Insights June 2012

Speaking the Unspeakable: Nurses Abusing Drugs

Paula Davies Scimeca RN, MS

No subject is more shrouded in a myriad of stigma, misunderstanding and ignorance than the issue of substance abuse.  When the misuse or abuse of alcohol or another drug infiltrates into the ranks of health professions such as nursing, the cloak of unspeakability morphs into an impenetrable code of silence where denial stands sentinel at the gates of what could have led to an open market of dialogue and brainstorming.  Instead tongues as well as limbs are bound, leaving nothing but mumbled, unintelligible whispers and spastic paralysis of limbs, suppressing initiatives to improve safety, mortgaging the future of both the healthcare system’s solvency and the nursing profession’s ability to self-regulate.

As discomforting and distasteful as the phenomenon of drug and alcohol abuse in nurses is to employers and the public, the theft of medications in health facilities is even more alarming.  In spite of the fact that the vast majority of nurses never take any pharmaceuticals from the workplace, hospitals and nursing homes are struggling increasingly with such events.  Many facilities are striving to establish best practices which not only detect, but deter substance abuse and drug theft. Yet the very heart of this quagmire originates in the hallowed, nearly unbreachable halls of nursing programs which offer inconsistent or inadequate education regarding the use, misuse and abuse of substances to students, despite decades of evidence citing this same lack as one of the top occupational hazards nurses face. (Baldwin, 2009; NCSBN, 2011.)

Recently, the state of Minnesota’s Department of Health and the Minnesota Hospital Association, along with other stakeholders, united to form a coalition to focus on the very real plague of institutional drug theft by health professionals.  In order to do so, they stepped out of their robe of denial, unfettered their limbs and liberated their tongues to speak the unspeakable: that reports of drug thefts in Minnesota facilities in 2010 had risen to more than double the rate of 2005. (Minnesota Hospital Association, 2012.)

In healthcare, where the margin for error is slim to none and the potential for irreversible harm is ever-present, Minnesota’s Controlled Substance Diversion Prevention Coalition stands out as a stellar example of transparency, integrity and courage. That Minnesota was not joined by other states in the quest to address this significant issue which can deleteriously affect outcomes for patients as well as health professionals, and even health systems, is possibly an even more shocking finding than the soaring rate of stolen medications.  Indeed, it would seem that Minnesota’s stakeholders have pushed past the Ghost of Healthcare Despair which Hugh MacLeod describes so eloquently in his essays.  (MacLeod, 2012.)

Surely in the aftermath of Minnesota’s report, it is increasingly apparent that academia in nursing and leadership in health systems should ensure that much more thorough and consistent education on substance abuse is given to all nursing students and licensed nurses, underscoring the occupational risk factors which exist. Due diligence dictates that licensing boards in all jurisdictions should set mandatory minimum educational requirements related to substance abuse prior to issuing nursing licenses and establish ongoing educational requirements for re-registration of those licenses to secure the utmost safety and welfare of the health professional. After all, it is the optimal health and wellbeing of the individuals rendering direct patient care which provides the firmest foundation upon which all patient outcomes ultimately rest.


Baldwin, Jeffrey N., Bartek, Jean K., Scott, David M., Davis-Hall, R. Ellen & DeSimone II, Edward M.(2009). “Survey of Alcohol and Other Drug Use Attitudes and Behaviors in Nursing Students.” Substance Abuse, 30:3, 230- 238.

MacLeod, Hugh. (2012).  “The Ghost of Healthcare Despair.” Accessed on line 6-5-2012 at

MacLeod, Hugh. (2012). “Forging Complete Questions to Defeat ‘The Ghost of Healthcare Despair.’”  Accessed online 6-5-2012 at

Minnesota Controlled Substance Diversion Final Report, March 2012.  Accessed online on 5-20-2012 at

National Council of State Boards of Nursing, (2011). “Substance Use Disorder in Nursing: A Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs.”  NCSBN, Chicago, IL.



Art Zwerling wrote:

Posted 2012/06/22 at 12:48 PM EDT

Paula Davies Scimeca RN, MS has once again brought to our awareness a huge, persistent, pervasive and apparantly growing malignant issue amongst our health care professionals; that of chemical dependency impacting the ability of these professionals to safely and effectively provide care for their patients. In particular, nursing as a unique discipline and largest group of health care professionals on the front lines of health care assessment and delivery appears to ignore or avoid the issue, particularly at the level of our academic institution. I am proud to say there are two noteable exceptions amongst nursing organizations that I am aware of, the AANA, (American Association of Nurse Anestthetists) see:
which has an extraordinarily proactive Peer Assistance program anf INTNSA (International Nurses Society on Addictions) see:

As a health care professional that has witnessed the horredous losses to the profession, our communities and institutions due to our unwillingness to acknowledge and address this issue in a forthright manner over the past >30 years, I call on my colleagues in education and policy development to stop the institutionalized denial!

Best regards,

Art Zwerling. DNP, CRNA, DAAPM
Elkins Park, PA


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