Pharmaceuticals have played a significant role in improving human life following the introduction of drugs that have helped to eliminate chronic ailments such as smallpox and polio. The emergence of psychoactive drugs has also helped in relieving pain and mental ailments. The success of the pharmaceutical industry is also evident through the increased production of drugs. In the United States (US) alone, 1.5billion prescriptions are distributed to drug stores. However, as the paper confirms, medical professionals divert most of these drugs for illegal purposes such as drug abuse. Nurses who engage in drug diversion are not only a danger to patients but also to the health institutions and nursing profession. Misuse of prescription drugs is becoming a perennial problem that calls for the attention of healthcare professionals. Thus, nursing leaders have the difficult role of creating, initiating, and implementing measures to control drug diversion and/or identify unscrupulous nurses.
Diversion of drugs is a contravention of the Codes of Ethics that have been set up by the American Nurses Association (ANA). Cases of drug diversion must be reported to senior officials in the health organizations. They should then be followed by an exhaustive investigation to understand the loopholes in the system. Nurses who are found liable for the diversion should be reprimanded. The prevailing cases of drug diversion are a proof that the available policies are not strong to prevent the occurrence of such incidents. The purpose of this discussion is to analyze drug diversion by nurses, its impact and measures that health experts and nursing leaders can adopt to control drug diversion.
Drug diversion refers to various scenarios that comprise or relate to the illegal distribution of prescriptions that are meant for a patient to another individual or organization. It also involves changing the manner in which medication should be administered, for instance, injecting a drug that should taken by mouth. Besides, the issue of hoarding drugs that should be taken daily is also part of drug diversion (Clark, 2015). Drug diversion entails using a medication contrary to the given instructions. Drug diversion has led to an increased abuse of opioids and anxiolytics among other types of drugs. As early as 1970s, the diversion of methadone in the US increased the pressure to ratify the onerous regulation to control the menace. A number of regulations were introduced, including the policy, which required medication to be taken under strict supervision (Clark, 2015). The menace also made medical practitioners hesitant in issuing treatment to patients who required higher doses since they feared that they (doses) would lead to diversion. However, as King (2014) reveals, when HIV/AIDS cropped in the 1990s, it became apparent that regulations of dose supervision had to be relaxed to allow HIV patients to access treatment even in privacy.
After several studies, legal adjustments were made to eliminate the 20 years of strict regulations. However, the laxity of laws created loopholes through which unscrupulous clinicians could divert drugs. A similar observation can be made in Canada and Australia. The fight for drug diversion goes on. An urgent need has arisen for law enforcement to address the situation. As the government controls drug-related felonies, ailments such as HIV and Opioid Substitution Treatment (OST) create a need to relax strict laws on treatment. The situation takes the health center back to the problem of drug diversion. In the US, drug diversion has become a national menace going by the evidence produced by the Drug Abuse Warning Network (DAWN). According to reports by DAWN, most of the legally produced drugs are being converted for illicit purposes, with my benzodiazepines being one of the most diverted drugs (Clark, 2015).
While several regulations in the health sector are meant to control drug diversion, clinicians have not filled the gaps that lead to drug diversion. The impact of drug diversion is insidious. The evil act leads to the death of patients due to improper medication. Drugs are often diverted with the aim of being abused. For people who experience drug addiction, drug diversion is usually done to make the drugs accessible to them, despite the health implications. Some nurses are also drug addicts. When they persist in abusing drugs, it interferes with their professionalism. Moreover, the government suffers financial losses following medications that do not get to patients. Despite the dangers that drug diversion poses to the society, there has not been an exhaustive study on drug diversion among nurses. The paper is founded on these reasons. It discusses drug diversion by examining the problem, its impacts, and practical remedies.
Drug diversion has become a grave problem in the US. For instance, in 2010, about 38329 lives were lost due to a drug overdose, with 22134 being caused by abusing of prescription drugs, particularly opioid. The population of Americans who exploit medicine is larger compared the sum of cocaine and heroin addicts. The United States suffers an economic loss of about $53.4billion due to abuse of prescription drugs. The figures for prescription drug abuse have been increasing annually. This situation is ironic upon considering the fact that the American demography has been expanding at less than 1%. A simple explanation for the situation is that people desire to feel good. Prescription drugs provide a way through which people can eliminate what ails them. In the process, people become addicted such that they suffer from health issues. Many of them have died because of this situation. Clinicians play a core role in the persistence or reduction of abuse of prescription drugs through drug diversion (Clark, 2015).
