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Pain Management for Nurses with a History of Substance Abuse
Jean B. Lazarus, EdD, RN
Alabama Board of Nursing
October 2001

The primary role of regulatory agencies is public protection through the implementation of controls that emanate from statutes and rules. Regulations establish qualifications for entry and continued competence to practice under an officially sanctioned credential. Such qualifications include education and experience appropriate to the practice, and a stipulation usually demanding moral integrity. Even so, an estimated 6 to 12 percent of practicing nurses abuse controlled substances, most often depending on their work place as the source of procurement. Unfortunately, a small percentage is captured for disciplinary action, and then most often, after the condition is so severe as to potentially compromise public safety.

The Alabama Board of Nursing recently completed a study involving 50 of 250 chemically dependent nurses who were enrolled in the disciplinary and alternative to discipline programs (Lazarus & Morocco, 2000). The primary focus was evaluation of program effectiveness and compliance with the law. The qualitative nature of the study revealed a number of findings to consider for program improvement, including potentially conflicting situations involving pain management for individuals who abuse drugs and hold a license to practice nursing. The concerns are aptly represented in the consensus statement of 22 national organizations, "Promoting Pain Relief and Preventing Abuse of Pain Medications: A Critical Balancing Act," (ASLME.ORG).

When describing life events that were perceived as influential in the development of chemical dependency, pain and pain management appeared as recurring themes. Over 80 percent of the study participants described situations of physical, mental and sexual abuse from childhood through their current adult lives. More than 50 percent reported that medication for pain control due to various surgeries, back pain and migraine headaches contributed to their addiction. Often the nurses stated that the medications not only relieved immediate symptoms but also created a sense of well being and being energized.

In seeking recovery, these nurses expressed anxiety about whether they could bear pain without medication or if they had to have medication, would their addition be fully reactivated. One person repeatedly said he was told he would be "o.k." after having a local anesthetic, but it wasn't. "The pain was unbearable." The Board of Nursing has taken steps to allow for treatments requiring pain medication, but remain cautious about monitoring for failure to comply with legal stipulations. Allowing for continued licensure while providing for humane treatment of drug abusing care givers who need medication for pain control creates a potential conflict for the regulatory agency that has a mandate for public protection.