What are the signs or symptoms suggestive of prescription drug abuse or misuse among healthcare professionals?

Signs and Symptoms of Prescription Drug Abuse or Misuse Among Healthcare Professionals

Healthcare professionals exhibiting prescription drug abuse or misuse may show behavioral, physical, and work-related signs including changes in work attendance patterns, medication discrepancies, unusual behavior, and physical symptoms of intoxication or withdrawal. 1

Behavioral Signs

• Changes in work patterns:

  • Frequent absences, tardiness, or unexplained disappearances from the unit
  • Volunteering for overtime or extra shifts, especially on nights or weekends when supervision is reduced
  • Preference for specific shifts where drug access is easier (nights, weekends)
  • Volunteering to administer medications for other healthcare professionals' patients
  • Arriving early or staying late unnecessarily

• Medication-related behaviors:

  • Discrepancies in medication documentation (excessive waste, incorrect counts)
  • Patients reporting inadequate pain control despite documented administration of pain medications
  • Frequent reports of medication errors or spills requiring replacement doses
  • Offering to pick up prescriptions for colleagues
  • Frequent reports of lost prescriptions or requests for early refills of personal prescriptions

• Social and interpersonal changes:

  • Increasing isolation from colleagues
  • Mood swings, irritability, or inappropriate emotional responses
  • Elaborate or implausible explanations for behavior
  • Difficulty meeting deadlines or completing assignments
  • Deteriorating personal appearance and hygiene

Physical Signs

• Signs of intoxication:

  • Slurred speech
  • Unsteady gait or coordination problems
  • Pupillary changes (constriction with opioids, dilation with stimulants)
  • Drowsiness or excessive energy
  • Confusion or memory lapses

• Signs of withdrawal:

  • Diaphoresis (excessive sweating)
  • Tremors
  • Anxiety or irritability
  • Nausea, vomiting
  • Muscle aches or pain

• Other physical indicators:

  • Frequent use of breath mints, mouthwash, or perfume to mask odors
  • Wearing long sleeves consistently (potentially to hide injection sites)
  • Weight loss or gain
  • Bloodshot eyes or dilated/constricted pupils

Work Performance Issues

• Declining work performance or inconsistent quality of work
• Errors in judgment or clinical decision-making
• Difficulty concentrating or following through on tasks
• Increased patient complaints
• Excessive time spent near medication storage areas
• Documentation errors or inconsistencies

Risk Factors

Healthcare professionals are at particular risk for prescription drug misuse due to:

• High-stress work environments
• Access to controlled substances
• Knowledge about medications and their effects
• Ability to self-medicate for physical or psychological pain
• Reluctance to seek help due to fear of professional consequences 1, 2

Screening and Intervention

When prescription drug misuse is suspected in a healthcare professional:

1. Document specific behaviors of concern
2. Follow institutional policies for reporting
3. Refer to employee assistance programs or physician health programs
4. Implement appropriate monitoring if the professional returns to practice

Prevention Strategies

• Implement secure medication management systems
• Conduct regular audits of controlled substance administration
• Provide education about substance use disorders as diseases requiring treatment
• Create non-punitive pathways to treatment for healthcare professionals
• Reduce stigma associated with substance use disorders in healthcare settings 1

Healthcare professionals with substance use disorders often respond well to structured treatment programs with monitoring components, with higher recovery rates than the general population when properly identified and treated.