Worldwide, about 600,000 deaths have been attributable to drug overdose in 2019 (WHO, 2025). Proof means that the danger of overdose is elevated amongst some healthcare staff (HCWs). One population-based cohort examine in america of America, for instance, discovered that counsellors, social staff, psychologists, and different group and social service staff have greater than twice the danger of deadly drug overdose as folks working exterior of healthcare (Olfson et al., 2023). Others estimate that 8-15% of physicians dwell with substance use dysfunction (SUD) (Samuelson & Bryson, 2017).
There may be an elevated danger of deadly drug overdose in HCWs, however there’s a dearth of qualitative analysis exploring what may contribute to this downside. This can be defined by the reluctance of HCWs experiencing SUD to take part in interviews/focus teams due to stigma, denial of the illness, psychiatric comorbidities, and the concern {of professional} and social reprimand (Vayr et al. 2019).
Nevertheless, there are particular ‘occupational hazards’ that may enhance HCWs’ vulnerability to substance use. This consists of that many HCWs have data of and direct entry to a variety of medicines, together with opioids, which pose a high-risk for dependency (Mielau et al., 2021). Compounding this danger is the excessive stage of stress, burnout, nervousness, and melancholy skilled by many HCWs, typically ensuing from lengthy working hours, excessive affected person demand, unfair pay, and vicarious trauma from experiencing recurrent and extended affected person struggling (Teoh et al., 2024; Olaya et al., 2021).
Addressing this information hole is a mandatory step towards creating evidence-based methods for overdose prevention and focused assist for HCWs residing with SUD. On this weblog, I summarise the mixed-methods examine by Algahtani et al. (2024), which aimed to “determine components that contribute to deadly overdose in healthcare professionals, each intentional and unintentional, and information suggestions for hurt discount.”
The chance of deadly drug overdose is elevated in healthcare staff, however the components driving this are poorly understood due to stigma, denial, and concern {of professional} reprimand.
Strategies
As there may be problem gathering information instantly from HCWs experiencing SUD, the researchers collected information from the Nationwide Programme on Substance Use Mortality (NPSUM). They used a scientific technique to seek for reported deaths of HCWs the place illicit substances and licensed medicines (excluding nicotine, caffeine, and alcohol when not co-implicated with different substances) have been accountable (NPSUM, n.d.). They included college students, retirees, and HCWs who had left the occupation of their search, however excluded veterinary HCWs.
Deaths are voluntarily reported to the NPSUM by coroners in England, Wales, and Northern Eire and are based mostly on healthcare data, postmortem investigations, and reviews from witnesses, household and associates, and emergency companies. Stories from 1st January 2000-31st December 2022 have been sampled.
The evaluation adopted a mixed-methods strategy. The authors used descriptive statistics to summarise the demographics of the HCWs, the circumstances of their deaths, and the medicine concerned. Free-text information have been analysed qualitatively to create themes that recognized the components that will have contributed to the HCWs deadly drug overdose.
Outcomes
Demographics of healthcare staff
58 reviews have been included within the evaluation. They comprised: 47 (81%) employed as HCWs on the time of their demise; 3 (5%) retirees; 4 (7%) on long-term sick depart; 2 (3%) college students; 2 (3%) non-clinical employees. Median age was 38 years, and 39 (67%) have been male. Medical doctors have been the most important group (48%, n=28). This included 9 anaesthetists, 5 Common Practitioners (GPs), and 13 with unknown specialities. Deaths have been categorised as suicide in 28 (48%) circumstances, unintentional in 24 (41%) circumstances, and undetermined in 6 (10%) circumstances. Opioids have been essentially the most ceaselessly implicated drug, cited in 25 (43%) circumstances, adopted by benzodiazepines in 14 (24%) circumstances. The remaining three deaths have been attributed to illicit medicine, with every case co-implicated with licensed medicines.
Psychological and Bodily Well being Issues
The authors recognized a number of components underneath the umbrella of psychological and bodily well being issues that might have contributed to the HCWs’ deadly drug overdose. 29 (50%) HCWs had a psychological well being situation, with some being involved with psychiatric companies days earlier than their demise. 28 (48%) alluded to a current deterioration in psychological well being, ceaselessly attributed to work-related pressures reminiscent of extreme time beyond regulation, treating sufferers who had skilled vital trauma, and allegations {of professional} misconduct. By way of bodily well being issues, self-medicating to alleviate continual ache was described in 8 (14%) circumstances. For some HCWs, substance use solely turned obvious autopsy; for instance, one coroner discovered lesions on a nurse’s wrist (suggestive of intravenous (IV) use), who didn’t appear to have a historical past of SUD.
