• Substance Use Disorders Among CRNAs

    We recently sat down with Leigh Taylor, DNP, CRNA, to learn what has transpired since the publication of her paper “Substance Abuse and Misuse Identification and Prevention: An Evidenced-Based Protocol for CRNAs in the Workplace,” in the June 2020 issue of AANA Journal.


    Substance abuse is the main cause of anesthesia personnel professional impairment.

    About one in 10 nurse anesthetists experience addiction to drugs or alcohol.

    These are among the statistics Leigh Taylor, DNP, CRNA, cites in her paper “Substance Abuse and Misuse identification and Prevention: An Evidence-based Protocol for CRNAs in the Workplace,” published June 2020 in the AANA Journal.1 [Substance Abuse and Misuse Identification and Prevention: An Evidence-Based Protocol for CRNAs in the Workplace – PubMed (nih.gov)]

    In the paper, Taylor, assistant professor and coordinator of clinical education at Fairfield University and a practicing CRNA at Yale-New Haven Health System at Bridgeport Hospital, offers practices, hospitals, and health care systems an evidence-based protocol.  Hers is a standardized approach for preventing and quickly identifying substance abuse and misuse in the nurse anesthetist.

    Despite the startling statistics (which date from well before the COVID pandemic) and a steady increase in scrutiny by the U.S. Drug Enforcement Administration (DEA) on substance use and diversion in hospitals, Taylor says there is little research on the problem of substance use disorder among anesthesia providers.  Substance use disorder continues to go relatively unchecked until something bad happens.  And when that occurs, there are few protocols in place to help anesthesia providers get better and go safely back to practice.

    What led you to write this paper? 

    Taylor:  I had a very close friend who died by suicide, and it was a shock.  He was a CRNA.  He was the person who came to work and was happy and helpful.

    It rocked my world to the point of my asking why did this happen?  What are we doing?  What could have prevented it?

    The data supports that there is a substance use disorder problem among anesthesia providers.  While I cannot change what happened to my friend, maybe I can make a difference moving forward for people who are struggling.

    I looked at what we are doing to try to prevent this problem and found nothing to guide anesthesia groups and practices in screening.  The AANA has wonderful resources on drug testing, but there were not a lot of workplace policies and procedures out there specific to anesthesia groups.

    How did you develop the 8 components of your Substance Abuse and Misuse Identification and Prevention (SAMIP) protocol?

    Taylor:  I took best practices from agencies including the U.S. Department of Transportation and the Substance and Mental Health Services Administration. I also looked at other countries — Canada was one — and tried to determine, what are they doing?

    The essence of the resulting protocol it is there are eight components that provide structure to early identify and potentially prevent substance use disorder for CRNAs in the workplace.

    What were your goals with the paper, and have you realized those goals?

    Taylor:  I had two main hopes with this article.  I wanted to decrease the stigma and shame associated with substance use disorder by getting more evidence out there.  Two, I wanted to provide an evidence-based approach for anesthesia groups or departments looking to implement something for prevention or identification.

    I have presented on this at a couple of meetings, and people always come up to me and say, ‘We have this problem, and I don’t know how to address it.  We need some sort of structure to implement it in our group.’  So, I know that many people have taken this structure back to their anesthesia groups or departments, but unfortunately it is not a priority until it becomes a problem.  I am not finding a lot of proactive [groups].

    The stigma remains.  There are so many theories about why there is such a high incidence of substance use disorder among anesthesia providers.  We have a lot of access in the workplace.  We work alone.  We work in a high-stress environment.  And anesthesia providers are the persons in the operating room that everybody looks to when there is a problem.

    The structure of our job does not allow us to say, ‘Hey, I need help.’

    I am an AANA state peer advisor for Connecticut.  There are peer advisors for the AANA in all 50 states, and we work to improve wellness.  I do not know everything about substance use disorder, but I do have the passion and want to decrease the stigma and shame associated with asking for help.

    Are you seeing this problem in your students?

    Taylor:  Yes.  So, I do a lot in the classroom to foster self-care.  We practice mindfulness, breathing.

    My protocol offers steps in the workplace, but prevention starts with you and implementing good coping strategies, stress management, leaving work at work, and taking time for yourself with self-care.

    You have one life; one body.  You have to take care of it.

    While the prevalence of substance use disorder seems to be lower among student registered nurse anesthetists than certified registered nurse anesthetists, one study published in 2014 found the 5-year prevalence among these students was 0.65%.

    AANA Resources

    In a letter published April 2021 in the AANA Journal 2 [2021 April Letters (aana.com)] Taylor and coauthor Bridget Petrillo, MS, CRNA, list specific AANA resources for those with substance use disorder and others who know of a colleague struggling with alcohol or other drug use.



    1Taylor L. Substance Abuse and Misuse Identification and Prevention: An Evidence-Based Protocol for CRNAs in the Workplace. AANA J. 2020;88(3):213-221.

    2Petrillo B, Taylor L. In Response to “Substance Abuse and Misuse Identification and Prevention (SAMIP): An Evidence-based Protocol for CRNAs in the Workplace”. AANA J. 2021;89(2):101.


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