ARTIGO ORIGINAL
DOI: 10.11606/issn.1806-6976.v13i4p221-231

 

Use of psychoactive substance by health professionals: Integrative Review

 

Uso de sustancias psicoactivas por los professionales de la salud: Revisión Integradora

 

 

Márcia Astrês Fernandes^I; Joyce Soares e Silva^II; Jessica de Oliveira Veloso Vilarinho^III; Larissa de Oliveira Seabra^IV; Carla Danielle Araújo Feitosa^V

^IPhD, Adjunct Professor, Universidade Federal do Piauí, Teresina, PI, Brazil. RN, Hospital Psiquiátrico Areolino de Abreu, Teresina, PI, Brazil
²  Undergraduate student in Nursing, Universidade Federal do Piauí, Teresina, PI, Brazil
³  Specialization student in Occupational Health Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. RN, Hospital Dr. Bartholomeu Tacchini, Bento Gonçalves, RS, Brazil
⁴  Specialization student in Occupational Health Nursing, Centro Universitário Uninovafapi, Teresina, PI, Brazil
⁵  Master’s student, Universidade Federal do Piauí, Teresina, PI, Brazil

 

 

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ABSTRACT

The aim was to identify which factors lead health professionals to use psychoactive substances, identify the most commonly abused substances and the consequences for the worker’s life. This is an integrative review carried out in the database of virtual health library, which resulted in 88 articles, of which after evaluation there were 12. It was found that triggering factors were related to pressure at work, environmental and individual risks and that centrally acting drugs are used despite they recognized the risks. We concluded that conducting research on the professional profile is important in order to implement preventive health interventions for this population.

Descriptors: Health Personnel; Occupational Health; Substance-Related Disorders.

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RESUMEN

El objetivo fue conocer los factores que llevan los profesionales de la salud al uso de sustancias psicoactivas, identificar las más utilizadas y las consecuencias para la vida del trabajador. Se trata de una revisión integradora, la busca fue hecha en la biblioteca virtual en salud, que resultó en 88 artículos, dos puestos para la evaluación restaram-se 12. Se encontró que los factores desencadenantes estaban relacionados con las exigencias del trabajo, con los riesgos ambientales e individuales, y que al tiempo que reconoce los riesgos de uso, consumen drogas de acción central. Se concluye que es importante hacer más  investigaciones sobre el perfil profesional con la intención de implementar  acciones preventivas de salud para esta población.

Descriptores: Personal de Salud; Salud Laboral; Trastornos Relacionados con Sustancias.

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Introduction

Psychoactive Substances (PS) are those that act on the central nervous system, altering brain functioning and the notion of perception and behavior. PS are divided into legal and illegal substances. The first can be sold in local commerce with governmental authorization and permission from society, while illegal drugs can not; they all banned and are generally associated with addiction and violence⁽¹⁾.

It is important to emphasize and learn the incidence of the use of PS among health professionals who care for the health of others, sometimes leaving their own health in second place. A study conducted at a public college in Rio de Janeiro surveyed the epidemiology of recurrent drug use, revealing that 83% of the research participants had tried or used drugs, especially alcohol, tobacco and anxiolytics. Regarding the regular use of PS, about 9% reported that they still used it. The justification given by professionals was that drugs served to provide relaxation, celebrate special situations and rejoice, and relief anxiety⁽²⁾.

Another research conducted at a college in Rondônia with Nursing students revealed that use of alcohol is prevalent, followed by tobacco and marijuana. In addition, the population that most consumed drugs were the female, young and mostly single. With this, there is a growing concern with these professionals, because in their professional performance, all the basic concepts of health for the population is to be developed and disseminated by them. Learning the pattern of consumption of PS since undergraduate training up to professional exercise is important in order to better implement public health measures⁽³⁾.

The interest to investigate this topic arose from the study of two subjects of the Nursing course: Nursing in Mental Health, which addresses the problem of chemical dependence, and Nursing and Workers’ Health, which deals with issues related to the health and safety of workers. In view of the interdisciplinarity and transversality of the themes, the motivation and restlessness to carry out the present integrative review emerged. The study aims to know the motivating factors leading health professionals to use of psychoactive substances and their perception about such use, and also to identify the drugs consumed and the consequences for the life of the workers.