Vocational Elements – What I Perceived to Be ‘Occupational Hazards’
The authors recognized three vocational components that will have contributed to the HCWs deadly drug overdose. I interpreted these findings as depicting occupational hazards, highlighting dangers throughout the healthcare occupation that uniquely make HCWs susceptible to deadly drug overdose. First was that 37 (64%) HCWs (together with non-clinicians and retired HCWs) sourced the drug from their office. One retired pharmacist, for instance, had retained medicines from his former office with the perceived intent to die by suicide. The second was that 32 (55%) of HCWs used their medical data to manage the medicine utilizing gear taken from their office like intravenous traces (IVs), syringes, cannulas, and tourniquets and to handle unwanted side effects. In a single inquest, the coroner defined:
“[the HCP] would have had a great working data of anaesthetic medicine utilized in surgical procedures and would have identified that the medicine they injected themselves with would trigger them to lose consciousness and cease respiration.”
The ultimate occupational hazard current in 16 (28%) circumstances was the attainment of personal prescriptions from less-regulated sources exterior the UK. These reviews supplied one other instance of HCWs’ utilizing their medical data to affect what was prescribed.
Deadly drug overdoses in healthcare staff might have resulted from an intersection of declining psychological well being, self-medication for ache, and occupational hazards distinctive to their occupation.
Conclusion
There are occupational hazards that may contribute to deadly drug overdose amongst HCWs. These embrace that HCWs have entry to managed substances, data of dosing and managing unwanted side effects, and the facility to acquire prescriptions from less-regulated sources exterior the UK. Poor psychological well being, extreme working hours, and vicarious trauma from experiencing affected person struggling additionally contribute.
These findings affirm proof that SUD shouldn’t be a defect of character or private failure, however is as a substitute systemically embedded throughout the healthcare occupation (Wakeman et al., 2017). As such, healthcare establishments have a possibility to co-develop proactive prevention and assist methods with HCWs for these liable to, or experiencing SUD.
This examine highlights how addressing the danger of deadly drug overdose amongst HCWs requires a systemic strategy from healthcare establishments, slightly than solely particular person motion.
Strengths and Limitations
I consider the primary strengths of this examine have been that entries into the NPSUM embrace healthcare data and emergency service reviews. The inclusion of sources that have been documented instantly after the HCWs’ deaths might have decreased recall bias (witnesses misremembered an expertise) in comparison with if all witnesses have been interviewed retrospectively. The NPSUM attracts information from a number of sources. This may increasingly have supplied a fuller image of the components contributing to the HCWs’ deadly drug overdose than potential by interviewing a single individual.
Nevertheless, one of many foremost limitations of this examine was that reviews on veterinary HCWs have been excluded. Veterinary HCWs have comparable entry to psychoactive medicines and have a excessive incidence of work-related stress, burnout, nervousness, and melancholy so it’s potential that the findings are transferable (Pohl et al., 2022). Coroners aren’t required to report deaths to the NPSUM. Different components contributing to the HCP’s deadly drug overdose might not have been captured by this examine.
The NPSUM relies on reviews from witnesses, emergency companies, and other people throughout the HCWs’ private community. Whereas the info sources might corroborate one another, the knowledge remains to be topic to social desirability bias (witnesses reporting info perceived as beneficial to the info collector). As well as, these reviews might not absolutely seize the components the HCWs themselves would have seen as contributing to their deadly drug overdose. Stories from the NPSUM can differ intimately, and the outcomes supplied right here have been primarily summarised utilizing descriptive statistics and with few information extracts. As a consequence of this, the outcomes might have supplied much less depth than potential with interviews or focus teams.
Whereas information was collected from the Nationwide Programme on Substance Use Mortality, the brevity of the reviews and the summative nature of the evaluation limits our understanding.
Implications
Accessible and evidence-based psychological well being and habit assist, probably as a part of an worker help programme, might be step one to supporting HCWs experiencing SUD. Whereas concern or stigma {and professional} reprimand might stop some from accessing this assist (Vayr et al. 2019), systematic critiques present that, as soon as engaged, HCWs are responsive to those interventions and their return-to-work after recovering is achievable, sustainable, and protected (Kunyk et al., 2016).
