A few years ago, "Grif," RN, drove home from the university hospital where she worked. Singing and blasting her radio, rolling down the windows to let the cold air in, she tried to keep from nodding off after taking heavy narcotics during her shift.

Earlier, she had gone to the bathroom to destroy 80 cc of unused morphine from a patient’s IV drip. Usually, that requires a witness. But Grif’s witness signed a form and left her alone with the bag, she said. With nobody around to watch her, she found a cup, poured the morphine drip into it and drank.

"I didn’t realize how high my tolerance had become," she said. She had mainlined morphine, but never more than 10 cc. "Your body absorbs half of the drug when you drink it. That means I had absorbed 40 cc. That’s how much my tolerance had increased. Narcotics depress the respiratory system. I could have stopped breathing."

The experience was a wake-up call, she said. It was near the conclusion of an odyssey that began in 1994, in which she partook of all kinds of drugs. She first became addicted to Vicodin (hydrocodone bitartrate) to relieve the pain of fibromyalgia.

Grif graduated to narcotic analgesics––she mainlined morphine, Dilaudid (hydromorphone) and Demerol (meperidine). Her sister, also a nurse, was doing cocaine, and so she got into that, she said. Eventually, she moved on to freebase and crack.

She began taking drugs from work, however, only after she failed to get clean with the help of a doctor who tried to diminish her drug use gradually with prescriptions.

"Of course, I didn’t taper off. I used them up quickly and then went into withdrawal." This included flulike symptoms and kicking in her bed. Finally, a physician referred her to a therapist, who got her into rehab.

Grif, now clean for 3½ years, eventually became a home care nurse. She prefers not to work in a place where she has access to heavy drugs. She agreed to talk to NurseWeek as long as her real name was not used.

Although she said she functioned as a nurse through her years of addiction and kept her license, other nurses often don’t. Their problems, instead, become the patients’ problems.

Another nurse, Jo, also began taking drugs from the Minnesota hospital where she worked in the 1980s. "We didn’t have access to the pharmacy," she said. "The pharmacist would give us PCAs [patient-controlled analgesia] pumps. I would take out the Demerol, take out the morphine and give the patient a blast of saline in the IV. That relieves nothing."

For the most part, drug abuse among nurses such as Jo and Grif is not that much higher or lower than that of the general population. (Depending on the literature, it could be anywhere from 10 percent to 15 percent.) Nurses are special cases, however, in that they have extremely stressful jobs—and ready access to drugs. Some have a family history of substance abuse. Others start to relieve the pain of their own medical problems after, say, an operation.

"If I were to pick one scenario that’s most common for a nurse, it would be that one individual has had some chronic pain problem," said Mike Coley, program director of the South Dakota Health Professionals Assistance Program. "They no longer have a prescription for the pain and just begin using medications from the workplace."

Nursing is a physically demanding job that can tax one’s strength and often causes musculoskeletal problems, said Alison Trinkoff, professor in the Department of Psychiatric/Community Health and Adult Primary Care at the University of Maryland School of Nursing.

Then there are those who use drugs to fill an emotional need.

"Obviously, it did produce euphoria for me," said Karen Tucker, who works in nursing informatics at the Louisiana State University Medical Center. Tucker lost custody of her three children to her former husband while addicted to painkillers, Demerol and Darvon (propoxyphene). She also developed anorexia before she divorced and often had blackouts. She said it was all part of the same problem.

"I walked around for most of my childhood and adulthood with a large black ball in my stomach. I was always in pain—emotional and physical pain. Most of all, the drugs allowed me to change the way I felt. I did not want to feel."

Nurses now more than ever have access to peer assistance and statewide programs to kick their habits and save their licenses. Several states, including South Dakota and Indiana, have created legislation in the past five years that allows nurses to stay licensed as long as they join programs equivalent to Alcoholics Anonymous or Narcotics Anonymous. The legislation has tried to balance the need to protect the public, against the need to look at drug addiction as a disease. D. Kete Cockrell, MD, who runs the Indiana State Nurses Assistance Program, estimates that about 30 states sponsor support programs.

"I think the main reason it happened in Indiana was that the scope of the problem became so big," Cockrell said.

Many experts said that the old programs—if there were any—usually made it impossible to turn in a nurse, for fear of recriminations or lawsuits, or the fear of ruining someone’s life. More recent efforts make it easier to put people into treatment, rather than firing them or ignoring the problem.

Indiana’s program, modeled after others in the United States, requires nurses with drug problems to stop practicing and enter a 12-step treatment program. Nurses enter a continuing care contract with the program, which only monitors them. The terms of the contract at first require three AA or NA meetings a week and a nurse support group. Nurses also submit to random drug testing.

If he or she is an alcoholic, the nurse is not allowed to perform patient care or handle controlled substances for six months. If the nurse has abused substances other than alcohol, the ban lasts a year. Also, nurses in treatment cannot involve themselves in stressful situations such as ICU, obstetrics or postop.

"This is a true diversionary program," Cockrell said. "If the attorney general receives a complaint about a nurse involving the usage or diversion of drugs, that individual is given the opportunity to enter the [program] in lieu of being charged and having a form of legal action taken."

Besides the shame involved, nurses may avoid treatment for other reasons. For one thing, it’s expensive. Cockrell said an intensive outpatient program can cost up to $13,000 for six to eight weeks. Some see 12-step methods as religion-oriented, although Tucker and Cockrell counter that atheists have qualified groups they can join.

In many states, licensing boards don’t even have to know about drug treatment as long as a nurse follows the rules of the program. But if a nurse fails to demonstrate a commitment to the program, or proves a threat to patients, he or she can lose their license.

"They have freed me from all restrictions," said Jo, who started using Demerol in the mid-1970s after having a cesarean. "Now my license looks like anybody else’s."

Jo has seen both sides of the disciplinary process, and how some states still choose to deal with the problem in a punitive manner. After eight years off drugs, she had a relapse in 1997, but by that time, she had left the relatively magnanimous world of Minnesota for upstate Idaho.

"I was the surgery supervisor and I had access to everything. In Idaho, they hate nurses who use drugs," she said, breaking into tears. "I was arrested. I spent two nights in jail. I was shackled and brought to the courtroom where I pleaded guilty. I was charged with a felony." She avoided jail time, however.

Jo’s husband was ill with a heart condition and her youngest son had left home. She said the loneliness led her back to drugs.

"It was the most horrible thing, restarting drugs. I had such self-hatred, and I guess I still do," she said.

Since then, she said she has passed all her drug tests, joined the South Dakota program and taken a job working with patients with an internal medicine doctor. It was a hard road back, however, and her difficult experience in Idaho—"They wanted to lock me up and throw away the key"—and inability to find work immediately afterward has convinced her that the medical profession too readily turns its back on its own.

"If the people in the medical field truly believe that addiction is a disease, then why didn’t [doctors want to] hire me? That’s like saying no to a diabetic," Jo said.

Tucker agrees.

"I don’t think they treat nurses who have the disease of addiction with respect," she said.

Tucker, who facilitates programs for recovering nurses twice a week, said her own time on drugs was only a small part of her experience with addiction.

"My bottoming out had so many facets," she said. "My bottom occurred after I got sober." In fact, she said she lost her license long after she got clean. Another addicted nurse had been taking narcotics from a hospital, but Tucker was blamed and had to give up her license for six months. But even off drugs, Tucker said she has not completely recovered, and that the experience was important.

"When I did voluntarily surrender my license, I began cleaning cars and houses.
It finally occurred to me that people don’t live this way."