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."