When EMS Providers Have Drug Addictions

[Richard B the EMT]

I am unsure on this, but I think they have to turn in the empties, too.

[Just Plain Ruff]

I agree with the statement that addicts need to admit that they have a problem before they can accept treatment. How many agencies are really equipped to offer some form of referral service or help in the event that one of their members does have a problem? What type of things could be do to PREVENT providers from stealing medications? It's not just the EMS field that this is a problem, I have also heard of docs and nurses stealing meds or diverting them from patients who need them to fuel their own addiction.

As of last year my vollie FD began carrying narcs on our ambulance. They are kept on the ambulance in a locked box with a numbered zip tab and that box is in a safe that requires the ALS providers key tag AND code to gain access. It records when the safe is opened and we have to have a witness if/when we even open the safe and we must fill out the log book. The restock safe is located in the dispatch office (same set up) and the only people who have keys to that are the 2 narcs officers. Witnesses are needed for that to be opened also. Hopefully we have put into place enough safeguards so if we did have someone involved in our agency with a drug problem they couldn't get access to anything.

I'm wondering what other agencies have put in to place to discourage providers from trying to steal narcs. I'd be interested to hear if anyone has any input. Thanks!

Many agencies don't want to deal with the issue and although they have a EAP program in place (some but not all) most of the agencies I've worked at have just fired those who were caught stealing narcs. It seems like it's the common knee jerk reaction.

Many administrators of EMS Agencies don't have the knowledge base that they need to have in order to deal with an addicted employee. They also don't want to deal with the negative publicity that would be out there if their employee was arrested for the problem.

It's more reactionary instead of proactionary.

I know of several medics who were caught stealing narcs and other meds and they were summarily fired. No offer of help, no assistance even though there was an EAP in place. Report them to the state and their license get's pulled and that's that.

If the employee did admit to a problem and asked for help, they were referred to the EAP but when the EAP benefit was exhausted the employee was subjected to such scrutiny that they decided to quit so they weren't subjected to repeat drug tests. If the employee's that I know being subjected to daily or every other shift drug tests and those tests came out positive they were fired.

Not a good deal for anyone involved.

[rock_shoes]

Stealing narcs is as easy as marking down you gave a pt 10mg of morphine, when you've only given two. Put the excess into a separate container for yourself later on, and turn in the empty vial.

All service's I've ever I've worked with require someone to witness wastage. I know it doesn't prevent partners from working with each other but it's at least some kind of attempt at maintaining narcotic usage control. Some form of mental health screening prior to employment is more important than falling over oneself trying to ensure narcotics control.

[Emtpbill]

The narcs are in a locked cabinet that only the medic can access(emts don't carry keys) and they are zip tagged.

But in the back of the truck when it is only the medic and the pt. who is to say the medic gives 5cc of saline instead of 100 mcgs of fentanyl.

Patients don't know. Medics have a great deal of autonomy, atleast in the area of PA. I am in and could very easily get themselves in trouble.

[HotelCo]

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All service's I've ever I've worked with require someone to witness wastage. I know it doesn't prevent partners from working with each other but it's at least some kind of attempt at maintaining narcotic usage control. Some form of mental health screening prior to employment is more important than falling over oneself trying to ensure narcotics control.<br />

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Who said anything about wastage?

Medic gives pt 2 of morphine, and writes that he gave 10 of morphine. Take the extra 8mg, and put it in another vial (not hard to get), and turn in the now empty morphine vial to the pharmacy along with the drug box. Partner is driving, so they're oblivious. There's really no way to completely eliminate the potential for abuse.

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[Emtpbill]

In the same sense, how many services do random spot drug tests?

[HotelCo]

<br />In the same sense, how many services do random spot drug tests?<br />

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Mine does. You can clear a call, and be told to goto concentra. Once they tell you to go, you have a set amount of time to show up.

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[HERBIE1]

The abuse of drugs is one thing, but that is not the only issue. If a provider is an addict, obviously any controlled substances we carry are at risk, but it's so much more than that. A patient's belongings, valuables in the home- anything is fair game to be stolen and sold to support the person's habit. As noted, there are plenty of ways to pilfer the stock of narcotics. As the addict's problem escalates, they get more bold, ie more and more patients seem to need analgesics. As we know, until and unless someone is ready to accept help, even the best employee assistance programs are of no use.

It's a tough problem, in some ways I think we are no different than many professions, but the difference is we have access to, as well as opportunity to satisfy our addictions. We all know this can be a highly stressful job, and coping mechanisms can range from healthy- increased excercise and/or social diversions, to drug, alcohol abuse, and unhealthy eating habits.

I think the bottom line is watching out for each other. Look for signs of someone who is not coping well. Changes in attitude, demeanor, sleeping habits, social behaviors, personality issues-anything out of character can be a warning sign. Granted, some folks don't have regular partners, but we can still see changes in casual acquaintances and peers.

[flamingemt2011]

No, the bigger problem is this: Most departments say it is OK for you to fail a drug test as long as you have a prescription for what you test positive for. How many medics are on Lortab for their backs and coming to work high ? How can you prove when they took it, the test just shows a positive, there is no way of knowing when they took it.

[Richard B the EMT]

We've had several strings on drug testing of personnel. I've mentioned I signed a paper saying if they told me to "pee in the cup", that's what I'd do.

A newer policy is, they will randomly (so they say) pull over a unit, and test the team. They can come back the next day, following the platoon change, and test the crew again, meaning the platoon member from the previous day can be tested 2 days in a row.

And, although most here have said I'm paranoid, I still have reservations on eating Poppy-seed bagels, fearing I'll get a false reading.