Despite the prominence of diversion, the available data is limited. Few law enforcers and regulatory institutions have been assigned the duty of dealing with drug diversion. Nonetheless, the few investigations that have been done have shown that nurses who serve in many hospitals across the country participate in drug diversion. Most of the nurses suffer from substance abuse. Hence, they find diverting drugs an easy option for satisfying their drug addiction (King, 2014).
ANA approximates that about eight percent of them abuse drugs and alcohol to the point that it harms their proficiency. Other researchers have indicated that the rate at which nurses abuse drugs is close to that of the public. This observation implies that one out of every ten nurses is a drug addict. This finding is alarming upon considering the fact that the general population relies on medical practitioners such as nurses for their health. Only about a third of the registered clinicians are sanctioned annually on matters pertaining to their character. For those who are found to be addicted, there are no clear channels for them to seek treatment. Statistical findings by the Substance Abuse and Mental Health Services Administration (SAMHSA) reveal about 14 percent of drug addicts in America who seek medical attention (Wixson, 2014). Although the treatment for drug addictions is available in the US, health professionals are always reprimanded for abusing drugs before they receive treatment. This claim can explain why clinicians who are involved in substance abuse remain reluctant to seek medication (Wixson, 2014).
With the persistence of drug diversion and substance abuse among clinicians, pressure to change their punitive approach has increased. Nursing boards have lobbied the state legislatures to ratify diversion laws. Laws have been enacted to allow nurses who divert drugs and/or abuse substances to undergo treatment with no punitive actions being taken against them as long as they stick to particular guidelines. Nonetheless, while striving to control drug diversion and substance abuse among nurse and health professionals, it is important for stakeholders to understand the factors that cause nurses to engage in the activity.
Five main attitudes have been associated with drug diversion and substance abuse among clinicians. First, when health professionals start viewing abuse prescription drugs as a means of countering life challenges and/or having leisure, the move increases their risk of becoming drug addicts. Secondly, when nurses develop a culture of believing in drugs as a solution to any ailment due to the positive results that they witness from the patients, they resort to taking drugs wherever they have any displeasure. Extreme pharmacological optimism has led many people to overdose prescription drugs to the extent of endangering their lives. Thirdly, the assumption by most nurses that they the control their substance use becomes erroneous when they get addicted such that they lose control of their intake of drugs.
Moreover, some nurses only view themselves as caregivers and forget that they can also suffer the ailments of their patients. This assumption by nurses that they cannot be recipients of care makes them suffer in silence. The fifth attitude that most nurses among other health professionals have is choosing to diagnose and medicate themselves so that they can keep on working. Nevertheless, the working environment for most nurses often leaves them exhausted, thus forcing some of them to resort to taking drugs to overcome the stress. The absence of awareness among clinicians is also a main cause of substance abuse. Most nurses cannot tell the symptoms of addiction. Thus, they continue abusing drugs without noticing the danger (Haffajee, Jena & Weiner, 2015).
Nurses have an easy access to drugs. Where the systems are poor, they find it easy to divert drugs to satisfy their urge. For nurses who find it difficult to access and divert drugs from their working stations, they opt to change their locations. Nonetheless, for nurses who have no access to prescription drugs, particularly nursing students, they opt to abuse illegal drugs. The absence of institutional regulations and proper supervision in the stockpiling and dispensing drugs has promoted the diversion, with very few culprits being held accountable (King, 2014). Furthermore, most health institutions have weak drug prescription traditions. For instance, when clinicians realize that they need medical attention after self-diagnosis, they receive prescriptions from the colleagues without following the procedures that other patients would follow in such instances (Haffajee et al., 2015).