 

Methodology

Health in modern times has been challenged to rest upon evidence based practice. Thus, this study used the method of integrative review. This research method allows gathering the main results of researches carried out on a certain theme through previously chosen inclusion and exclusion criteria. An integrative review highlights the gaps that need to be addressed and serves as a guide for future scientific studies⁽⁴⁾.

In order to make it operational, the following phases were adopted in the present work: formulation of the problem and identification of the theme, establishment of inclusion and exclusion criteria, collection and evaluation of data, analysis and interpretation of the collected data, and presentation of results. Thus, to guide the review, the following questions were established: What motivates health professionals to use psychoactive substances and what perceptions do they have about their use? Which substances are most consumed and how does this use affect the life of the workers?

"Health professionals, worker’s health and psychoactive substances abuse" were used as descriptors in the study, in a grouped and organized way. The criteria used for the search were articles published in national journals and articles that addressed the theme "use of psychoactive substances by health professionals". In the course of the research, it was noticed that the temporal criterion should not be used due to the scarcity of studies available on this theme.

In the results of the initial search, 88 articles were found. After a synthetic reading of the studies, it was observed that 28 articles should be excluded because they were repeated, and 49 articles because they did not address the chosen theme. Thus, 12 papers published in national journals were kept in the study. The bibliographical survey was carried out through the Virtual Health Library - VHL, with search in Public databases/Medline publisher - PubMed, Scientific Electronic Library Online - Scielo, Latin American and Caribbean Health Sciences - Lilacs and Medical Literature Analysis and Retrieval System Online - Medline.

The primordial information in the studies to be highlighted was defined after a careful reading of the selected articles and based on the guiding question of the research. This stage culminated in the segregation of work into two categories. These categories were based on the contexts most often portrayed by the articles and on the subjects that can qualitatively better contribute to the development of the chosen theme. They are: Factors triggering the use of psychoactive substances by health professionals and the perception of these professionals about this use and; Psychoactive substances used by health professionals and the consequences of their use and abuse.

From the textual analyses, a summary table listing the publications was prepared and the following topics were presented: title, journal, authors, year, objective, result and conclusion. Data were analyzed after a careful reading of the selected texts, focusing on the proposed objectives and according to the results found.

 

Results

The complete reading of the analyzed articles after a screening by application of inclusion and exclusion criteria, a synoptic table was prepared (Figure 1) presenting details of the information rescued from the nine selected articles.

 

 

Among the articles included in the review, eight addressed the use of PS among nurses, one among physicians. Two articles dealt with the use of drugs specifically by the class of anesthesiologists, one by primary care network professionals, and another addressed the practice of self-medication by nursing workers in a hospital area.

As for the research sites of these articles, it was observed that seven were carried out in public hospitals, two specifically with workers of an Intensive Care Unit; two were performed in outpatient clinics for chemical dependence; one with primary health care professionals; and two at university research centers.

Regarding the type of journal in which the studies of this review were published, six were published in nursing journals, three in medical journals and three in general health journals. As for the type of research, four presented qualitative approach, four hadquantitative approach, two had a cross-sectional design and two were bibliographical surveys.

 

Discussion

The study on use/abuse of psychoactive substances by health professionals requires a detailed and in-depth analysis of the most common triggers and psychoactive substances. To aid this analysis, the articles were divided and discussed according to topics for a better understanding of the theme.

 

Triggering factors

Reflection on the factors that trigger the use of psychoactive substances should involve the understanding of the history of the individuals, the social environment in which they are inserted, the conditions in which they live and work, and the feelings experienced such as frustrations, dissatisfaction, fears and anguish that can make them look for activities and means that bring pleasure and relief to their problems⁽⁵⁾.

The use of psychotropics can be influenced by several reasons, among them anxiety, nervousness and daily stress. This could be observed when related to the workspace, with respect to a certain influence of the workload. Thus, physical and psychological wear is a factor that can lead people to get involved with psychoactive substances. Other determinants include the precarious conditions and inadequate work environment that discourages professionals^(5-6).

The profile of nursing workers who use PS is characterized by a predominance of women, workers with a extra load of home activities, deprived of leisure, and whi have positive feelings towards work but consider the work environment stressful. The most common stressors are related to excessive control by the institution, difficult interpersonal relationships, noncompliance of ethical precepts by colleagues, routine and repetitive activities, excessive number of patients, a climate surrounded by suffering and death, insufficient wages, lack of leisure, lack of support and recognition by the institution, among others⁽¹⁰⁾.

