Drug overdose deaths increased by nearly a third from April 2020 to April 2021, according to data the CDC published late last year, with overdose deaths exceeding 100,000 in a single year for the first time. But those numbers are only a small slice of the opioid epidemic that’s continued raging during the pandemic, and it glosses over who all those people are. Some of them are healthcare workers, and thousands more nurses, PAs, NPs, and other healthcare workers are struggling with addiction at a time when self-medicating may have seemed like the only answer to managing the moral injury and intense stress of a seemingly endless pandemic.

It’s hard to get reliable data on the prevalence of substance use disorders among nurses. Drug addiction rates among nurses tend to be similar to the general population, but nurses are more likely to misuse prescription medications because they often have more access to them. The prevalence may also vary according to the nursing environment. For example, one study in Texas found addiction to be more prevalent among “nurses working in long-term care, medical-surgical units, and home health care.”

A 2018 study estimated that 2% to 10% of nurses have a drug or alcohol dependency, and anywhere from 14% to 20% misuse or abuse substances. That means as many as one in five nurses may be struggling with substance misuse in some form, even if it doesn’t rise to the level of a formal diagnosis. While a substance use disorder used to mean the end of a career for most nurses, there are far more resources and support opportunities available today for those who need help.

The National Council of State Boards of Nursing notes that nurses can recover and thrive when they receive proper care. “When treatment for nurses is individually tailored to meet their needs and an appropriate supportive monitoring system is in place, nurses can recover and return to practice safely,” the NCSBN writes. “An extensive body of scientific evidence demonstrates that approaching substance use disorders as treatable illnesses is extremely effective for the individual using substances, as well as for society.”

Identifying the Symptoms

The symptoms of addiction are similar regardless of a person’s profession, but there are a number of signs that coworkers can look for if they think a colleague may need help.

These include:

• Mood swings.

• Agitation.

• Fatigue.

• Hand tremors.

• Bloodshot eyes and/or runny nose.

• A decline in hygiene and appearance.

• Lapses in memory.

• Difficulty with completing work assignments.

• Decreased productivity.

• Negligence in patient care.

• Frequent bathroom trips.

• Incorrect narcotic counts.

• Lack of witnesses during disposal of unused medications.

• Unexcused tardiness or absence from work.

• Seeking prescriptions from peers.

This weighted checklist also identifies signs across three domains. It’s important to recognize these symptoms in yourself or a colleague because it’s not only their own lives potentially at risk. For example, suppose nurses are under a drug’s influence or experiencing withdrawal while working. In that case, they may endanger their patients because of reduced reaction time, poorer judgment, and less inhibition—any of which could lead to medical errors or unprofessional behavior toward patients.

What To Do if You Suspect Addiction in a Colleague

Suppose you observe these symptoms in a fellow healthcare worker. In that case, the American Nurses Association Code of Ethics states that you have an ethical obligation to report it, despite the barriers you might face. First, approach the person directly to allow them to go with you and seek help. Ideally, talk with them before a shift begins and stress sets in or during a break on a day when things feel less crazy.

Be firm but compassionate, giving them a chance to talk and letting them know there are effective treatments that aren’t likely to cost them their job. For an in-depth discussion of recognizing, intervening, reporting, and following up with an addiction in the workplace, check out Washington state’s Guide for Assisting Colleagues Who Demonstrate Impairment in the Workplace.

Treatment for Addiction for Nurses

Whether it’s for you or a colleague, a wide range of treatment options are available for nurses with addiction, including helplines, legal assistance, peer assistance or mentorship, rehab treatment, and support groups.

Nearly every state’s board of nursing has nurse assistance programs or alternative-to-discipline programs specifically to address substance use disorder among nurses. In addition to support, treatment, and monitoring of nurses affected by substance use, these programs aim to help nurses reintegrate into their profession during and after recovery.

Many state programs use peer assistance programs that research has found to be effective in maintaining recovery. For example, a study examining outcomes from the Texas Peer Assistance Program for Nurses found that 41% of nurses completed the program without relapsing, while 32% experienced at least one relapse. The Texas program allows people to make referrals for themselves, colleagues, or loved ones and provides opportunities to serve as a peer support partner. Many other state programs are similar.

See this page from the American Society of Addiction Nursing for an extensive list of resources related to addiction.