Identifying substance use disorders in the OR
Michael van Doren MSN, RN, CARN

$7.95 		OR Nurse 2013
July 2012 
Volume 6  Number 4
Pages 36 - 45
 
  PDF Version Available!

ABSTRACT
"I didn't have a clue that our nurse anesthetist-one of our best-had a problem until I failed to see his head come up from the tent during induction. He nearly died from an overdose of sufentanil and midazolam [horizontal ellipsis] It was hard to tell who was the patient that day."Although the prevalence of substance abuse and addiction in nurses and other healthcare professionals is considered to be no higher than that of the general population, this means that 1 out of every 10 nurses may have a substance abuse problem during their lifetime.1 The OR is a high-risk setting for diversion of controlled substances because large quantities of these drugs are exchanged and used each day.2 Also, the OR's relative isolation may lead some OR nurses to believe that they're less vulnerable to substance abuse than nurses in other practice settings. But the evidence indicates that substance use disorders are a problem in the OR, especially in the form of diversion (drug theft).3This article focuses on how to respond if you discover that a coworker has an active substance use disorder, whether newly identified or a relapse.The term addiction is often used as an all-inclusive term for this disease, encompassing the less-severe state of abuse and the more severe, full-blown disease of dependency. Chemical dependency typically refers to alcohol and drugs. Substance abuse and substance dependency are different diagnoses under the Diagnostic and Statistical Manual for Mental Disorders-IV-TR, now undergoing a controversial revision. This article uses the preferred term substance use disorder, although the terms used in the cited references vary.Chronic, progressive, and potentially fatal, substance abuse and substance dependency describe different conditions calling for different interventions.Substance abuse, although not considered a disease, is characterized by clinically significant impairment, such as repeated school or work absences or poor performance related to substance abuse,

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