Worldwide, about 600,000 deaths had been attributable to drug overdose in 2019 (WHO, 2025). Proof means that the chance of overdose is elevated amongst some healthcare employees (HCWs). One population-based cohort examine in america of America, for instance, discovered that counsellors, social employees, psychologists, and different neighborhood and social service employees have greater than twice the chance of deadly drug overdose as individuals working outdoors of healthcare (Olfson et al., 2023). Others estimate that 8-15% of physicians stay with substance use dysfunction (SUD) (Samuelson & Bryson, 2017).
There’s an elevated threat of deadly drug overdose in HCWs, however there’s a dearth of qualitative analysis exploring what would possibly contribute to this downside. This can be defined by the reluctance of HCWs experiencing SUD to take part in interviews/focus teams due to stigma, denial of the illness, psychiatric comorbidities, and the concern {of professional} and social reprimand (Vayr et al. 2019).
Nonetheless, there are particular ‘occupational hazards’ that may enhance HCWs’ vulnerability to substance use. This consists of that many HCWs have data of and direct entry to a spread of medicines, together with opioids, which pose a high-risk for dependency (Mielau et al., 2021). Compounding this threat is the excessive stage of stress, burnout, nervousness, and melancholy skilled by many HCWs, usually ensuing from lengthy working hours, excessive affected person demand, unfair pay, and vicarious trauma from experiencing recurrent and extended affected person struggling (Teoh et al., 2024; Olaya et al., 2021).
Addressing this data hole is a needed step towards creating evidence-based methods for overdose prevention and focused help for HCWs residing with SUD. On this weblog, I summarise the mixed-methods examine by Algahtani et al. (2024), which aimed to “determine components that contribute to deadly overdose in healthcare professionals, each intentional and unintended, and information suggestions for hurt discount.”
The chance of deadly drug overdose is elevated in healthcare employees, however the components driving this are poorly understood due to stigma, denial, and concern {of professional} reprimand.
Strategies
As there may be issue gathering information instantly from HCWs experiencing SUD, the researchers collected information from the Nationwide Programme on Substance Use Mortality (NPSUM). They used a scientific technique to seek for reported deaths of HCWs the place illicit substances and licensed drugs (excluding nicotine, caffeine, and alcohol when not co-implicated with different substances) had been accountable (NPSUM, n.d.). They included college students, retirees, and HCWs who had left the occupation of their search, however excluded veterinary HCWs.
Deaths are voluntarily reported to the NPSUM by coroners in England, Wales, and Northern Eire and are based mostly on healthcare information, postmortem investigations, and studies from witnesses, household and pals, and emergency providers. Studies from 1st January 2000-31st December 2022 had been sampled.
The evaluation adopted a mixed-methods method. The authors used descriptive statistics to summarise the demographics of the HCWs, the circumstances of their deaths, and the medicine concerned. Free-text information had been analysed qualitatively to create themes that recognized the components which will have contributed to the HCWs deadly drug overdose.
Outcomes
Demographics of healthcare employees
58 studies had been included within the evaluation. They comprised: 47 (81%) employed as HCWs on the time of their loss of life; 3 (5%) retirees; 4 (7%) on long-term sick go away; 2 (3%) college students; 2 (3%) non-clinical workers. Median age was 38 years, and 39 (67%) had been male. Medical doctors had been the most important group (48%, n=28). This included 9 anaesthetists, 5 Normal Practitioners (GPs), and 13 with unknown specialities. Deaths had been categorised as suicide in 28 (48%) instances, unintended in 24 (41%) instances, and undetermined in 6 (10%) instances. Opioids had been probably the most often implicated drug, cited in 25 (43%) instances, adopted by benzodiazepines in 14 (24%) instances. The remaining three deaths had been attributed to illicit medicine, with every case co-implicated with licensed drugs.
Psychological and Bodily Well being Issues
The authors recognized a number of components underneath the umbrella of psychological and bodily well being issues that would have contributed to the HCWs’ deadly drug overdose. 29 (50%) HCWs had a psychological well being situation, with some being involved with psychiatric providers days earlier than their loss of life. 28 (48%) alluded to a current deterioration in psychological well being, often attributed to work-related pressures corresponding to extreme extra time, treating sufferers who had skilled vital trauma, and allegations {of professional} misconduct. By way of bodily well being issues, self-medicating to alleviate continual ache was described in 8 (14%) instances. For some HCWs, substance use solely grew to become obvious autopsy; for instance, one coroner discovered lesions on a nurse’s wrist (suggestive of intravenous (IV) use), who didn’t appear to have a historical past of SUD.
