Prescription drug abuse vexes the medical profession
By the numbers
Ohio Board of Nursing
Registered nurses (2007): 158,295
Licensed practical nurses: 48,241
Drug and alcohol complaints (2007): 706 *
Drug and alcohol complaints (2002): 400
Ohio Medical Board
Licensed doctors: 40,297
Total disciplinary actions (2007): 175
Number due to alcohol/drug impairment (No. 1 cause): 70
*Board says increase reflects more nursing licenses issued and stricter mandatory reporting law.
At 6:20 in the morning, 40 minutes before her shift started, the nurse was seen in street clothes walking out of a medication room at Hillcrest Hospital.
A suspicious co-worker alerted a manager, which led to an investigation into whether the nurse was dipping into narcotic pain medications. An audit of an automated pill-dispensing machine found that the nurse had entered a patient's name to get two tablets of the painkiller Vicodin for herself. She was confronted and admitted she had stolen Vicodin twice before, according to prosecutors.
The nurse illustrates a common crime in healthcare facilities, and the addictions among professionals who work there. Drug and alcohol problems are a leading cause of disciplinary action by state nursing and medical boards.
Some say prescription drug abuse is on the rise among health-care professionals. Others say the numbers have not changed much, but that drugs of choice are more powerful, and addicted professionals often go to greater lengths to get them.
"About 50 percent of what we do is related to some kind of drug or alcohol abuse," said Lisa Ferguson-Ramos, compliance manager for the Ohio Board of Nursing. Nurses have returned to work to take drugs after they were placed on leave or fired, she said; one nurse dressed in disguise and sneaked into a facility to steal pain patches off patients.
In July, the Hillcrest nurse and nine others were indicted in Cuyahoga County for stealing prescription drugs from their employers for personal use.
The 10 cases are unrelated. The nurses worked all over town, mostly at hospitals except two who worked in a nursing home and correctional facility.
Cuyahoga County indicts 40 to 70 nurses a year for felony drug thefts. The addictions often follow legitimate prescription use for injuries or surgeries, according to prosecutors.
The electronic dispensers -- sort of like ATMs for Percocet, Oxycontin and other painkillers -- have made thefts far easier to detect and prosecute. Some machines require that users swipe a card and enter a password to get in, others use fingerprint identification. The technology tracks drug orders, inventory and withdrawals.
Most of the nurses indicted in July were caught through an audit of the machines.
As long as nurses aren't dealing drugs or depriving patients of pain medication, first-timers are offered treatment in lieu of conviction. Most return to work in a year or two with restrictions and mandatory drug screens. Rare is the repeat offender, the prosecutor's office says.
Lawyers for several of the indicted nurses declined to comment.
Among health professionals, nurses are most often snared in Cuyahoga.
But Dr. Ted Parran, an addiction specialist at Case Western Reserve University who consults with the Ohio Medical Board, says doctors, nurses and pharmacists have similar rates of drug and alcohol addictions as the general public.
"About 10 percent will develop a drug or alcohol problem over a lifetime," Parran said.
Prescription drugs have been the favored choice among addicted health professionals, he said. Ten years ago, Case researchers surveyed doctors in four states who were treated for addiction and in recovery. "We were astounded that three-fourths used controlled (narcotic) drugs as part of their addictive behavior," Parran said. "Most of them admitted they got the controlled substances not through legitimate venues."
Prescription drug abuse is increasing in general, but "doctors, nurses, pharmacists and dentists have always had access," he said.
D. Christopher Hart, 54, lost his Ohio pharmacy license in December 2004, after being caught a second time taking Vicodin from pharmacies where he worked. The first time, in the early '90s, his license was suspended. He went through treatment and five years of drug testing and AA meetings.
The second time, his license was revoked.
He had been stealing about 15 pills a day, which he said made him feel euphoric, "like a superpharmacist." He thought he could manage it because he was the drug expert. "Then the disease kicks in, and you have no control," he said.
Today, Hart lectures on the perils of addiction as an instructor at three Ohio pharmacy schools. He started the class at Ohio Northern University in 2005 with 10 students. Now the class is regularly filled. This fall he added teaching duties at the Northeastern Ohio Universities College of Medicine and Pharmacy in Portage County.
"Somebody in recovery needs to teach this course," Hart said. "Students want to hear this kind of stuff. The situation is out there. Let's not stick our heads in the sand."
Parran said 80 to 90 percent of doctors who go through the medical board recovery program attain long-term sobriety. The success rate for other health professionals is not as high because the programs aren't as stringent, he said.
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