3 Pillars to Reduce Health Care Drug Diversion Among Nurses With Substance Use Disorder

The Statewide Peer Assistance for Nurses (SPAN), an affiliate of the New York State Nursing Association, is devoted to helping nurses throughout the state obtain the resources, guidance, and peer support they need to recover from substance use disorders (SDUs) — including SUDs correlated with drug diversion at hospitals and other medical settings.

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But while many health leaders think they have a grasp of who is at risk, many of the nurses who come to a SPAN are not always who one would expect to see.

They are high performers who, on the surfacem seem at the top of their game, quietly struggling behind the scenes. They are breadwinning moms and dads with children to support. According to a study published in The Journal of Nursing Administration, between 8% and 20% of all nurses in the United States have had trouble with 1 or more SUDs during their careers.¹

But too often, they are afraid of the consequences of seeking help. This is especially true for nurses with SUDs engaging in drug diversion, a felony that can result in criminal charges and loss of one’s nursing license. Over past 5 years, I have personally known 11 nurses who died from SUDs or correlated behavioral health issues because they could not receive the interventions they needed sooner.

Understanding the Challenges

Most health leaders are well aware that health care physician burnout rose to epidemic proportions during the COVID-19 pandemic, according to a study in the International Journal of Environmental Research and Public Health.²

But nurses seem to be feeling the impact more acutely. In a 2022 online survey of 2,500 nurses conducted by Trusted Health, nurses rated their current mental health and wellbeing at an average of 5.8 out of 10, a 26% decline from 7.8 from the same survey conducted pre-COVID-19. The majority of nurses surveyed reported feelings of burnout (75%), compassion fatigue (66%), depression (64%), declines in their physical health (64%) and extreme feelings of trauma, extreme stress and/or PTSD (50%). One in 10 said they experienced suicidal thoughts because of the pandemic.³

In a research report published by the National Insititute on Drug Abuse, the correlation between mental health issues and SUDs is strong.⁴ Although nurses are reporting higher levels of burnout and mental health problems, there have been cutbacks to internal support programs, as well as programs to mitigate drug diversion. As a 2021 report by Invistics and Porter Research observed, more than 8 in 10 health care professionals (82%) know or have met someone who has diverted drugs. However, the same survey noted that health care organizations are scaling back resources — namely the reliance on dedicated, in-house drug diversion professionals — to address this problem.⁵

While it is important to note that not all clinicians with SUDs divert, or steal, medications intended for patients, it is hard for nurses with SUDs to work in close proximity to medications they may crave. If there are not protocols in place to prevent diversion, or behavioral health solutions to address underlying causes of diversion, nurses may be more likely to divert.

The Intersection of Mental Health Screening, Technology, and Peer Support

No single system or process is powerful enough, in isolation, to eliminate drug diversionor cure SUDs, but by utilizing the following 3 tactics in combination, including mental health screening, artificial intelligence (AI) technology, and peer support, health care organizations can mitigate risk much earlier than they would otherwise.

1. Mental Health and SUD Screening: Employee screening tools from organizations, such as the American Foundation for Suicide Prevention, can help health care organizations and individuals increase awareness of escalating behavioral health issues — including SUDs — before they become impossible to ignore. To encourage nurses to engage with these tools, and answer questions honestly, employers can emphasize the confidentiality of the screening processes.
2. Technology: Advances in AI and machine learning have led to the development of sophisticated analytics tools that can process and synthesize data from multiple sourcesm including police reports, pain-scale ratings, and employee timecards, alerting clinical supervisors to behavior that correlats with drug diversion. What makes AI-based software better than analytics-based software used a decade ago is that AI constantly absorbs new information and gets smarter at detecting patterns of behaviors associated with diversion, leading to earlier red-flag alerts and interventions. Notably, a retrospective study published by the American Journal of Health-System Pharmacy revealed that advanced analytics and machine learning technologies detected known diversion cases at an average of 160 days faster than existing, non-machine learning detection methods. Additionally, the machine learning model demonstrated 96.3% accuracy.⁶
3. Peer Support: Finally, we need to make sure peer support groups like SPAN, which are staffed by nurses, are accessible to all who seek help. Nurses face so many unique challenges in their careers and barriers to recovery from SUDs that only their peers – men and women who have been in their shoes — can truly empathize with. Organizations like SPAN utilize a variety of support tools such as in-person or virtual group meetings, 1:1 counseling, webinars, etc. that empower nurses to seek help for SUDs and correlated behavioral health issues. Notably, these resources should be embedded into existing resources and teams whenever possible. For example, some organizations might not consider including a peer support specialist as part of a drug diversion team, but that’s a missed opportunity to offer nurses support when they need it most. When taking a multidisciplinary approach to diversion, looking at preventive opportunities and ensuring that facilities provide that structure is critical.

These 3 strategies are critical to leveraging a more informed and compassionate approach to helping nurses address SUDs. By arming nurses with tools and support they need to do their jobs effectively, and recover from SUDs, health care employers can make a measurable impact in their communities.

About the Author

Deborah Koivula, RN, BSN, CARN is the outreach coordinator for Statewide Peer Assistance for Nurses (SPAN) in New York, an affiliate of the New York State Nurses Association. She is also an advisory board member of HealthcareDiversion.org.

References

1. Monroe T, Vandoren M, Smith L, Cole J, Kenaga H. Nurses recovering from substance use disorders: a review of policies and position statements. J Nurs Adm. 2011;41(10):415-421. doi:10.1097/NNA.0b013e31822edd5f
2. Arble E, Manning D, Arnetz BB, Arnetz JE. Increased Substance Use among Nurses during the COVID-19 Pandemic. Int J Environ Res Public Health. 2023;20(3):2674. doi:10.3390/ijerph20032674
3. Trusted Health. 2022 Frontline Nurse Mental Health & Well-Being Survey. 2022. Accessed November 2, 2023. https://assets-global.website-files.com/62991a992ad4fe937e88efec/62d1ba32d9f1be54b8361503_Trusted%20Health%202022%20Mental%20Health%20Survey.pdf
4. NIDA. Part 1: The Connection Between Substance Use Disorders and Mental Illness. National Institute on Drug Abuse website. September 27, 2022 Accessed November 2, 2023. https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness
5. Biernikiewicz M, Taieb V, Toumi M. Characteristics of doctor-shoppers: a systematic literature review. J Mark Access Health Policy. 2019;7(1):1595953. Published 2019 Mar 27. doi:10.1080/20016689.2019.1595953
6. Knight T, May B, Tyson D, McAuley S, Letzkus P, Enright SM. Detecting drug diversion in health-system data using machine learning and advanced analytics. Am J Health Syst Pharm. 2022;79(16):1345-1354. doi:10.1093/ajhp/zxac035