Vocational Components – What I Perceived to Be ‘Occupational Hazards’
The authors recognized three vocational components which will have contributed to the HCWs deadly drug overdose. I interpreted these findings as depicting occupational hazards, highlighting dangers throughout the healthcare occupation that uniquely make HCWs susceptible to deadly drug overdose. First was that 37 (64%) HCWs (together with non-clinicians and retired HCWs) sourced the drug from their office. One retired pharmacist, for instance, had retained drugs from his former office with the perceived intent to die by suicide. The second was that 32 (55%) of HCWs used their medical data to manage the medicine utilizing tools taken from their office like intravenous traces (IVs), syringes, cannulas, and tourniquets and to handle negative effects. In a single inquest, the coroner defined:
“[the HCP] would have had working data of anaesthetic medicine utilized in surgical procedures and would have identified that the medicine they injected themselves with would trigger them to lose consciousness and cease respiration.”
The ultimate occupational hazard current in 16 (28%) instances was the attainment of personal prescriptions from less-regulated sources outdoors the UK. These studies offered one other instance of HCWs’ utilizing their medical data to affect what was prescribed.
Deadly drug overdoses in healthcare employees could have resulted from an intersection of declining psychological well being, self-medication for ache, and occupational hazards distinctive to their occupation.
Conclusion
There are occupational hazards that may contribute to deadly drug overdose amongst HCWs. These embrace that HCWs have entry to managed substances, data of dosing and managing negative effects, and the ability to acquire prescriptions from less-regulated sources outdoors the UK. Poor psychological well being, extreme working hours, and vicarious trauma from experiencing affected person struggling additionally contribute.
These findings affirm proof that SUD will not be a defect of character or private failure, however is as an alternative systemically embedded throughout the healthcare occupation (Wakeman et al., 2017). As such, healthcare establishments have a possibility to co-develop proactive prevention and help methods with HCWs for these susceptible to, or experiencing SUD.
This examine highlights how addressing the chance of deadly drug overdose amongst HCWs requires a systemic method from healthcare establishments, fairly than solely particular person motion.
Strengths and Limitations
I consider the primary strengths of this examine had been that entries into the NPSUM embrace healthcare information and emergency service studies. The inclusion of sources that had been documented instantly after the HCWs’ deaths could have lowered recall bias (witnesses misremembered an expertise) in comparison with if all witnesses had been interviewed retrospectively. The NPSUM attracts information from a number of sources. This may increasingly have provided a fuller image of the components contributing to the HCWs’ deadly drug overdose than potential by interviewing a single individual.
Nonetheless, one of many essential limitations of this examine was that studies on veterinary HCWs had been excluded. Veterinary HCWs have related entry to psychoactive drugs and have a excessive incidence of work-related stress, burnout, nervousness, and melancholy so it’s potential that the findings are transferable (Pohl et al., 2022). Coroners aren’t required to report deaths to the NPSUM. Different components contributing to the HCP’s deadly drug overdose could not have been captured by this examine.
The NPSUM relies on studies from witnesses, emergency providers, and folks throughout the HCWs’ private community. Whereas the info sources could corroborate one another, the data continues to be topic to social desirability bias (witnesses reporting info perceived as beneficial to the info collector). As well as, these studies could not totally seize the components the HCWs themselves would have seen as contributing to their deadly drug overdose. Studies from the NPSUM can differ intimately, and the outcomes provided right here had been primarily summarised utilizing descriptive statistics and with few information extracts. As a consequence of this, the outcomes could have provided much less depth than potential with interviews or focus teams.
Whereas information was collected from the Nationwide Programme on Substance Use Mortality, the brevity of the studies and the summative nature of the evaluation limits our understanding.
Implications
Accessible and evidence-based psychological well being and dependancy help, probably as a part of an worker help programme, could possibly be step one to supporting HCWs experiencing SUD. Whereas concern or stigma {and professional} reprimand could forestall some from accessing this help (Vayr et al. 2019), systematic opinions present that, as soon as engaged, HCWs are responsive to those interventions and their return-to-work after recovering is achievable, sustainable, and protected (Kunyk et al., 2016).
