Worldwide, about 600,000 deaths have been attributable to drug overdose in 2019 (WHO, 2025). Proof means that the chance of overdose is elevated amongst some healthcare staff (HCWs). One population-based cohort examine in the US of America, for instance, discovered that counsellors, social staff, psychologists, and different group and social service staff 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 reside 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 drawback. 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).
Nevertheless, there are particular ‘occupational hazards’ which may improve HCWs’ vulnerability to substance use. This contains 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, anxiousness, and melancholy skilled by many HCWs, typically 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 information hole is a obligatory 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 “establish elements that contribute to deadly overdose in healthcare professionals, each intentional and unintended, and information suggestions for hurt discount.”
The danger of deadly drug overdose is elevated in healthcare staff, however the elements driving this are poorly understood due to stigma, denial, and concern {of professional} reprimand.
Strategies
As there’s problem accumulating knowledge instantly from HCWs experiencing SUD, the researchers collected knowledge 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) have 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 primarily based on healthcare data, postmortem investigations, and stories from witnesses, household and mates, and emergency providers. Studies from 1st January 2000-31st December 2022 have been sampled.
The evaluation adopted a mixed-methods strategy. The authors used descriptive statistics to summarise the demographics of the HCWs, the circumstances of their deaths, and the medication concerned. Free-text knowledge have been analysed qualitatively to create themes that recognized the elements that will have contributed to the HCWs deadly drug overdose.
Outcomes
Demographics of healthcare staff
58 stories have 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%) have been male. Docs have been the biggest group (48%, n=28). This included 9 anaesthetists, 5 Basic Practitioners (GPs), and 13 with unknown specialities. Deaths have been categorised as suicide in 28 (48%) circumstances, unintended in 24 (41%) circumstances, and undetermined in 6 (10%) circumstances. Opioids have been probably the most continuously implicated drug, cited in 25 (43%) circumstances, adopted by benzodiazepines in 14 (24%) circumstances. The remaining three deaths have been attributed to illicit medication, with every case co-implicated with licensed drugs.
Psychological and Bodily Well being Issues
The authors recognized a number of elements below 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, continuously attributed to work-related pressures corresponding to extreme additional time, treating sufferers who had skilled vital trauma, and allegations {of professional} misconduct. By way of bodily well being issues, self-medicating to alleviate power ache was described in 8 (14%) circumstances. 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 Elements – What I Perceived to Be ‘Occupational Hazards’
The authors recognized three vocational elements that will have contributed to the HCWs deadly drug overdose. I interpreted these findings as depicting occupational hazards, highlighting dangers inside the healthcare occupation that uniquely make HCWs weak 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 scientific data to manage the medication utilizing tools taken from their office like intravenous strains (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 medication utilized in surgical procedures and would have identified that the medication they injected themselves with would trigger them to lose consciousness and cease respiration.”
The ultimate occupational hazard current in 16 (28%) circumstances was the attainment of personal prescriptions from less-regulated sources outdoors the UK. These stories offered one other instance of HCWs’ utilizing their scientific data to affect what was prescribed.
Deadly drug overdoses in healthcare staff might 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 embody 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 just isn’t a defect of character or private failure, however is as an alternative systemically embedded inside the healthcare occupation (Wakeman et al., 2017). As such, healthcare establishments have a chance to co-develop proactive prevention and help methods with HCWs for these liable to, or experiencing SUD.
This examine highlights how addressing the chance of deadly drug overdose amongst HCWs requires a systemic strategy from healthcare establishments, quite than solely particular person motion.
Strengths and Limitations
I consider the principle strengths of this examine have been that entries into the NPSUM embody healthcare data and emergency service stories. The inclusion of sources that have been documented instantly after the HCWs’ deaths might have diminished recall bias (witnesses misremembered an expertise) in comparison with if all witnesses have been interviewed retrospectively. The NPSUM attracts knowledge from a number of sources. This may occasionally have provided a fuller image of the elements contributing to the HCWs’ deadly drug overdose than doable by interviewing a single particular person.
Nevertheless, one of many primary limitations of this examine was that stories on veterinary HCWs have been excluded. Veterinary HCWs have comparable entry to psychoactive drugs and have a excessive incidence of work-related stress, burnout, anxiousness, and melancholy so it’s doable that the findings are transferable (Pohl et al., 2022). Coroners will not be required to report deaths to the NPSUM. Different elements contributing to the HCP’s deadly drug overdose might not have been captured by this examine.
The NPSUM is predicated on stories from witnesses, emergency providers, and other people inside the HCWs’ private community. Whereas the information sources might corroborate one another, the knowledge remains to be topic to social desirability bias (witnesses reporting info perceived as beneficial to the information collector). As well as, these stories might not absolutely seize the elements the HCWs themselves would have considered as contributing to their deadly drug overdose. Studies from the NPSUM can fluctuate intimately, and the outcomes provided right here have been primarily summarised utilizing descriptive statistics and with few knowledge extracts. As a consequence of this, the outcomes might have provided much less depth than doable with interviews or focus teams.
Whereas knowledge was collected from the Nationwide Programme on Substance Use Mortality, the brevity of the stories and the summative nature of the evaluation limits our understanding.
Implications
Accessible and evidence-based psychological well being and habit help, doubtlessly as a part of an worker help programme, may very well be step one to supporting HCWs experiencing SUD. Whereas concern or stigma {and professional} reprimand might stop some from accessing this help (Vayr et al. 2019), systematic critiques present that, as soon as engaged, HCWs are responsive to those interventions and their return-to-work after recovering is achievable, sustainable, and secure (Kunyk et al., 2016).
The important thing to success, due to this fact, could also be to create a working setting that encourages HCWs to entry this help. This may very well be achieved by involving HCWs with lived expertise of SUD and habit within the co-design of consciousness assets. As well as, curricula in undergraduate medical faculty, and basis and speciality coaching might profit from emphasising that SUD is an habit 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 staff might profit from entry to inside psychological well being and habit providers, however uptake is contingent upon fostering a non-stigmatising office tradition.
Assertion of Curiosity
Amelia is at present conducting a post-doc on psychological well being and habit 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 staff: A thematic framework evaluation of coroner stories. Habit, 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 habit: A blended research evaluation. 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 habit stories, 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 staff through the COVID-19 outbreak: a scientific evaluation and meta-analysis. Journal of scientific 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 staff in the US: a population-based cohort examine. Annals of inside 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 evaluation. 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 circumstances, 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 issues and its penalties for healthcare supply: systematic evaluation. 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 evaluation. 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 normal internist preparedness, attitudes, and scientific follow. Journal of Habit Drugs, 11(4), 308-314.https://doi.org/10.1097/ADM.0000000000000314
World Well being Organisation. (2025) Opioid overdose. https://www.who.int/news-room/fact-sheets/element/opioid-overdose
