BC is at the forefront of addiction research and treatment provision. So when nurses develop substance use problems, why are are they not afforded the same right to quality and ethical health care as other citizens?
In 2013, I was working as a nurse for the Vancouver Coastal Health Authority. I had been using alcohol and other drugs while on vacation and suddenly stopped prior to returning to work. This resulted in severe withdrawal symptoms. I was hospitalized and my substance use problems were reported to the College of Registered Nurses of BC.
My nursing licence was suspended and I was required to undergo a $2,500 assessment conducted by a private family physician chosen by my employer.
I had never been impaired at work and my employer had never expressed dissatisfaction with my work performance or attendance.
However, after diagnosing me with a substance use disorder, the physician recommended life-long abstinence, attendance at a $30,000 private 12-step addiction treatment facility in Guelph Ontario, daily attendance at Alcoholics Anonymous meetings, three years of random testing of my urine, blood, liver enzymes and hair follicles, attendance at the physician’s private medical monitoring company for 3 years at $650 a month, a 2 year ban on handling narcotics in the workplace and attendance at Caduceus (peer support) meetings for health care professionals.
As an atheist, the religious philosophy of 12-step programs is contrary to my worldview, and as a nurse I know the efficacy of 12-step programs is questionable. So I proposed an alternative treatment plan of attending a public addiction treatment centre in BC, counselling with the Fraser Health Authority, SMART Recovery meetings and drug testing.
The physician refused my proposal and wrote in his medical report that I was “arrogant” to think that I know more about addiction treatment than the “experts”. My employer told me that I could not work as a nurse in BC unless I followed a 12-step program.
I attended the 5 week treatment centre in Ontario. I was told that I was in denial and my substance use problems were a result of character defects and that I needed to pray and surrender to a higher power.
It felt like a cult.
When I returned to Vancouver I continued with 12-step meetings. I despised the religious philosophy, the public speaking, the endless stories of drug use and the absence of any qualified group leaders.
Attending meetings made me want to drink.
During Caduceus meetings my peers bullied me into adopting the 12-step philosophy. The physician moderating the meetings encouraged this behaviour.
I asked the BC Nurses Union (BCNU) to advocate for me, but they also told me I must follow a 12-step program.
I was unwilling to continue with this archaic, unhelpful and religious treatment, so I withdrew from the program. As a result, in 2015 I was fired and I am no longer allowed to work as a nurse.
All of my drug tests had been negative.
I filed a complaint with the College of Physicians and Surgeons of BC. They dismissed my complaint, claiming that 12-step abstinence-based treatment is the community standard for treating nurses with substance use disorders.
I have now filed a complaint with the BC Human Rights Tribunal.
My experience is not unique. Researchers and clinicians have exposed the shortcomings (see references below) of workplace substance use policies for nurses and other health care professionals. Charlotte Ross summarized the findings of her PhD thesis to me:
Policies are based on an outdated understanding of substance use disorders as moral failings. Nurses are not afforded the same right to quality and ethical health care as other citizens, and the programs are rife with conflict of interest, power imbalances and prevailing corporate interests.
An arbitrator recently ruled that the Interior Health Authority’s workplace substance use policy is discriminatory and must be suspended pending a major overhaul. However, discriminatory workplace substance use policies remain in effect for health care professionals and other people in BC who work in safety sensitive occupations.
After being fired, my substance use problems got worse until I connected with a physician who prescribed Naltrexone, which led to the gradual stabilization of my condition. Despite being the first line treatment for alcohol use disorders, this medication was never offered to me while I was enrolled in the treatment and monitoring program for nurses.
I have started a petition calling on the BC Health Authorities, the BCNU and the BC College of Nursing Professionals to overhaul their workplace substance use policies.
Workplace substance use policies are necessary to protect public safety. However, the current policies force nurses into treatment and monitoring programs that are punitive, one-size fits all, faith-based and profit driven.
Nurses with substance use problems must be treated fairly and given a choice of evidence based treatment options.
Ross, Charlotte A. (2018). An Institutional Ethnography of Substance-Use Practices Among Nurses and Related Management Intervention Practices in a Province in Western Canada. (Unpublished doctoral dissertation). Simon Fraser University, Burnaby, British Columbia, Canada. Retrieved from https://theses.lib.sfu.ca/file/thesis/4956. Read Chapter 4
Urbanoski, K. A. (2010). Coerced addiction treatment: Client perspectives and the implications of their neglect. Harm Reduction Journal, 7, 13.
Lawson, N. D. & Boyd, J. W. (2018). Flaws in the methods and reporting of physician health program outcome studies [Letter to the editor]. General Hospital Psychiatry, 54, 65-66.
Chapnick, Jonathan. (2014) “Beyond the label: Rethinking workplace substance use policies”. Conference paper: CLE Human Rights Conference, at Vancouver.
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