
- Long clinical hours
- Abnormal sleeping hours
- Sentinel Events (PTSD)
- Adverse Childhood Events (ACE): abuse, parental death or other traumas
- Co-morbid health diagnosis
- Stressful career
What are risk factors of substance use disorder?
- Males
- Self medication of symptoms associated with comorbid psychiatric disorders
- Proximity of large quantities of highly addictive drugs/easy access
- Prior history of treatment for SUD
- Family history of SUD with having used a “major opioid” as the drug of choice
- No longer involved in treatment or monitoring programs
What are SIGNS of drug diversion? (8)
- 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
- Times of cases do not correlate when provider dispenses drug from automated dispenser
- Inappropriate drug choices and doses for patients
- Missing medications or prescription pads
- Drugs, syringes, needles improperly stored
- Signs of medication tampering, including broken vials returned to pharmacy
What are BEHAVIORS of drug diversion? (6)
- Consistently uses more drugs for cases than colleagues
- Frequent volunteering to administer narcotics, relieve colleagues of casework, especially on cases where opioids are administered
- Consistently arrives early, stays late, or frequently volunteers for overtime
- Frequent breaks or trips to bathroom
- Heavy wastage of drugs
- Drugs and syringes in pockets
What are SIGNS of drug impairment? (5)
- Physical indications (e.g., track marks, bloodshot eyes)
- Signs indicative of drug diversion* (see right column)
- Deterioration in personal appearance
- Significant weight loss or gain
- Discovered comatose or dead
What are BEHAVIORS of drug impairment? (13)
- Severe mood swings, personality changes
- Frequent or unexplained tardiness, work absences, illness or physical complaints
- Elaborate excuses
- Underperformance
- Difficulty with authority
- Poorly explained errors, accidents or injuries
- Wearing longs sleeves when inappropriate
- Confusion, memory loss, and difficulty concentrating or recalling details and instructions
- Visibly intoxicated
- Refuses drug testing
- Ordinary tasks require greater effort and consume more time
- Unreliability in keeping appointments and meeting deadlines
- Relationship discord (e.g., professional, familial, marital, platonic)
What is included in the BIG 5 drug test panel?
- Amphetamine and Methamphetamine
- Cocaine metabolite
- Marijuana metabolite
- Opiates (codeine, morphine)
- PCP
**screening for propofol and fentanyl are a different test
What drugs can be tested through hair analysis?
- Cocaine
- Marijuana
- Opiates (including heroin and synthetic opioids like Fentanyl)
- Amphetamines (methamphetamine and Ecstasy)
- PCP
- Propofol
*detected up to 90 days post use
