US: Prescription Drug Misuse High Among Nurses During Pandemic

Healthcare Facility Drug Diversion

Home health RNs have highest rates, but those working at hospitals most likely to have an SUD

Rates of prescription drug misuse among nurses were nearly double that of the general population, though their overall drug misuse was lower, according to results from a survey study that took place during the COVID-19 pandemic.

The rate of misuse of prescription drugs by nurses was 9.9% compared with 5.9% for the general population, while the rates of misuse of both illicit and prescription drugs were 15.6% and 20.8%, respectively, reported Alison Trinkoff, ScD, MPH, RN, of the University of Maryland School of Nursing in Baltimore, and colleagues.

Rates of prescription drug misuse among nurses were nearly double that of the general population, though their overall drug misuse was lower, according to results from a survey study that took place during the COVID-19 pandemic.

The rate of misuse of prescription drugs by nurses was 9.9% compared with 5.9% for the general population, while the rates of misuse of both illicit and prescription drugs were 15.6% and 20.8%, respectively, reported Alison Trinkoff, ScD, MPH, RN, of the University of Maryland School of Nursing in Baltimore, and colleagues.

The rate of misuse of illicit drugs alone was 5.7% among nurses, they noted in the Journal of Nursing Regulation.

During the pandemic, staffing shortages combined with the substantial increase in patient needs impacted nurses’ capacity to provide safe care, increasing risk factors for substance use, all of which compelled Trinkoff and team to look at the current prevalence of substance use in the nursing population.

Trinkoff told MedPage Today that the timing of the survey may have influenced the data in some way.

“I hesitate to say, ‘oh, forget all this,’ because it was a pandemic,” she said.

Instead, she argued, the data “laid bare” trends that were already occurring; “they’re just being made more extreme or worse, given the pandemic.”

“Given that 18.0% of nurses in our study meet substance use problem criteria overall, this issue bears continuing scrutiny from policy makers and other stakeholders,” the authors wrote.

Overall, 11.4% of nurses screened positive for substance use problems, and 6.6% were categorized as having substance use disorders (SUDs) compared with 7.4% in the general population.

Illicit drug use was more common among nurses younger than 45 compared with those 45 and older (8.2% vs 4.2%, P=0.07), and was highest among those in critical care specialties (15%) and those working in emergency, trauma, or urgent care (10%). Younger nurses were also significantly more likely to use alcohol and nicotine, the authors noted.

The highest rates of prescription drug misuse, defined as use without a prescription or at higher doses than prescribed, were among nurses working in nursing homes and assisted-living facilities (15.8%); home health and hospice (19.0%); and government, community, and military sites (15.2%).

Past-year alcohol use was also highest among nurses in nursing homes and assisted-living facilities, with a prevalence of 42.9%.

Nurses in nursing homes and assisted-living facilities had triple the odds of alcohol use (95% CI 1.5-6.1) and five times the odds of nicotine use (95% CI 1.5-16.9) compared with a reference group of nurses who worked in businesses, schools, and other settings.

However, SUDs were most common among nurses working in hospitals (8.5%), ambulatory care (7.0%), and those working at multiple sites (6.7%). The highest rates of SUDs were identified in staff nurses (8.5%); charge nurses, coordinators, or nurse managers (7.5%); and other administrators (6.1%).

There were significantly higher odds of SUDs among hospital nurses than the reference group (OR 5.3, 95% CI 1.3-22.0).

Because the survey was sent out during the pandemic, nursing homes were the “most seriously affected” of all clinical settings because patients there were at the highest risk of death and severe illness, along with hospitals, which were tasked with treating seriously ill patients, Trinkoff noted.

Availability and access to prescription medications is likely a factor in substance use, she added. In addition, hospitals may be more likely to have automated systems to help account and track substances compared with nursing homes.

Of note, approximately 29.9% of nurses with substance use in the past year indicative of a substance use problem said they needed to “cut back,” and 27.5% said they “felt bad or guilty” about this substance use, the authors said.

Study Details

The survey was sent both by email and regular mail to 3,973 RNs in nine states representative of the U.S. population from November 2020 to March 2021, as part of the Nurse Worklife and Wellness Study. The researchers received 1,215 responses (a response rate of 30.6%), and of those, 1,170 were included in the analysis. Median age of respondents was 52, and 91% were women.

Only actively licensed RNs, including APRNs, were included; licensed practical nurses (LPNs) were excluded. Data were taken from the Nursys database for seven of the nine states; the study authors downloaded the RN list for one state, and purchased a mailing list for the other.

To measure substance use, respondents who reported past-year use were asked to respond to a total of 10 items, adapted from the Drug Abuse Screening Test. The researchers also used SUD criteria from the DSM-5.

Respondents who screened positive for one to two symptoms were categorized as having a current substance use problem, while those with scores of three or higher were deemed to have a potential SUD.

The authors noted that the sample size of the current study was smaller than previous survey studies, but Trinkoff said that she and her team were still able to “make reasonably precise prevalence estimates.”

Because it is a “sensitive topic” and regardless of the fact that the data were de-identified, people do sometimes fear the potential for consequences, so these estimates are always seen as “conservative,” she added.

In addition, due to the limitations of cross-sectional surveys, the results do not indicate causal relationships.

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