Drug misuse and addiction among healthcare professionals stands out as a multidimensional problem that needs to be addressed along with individual predispositions, working conditions, professional access to drugs, and the stigma anxiety affecting help-seeking behaviors.
Presidential Advisor to Üsküdar University, Head of Internal Medical Sciences Department, Faculty of Medicine, and Faculty Member of the Department of Medical Pharmacology, Prof. Tayfun Uzbay, evaluated the factors increasing the risk of drug addiction in healthcare professionals, the misuse potential of drugs like propofol and fentanyl, the importance of traceability in hospitals, and peer support systems that could be established in Turkey.
Intense work pace, night shifts, and burnout can increase risk
Stating that drug misuse and addiction in healthcare professionals cannot be attributed to a single cause, Prof. Tayfun Uzbay said, “There are many reasons for drug misuse and addiction in healthcare professionals. Intense work pace, night shifts, sleep disorders, burnout, stress, and pre-existing mental health problems or a history of other substance use in some individuals increase the risk. Although easy access to these drugs as a healthcare professional increases the risk, it is not a sole cause of addiction. However, it can facilitate the transition to misuse in an individual predisposed to addiction. Especially anesthesia and intensive care workers have easy contact with propofol and strong opioids. In our comprehensive review on propofol, we observed that healthcare professionals, especially anesthesia workers, prominently stood out among published cases.”
Fentanyl has high potential for developing severe physical dependence
Stating that drugs such as propofol and fentanyl have some important characteristics in terms of their misuse potential, Prof. Uzbay said, “One of the common features of these drugs is their very rapid onset of action. Fentanyl is a very powerful opioid that can create pleasure and relaxation, but it can also be fatal by suppressing respiration in a dose-dependent manner. Tolerance develops to its effects, and it has a high potential for developing severe physical dependence.”
Narrow range between safe dose and toxic dose for propofol
Emphasizing that propofol is a different drug from opioids, Prof. Uzbay stated, “Propofol is not an opioid but a short-acting intravenous anesthetic. Its short duration of action is a significant advantage in clinical practice. Therefore, it is frequently used in invasive short-term procedures and provides significant comfort.”
However, drawing attention to the fact that propofol's misuse potential should not be overlooked, Uzbay said:
“Despite not being an opioid, the drug's stress-reducing and euphoric effects have also been reported. More importantly, the safety margin between the safe dose and the toxic dose that can lead to severe respiratory and circulatory depression is quite narrow. Depending on the individual's sensitivity, overdose or individual susceptibility can lead to severe, even fatal, consequences. For this reason, it is extremely dangerous for even an experienced healthcare professional to use propofol on their own.”
Experimental studies point to the rewarding effects of propofol
Referring to the experimental research conducted in the laboratories of Üsküdar University Neuropsychopharmacology Application and Research Center (NPFUAM), Prof. Tayfun Uzbay said, “Some experimental studies we conducted in Üskübar University NPFUAM laboratories also show that there is a neurobiological basis related to these effects. We had previously shown that propofol has stimulant/rewarding effects in rats, such as conditioned place preference and increased locomotor activity, which we observe in substances with addiction potential. Other experimental studies published later also provided findings supporting the rewarding and addiction-related effects of propofol.”
Addiction can remain hidden for a while in healthcare professionals
Stating that drug addiction developing in healthcare professionals can sometimes be noticed late, Prof. Uzbay noted that healthcare professionals' close knowledge of drug effects, dosages, and work environments can facilitate the concealment of use.
Prof. Uzbay said, “Since healthcare professionals know the drug's effects, dosages, and work environment well, they can conceal their use for a period and may appear to be maintaining their professional functions. The short duration of propofol's effect can also make it harder to detect.”
“Will I lose my profession?” anxiety can delay seeking help
Emphasizing that concerns about loss of professional reputation and stigmatization can also delay seeking treatment, Prof. Uzbay said, “In addition, anxieties such as ‘Will I lose my profession?’ and ‘What will my colleagues think?’ can delay a person from seeking help.”
Stating that the delay in seeking help should be evaluated not only for the healthcare professional themselves but also for patient safety, Prof. Uzbay commented, “This situation both delays treatment and increases the risk for patient safety regarding patients who come into contact with this healthcare professional. The goal here should be to detect the problem early.”
