Opioid Crisis On Healthcare Workers
Written by Izabella Zakatsiolo
Beatrice sighed as she glanced at Ray’s chart before stepping into the exam room. He was back. Again. Deeply sunken eyes, arms crossed over faded track marks from IV drugs.
"I messed up," he muttered under his breath.
She forced a smile. "You’re here. That’s what matters.”
Ray scoffed. "You don’t have to pretend. I see it in your eyes."
Guilt tightened in her chest. She chose this work to help others, but the endless cycle of relapse and recovery was wearing her down.
Yet, Beatrice couldn’t walk away, because behind every relapse was a person still trying.
Treating patients with opioid use disorder (OUD) presents significant challenges for healthcare providers. The complexities of OUD, including its persistent nature and the high potential for relapse, can contribute to feelings of helplessness and burnout among healthcare workers (Dydyk, 2024). The societal stigma surrounding addiction may influence providers' perceptions and interactions with patients (Horner et al., 2019). Addressing these challenges is crucial for improving care for individuals with OUD and supporting the well-being of the healthcare professionals dedicated to treatment.
Difficulties in treatment and stigma
Unfortunately, the stigma surrounding opioid use often interferes with proper patient care. The fear of addiction and misuse can lead healthcare providers to undertreat pain, even with patients in genuine distress.
“I had a patient once who was in so much pain, he had a history of opioid use and we were only giving him Tylenol, Tylenol, Tylenol and we finally did some scans and he had [metastases] everywhere. So, then we were like, ‘oh --- we were only giving him Tylenol. For me especially, that kind of put things in perspective. This guy who has been clean and we weren’t treating him adequately (Horner et al., 2019).”
In this case, a patient with a history of opioid use was simply given off-the-counter pain medication, despite verbalizing his immense pain and suffering from widespread cancer. However, the realization of the health care workers came too late as the patient’s pain was underestimated because of his past.
This isn’t an isolated incident. Walking on a tightrope, healthcare providers constantly struggle to balance the responsibility of prescribing medications with empathetic and effective care. The opioid crisis has instilled a fear so deep that even patients with legitimate pain are often treated with doubt first, and relief second... If at all. Providers hesitate, fearing scrutiny and the legal consequences that could end their careers. Overprescribing laws, malpractice claims, and even potential manslaughter charges loom over every decision (Tariq et al., 2024), making some healthcare workers so cautious that they unintentionally let patients suffer.
But when did fear become more powerful than compassion? When did a person’s past mistakes become more important than their present pain? The reality is that patients with a history of opioid use still deserve dignity. They still deserve to have their pain acknowledged and their suffering eased. Until the stigma is broken, until we stop assuming addiction before we assume need, more patients will be left to suffer, simply because of who they used to be.
Emotionally toll and how burnout affects the treatment of patients
Healthcare workers treating patients with OUD often face significant emotional strain, leading to frustration and burnout (Horner et al., 2019). The relentless cycle of addiction means that they often see the same patients return days or weeks later, caught in the loop they cannot seem to escape.
“It’s a challenge to treat some of those patients sometimes. Not only because of the management of the pain and the agitation and all of those, but sometimes the psychosocial aspect of knowing that they’re going to go back out and do this all over again, and there’s a very real possibility that we’ll see them again in a couple days, couple weeks, couple months, so it’s not just a burden on the patient, but it’s a burden on the caregivers too, knowing what the possible outcomes are (Horner et al., 2019).”
Unlike other chronic illnesses, addiction has an element of personal choice. This makes it extremely difficult for healthcare workers to separate their medical responsibility from increasing feelings of frustration. Many may struggle with the emotional dissonance of wanting to help while knowing that their efforts might simply be temporary. Unfortunately, repeated exposure to suffering, relapse, and even overdose deaths are deeply disheartening and lead to a loss of hope. This can cause some individuals to detach emotionally as a coping mechanism (Horner et al., 2019).
When healthcare workers lose hope, patients suffer too. Overwhelmed and emotionally exhausted, some healthcare workers become less empathetic or even hesitant to fully invest in a patient’s treatment. Over time, this can contribute to compassion fatigue or secondary traumatic stress, a state where providers struggle to maintain the emotional resilience necessary for effective care (Horner et al., 2019). If left unaddressed, this can lead to burnout, job dissatisfaction, and even the decision to leave the field altogether.
This sense of futility and uselessness continues to the operating table.
“So say a heart surgeon, it’s an IV (intravenous) drug abuser, and they have a really bad valve or an infected valve, and they have to do a surgery to replace it, and then they have to do it a second time, and then they continue doing their drugs, at what point do you stop offering lifesaving surgeries? Because they keep doing these drugs that are killing them, pretty much. So that's another aspect of it, at what point do you stop offering it? You know, there are some surgeons that say, ‘I’ll do it twice, but I won’t do it a third time’ (Horner et al., 2019).”
This is the agonizing dilemma that doctors across the country, and even Hamilton, face. The patient isn’t just a body on the table; he’s someone’s son, brother, maybe even a father. But he’s also a drug user, someone who left the hospital after his first valve replacement and went right back to the habit that brought him there. The brutal reality is that he might do it again. And if he does, will the surgeon be willing to cut open his chest a third time? A fourth? At what point does medicine draw the line between saving a life and prolonging suffering?
