Masters Theses

Date of Award

5-1997

Degree Type

Thesis

Degree Name

Master of Science

Major

Health Promotion and Health Education

Major Professor

Jack S. Ellison

Committee Members

Bill C. Wallace, Eugene C. Fitzhugh

Abstract

The primary purpose of this study was to determine the prevalence of controlled drug misuse among actively practicing Certified Registered Nurse Anesthetists (CRNAs). A second purpose was to determine variance in controlled drug misuse regarding the variables of age, gender, population and geographic area of residence, type of anesthesia position currently held, and number of years in anesthesia practice.

The participants (N = 1,709) were actively practicing CRNAs who were members of the American Association of Nurse Anesthetists at the time of this study, and could be classified as “Certified” or “Recertified” according to the criteria established by the Council on Certification of Nurse Anesthetists, or the Council on Recertification of Nurse Anesthetists. In addition, this research was delimited to specific drugs that are commonly used, and easily obtainable, by CRNAs in clinical practice. Furthermore, the drugs included in the study were classified as “controlled substances” by the United States Drug Enforcement Administration under the terms of the Controlled Substances Act of 1984, and listed in the Code of Federal Regulations. Part 21. They consisted of narcotic agonist/antagonists, barbiturates, benzodiazepines, dissociative drugs, inhalation agents, opioids, and propofol.

Data for this research were measurements of controlled drug misuse, obtained by mailing a self-administered survey developed exclusively for this project. This instrument allowed for stratification according to admitted misuse of controlled drugs commonly employed in the clinical practice of anesthesia, and established the prevalence of controlled drug misuse in the target population. On the basis of CRNA responses, four groups were composed; non-misusers of controlled drugs (N = 1,542); past misusers of controlled drugs (N = 69); recent misusers of controlled drugs (N = 40); and, current misusers of controlled drugs (N = 58). These groups were further subdivided on the basis of age. gender, area of residence and population density, type of anesthesia position held, and length of anesthesia practice. The participants were asked to voluntarily self-administer the CRNA Drug Misuse Questionnaire. Descriptive statistical comparisons, frequencies, and chi-square tests (p<0.05) were made from contained variables.

Based on the findings and the analysis of the data obtained, the following are major conclusions relative to controlled drug misuse:

  1. 1. Participating CRNAs admitting current, recent, or past controlled drug misuse totaled 10% of the total sample (167 of 1,709 respondents).
  2. 2. At 64% (106 of 167 respondents), male CRNAs admitting to misuse of controlled drugs represented a disproportional high number when considering that they comprised only 46% of all respondents.
  3. 3. Of 167 CRNAs admitting to controlled drug misuse, 41% (69 respondents) were past misusers, 24% (40 respondents) were recent misusers, and 35% (58 respondents) were current misusers. The total number of admitted misusers (N =167) included 107 (64%) CRNAs who indicated poly-drug misuse.
  4. 4. The controlled drug preference among all admitted misusers showed a highly significant change from the findings of studies which investigated similar, medically oriented groups, and included (in descending order of preference): (a) midazolam (sublingual/intranasal/per os); (b) N2O; (c) fentanyl (sublingual/injection); (d) propofol; (e) ketamine; (f) narcotic agonist/antagonists; and, (g) barbiturates.
  5. 5. A significant relationship existed at the 0.05 level between gender, geographic location, population of residence area among CRNAs, and the likelihood for controlled drug misuse. In addition, an equally significant relationship existed (p<0.05) between recency of controlled drug misuse, and drug(s) of choice.

Recommendations include specific tactics for strengthening drug misuse education and prevention in Nurse Anesthesia Education Programs, and a vast improvement regarding the enforcement of federal rules established to prevent controlled drug misuse. Modifications in research design and additional studies in the research area were suggested.

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