Overdoses in Healthcare Workers: A thematic framework analysis of coroner reports
Background: Many healthcare workers have unique access to controlled medications, including opioids and strong hospital-only sedative drugs (e.g., propofol), and possess detailed knowledge about the physiological effects of these drugs. The often stressful nature of their work, marked by long hours and emotional challenges, might lead healthcare workers to take drugs from the workplace and use them – either as a way to cope or to cause deliberate self-harm.
Aim: The aim of this study was to investigate the contributing factors of fatal overdose among healthcare professionals working in the UK.
Method: The study utilized data from the National Programme on Substance Abuse Deaths (NPSAD) in the UK, focusing on coroner reports from the years 2000 to 2022. The NPSAD was searched by keyword for occupations and specialities of healthcare workers (e.g., doctor, nurse, medic, anaesthetist). Inclusion criteria for cases was that decedents had been either working or studying in a clinical environment with access to medications. Exclusion criteria for cases was for people listed as retired healthcare workers, or people suspended from working at the time of their death. Both quantitative analysis of decedent demographics and qualitative thematic analysis of the circumstances leading to and surrounding the deaths was performed.
Results: The study identified 51 relevant cases, predominantly males (73%) with a median age of 35. Decedents were more commonly listed as living with other people (57%; n=29) than alone (37%; n=19), with most decedents having lived in more affluent areas of the country. Doctors were the healthcare profession most represented (53%; n=27/51); where practice specialty was known (70%; n=19/27), anaesthetists accounted for 47% of cases (n=9/19) and GPs for 26% of cases (n=5/19). Over half of cases were concluded as suicide or undetermined intent (59% of cases, n=30/51), with opioids being the most commonly implicated drug class (47% of cases, n=24/51). We developed a qualitative framework and identified seven themes organised into two categories: Category 1 Vocational Factors with themes of access to drugs from the workplace, used skills and/or equipment for IV drug administration, and the obtaining of private prescriptions; Category 2 Mental and Physical Health Problems with themes of mental health conditions, impact of recent events, self-medicating for chronic pain, and a history of drug misuse or overdose.
Conclusions: This study further reiterates that healthcare staff are at particular risk of fatal drug overdose due to their unique access to drugs, equipment and skills, and their exposure to challenging and stressful conditions which may cause or exacerbate mental ill health. Some of these factors are inherent to the working environment, individuals, or healthcare system, and cannot easily be changed. However, other aspects may have scope for improvement to reduce the risk of fatal drug overdose to healthcare staff of the future.
