By R Carter
As the war on prescription opiates continues, the massive campaign of disinformation by state and federal officials of laying the blame at the feet of doctors prescribing for chronic pain, is now spilling over into the lives of other healthcare professionals suspected of diversion. According to the Mayo Clinic a leader in developing programs to detect diversion in hospitals and clinics, as many as 15% of healthcare workers were diverting controlled substance in 2011.
Considered a victimless crime by some, such individuals are sent to treatment and following completion of a rigorous program, return to their healthcare jobs in positions of trust.Healthcare professional are considered a special group due to personality makeup and the fact that they have greater access to controlled substances. As such, a stay in treatment often goes 90-120 days as apposed to the 30 days for others.
Returning to their careers in healthcare has been the traditional response for decades, but with relapse rates as high as 70% for some groups such as psychiatry, surgical personnel and anesthesia providers, combined with a no tolerance response from regulatory boards, physicians and nurses in the near future may find themselves unemployable.
The diversion problem not only has hospitals and clinics in a panic, but of equal concern is how to respond once a professional has completed a period of treatment and abstinence from healthcare. A 2008 longitudinal study reported that 71% of first time participants who completed their treatment programs maintained sobriety for five years posttreatment. But is five years long enough for a chronic and debilitating disease in this new era of opiate hysteria?
This report from HireRight suggests this problem is overlooked, with 90% of Long-term Care Organizations employing individuals with criminal convictions, in part due to the fact that those recovering from a substance abuse disorder, more often than not, must find lower qualified and lower paying jobs. The Bureau of Labor Statistics estimated that in 2014 there were 16,000 healthcare positions that needed filling and the numbers keeps growing as a larger percentage of our population becomes elderly.
After 30 years of cost cutting, driven primarily by insurance companies implementing managed healthcare programs, healthcare facilities are greatly understaffed. In the 1980’s the average patient to nurse ratio was 4:1, today that ratio is often 15:1. In post surgical rehabilitation centers and nursing homes, that ratio is 30:1, with staff positions often filled by temps because of the shortage.
The results has been fewer highly educated individuals for providing care as fewer people go on to get an education in such low paying but demanding positions. Government, educators and hospitals have managed by creating lower skilled certification standards for so called technician positions, but this too has it’s problems, as studies show that lower skilled groups have higher rates of drug diversion in clinical settings.
Following elective surgery or surgery due to an injury, patients are kept at acute care facilities for only a few days and are then transferred to post-surgical facilities for the remaining time. In these facilities patients report going as long as 8 hours without pain medication because nurses never return after a request is made. Begging the question, is this a staff shortage problem or a diversion problem?
As someone who was recently discharged from such a facility, I can testify to this. It’s not unusual to walk the halls of these facilities hearing multiple calls for help because of pain. And it’s not just those on Medicare and Medicaid, as top line insurers of managed care plans attempt to squeeze more profit from a smaller population. Individuals on these plans and in these facilities are, for all practical purposes, left to fend for themselves, bed rails up and no way to even get to a bathroom. Unable to defend themselves, often helpless and hopeless because our government supports corporate profits ahead of patient well being.
And now with growing concerns about addiction it’s easy to justify not treating pain in these groups. The mental and emotional anguish created by this trend known no bounds, but such facts are hidden behind the nobel jesters of our legislators, selling us a stronger economy in a drug free society. When you look at how these ideas are implemented, it is anything but good for John Q Public.
What will happen if healthcare organizations are forced by regulation or public pressure to stop rehiring recovered substance abusers? Can we survive a 15% reduction in the number of healthcare professionals? And with hallways filled with cries and moans of “Somebody please help, I’m hurting”, will our legislators be there to support our need? What is now only a travesty will soon become an epidemic of neglect if the current trend continues.
A new report by data firm Protenus finds that this so-called “opioid diversion” is a growing problem. In 2018, more than 47 million doses of legally prescribed opioids were stolen, an increase of 126 percent from the year before. That’s 47 million doses that were supposed to go to patients for legitimate surgical procedures who didn’t get them. I dare say, many of those were individuals in those post-surgical facilities or nursing homes.
Protenus found 34 percent of these incidents happened at hospitals or medical centers, followed by private practices, long-term care facilities and pharmacies. Only 77% of the cases identified a particular drug, but the most common was Oxycodone, followed by hydrocodone and fentanyl.
Sixty-seven percent of the time, doctors and nurses are responsible. Dr. Stephen Loyd of Tennessee was one of them.
“What I didn’t realize was how quickly it would escalate. Going from that half of a five milligram Lortab, to within three years about 500 milligrams of Oxycontin a day. That’s about 100 Vicodin,” he said.
For three and a half years, he siphoned drugs away from his patients.
“There was no requirements on what happened to those pills. They could go down the toilet or they could go in my pocket,” Loyd said.
He warns that people who work in the healthcare industry are at high risk of abuse.
“They’ve got high stress jobs. A lot of them, like myself, have workaholism. And not only that, you have access,” Loyd said.
He’s now been clean for 15 years and was the director of Tennessee’s Mental Health and Substance Abuse Services division before running a rehab facility in Murfreesboro, Tennessee. Loyd implores addicted health care workers to admit they need help, which he knows was the hardest part for him until he was confronted by his own father.
After confessing to his dad fears of losing his house, car and career should he come clean, his father responded, “None of those things are gonna do you any good if you’re dead.”
Kira Caban of Protenus said the firm’s findings are likely a “tip of the iceberg” considering only a fraction of opioid diversions are uncovered because an addict admits to the behavior or a patient gets sick. The Department of Justice established an Opioid Fraud and Abuse Detection Unit to , but it’s operational in less than a third of the country.