There are two secrets to Edie Falco's competence as nurse Jackie Peyton on Showtime's Nurse Jackie. First, she is smarter than most of the doctors. And second, "a little oxy," as Falco refers to the opiate painkiller Oxycontin, which she uses, along with Vicodin and Percocet, to help her stay alert and manage her emotions through the harrowing days in the emergency room.
For nurse Jackie, "a little oxy" is a way to get through the day, and she seems to be in control of her consumption. But for many nurses and physicians, even a small amount of a narcotic or other drug can be the start of a lot of trouble.
Debbie, a 45-year-old nurse who works in a Michigan hospital and who requested that her last name not be used, spent years as an alcoholic before becoming sober and completing nursing school. She was substance-free for nine years until her brother, father and a close friend died in a short amount of time.
"I had multiple losses in my life, I was working in high intensity work. I was not taking care of my recovery firsthand," Debbie said. "I was picking up alcohol just to relax... It kind of crept up on me, and all of a sudden I was drinking again."
"It's kind of like a roller coaster ride. One isn't enough and you're doing two [painkillers]," Debbie said. "Before you know it, you're having to medicate yourself just to go to sleep."
Drug abuse among those in the health professions is no higher or lower than that of the general population, between 10 and 15 percent. The key differences are access and expertise. Nurses and physicians encounter an array of mind- and mood-altering substances every day in the course of their jobs, and they know exactly how they work.
Dr. Michael Brooks, director of psychiatric services at Brighton Hospital in Brighton, Mich., pointed out that opioid treatments, which as little as 20 years ago were reserved for terminal, malignant pain, have been used more frequently for chronic pain.
"With that change of philosophy, there is more free use for prescription opiates for use of chronic pain. Which means more exposure for people in medical fields," he said.
And exposure can be a problem for those predisposed, whether genetically or because of past behavior, to become addicts.
"If you're an addict, eventually your drug of choice is whatever is in front of you," Debbie said.
And while some nurses or physicians may dabble in drug use to relieve stress -- including alcohol, marijuana, cocaine and heroin -- others do so out of curiosity for what their patients feel. This is particularly true for those who work in anesthesiology, where access to powerful narcotics such as morphine is easiest.
"They see a sense of calm that comes over a patient's face when a medicine is administered," said Dr. Michael Fitzsimons, an anesthesiologist and the administrative director for the Substance Abuse Prevention program at Massachusetts General Hospital. "The care provider sees their pain and anxiety being relieved. You kind of develop a sense of curiosity about it."
In the depths of her relapsed addiction, Debbie said she was injecting 15 milligrams of Dilaudid, a narcotic eight times more potent than morphine, into herself. The normal adult oral dosage of Dilaudid is up to 10 milligrams. The injected dose is even smaller, about 1.3 milligrams.
"The unfortunate thing is that 10 to 20 percent of addicts in medicine will actually present dead," said Fitzsimons. "They're found dead in the call room or at home because they utilize these substances, not appreciating the potency."
And providing medical care under the influence of a drug can jeopardize patients.
"No patient should ever accept the care of a person under influence," Fitzsimons said.
But often, those who are addicted remain high functioning, and colleagues may not know until the addiction becomes very severe that anything is wrong.
Her addiction was not fatal, but Debbie did resort to stealing from her workplace to support her addiction. And as her behavior changed, her colleagues began to notice her problem.
"I never ever thought the day would come that I would one day relapse and jeopardize my profession. That I would find myself in a position where drugs were available and I would take them," Debbie said. "And it did come."
After an anonymous call was made to the hospital director, Debbie was pulled away from her duties, given a drug test, which she failed, and was fired.
"That's the same thing a cocaine or heroin addict does when they're addicted -- break into homes and cars," Brooks said. "But it's not so much about the individual as the disease [of addiction]. And they usually get caught."
After losing her job, Debbie felt shame and remorse and sank into a depression that eventually culminated in a suicide attempt. Still, she chose to receive treatment and eventually returned to nursing, though not, she decided, at her old job because of the temptations there.
"I had to remove myself from that environment and get to a safe place," Debbie said. "I know in my heart of hearts that I can't use any mind-mood-altering substances. The stimulus just starts the craving phenomenon."
The anonymous call that probably saved Debbie's life may not have been possible 20 years ago, according to Brooks.
"There used to be a code of silence among medical personnel... and meant to be protective for the person who's using, but it's a reverse protection," he said. "Now, the air is more that people are alert to this and the consequences are greater and we are rapid to identify and intervene in the problem."