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Turning to drugs
Why are some Australian healthcare professionals at an increased risk of drug use and early death?
Jennifer Pilgrim interviewed by Dallas Bastian
Between 2003 and 2013, nearly five deaths per 1000 employed Australian healthcare professionals were caused by drugs.
This finding is part of a recent Monash University study that aimed to identify the best approaches to dealing with the drug use and mental health needs of healthcare professionals.
The team analysed the drug-caused deaths reported to the coroner of physicians, nurses, dentists, psychologists, psychiatrists, physiotherapists, pharmacists, paramedics and veterinarians.
The research revealed that between 2003 and 2013, there were on average 37 drug-caused healthcare professional deaths each year.
These deaths commonly involved women in their mid-40s, a diagnosis of mental illness, personal and professional stress, and an intent to self-harm. In nearly a fifth of cases, the drugs were sourced from the workplace.
Just over half the deaths recorded were intentional self-harm deaths, followed by unintentional deaths, at about 37 per cent.
Mental illness was diagnosed in almost half the cases, with the majority involving depression. A number of cases reported stressors such as a relationship, or a workplace or money issue.
Dr Jennifer Pilgrim, head of the Drug Harm Prevention Unit at Monash University, said the study also found a significant association between specific professions and drugs of choice, and added the research revealed some different trends to those shown in existing literature.
“ For example, nurses, dentists and pharmacists reportedly gravitate towards misuse of opioids; however, in this study, these healthcare professionals misused opioids along with other substances, namely benzodiazepines,” Pilgrim said.
Nursing Review sits down with Pilgrim to discuss the study’ s observations on occupation-specific drug choice and how the information might inform approaches to health professionals’ drug use and mental healthcare needs.
NR: Why is it important that research explores these types of deaths, and why did the research team decide to look at deaths reported to the coroner? JP: We know from previous research, mainly from the USA and the UK, that there are a number factors that put healthcare professionals at an increased risk of drug use and early death. These include factors like long hours and stressful jobs; they’ re constantly dealing with critically ill people and the dying; and obviously their increased access to drugs.
Until this study, we didn’ t know what the situation was here in Australia, and if this was a problem here too. Also, we had no studies, to our knowledge, examining all healthcare professionals. A lot of them focused on either just the doctors or just the nurses. We wanted to look at all healthcare professionals that had access to drugs, which included paramedics and veterinarians as well.
What was revealed about the prevalence of these deaths among the different groups of healthcare professionals? We found 404 deaths between 2003 and 2013. Most involved intentional self-harm and mental illness. Many also involved professional and personal stresses, such as financial problems, relationship issues, and other kinds of workplace stresses. What we found was that [ nurses had the highest number of deaths ] across the healthcare professional group overall. However, when we considered the healthcare professionals in terms of the actual number of people employed in these positions across Australia, we found that the rate of deaths was actually highest among the veterinarian group.
How would you characterise these deaths? What were some commonalities you discovered? What was also interesting was the prevalence of females in the study. Previous studies have shown that while nearly a third of all physicians are female, around 90 per cent of those physicians treated for substance abuse are actually male. However, this might be explained by the high proportion of females in the nursing group, which happened to make up the largest healthcare professional type across the whole cohort. Since males have generally represented the higher risk group for suicide, a lot of the prevention programs have been gender focused, but perhaps we need to take a step back and look at suicide prevention among both males and females in the healthcare industry specifically.
The other major concern that arose from this study was that over half of the cases were intentional self-harm, or suicides. Generally, from studies we’ ve conducted on drug-caused deaths in Australia in other settings or populations, we see maybe 25 per cent are suicides. So this was a much larger proportion of suicides seen among healthcare professionals – something that’ s been raised in the international literature before.
It was a particular problem among the veterinary group. Anecdotal evidence suggests that this might be from a range of reasons like the higher mortality rate among animals compared with humans and the fact that vets are constantly having to
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