Some surgeons have already made their choice. It’s not indifference. It’s not a lack of empathy. It’s exhaustion. It’s the deep frustration of watching a patient be handed a second chance, sometimes a third, even a fourth, only to see them throw it away. It’s knowing that every transplant list is full, that every heart valve given to one patient means another may never get their turn. And yet, how do you look at a living, breathing person in front of you and decide they are beyond saving?
The answer isn’t simple. Addiction is a disease, but it’s also a disease that manifests in choices-destructive, devastating choices. In the world of limited medical resources, those choices carry weight. Some would argue that a person who continues using IV drugs after multiple life-saving surgeries is knowingly rejecting the gift they’ve been given. Others argue that addiction is relentless, that relapse is not a moral failing but a symptom of the illness itself.
So where does the line get drawn? How many times should we offer redemption in the form of a scalpel and sutures? At what point does compassion give way to practicality? These are the impossible questions that surgeons and healthcare workers must answer every day, balancing the duty to help patients with the painful reality that some people, no matter how many times you save them, may never stop walking the path toward their own destruction.
Some providers set personal limits, refusing to perform life-saving procedures after repeated relapses (Horner et al., 2019). This immense moral conflict, balancing compassion with the reality of limited resources and the likelihood of continuous self-harm, can be emotionally exhausting, contributing to burnout. Addressing this issue requires systemic support for healthcare workers, including mental health resources, ethical guidance, and policies that acknowledge the complexity of addiction care. Without this, providers risk emotional exhaustion and therefore further complicating care for one of the most vulnerable patient populations.
Addiction is contagious
Surrounded by narcotics daily, some healthcare workers may find themselves silently fighting their own battles with addiction. Administering them, tracking them, ensuring their responsible use- that access becomes a temptation into something that they never imagined would happen to them.
“So, the other thing, so about 10% of healthcare providers become addicted themselves. We are surrounded by narcotics and have easy access to them. I’m on the nurse pharmacy committee that actually audits this and does surveillance and all that kind of stuff. So we actually had a nurse come talk to us and some of our leaders about how it happened to him, so I think there’s nothing better than a story (Horner et al., 2019).”
The addiction begins quite subtly. A nurse, exhausted from endless shifts, takes a painkiller meant for a patient to get through the day. A doctor, weighed down by the emotional toll of losing yet another patient, finds comfort in the same opioids they prescribe. The stress, the trauma, the crushing responsibility- these pressures don’t just disappear when they leave work. For some, the easiest way to numb the pain is with the very drugs they are trusted to administer.
A study released from the Butler Center of Research (2015) indicated that 10-15% of healthcare workers will struggle with substance abuse disorders at some point in their career. This is particularly evident in physicians, with rates 5 times higher than the general population, especially with drugs such as benzodiazepine and opioid abuse (Butler Center of Research, 2015). Additionally, researchers at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center highlight that, after adjusting for age and sex differences, social workers and behavioral health professionals have a 122% higher likelihood of dying from a drug overdose compared to non-healthcare workers. Similarly, healthcare support staff face a 100% increased risk, while registered nurses were 51% more likely to experience a fatal overdose. In regards to healthcare workers overall, 84.5% of overdose fatalities involved opioids, with 76% classified as unintentional (Berger, 2023).
Addiction doesn’t care about where you work or your level of education. It doesn’t discriminate between those in scrubs and those in hospital gowns. For healthcare workers, the shame can be unbearable. They are the ones who are supposed to fix and help people, not fall apart. The fear of judgment, of losing their license, of being seen as weak, keeps many suffering in silence. They learn to hide it well, until they can’t anymore.
Some get caught. Others confess. Some never make it to recovery. But the reality is clear: addiction in healthcare is not just a patient problem. Until we stop pretending that those who help are somehow immune from needing help themselves, we will continue to lose some of the best among us; not to the job, but to the drugs meant to help others survive.
Final thoughts
The internal conflicts, ethical dilemma, and feelings of helplessness and burnout affect the lives of healthcare workers who treat patients with opioid use disorder. These feelings are further compounded by societal stigma surrounding addiction. The vicious cycle of addiction and relapse causes healthcare workers to feel burnt out, emotionally exhausted, and, unfortunately in some cases, susceptible to the same addiction they work to address and treat. This highlights the urgent need for systemic support, mental health resources, and policies that provide healthcare providers with the tools to understand the complexity of addiction care without sacrificing their own health.
Only by breaking the stigma around both addiction and those who care for individuals with OUD can we create a healthier and more compassionate environment for patients and providers alike.
References
Berger, S. (2023, August 14). Fatal drug overdoses affect health care workers in large numbers. Columbia University Mailman School of Public Health. https://www.publichealth.columbia.edu/news/fatal-drug-overdoses-affect-health-care-workers-large-numbers
Dydyk, A. M. (2024, January 17). Opioid use disorder. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK553166/
Horner, G., Daddona, J., Burke, D. J., Cullinane, J., Skeer, M., & Wurcel, A. G. (2019). “you’re kind of at war with yourself as a nurse”: Perspectives of inpatient nurses on treating people who present with a comorbid opioid use disorder. PLOS ONE, 14(10). https://doi.org/10.1371/journal.pone.0224335
Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2024, February 12). Medication dispensing errors and prevention. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK519065/
Opioid use disorder in the medical field: Hazelden Betty Ford. Opioid Use Disorder in the Medical Field | Hazelden Betty Ford. (2015). https://www.hazeldenbettyford.org/research-studies/addiction-research/health-care-professionals-substance-abuse