Researchers have observed how substance use persists among clinicians because of the liberty they have to access drug stores, distribution channels, and the strenuous job. Subsequent studies have also indicated that the increased work burnout and keeping a company of colleagues who engage in substance use expose nurses to the risk of abusing prescription drugs. Despite the knowledge by most nurses that they are exposing themselves to risks, they proceed to abuse prescription drugs with the assumption that they (drugs) cannot harm them because they will remain in control (Smith, 2012).
Moreover, various working schedules have been highly connected to drug diversion and narcotic use among clinicians. Nurses who have long work shifts and nightshift rotations have been reported to have a high likelihood of diverting drugs (Haffajee et al., 2015). Night shifts and prolonged working hours cause exhaustion, sleep deficiency, circadian rhythm disorder, and several other mental and physical effects. Some of the physical injuries that nurses suffer from because of long working hours include musculoskeletal injuries and pain. The injuries and pain trigger clinicians to seek self-medication for their physical and emotional problems (Wixson, 2014).
Stigmatization of individuals who engage in narcotic abuse has been observed to aggravate the rate of drug and diversion among users. Health professionals are respected in the society. They are expected to uphold high morals. Consequently, they are barely expected to do unethical things. Those who engage in acts such as diversion and drug abuse are secluded and discriminated. This discrimination only exacerbates their situation since they resort to burying themselves in unethical behaviors. Scholars have often proposed that health institutions should create a culture that does not discriminate health professionals who abuse drugs, but rather provide assistance to them. The society, as well as nurse leaders, must recognize that clinicians are just as human beings. They have emotional, mental, and physical challenges.
While most health institutions are aware of the risk factors that promote drug diversion, protective factors have not been addressed. Creating regulations and policies is not enough to control drug diversion if the nurse leaders do not strive to understand protective factors and input them into their systems. Protective factors comprise the ideals and public morals that are taught in the schools, religious organizations. Such factors are enlisted in the ANA Code of Ethics. When nurses are strongly aware of these ideals, they are likely overcome the pressures of engaging in diversion and substance abuse (Haffajee et al., 2015). Protective factors also comprise how clinicians are handled in hospitals. Providing flexible working hours, job contentment, and proper interaction between nurses to encourage good social networking can keep the nurses in check. Additionally, protective factors also comprise components that encourage nurses to recuperate from substances use (Wixson, 2014).
Most nurses are women (Haffajee et al., 2015). The female gender forms about 92 percent of the entire population of nurses as reported by the United States Department of Labor Women Bureau (Haffajee et al., 2015). Thus, it is important for nurse leaders to consider the risk factors that might cause a particular population to be susceptible to substance abuse and eventually opt to divert drugs. A research by Wixson (2014) shows how women get exhausted faster. Thus, they can easily get addicted. Besides facing brutal symptoms relative to men, statistical findings indicate that women tend to misuse few drugs as compared to men (Haffajee et al., 2015).
Schaefer and Perz (2014) observe that women are quick to report symptoms of substance abuse such as anxiety and insomnia. However, physicians often take time before they discover the root problem since they can confuse the symptoms with other issues. This situation makes women continue abusing narcotics for a long time even after reporting the former symptoms. Moreover, women tend to abuse prescription drugs more than other substances such as alcohol or illicit drugs (Schaefer & Perz, 2014). The contemporary society harshly reviles women who drink alcohol or abuse drugs. Women are expected to have higher morals than men. Moreover, women who engage in drugs can easily be sexually victimized. Thus, they are often advised against abusing drugs. The social stigmatization provides an excuse for women who abuse drugs to opt for prescription drugs because they can easily access them unnoticed (Surratt, 2014).
Several laws and regulations agencies have been enacted to control drug diversion in health institutions. The Drug Enforcement Administration (DEA), as well as Food and Drug Administration (FDA) among other agencies have been at the forefront in controlling substance use in America. These regulations often classify drugs based on their impact on the public, their addictive nature, or global limitations. Nonetheless, the US has had to restrict substances that are not restricted in other countries (Haffajee et al., 2015). As a regulatory agency, DEA has been issuing registration numbers to medical practitioners who are allowed to dispense drugs under given regulations. Nonetheless, these regulations have been disregarded, thus leading to the persistence of drug diversion (Wixson, 2014).