Drug must leave a trace from its entry into the hospital until its disposal
Stating that a strong traceability system is necessary for tracking drugs with misuse potential in hospitals, Prof. Uzbay said that the fundamental approach should be to record the entire process from the drug's entry into the hospital to its use or disposal.
Prof. Uzbay said, “I believe the fundamental principle in this matter is: A drug must leave a clear trace at every stage, from the moment it enters the hospital until it is administered to a patient or its unused portion is disposed of.”
Stating that electronic record systems are of great importance in this context, Prof. Uzbay continued as follows:
“Electronic stock tracking, recording of the person receiving the drug, matching which dose was administered to which patient with user and time information, recording of unused quantities, and a second verification, especially for risky drugs, are very important.”
Recurring small stock discrepancies should be examined
Noting that discrepancies between stock records and actual use should also be carefully evaluated, Prof. Uzbay said, “Small but recurring discrepancies between stock and actual use should be carefully examined.”
Underlining that such audits should not be seen as a practice intended to incriminate healthcare professionals, Uzbay stated, “The aim here is not to constantly view the healthcare professional as suspicious, but to establish a system that protects both the employee and the patient.”
“I believe there is a regulatory gap regarding propofol”
Stating that propofol is not on controlled substance lists in the classical sense in many countries, Prof. Uzbay expressed that this situation necessitates closer monitoring of the drug's use, especially in healthcare institutions.
Prof. Uzbay said, “I believe there is a regulatory gap here regarding propofol. In many countries around the world, propofol is still not on the classical controlled substance list. This situation highlights the need for stricter monitoring of drug access and use, especially in healthcare institutions.”
Pointing to their comprehensive review on propofol, Prof. Uzbay said, “In our latest review, in light of existing scientific data, we concluded that propofol should be more strictly controlled and evaluated among controlled substances.”
Proposal for a confidentiality-based peer support system for Turkey
Stating that a confidentiality-based peer support system, where healthcare professionals struggling with addiction can seek help, could provide significant benefits for Turkey, Prof. Tayfun Uzbay emphasized that the system should not be solely punitive.
Saying, “I believe such a system would be very beneficial for Turkey,” Prof. Uzbay stated, “Instead of the fear of being directly penalized when a problem arises, healthcare professionals should have a professional structure they can safely turn to.”
Addiction psychiatry, anesthesiology, and pharmacology must work together
Stating that the peer support program to be established should have a multidisciplinary structure, Prof. Uzbay said, “The program can be established as an independent structure where addiction psychiatry, occupational health, anesthesiology, pharmacology, nursing, and, if necessary, hospital pharmacy work together.”
Stating that keeping applications as confidential as possible could facilitate help-seeking behavior, Prof. Uzbay said, “Rapid assessment and access to treatment should be provided, and the individual's safe return to the profession should be monitored after treatment.”
Confidentiality cannot be absolute in situations threatening patient safety
Emphasizing that while the principle of confidentiality is important in peer support programs, patient safety must remain the priority, Prof. Uzbay said, “Of course, confidentiality cannot be absolute in situations that threaten patient safety. This distinction must be made well.”
Drawing attention to the fact that treatment and supervision should not be seen as alternatives to each other in the fight against addiction, Uzbay made the following assessment:
“The most important point is not to see treatment and supervision as alternatives to each other. A good system should both make unauthorized access to drugs difficult and facilitate help-seeking for healthcare professionals who develop addiction.”
“If you only establish a control system, the problem can be concealed”
Emphasizing that both drug safety and healthcare professionals' access to treatment should be addressed together for an effective fight, Prof. Tayfun Uzbay concluded his words as follows:
“If you only establish a control system, the problem can be concealed; if you only establish a treatment system and neglect drug safety, misuse can continue, and patients can also suffer from this.”
A recent comprehensive review by Prof. Tayfun Uzbay and his colleagues, which addresses the misuse and addiction potential of propofol in light of experimental and clinical data, also reveals scientific findings on the subject. The review can be accessed via the link below:
https://pmc.ncbi.nlm.nih.gov/articles/PMC12013994/
