WHEN DRUG ADDICTION INVADES THE PRACTICE OF MEDICINE

Jones* was absolutely heartbroken when he found out that he was not eligible to join medical school in Kenya when he finished high school. Coming from a humble background, he could not afford to pursue his dream. However, Kenya was just starting to train nurses at degree level and Jones was able to get into the pioneer class.

Four years later, with a degree rightfully earned, Jones headed off to practice an art he had come to love. He took the Nightingale Pledge to heart and practiced it with his whole being. He loved his patients and worked with utmost dedication. Within a few years, he was back to school studying hard to become a critical care nurse. He had found his calling.

Away from work, Jones spent his free time playing basketball at a local club. He had played for his high school team but had been away from the game for quite a while. It felt good to be back in practice. He also started dating a young doctor he met during his specialist training. Life was turning out pretty well for a young man who had thought he would never recover from losing his dream.

However, one evening, during a basketball tournament, Jones suffered an injury and fractured his tibia and fibula, the bones of the leg. What followed was a dark period of excruciating pain and frustration at not being able to do either of the things he loved. He underwent surgery but had to remain in hospital for some time.

To manage his pain, he would receive opiod injection medication every eight hours. The shots would be a welcome relief as not only would they suppress the pain but would also knock him out and allow him to sleep away the endless hours he spent lying there. When he went home, despite having adequate pain relief from the oral tablets that he was prescribed for, he struggled to sleep.

With his girlfriend being a doctor, it was possible for Jones to get a prescription for sleeping pills  but he wasn’t quite able to get the kind of knockout he wanted. He pleaded with her to bring him prescription opioid injection medication and he would inject himself to sleep.

Five months after the injury, Jones was back to work. He was happy to get back to doing what he loved. However, despite healing well, the 12-hour shifts in the critical care unit spent on his feet were heavily taxing. His leg would throb after work and he couldn’t wait to get home and put it up and rest. However, he found himself drifting back to sneaking in a shot of the opioids to alleviate the pain and sleep.

Before Jones knew it, he was regularly injecting himself prescription medication to sleep. He began pilfering the medication from the dangerous drugs locker in the critical care unit to meet his needs. What started as a medical need was turning into a monster that Jones was having trouble taming. He did not have the capacity to face up to the magnitude of the problem.

The addiction roller-coaster had long taken off. Suffice it to say, Jones never played basketball again. His relationship with his girlfriend hit the rocks and his supervisor caught up with his pilfering. Instead of a disgraceful dismissal. Jones was offered an opportunity to hand in his resignation.

The cycle of addiction is the same irrespective of the drug of addiction. A bright young nurse who was on the path to a bright future, was instead on a downward spiral to oblivion. Seven years of moving from one job to another, one seedy apartment to the next, losing friends and family eventually culminated in finally losing his license to practice for grossly endangering patients’ lives.

There a many reasons why anyone would find themselves going down the slippery slope of addiction. Many are harshly judged, especially when they are hooked onto illegal substances. For healthcare practitioners, the easy access to prescription drugs of addiction easily fuels the addiction flames in record time.

Unfortunately, no one is usually paying attention until things get out of hand. Unfortunately in Kenya, there is no mechanism in place to deal with health workers who get into prescription drug abuse.  In the Unites States of America, there exists a robust physician health programme that is set up to support practitioners whose ability to practice safely is impaired. The impairment may be medical such as mental illness, cognitive impairment or drug addiction.

The risk these practitioners pose to patient care cannot be underestimated. Nobody wants  to be under anesthesia and the doctor responsible for your life slumps in a corner from the effect of a pethidine shot he gave himself instead of you. Of that moment when you are bleeding out and the doctor’s hands are shaking too hard to put in the lifesaving cannula required to transfuse you. Or when your teenager is writhing in pain from a sickle cell crisis and the nurse has injected him with saline since she cannot account for the pethidine via meant for him but she has already injected herself.

A health practitioner suffering addiction, and specifically prescription medication addiction, is not only a danger to himself but is an even bigger danger to the patients. As we strive to take care of our patients struggling with addiction, we need to set up a system to ensure the same care is extended to our health workers.

The system must work by providing a safe place for them to seek help without judgement. We must also enable fellow health workers to report their colleagues who may be unfit to practice due to addiction. However, the reporting should not be for punitive purposes but for enabling access to support and care. It is definitely time for a physician health programme in Kenya!