Implications for Advanced Practice Role
Advanced Registered Nurse Practitioners (ARNPs) is a body that comprises nurses who are permitted to perform some duties that have traditionally existed in the medical profession. This authority is granted to these nurses because of the advanced education they have acquired during their practice. ARNPs are allowed to prescribe drugs. About 47 states allow ARNPs to prescribe controlled drugs from Florida (Kirschner, Ginsburg & Snyder, 2014). Controlled substances comprise drugs whose distribution or prescription is restrained by federal and state regulations because of the capability of the drugs being diverted and misused. These substances include stimulants, hallucinogens, and depressants (Kirschner et al., 2014). Parties that advocate ARNPs to be allowed to dispense drugs argue that the body enables individuals who cannot access important healthcare services to receive the needed medication even in areas that have no physicians. They also claim that the body is more opportune for both physicians and patients in the underserved regions and that it will ultimately enhance the quality of life of many Americans. ARNPs have adequate knowledge to comprehend and prescribe the controlled drugs and that they have done an impressive work since they were allowed to prescribe controlled substances (King, 2014).
In a desolate contrast, opponents claim that advanced practice nurses do not have the experience to diagnose or treat ailments. Moreover, with the persistence of drug diversion, opponents fear that it will increase substance abuse and diversion from the distribution channels. With reference to the previous discussions, it is clear that permitting ARPNs to dispense drugs increases the risk of substance use and diversion. For instance, 13 percent of drugs that were dispensed in the US in 2007 included controlled substances. About 6.3 percent of this category of drugs was not accounted for, thus indicating that they must have been diverted for improper use.
Prescription drugs are highly abused in the US. As part of medical practitioners, advanced practice nurses abuse and divert controlled drugs. Some of the drugs that are diverted are taken to street drug traffickers. Moreover, patients may pretend to be seeking medical attention while their real agenda is to get controlled substances in an effort to sell them unscrupulously. The US government has shown commitment to fighting drug abuse and diversion, as well as an unsuitable prescription. About 30 states have initiated prescription-monitoring programs to help in trailing the drug distribution channels to limit cases of drug diversion. However, some states such as Florida have not introduced any program that can monitor the prescription. Thus, they have exposed health professionals and the public to improper use of prescription drugs (Haffajee et al., 2015).
ARNPs are highly respected health professionals. The society largely depends on their services. They provide services where service physicians are unavailable in particular regions. Nonetheless, when drug diversion becomes an importunate problem, it endangers their (ARNPs) morality, as well as job security. It also creates fear among the public who will become reluctant in visiting hospitals where nurses are abusing substances. Furthermore, allowing ARNPs to prescribe controlled substances enables the government to provide quality healthcare even in situations that it could not have accessed due to inefficiency of physicians. This move builds the trust of the citizens in the government (New, 2014). Nonetheless, the federal and state governments may be forced to amend their laws to disallow ARNPs from prescribing controlled substances as a means of limiting drug diversion. This provision creates confusion in the government and other stakeholders concerning the steps that can be employed to ensure that quality medical care is given to the public while controlling drug abuse, which is quickly becoming a scourge in the country (Kirschner et al., 2014).
Pros and Cons of dealing with Drug Diversion as a Nurse Leader
Nurse leaders have a duty to fight and prevent drug diversion. They may face a number of benefits and disadvantages because of striving to handle drug diversion. One of the benefits is that nurse leaders will seek the help of the state and federal government to save the huge expenses that the US suffers due drug diversion and abuse. As noted earlier, drug diversion and substance use lead to loss of about $50billion, which is equivalent to the amount that is needed to give drug addicts medical attention. Nurse leaders have an opportunity to assist in reducing the unnecessary expenses, which could be reinvested in other sectors (Schreiner, 2012).
Secondly, nurse leaders can identify their colleagues who are suffering from substance abuse and lead them to recovery. Most of the nurses who engage in drug diversion have a number of risk factors that push them such as genetic issues and/or environmental and occupational stress. Although this identification may lead to stigmatization of those who are found to be diverting drugs, the subsequent steps that the nurse leaders may take in assisting the culprits will be of great significance. These steps should not always include punitive measures. Such stern measures may make other nurse patients who are suffering from addiction to opt to remain silent (Schreiner, 2012).