The important thing to success, subsequently, could also be to create a working setting that encourages HCWs to entry this help. This could possibly be achieved by involving HCWs with lived expertise of SUD and dependancy within the co-design of consciousness assets. As well as, curricula in undergraduate medical college, and basis and speciality coaching could profit from emphasising that SUD is an dependancy and well being situation that requires help, not a private failure or a selection as some HCWs have reported in qualitative research (Boekel et al., 2013).
Healthcare employees could profit from entry to inner psychological well being and dependancy providers, however uptake is contingent upon fostering a non-stigmatising office tradition.
Assertion of Curiosity
Amelia is at the moment conducting a post-doc on psychological well being and dependancy analysis. No conflicts of curiosity to declare.
Edited by
Dafni Katsampa.
Hyperlinks
Major Paper
Algahtani, T., Gee, S., Shah, A., Williams, B. D., Gorton, H. C., Welch, S., & Copeland, C. S. (2025). Deadly drug overdoses in healthcare employees: A thematic framework evaluation of coroner studies. Dependancy, 120(11), 2270-2281. DOI: https://doi.org/10.1111/add.70139
Different References
Kunyk, D., Inness, M., Reisdorfer, E., Morris, H., & Chambers, T. (2016). Assist searching for by well being professionals for dependancy: A blended research assessment. Worldwide Journal of Nursing Research, 60, 200-215. https://doi.org/10.1016/j.ijnurstu.2016.05.001
Mielau, J., Vogel, M., Gutwinski, S., & Mick, I. (2021). New approaches in drug dependence: opioids. Present dependancy studies, 8(2), 298-305. https://doi.org/10.1007/s40429-021-00373-9
Olaya, B., Perez-Moreno, M., Bueno-Notivol, J., Gracia-Garcia, P., Lasheras, I., & Santabarbara, J. (2021). Prevalence of melancholy amongst healthcare employees through the COVID-19 outbreak: a scientific assessment and meta-analysis. Journal of medical medication, 10(15), 3406. https://doi.org/10.3390/jcm10153406
Olfson, M., Cosgrove, C. M., Wall, M. M., & Blanco, C. (2023). Deadly drug overdose dangers of well being care employees in america: a population-based cohort examine. Annals of inner medication, 176(8), 1081-1088. https://doi.org/10.7326/M23-0902
Pohl, R., Botscharow, J., Böckelmann, I., & Thielmann, B. (2022). Stress and pressure amongst veterinarians: a scoping assessment. Irish Veterinary Journal, 75(1), 15. https://doi.org/10.1186/s13620-022-00220-x
Samuelson, S. T., & Bryson, E. O. (2017). The impaired anesthesiologist: what you need to learn about substance abuse. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, 64(2), 219-235. https://doi.org/10.1007/s12630-016-0780-1
Teoh, Ok. R. H., Dunning, A., Taylor, A. Ok., Gopfert, A., Chew-Graham, C. A., Spiers, J., … & Riley, R. (2024). Working situations, psychological misery and suicidal ideation: cross-sectional survey examine of UK junior medical doctors. BJPsych open, 10(1), e14. https://doi.org/10.1192/bjo.2023.619
The Nationwide Programme on Substance Use Mortality (NPSUM). (n.d.). The Nationwide Programme on Substance Use Mortality – King’s Faculty London. https://www.kcl.ac.uk/analysis/the-national-programme-on-substance-use-mortality
Van Boekel, L. C., Brouwers, E. P., Van Weeghel, J., & Garretsen, H. F. (2013). Stigma amongst well being professionals in direction of sufferers with substance use problems and its penalties for healthcare supply: systematic assessment. Drug and alcohol dependence, 131(1-2), 23-35. https://doi.org/10.1016/j.drugalcdep.2013.02.018
Vayr, F., Herin, F., Jullian, B., Soulat, J. M., & Franchitto, N. (2019). Obstacles to searching for assist for physicians with substance use dysfunction: a assessment. Drug and alcohol dependence, 199, 116-121. https://doi.org/10.1016/j.drugalcdep.2019.04.004
Wakeman, S. E., Kanter, G. P., & Donelan, Ok. (2017). Institutional substance use dysfunction intervention improves basic internist preparedness, attitudes, and medical observe. Journal of Dependancy Medication, 11(4), 308-314.https://doi.org/10.1097/ADM.0000000000000314
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