RECOVERY AND ASSISTANCE PROGRAMS FOR HEALTHCARE WORKERS WITH SUBSTANCE USE DISORDER

To advocate that hospitals and health systems support and promote recovery and assistance programs for healthcare personnel with substance use disorders, including those who have diverted controlled substances to support their own drug addiction; further,

To encourage state licensing boards to support structured rehabilitation programs that demonstrate a clear pathway for recovery and hospitals and health systems to support the return to practice upon successful completion of the program.

Rationale

At least one in every 100 healthcare workers (HCWs) is estimated to have diverted medication. Because most drug diversion goes undetected, the true number is likely much higher. Moreover, an estimated 10-15% of HCWs will misuse substances within their career. Due to the physical demands of the job, increasing levels of burnout, and ease of access to controlled substances (CS), occupational risk factors contribute to substance misuse in the healthcare setting. Substance use disorders (SUDs) are formally recognized by The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, with decades of research linking these disorders to changes in brain chemistry. Historically, the stigma associated with such diagnoses and the fear of license revocation have prevented HCWs from seeking treatment. Many hospitals and health systems have begun to offer confidential faculty and staff assistance programs; however, these resources continue to be underutilized. Even after diverters have been caught, many will not admit to any wrongdoing for fear of loss of employment. These situations can lead to the diverter resigning and seeking employment elsewhere. Often, the behavior will continue, putting patients and co-workers at risk for safety events. Furthermore, the risk of suicide is high after personnel are confronted about diversion. 

To prevent poorer overall health and financial instability, HCWs need to retain their healthcare insurance and access treatment on while on leave of absence or disability, with return to work after completing state board-mandated protocols. ASHP supports employer-sponsored drug programs that promote the recovery of impaired individuals (see ASHP Statement on the Pharmacist’s Role in Substance Abuse Prevention, Education, and Assistance). Less punitive approaches are recommended in the ASHP Guidelines on Preventing Diversion of Controlled Substances, which state that sanctions should take into account whether the HCW is supporting his or her own substance use disorder (or that of an associate) or there has been theft of CS for sale and financial gain. The guidelines further recommend that when an HCW is diverting to support a substance use disorder, the diversion should be reported to applicable licensing boards, and the HCW should be referred to a substance abuse program. The guidelines encourage healthcare organizations to establish a process to support recovery for HCWs who are diverting CS for an active substance abuse problem (i.e., an employee assistance program process, which may include mandatory program referral, reporting to the relevant state board or professional assistance program, and a contract for the HCW’s return to work). Also known as alternatives to discipline programs (APDs), APDs are non-punitive monitoring programs that allow HCWs to return to work after receiving treatment for an SUD. 

The intent of these programs is to support decriminalization of SUDs to avoid interfering with an empathetic approach to employee substance use disorders. However, this must be balanced with other priorities, including patient safety, legal and regulatory compliance, and employee protection. A 2021 ASHP survey found that 83% of surveyed healthcare organizations supported employee substance use recovery programs, and 65% had return-to-work policies for employees who wanted to re-enter the workforce following recovery. SAMHSA defines recovery as a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. State boards of pharmacy have embraced employee substance use recovery programs and return-to-work policies. Given their essential role in enabling HCWs to return to practice, ASHP encourages all state bodies responsible for licensing HCWs to support accessible, affordable, and structured rehabilitation programs for HCWs with substance use disorders that lead to return to practice upon successful completion.