The Nursing work process throughout Brazil is represented by an exhaustive workload and high demands. Low wages cause workers to seek further jobs, culminating in the accumulation of responsibilities. These aspects impair the quality of life of workers, since there is no time for leisure to spend with the family or for extra work activities that cause them pleasure^(14-15).

In this respect, Martins and Zeitoune⁽⁵⁾ point out that nursing workers feel satisfied with their work, seeing the task of caring for others rewarding, despite the moments of sadness and suffering. And this ambivalence of feelings creates conflicts within these professionals who sometimes need other unhealthy means to relieve stress. Thus, the use of PS as a solution to alleviate persisting problems in the family or work environment is dangerous because the effects of this practice have been confirmed as harmful to society as a whole. Moreover, if an individual lacks protective factors such as family, religion, emotional and other well-structured conditions, other means will consequently be used in an attempt to reduce distress and suffering.

Other triggers that can be mentioned are work and family demands, environmental and individual risks that facilitate drug availability, poverty, social change, genetic predisposition, and social exclusion. Although tension exists in all professions, some professionals are more predisposed to get involved with drug abuse than others. The experience of pleasure or suffering depends on the interaction between the subjectivity of the worker and the environmental, socio-cultural, economic and political conditions in which work is embedded⁽⁶⁾.

With respect to the reasons that can lead nursing workers to use drugs, it is necessary to know the risk factors and protective factors. Risk factors include situational conditions and the environmental context involving the likelihood to use drugs. On the other hand, protective factors correspond to the environmental context and situational conditions that inhibit or reduce the likelihood of such use. This way, it is understood that there are reasons that lead some professionals in the same work environment to present a greater risk behavior than others^(5,14).

Regarding the medical category, research indicates that this is the one that most gets involved with self-medication, and the reasons are exposure to work stress, more than one employment in most cases, and easy access to medications. Thus these are risk factors for the abuse of psychoactive substances among health professionals. With respect to the health professionals in general involved in the research, the majority of the people involved with consumption of PS were women, and one third were of low socioeconomic level⁽¹³⁾.

However, the desire to relax, to end problems, and to feel a little pleasure are not the only aspects that lead professionals to use drugs. The need to stay awake for longer periods of time, to be able to work more, and the frequent need to hold on more than one job to support the family have a similar influence favoring the use of PS⁽⁵⁾.

Occupational conditions of health professionals should be better worked, as well as the workload and mental hygiene. This is true in particular in the case of the nursing group that is directly involved in the care of individuals, who handles psychotropic substances in a daily basis, and are thus vulnerable to involvement with these drugs. It is necessary that the health institution takes care of the quality of life and work of these professionals, because it is paramount to take care of who provide care⁽⁶⁾.

Some studies bring several reasons reported by health care professionals to justify the use of PS, among them the sadness and anxiety caused by the profession and by their interaction with patients. In addition, they report that the lack of medication causes them feeling "that the day will be very bad". It is observed, however, that as these professionals sense they are recognized in their work environment, the incidence rate of use of PS decreases. Thus, recognition is a means of combating mental illnesses among these workers^(14-15).

One factor that may also influence the use or not of SPA concerns the knowledge about these substances and the perception of the users. In this sense, with regard to the perception of health professionals about the use of psychoactive substances, it was possible to observe that they know and admit that drugs are chemical substances that cause changes in their behavior and are harmful to health⁽⁷⁾.

The recognition of licit drugs as something incorporated into society, and of illicit drugs as something different, is cultural. However, the consumption of both kinds of drugs is detrimental to the health of the individuals. Some people may claim that they drink, smoke and self-medicate without seeing it as a bad thing, but rather as natural practices. It is necessary to highlight that alcohol, tobacco and some drugs, especially anxiolytics and amphetamines, are the most consumed drugs and those that cause the greatest harm to the people⁽⁷⁾.

The similarity between the body of patients and professionals is also used as a justification for the use of medications without precise indication and medical evaluation. In this situation, it is noteworthy that the professionals are aware of the risks that the drug brings, showing therefore a contradiction in the sense that they know the risks for others but not for themselves⁽⁷⁾.

