I’ll begin by saying that I have a diagnosis of opioid use disorder (OUD) secondary to PTSD. I began diverting Norco from a pharmacy with which my hospice company had a contract. At the time, I had access to various narcotics as an RN case manager, which was quite concerning. This environment became a breeding ground for nurses seeking to divert medication for their own substance abuse.
My battle with OUD and substance use disorder followed a lengthy struggle with PTSD. Although I knew I needed help, I was too prideful to ask for it. I also feared reaching out to my employer and the regulatory board. Once a nurse reveals their struggles, there’s no going back. I experienced days when I suffered through withdrawal symptoms, comparable to having the flu but multiplied by ten, while lying on the floor, hugging the toilet.
I was faced with three choices:
- Take personal time off work and endure withdrawals for 7 to 10 days.
- Remove the mask and seek help openly by disclosing everything to my employer and the regulatory board. This option could result in job loss and loss of freedom. I chose this option and self-reported my diversion. Consequently, I was terminated from both my full-time jobs while undergoing inpatient treatment.
- Take the easy way out, ignoring the signs and obtaining another prescription, perpetuating the cycle of substance use.
They say the hardest lessons in life lead to an easy life, but the easiest lessons lead to a hard life.
My journey into prescription pain pill diversion began after being prescribed Norco 7.5. Initially, I administered them correctly and stored them in the medicine cabinet. However, eight months later, I found myself rummaging through the cabinet, and I’ll never forget the sound of those pills rattling as they fell and hit the bar counter. That day marked the beginning of my hydrocodone use. I had 33 pills left, and I started taking one a day for a few days, then two a day, then eight a day, and so on.
When I self-reported my battle with OUD, I had taken 28 Norco 10/325. I spoke to the regulatory board about the necessary steps to seek treatment and immediately underwent detoxification at a medical center. Due to the high risk of relapse, I was isolated during detox. After the first night, I experienced a sense of euphoria, almost feeling high. I inquired about the medication I was receiving from the nurse, who informed me it was Suboxone strips. At that time, I was unfamiliar with Suboxone. On the second day of detox, I requested to discontinue Suboxone from my treatment plan because I knew I wouldn’t die from opioid withdrawal.
Suboxone provided a euphoric feeling, which was not my intention. I wanted to rid my system of this destructive drug. After a few more days of detox, I was transferred to an inpatient center for a minimum of 30 days. Being unfamiliar with drug dealers and users, I initially held judgment towards others. It took 10-14 days for me to open up and realize that these addicts were just like me. The alarming part was that they had all started with prescription pain pills and were regular participants in the program. Eventually, I found my footing, progressed to phase 1, and completed the 30-day treatment. Subsequently, I turned myself in to the local police station, facing five counts of obtaining narcotics through fraud. My workplace had become my drug dealer. The drugs I obtained were legitimate, not tampered with. The patients were not mistreated or neglected; they received different narcotics such as Fentanyl patches every three days, unbeknownst to them.
I entered the recovery nurse program for a few months but couldn’t continue due to the charges I faced. The regulatory board advocated on my behalf to handle disciplinary action, but unfortunately, that wasn’t part of their plan. On January 6, 2020, I accepted a plea deal for two counts of obtaining narcotics through fraud and a two-year intensive supervision program followed by drug court completion. Throughout the numerous meetings and hearings, no one from the regulatory board informed me about the impending OIG Exclusion. I completed the intensive supervision program after seven months and immediately began drug court in August 2020. In that program, participants undergo a minimum of 24 months of rigorous treatment. I was on the path to putting it all behind me until I received a letter from the Office of Inspector General (OIG) stating their intent to exclude me. I informed them that my charges would be vacated and expunged upon program completion, but they dismissed it and proceeded with the exclusion. As predicted by a former OIG Director, my appeal was merely rubber-stamped. The OIG seems to kick the little guys while they’re already down. Consequently, I received a mandatory five-year exclusion for obtaining five hydrocodone prescriptions totaling less than $400.
Under the current law, the OIG cannot consider any mitigating or contributing factors relating to the exclusion. Individuals like myself face exclusion due to medication obstruction charges. The OIG lurks in the background, waiting for the most vulnerable moment of nurses who are often financially ruined and have their careers on display for everyone to see. This doesn’t seem beneficial for nurses already struggling with severe issues. I faced not only job and career loss but also financial ruin and legal consequences.
Ironically, the U.S. government decided to punish an individual suffering from OUD caused by PTSD. The same government entrusted with protecting individuals with disabilities is now discriminating against them. Opioid use disorder was recognized as a protected disability under the Americans with Disabilities Act in 2022. However, the OIG Exclusion laws were implemented prior to the opioid epidemic and before OUD was acknowledged as a protected disability.
I aim to raise awareness of the issue faced by health care professionals. I believe it is long overdue for a policy revision that offers an opportunity for early reinstatement to excluded individuals who meet specific criteria, such as:
- The convictions leading to exclusion must directly relate to addiction disorder or substance use disorder.
- The convictions must not be for distribution, sale, possession with intent to distribute, production, manufacture, or cultivation of controlled substances, nor any violent crimes.
- Successful completion of a certified drug court program in the state where the convictions occurred.
- Successful vacating and expungement of all criminal charges and convictions.
- For licensed health care professionals whose health care license has been revoked, suspended, or surrendered, the license must be reinstated by the state licensing authority before applying for reinstatement.
- Early reinstatement is not available to excluded individuals whose health care license was revoked, suspended, or lost due to patient abuse or neglect.
- Financial harm must be less than $5,000.
Alternatively, a simpler change would be to revise the current law to consider the OIG’s definition of conviction. This change would allow for early reinstatement once an excluded individual completes a drug court program. It would provide an opportunity for reinstatement, rather than guaranteeing it. Such a revision would reduce paperwork as most excluded individuals would forego filing an initial appeal if they knew they could apply for early reinstatement after completing an intervention court, particularly drug court. Drug courts impose strict rules, disallowing participation by drug sellers or those intending to sell drugs. These programs typically last a minimum of two years, sometimes extending to five years. I completed my drug court program in two years. Although I am biased as I have a personal stake, this revision seems like a common-sense solution. Much has changed since these policies and laws were implemented. Mental health and substance abuse advocacy groups agree that this change is necessary and would aid many health care professionals in recovery. Drug court saved my life, and statistics prove its effectiveness in reducing recidivism. It’s an incredibly stringent program, and I cannot imagine where I would be without it. Overcoming substance abuse, the criminal justice system, and the regulatory board were daunting tasks, but overcoming the OIG is a tremendous challenge that requires extensive discussions among influential individuals in Congress.
Furthermore, it’s important to note that post-conviction relief, such as expungement, does not necessarily remove an individual’s name from the List of Excluded Individuals/Entities. According to Section 1128(i) of the Social Security Act, a conviction for exclusion purposes includes a criminal offense “when a judgment of conviction has been entered against the individual or entity by a Federal, State, or local court, regardless of whether there is an appeal pending or whether the judgment of conviction or other record relating to criminal conduct has been expunged.”
Chris Kyzar is a nurse.