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1 Peer Assistance Update Greg Stocks CRNA EJD

2 AANA Peer Assistance History  26 Years of service.  Leader in the industry.  Started as Ad-Hoc Committee.  Included in the Joint Committee Conference in 2006.  Wellness Program 5 years young.

3 Latest Information:  AANA Wellness Restructured  State Peer Advisor  AIR Survey  Propofol  Education Initiatives

4 AANA Peer Assistance Peer Assistance Advisors Committee (PAAC) Peer Assistance Advisors Committee (PAAC) Wellness Committee Wellness Committee Art Zwerling (Senior Advisor) Heather Wilson Gregg Rampleman

5 State Peer Advisors (SPA)  Volunteer CRNAs in each state.  Resource for education and intervention.  Familiar with local resources (monitoring and treatment programs, nurse practice act).

6 North Carolina State Peer Assistance Linda Stone CRNA MSN (919) 250-9740

7 What We Do…..  National Hotline 24/7  Resource for professionals in crisis.  Detoxification and treatment recommendations and resources.  Assist in planning interventions.  Assist in re-entry planning.

8 And…..  Provide educational resources and speakers for anesthesia schools, departments and institutions.  Provide model policies and procedures.  Monitor and engage in research and evaluate latest treatment methods.

9 Anesthetists In Recovery (AIR) Survey Data  Online confidential support forum  Moderated, Members Only  SRNAs and CRNAs in recovery  5 Question Survey  110 Respondents

10 Air Survey 1)What was your drug of choice? 2)If your drug of choice was propofol, why? 3)Have you ever self administered propofol? 4)Besides your drug of choice, what other substances did you abuse? 5)At what point during your anesthesia career did you become chemically dependant?






16 The DEA. The King of Pop. The PAAC. The inside story…….

17 Propofol: Sept. 2008  PAAC meets in Chicago  Propofol abuse discussed  Multiple deaths reported  Propofol whitepaper proposed with an AANA position paper in mind.

18 Propofol: What we found  First reported abuse in 1992 by anesthesiologist.  Multiple reports from around the world of abuse, most with fatal outcomes.  Research shows propofol affects the dopamine reward system like other drugs of abuse.

19 And we found more….  Abuse drastically under reported in the literature.  Death rate 38-50% of all who abuse it.  Hotline calls are frequently about propofol abuse.  Multiple deaths reported in PAAC in last 12 months.

20 The Good News  Ease of access is the overwhelming reason for choice of propofol.  When controlled, propofol abuse falls dramatically…so do deaths.  The recommendation for immediate control is made to the AANA Board.  Need for DEA control is identified.

21 Michael Jackson: An unlikely turn of events…….  PAAC submits “The Urgent Case for Re- Classification of Propofol as a Controlled Substance” to CPIA, Practice and the AANA BOD early 2009.  AANA BOD creates Position Statement 2.14 “Securing Propofol” in record time on June 6, 2009. Revised 9/09

22  June 22, 2009 the Position Statement is published on the AANA website.  Three days later Jackson dies.  Propofol is implicated within days creating a media firestorm and making Propofol a household name.

23 Fospropofol… An unlikely coincidence!  Pro-drug of propofol.  Was awaiting final FDA packaging approval coincidently.  Proposal for Schedule IV status published in August.  Schedule IV status finalized in October.

24 Control of Propofol What it will do…and what it won’t do.  Will NOT likely decrease incidence of substance abuse in anesthesia.  Will NOT significantly impact patient care.  WILL decrease incidence of propofol abuse very dramatically.  WILL save scores of lives of our colleagues and friends.

25 The Uproar:  “We don’t need no more stinking regulation!”  “Control of drugs hasn’t stopped the problem!”  “Patient’s will suffer in an emergency!”  “If someone is stupid enough to abuse it and die, that’s their own problem!”

26 Propofol: The Future  Schedule IV  Scheduling supported by the AANA and ASA.  Sooner than later.  Get used to it now.  Simmer down.

27 Education Initiatives  Standard Curriculum for all anesthesia programs.  Standardized PowerPoint presentations, Wearing Masks video, learning outcomes.  February ASF.  Random drug screening.


29 Contact me: Greg Stocks CRNA EJD (410) 916-5885 (confidential) Visit the Wellness booth!

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