The important thing to success, subsequently, could also be to create a working setting that encourages HCWs to entry this assist. This might be achieved by involving HCWs with lived expertise of SUD and habit within the co-design of consciousness assets. As well as, curricula in undergraduate medical college, and basis and speciality coaching might profit from emphasising that SUD is an habit and well being situation that requires assist, not a private failure or a alternative as some HCWs have reported in qualitative research (Boekel et al., 2013).
Healthcare staff might profit from entry to inner psychological well being and habit companies, however uptake is contingent upon fostering a non-stigmatising office tradition.
Assertion of Curiosity
Amelia is presently conducting a post-doc on psychological well being and habit analysis. No conflicts of curiosity to declare.
Edited by
Dafni Katsampa.
Hyperlinks
Main Paper
Algahtani, T., Gee, S., Shah, A., Williams, B. D., Gorton, H. C., Welch, S., & Copeland, C. S. (2025). Deadly drug overdoses in healthcare staff: A thematic framework evaluation of coroner reviews. Habit, 120(11), 2270-2281. DOI: https://doi.org/10.1111/add.70139
Different References
Kunyk, D., Inness, M., Reisdorfer, E., Morris, H., & Chambers, T. (2016). Assist looking for by well being professionals for habit: A combined research overview. Worldwide Journal of Nursing Research, 60, 200-215. https://doi.org/10.1016/j.ijnurstu.2016.05.001
Mielau, J., Vogel, M., Gutwinski, S., & Mick, I. (2021). New approaches in drug dependence: opioids. Present habit reviews, 8(2), 298-305. https://doi.org/10.1007/s40429-021-00373-9
Olaya, B., Perez-Moreno, M., Bueno-Notivol, J., Gracia-Garcia, P., Lasheras, I., & Santabarbara, J. (2021). Prevalence of melancholy amongst healthcare staff in the course of the COVID-19 outbreak: a scientific overview and meta-analysis. Journal of medical medication, 10(15), 3406. https://doi.org/10.3390/jcm10153406
Olfson, M., Cosgrove, C. M., Wall, M. M., & Blanco, C. (2023). Deadly drug overdose dangers of well being care staff in america: a population-based cohort examine. Annals of inner medication, 176(8), 1081-1088. https://doi.org/10.7326/M23-0902
Pohl, R., Botscharow, J., Böckelmann, I., & Thielmann, B. (2022). Stress and pressure amongst veterinarians: a scoping overview. Irish Veterinary Journal, 75(1), 15. https://doi.org/10.1186/s13620-022-00220-x
Samuelson, S. T., & Bryson, E. O. (2017). The impaired anesthesiologist: what you need to learn about substance abuse. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, 64(2), 219-235. https://doi.org/10.1007/s12630-016-0780-1
Teoh, Okay. R. H., Dunning, A., Taylor, A. Okay., Gopfert, A., Chew-Graham, C. A., Spiers, J., … & Riley, R. (2024). Working circumstances, psychological misery and suicidal ideation: cross-sectional survey examine of UK junior docs. BJPsych open, 10(1), e14. https://doi.org/10.1192/bjo.2023.619
The Nationwide Programme on Substance Use Mortality (NPSUM). (n.d.). The Nationwide Programme on Substance Use Mortality – King’s School London. https://www.kcl.ac.uk/analysis/the-national-programme-on-substance-use-mortality
Van Boekel, L. C., Brouwers, E. P., Van Weeghel, J., & Garretsen, H. F. (2013). Stigma amongst well being professionals in the direction of sufferers with substance use issues and its penalties for healthcare supply: systematic overview. Drug and alcohol dependence, 131(1-2), 23-35. https://doi.org/10.1016/j.drugalcdep.2013.02.018
Vayr, F., Herin, F., Jullian, B., Soulat, J. M., & Franchitto, N. (2019). Obstacles to looking for assist for physicians with substance use dysfunction: a overview. Drug and alcohol dependence, 199, 116-121. https://doi.org/10.1016/j.drugalcdep.2019.04.004
Wakeman, S. E., Kanter, G. P., & Donelan, Okay. (2017). Institutional substance use dysfunction intervention improves normal internist preparedness, attitudes, and medical follow. Journal of Habit Drugs, 11(4), 308-314.https://doi.org/10.1097/ADM.0000000000000314
World Well being Organisation. (2025) Opioid overdose. https://www.who.int/news-room/fact-sheets/element/opioid-overdose
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