Addiction grows deep

Jack Stem does not hesitate to talk about the chronic illness that nearly took his life.

Stem, a former registered nurse and certified registered nurse anesthetist from Cincinnati, openly discusses his battle with addiction because he knows other nurses deal with the same issues.

Stem’s exposure to prescription pain medications began, like many addictions, with a legitimate medical need.

“I developed my addiction to prescriptions as the result of a back condition called spondylolisthesis,” Stem said.

Stem received a diagnosis for spondylolisthesis at 19. The condition, which describes displaced vertebrae, is both chronic and progressive.

Stem said he managed his pain with doses of prescription pain killers for years. But by 1990, Stem said his typical doses did not seem to work.

“At some point my addiction had become triggered,” Stem said.

Research shows that genetics can predispose people to addiction. Stem said he believes his genes paved the way for substance abuse.

Eventually, Stem’s neurologist cut him off from his pain medication and Stem had to find another way to feed his addiction.

“When you’re an anesthetist and you are handling your drug of choice all day long, that’s not a good thing,” Stem said.

Stem diverted drugs from the hospital where he worked.

“I was using the drugs that were left over from the end of the day so the patients got their meds,” Stem said. “I would chart that they got what I took from the pharmacy and I would keep the rest for me.”

Stem successfully took fentanyl, and then worked his way up to sufentanil, an opiate about 10 times stronger than fentanyl.

“The more potent the drug the faster the disease (addiction) progresses,” Stem said. “Here’s the scary thing, the people I work with saw that something was wrong and they didn’t do anything.”

In both Kansas and Missouri, nurses can report suspicion of substance abuse to state boards of nursing. The boards do not automatically revoke the nurse’s license, but deal with each nurse on a case-by-case basis.

“If at all possible they try to put them in that (Kansas Nurse Assistance) program,” said Diane Glynn, BSN, JD, practice specialist for the Kansas Board of Nursing.

The Kansas Nurse Assistance Program, commonly referred to as KNAP, facilitates treatment programs for nurses who have substance abuse problems. Missouri does not currently have a program like KNAP, but Missouri Board of Nursing Executive Director Lori Scheidt said plans are under way for a similar program in Missouri.

In Stem’s situation, no nurses or medical personnel reported his abuse. His youngest daughter, Kimberly, found him unconscious one day in 1990.

Stem said he had finally had back surgery for his spondylolisthesis. During his recovery he weaned himself off the opiates.

“I was probably in better shape than I’d been in years and I wasn’t taking any medications at all,” Stem said.

But when Stem started back to work he had not prepared for the temptation he would face.

“When I popped that first vial of medication I started sweating and my heart rate went up and I wasn’t ready for that,” Stem said. “Because I hadn’t been in any kind of therapy I wasn’t ready and within a couple of weeks I relapsed.”

Stem started to divert again but he did not take into account the weeks he had spent off of opiates.

“My tolerance to the drug dropped because I wasn’t taking it anymore,” he said.

Armed with the same doses Stem used to take, he got high at home and overdosed.

Kimberly noticed that her father did not look right and informed her mother, Stem’s wife at the time.

“The next thing I know I’m in the emergency room at the hospital I work,” he said. “I almost ended up dead as a result of that.”

The hospital ran a typical toxicology screening and Stem said he knew he had been busted.

Stem went on probation and entered a treatment program.

“Unfortunately I didn’t buy into the whole treatment thing,” Stem said. “I relapsed.”

Stem went back to work within about a month. He said today, most experts recommend a year or two away from the medical setting for recovering addicts, if the person can return to work at all.

“Sometimes you can’t, and I was one of those, but I almost ended up dead trying to figure that out,” Stem said.

Stem did not lose his license after his second relapse. He entered a 12-step program and said he decided to face his addiction.

Stem went back to work as a nurse at a home care facility but stayed away from anesthesia for three years. Around that time a friend in anesthesia offered him a part-time gig in a nearby town. The 38-bed hospital had only two operating rooms which were staffed by Stem’s certified registered nurse anesthetist friend and the anesthesiologist. When the two went on vacation, Stem became responsible for the anesthesia at the hospital.

Stem said he now recognizes the elements that led to his final relapse. He was in the middle of a divorce, in a strange city, without any support.

“Eventually I just thought, ‘screw it,’ so I just started using again,” Stem said.

Within three weeks, Stem said, he had increased his doses to lethal limits.

“You don’t start over from scratch. You start where you left off,” he said.

Stem’s friend organized an intervention that included the anesthesiologist, nurses from the home health care facility and Stem’s sponsor.

Stem lost his nursing license.

“Even if they didn’t take it away I was giving it up,” he said. “I knew that if I didn’t do something I’d end up dead.”

Stem founded Peer Advocacy for Impaired Nurses, LLC in 2008 to help nurses achieve long-term recovery. He said he wants to bring the issue into the light and teach health care professionals to classify addiction as a disease.

“A cancer patient is diagnosed, a diabetic is diagnosed, a drug addict is caught,” Stem said. “(Nurses) are not coming out of the closet so to speak and they are not going to reveal themselves because of the judgmental, punitive nature of our society and of our profession.”

Stem said he finds fulfillment in helping other nurses through recovery.

“If it hadn’t been for my treatment and the programs I went through I would have been dead,” he said. “I wouldn’t trade a day.”

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