Fatal drug overdoses in healthcare workers: A thematic framework analysis of coroner reports.

Background and aims: Healthcare workers face specific vulnerabilities for drug overdose due to their unique access to medications, clinical knowledge and work-related stress. This study aimed to understand the characteristics of fatal overdoses in healthcare workers with a view to providing guidance for preventative strategies.

Design, setting and cases: We retrospectively identified cases in England, Wales and Northern Ireland reported to the National Programme on Substance Use Mortality between 2000 and 2022 where decedents were working or studying within a healthcare setting at the time of their death or had previously worked in healthcare.

Measurements: Quantitative analyses were conducted to report summary demographics of decedents, the circumstances of deaths and the drugs involved. A qualitative thematic framework analysis was performed to identify and explore factors that may contribute to fatal drug overdose in healthcare professionals.

Findings: In the identified cases, doctors were the most represented profession (48% of cases, n = 28/58) with opioids the drug class most often implicated in causing death (43% of cases, n = 25/58). Whilst there was scant evidence of recreational drug use in the identified cases (n = 3), hospital-only medications prominently featured [propofol in 29% (n = 17/58); midazolam in 10% (n = 6/58); neuromuscular blocking agents in 9% (n = 5/58)]. Qualitative analysis identified seven themes including accessing drugs from the workplace, use of skills and/or equipment for intravenous drug administration, obtainment of private prescriptions, diagnosed mental health conditions, recent events likely to have negatively impacted mental health, chronic pain and self-medicating and history of substance use disorder and/or overdose.

Conclusions: The characteristics of fatal drug overdoses among healthcare workers in England, Wales and Northern Ireland appear to differ from those observed in the overall population of people who use drugs in the UK. To prevent such deaths, it is important that healthcare workers can access bespoke care and support tailored to the specific challenges that they face.