Nurse leaders may desire to control drug diversion in their working stations, although they have to adhere to the set rules and regulations. Nurse leaders cannot control drug diversion without the support of regulatory bodies and the government. Moreover, nurse leaders may also be part of the culprits who participate in diversion. Thus, the presence of an independent body that is charged with the duty of protecting the distribution of prescription drugs is more important than having nurses supervising themselves. Efforts for nurse leaders to fight drug diversion without proper laid down policies may only lead to constant disagreement between nurse leaders and their juniors (Schaefer & Perz, 2014).
Conflict Resolution Models/Theories
Over the years, stakeholders have worked hard to initiate mitigation steps that can help in the reduction or elimination drug diversion. Through the Office of National Drug Control Policy, the US suggested a number of measures to control the diversion of prescription drugs among health professionals. These measures include the creation of awareness, proper drug dumping, monitoring, and enforcement. Moreover, other commentators have proposed other means such as the formulation and creation of clinical guidelines.
King (2014) asserts that one of the means of dealing with drug diversion is through alternate formulations, which involve adjusting the ways of preparing drugs that have a high likelihood of being diverted or misused by nurses. For instance, pharmacists can opt to dilute methadone liquid such that it is taken in large portions, thus discouraging those who abuse it through injection to remain hesitant. Moreover, it also reduces its impact in case it is to be abused. Incorporating opioid antagonists such as naloxone can assist in reducing the intravenous impacts of buprenorphine. Notably, more studies are still being established to confirm the efficacy of alternate formulations.
Most abusers give a general misleading assertion that since the FDA endorses prescription drugs, their impact should be mild even when it is abused. Moreover, direct-consumer promotion of the drugs engulfs the thoughts of purchasers. Most of them are unaware that sharing medications endangers their lives. Nurses should be taken through refresher and training programs where they are reminded the necessity of protecting the society from abusing prescription drugs. Since some nurses also become users, there is a need to create programs to educate them on how they can fight addiction. Federal agencies such as DEA should work closely with health institutions to help impart the knowledge (Kirschner et al., 2014).
Prescription Drug Monitoring Programs (PDMPs) have been approved in several states across the US. PDMPs are met to identify and thwart diversion attempts. While 43 states have endorsed the idea, it is only effective in about thirty-five states. This situation calls for the support of stakeholders for the programs to run efficiently in the remaining states. The General Accounting Office has reported the efficiency of PDMPs in controlling diversion. Nonetheless, there is a need for the those who manage the programs to be keen with data analysis so that they detect nurses who are involved in diversion while at the same time availing relevant measures to assist such nurses (New, 2014).
Most of individuals who abuse prescription drugs receive them from their families and health professionals because there is no proper channel through which drugs that have not been used can be disposed. With the poor dumping systems, unscrupulous nurses find an opportunity to sell them to the public for fraudulent means or even abuse them. Hospitals should be structured in a way that they can account for drugs that are left in their stores before they receive a new supply of drugs (New, 2014).
While efforts are made to help nurses who might be struggling with substance abuse and alcoholism, punitive measures should be taken against nurses who breach the Code of Ethics set up by the ANA. Nurses are supposed to understand and adhere to the Code of Ethics when serving the public. Thus, whenever they provide the wrong medication to patients who do not require it or divert prescription drugs, contrary to what they are meant for, they should be reprimanded for their actions. Drug diversion endangers not only the lives of the public, but also their (nurses) lives, contrary to the role nurse are met to accomplish. Furthermore, punitive measures help to caution other clinicians from participating in search unethical acts.
The issue of drug abuse and diversion has become an alarming problem in the US. Health professionals, particularly nurses, have been held accountable for most of the diversion, which has resulted in the loss of lives and finances. Many risk factors trigger nurses to engage in substance abuse and drug diversion. Advanced practice nurses have a special role in minimizing this diversion upon considering that they are allowed to prescribe controlled drugs, which are the most abused prescription drugs. Moreover, if proper measures are implemented, diversion will be a bygone problem. Stakeholders need to provide proper education and alternate formulations while monitoring and tracking drug distribution among other measures. Indeed, drug diversion is not an easy problem to overcome. However, it calls for cooperation among all stakeholders to eliminate the menace.
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