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  • Writer's pictureDr. Steven L Orebaugh

Opioids, Health Care Workers, and 'The Stairs on Billy Buck Hill'



The opioid crisis affects Americans from all walks of life: rich, poor, accomplished, unemployed, young, and old.


Health care practitioners, including doctors, nurses, and pharmacists, are generally well-informed about the dangers of these drugs and their potential to cause addiction. Sadly, despite this degree of understanding, those who practice to improve others’ health are at a higher risk than the general population of developing drug or alcohol dependence.


While about 12% of all Americans have a substance use disorder, this number may be over 10% for physicians and as high as 15%for nurses.

Not so surprising…


Why would this occur among relatively sophisticated workers? Doubtless, there are high levels of stress among physicians and nurses, and stressed people seek means to alleviate these nagging problems. Unusual hours, long days, and the daily grind of caring for ill individuals all contribute to the psychological demands of these positions.


Dedication to a profession may also lead to relationship problems at home, the very site where most workers hope to find peace and happiness. Given all of this, it is perhaps not so surprising that those who work in health care have potentially higher rates of substance use disorder, alcoholism and addiction.


Daily Exposures…


For those in acute care specialties, administration of opioids, either by mouth or intravenously, is a part of the daily routine. These drugs hold an essential place in alleviating suffering in hospitals, operating rooms and clinics, even as public health authorities work to reduce the overall use of potentially addicting drugs in medicine.


But for some, the relative ease of acquiring opioids leads to diversion and dependence. Those with their frequent hands-on administration of these drugs are particularly vulnerable to the insidious attraction of the drugs.


How It’s Touched My Life


Tragically, my own professional life has been touched by the missteps of a number of colleagues with opioid medications.


A true friend and valued co-worker disappeared from our site one day, even as he was considered for a leadership position.


And several of our trainees developed opioid use disorder, their lives coming unraveled as the addiction increased in severity-one of them paid the ultimate price, found on the floor in his apartment.


A favorite mentor from my days in training was later revealed to be compromised by fentanyl use.

Most recently, a nurse essential to our team was found to be diverting opioids, his dismissal creating a major void in our practice.


All were valuable assets in our professional environment, and the loss of them was deeply felt.


An Inspiration to Write…


It was with these friends and colleagues in mind that I developed the idea for “The Stairs on Billy Buck Hill.”


While administrators and pharmacists have become ever-more sophisticated in their detection of drug diversion, the problem is still very significant. And it affects not only the provider himself, but also his family, friends, and, importantly, the care he provides to his patients.


I tried to illustrate this gradual deterioration of competence in the novel-Kirk, the physician at the center of the story, was unaware of how his skills and judgment were failing, even as he assured himself that he was more energetic, keen, and productive than ever. He could not heed the cues of those around him that something was awry. And soon he paid a terrible price.


A Shot at Redemption


But as with most calamities, there is a silver lining if one simply looks hard enough. So it was for Kurt. After he lost virtually everything meaningful in his life, he discovered a challenging path back to redemption. But the question remained: did he still possess the energy and dedication to his profession to be able to climb out of the depths to which he had descended, and to grasp an opportunity to once again practice medicine while re-establishing his relationships with those he dearly loved.

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