 

Psychoactive substances used by health professionals

A study carried out in two public hospitals in Rio de Janeiro, a large general hospital and a reference center for maternal and child health, revealed that the prevalence of self-medication among nursing workers was 24.2%. The most consumed drugs were those for the nervous system, corresponding to 46.7% of the cases, and the most used subgroup was that of analgesics - 43.4%⁽⁹⁾.

A study carried out at a Philanthropic Hospital in a city in Paraná revealed that 70.5% of the interviewed nurses reported using psychoactive medications and 44% practiced self-medication because of the ease of obtaining the medications⁽¹⁴⁾. According to Bittar and Gontijo ⁽¹⁶⁾, self-medication is related to a complex set of intrinsic and extrinsic factors pertaining to each individual. This includes their conception of work, the level of satisfaction with the work environment, the way how they deal with the challenges of the profession, cultural patterns and the level of education related to medication. In the study carried out in a Hospital in Uberaba-MG with nursing workers, the authors concluded that 66% of the nurses practiced self-medication frequently or sporadically and that psychic disorders such as anxiety, stress and depression were the health problems most reported by this professional category.

Self-medication tends to be more frequent among younger people, and higher education levels are more often associated with self-medication. There are innumerable reasons that can explain this, including greater knowledge about medicines, greater economic power, less confidence in doctors, and a greater sense of personal autonomy regarding personal decisions on health issues⁽⁹⁾.

With regard to anesthesiologists, the use of alcohol and other drugs caused them professional problems (87.7%), marital problems (52.6%), psychiatric hospitalization (29.1%), automobilistic accidents (21.1%), unemployment in the previous year (17.5%) and problems with the Regional Council of Medicine (24.6%). The use of opioids was also high in this category and the age of onset of this addiction coincided with the phase of medical residency and the immediate period following this phase, which seems to be a time of greater vulnerability for this particular type of addiction. Besides personality disorders and psychiatric comorbidities, it is possible that other specific factors may have contributed to the emergence of dependence to opioids among anesthesiologists in the study sample⁽¹¹⁾.

The types of anesthetic agents most used by anesthesiologists were opioids, particularly an increased use of proporfol and inhaled anesthetics. Anesthesiologists tend to overuse opioids like fentanyl and sufentanil. There are several circumstances related to the professional activity of anesthesiology. Ease of access to drugs, solitary and stressful medical activity, excessive working hours and possible concomitance with psychiatric disorders are some of them⁽⁸⁾.

The most commonly used drugs among medical professionals are alcohol, cocaine, benzodiazepines, marijuana, opiates, amphetamines, and solvents. The most involved specialties are medical clinic, anesthesiology, pediatrics, gynecology and obstetrics, psychiatry, public health and radiology. The continuous use of these substances caused depression, bipolar affective disorder and personality disorder. As abovementioned, other problems were observed in these users, including unemployment in 30.8% of cases, marital problems and separation, car accidents, legal problems, and problems with the Regional Council of Medicine (RCM)⁽¹²⁾.

A study carried out in all basic health services in the urban area of ​​Pelotas between May and September 2004 revealed the prevalence of self-medication found in all professionals of 24.8%, similar to the study by Barros, Griep and Rotenberg⁽⁹⁾. The professional categories with the second highest rates in this study were nurses and dentists (32%). Those who performed more consultations per day had the lowest prevalence of self-medication⁽¹³⁾.

 

Conclusion

The present review allowed us to conclude that the most commonly used psychoactive substances by health professionals are alcohol, tobacco, anxiolytics, opioids, and self-medication with a wide variety of concomitant drugs. The reasons that lead them to seek to consume these substances in general are related to workload, work stress, family problems, as well as other external influences that may contribute to such behavior.

Therefore, health institutions need to be more prepared to deal with such cases, among their professionals, by creating specific protocols for this purpose. Moreover, there is a need for further research on the theme because the use of PS is a problem that affects not only the professionals, but the whole community. Thus, more field studies are needed to map and observe the profile of these workers so as to subsidize the implementation of actions in health institutions in favor of a more targeted preventive care.

 

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Recebido: 18.01.2016
Aceito: 23.01.2017

Corresponding Author:
Márcia Astrês Fernandes
Universidade Federal do Piauí
Campus Universitário Ministro Petrônio Portela
Bairro: Ininga
CEP: 64049-550, Teresina, PI, Brasil
E-mail: m.astres@ufpi.edu.br