When the Doctor Is the Addict
Self-medication and prescription drug abuse are problems that almost all doctors have to deal with in some form or another. Self-medication is defined by the National Institutes of Health (NIH) as “the selection and use of medications by individuals to treat self-recognized or self-diagnosed conditions.” The practice of self-medication is risky for a variety of reasons. Overdoses are one danger, and another is a toxic combination of substances that a non-medical professional may not realize could be dangerous. Self-medication may also involve the risk of addition and chemical dependency.
Nevertheless, almost all doctors encounter patients who are self-medicating with prescription drugs, or have self-medicated in the past. However, some doctors deal with this issue on a more personal level: some are abusing prescription drugs themselves. Although it may seem that medical professionals are at a lower risk for prescription drug abuse due to their medical knowledge, the reality is that the percentage of doctors who misuse drugs is about the same as the percentage of the population as a whole.
A recent study from the University of Florida, Gainesville, created anonymous focus groups for physicians receiving treatment for prescription drug abuse or other substance abuse. The study, lead by Lisa J. Merlo, PhD, MPE, gathered information from a group of 55 doctors currently in substance abuse recovery.
Of the 55 doctors in the study, 69 percent had abused prescription medications. The others were in treatment for alcohol abuse or illicit drug abuse, and the doctors who abused prescription drugs often had problems with either alcohol or illicit drugs as well.
Self-medication was one of the major reasons described by the doctors for their prescription drug abuse. The physicians in the study reported self-medicating for physical pain, emotional pain, and work-related or personal stress. Those abusing prescription pain medication typically began taking the medication for legitimate reasons, following an injury or surgery. Those taking medication for psychiatric problems or stress often described long-standing difficulties with these issues.
How Can Doctors “Self-Medicate?”
If doctors are qualified to prescribe medications for other people, why is it considered “self-medication” or prescription drug abuse if they obtain prescription drugs for themselves? There are medications and treatments that physicians are allowed to prescribe for themselves, or for family members. However, the American Medical Association has decided that it is inappropriate for physicians to self-prescribe controlled substances except in emergency situations.
A controlled substance is any substance regulated by the Controlled Substances Act of 1970. These substances are regulated because of their potential for abuse. Some of the drugs on the list of controlled substances are considered to have no medical value and a high risk of abuse. These drugs, which include MDMA (“ecstasy”) and LSD, are listed as Schedule I controlled substances. The rest of the list ranges from Schedule II controlled substances, which have a high risk of abuse but also recognized medical value, to Schedule V controlled substances, which have very little risk of abuse or harm as well as accepted medical value.
Commonly abused prescription drugs such as morphine, amphetamines, anabolic steroids, and benzodiazepines (which include Valium and Xanax), are all on the list of controlled substances. Schedule I controlled substances are illegal for all persons in the United States.
When physicians wish to take medications on the controlled substances list, they must obtain the consent of another physician. This is also the case if they wish to provide controlled medications for family members. When physicians obtain legal controlled substances for themselves or for family members, this is considered to be prescription drug abuse.
Although doctors have advanced medical and drug knowledge that may help to lower their risk of drug abuse, this may be offset by the ease with which doctors can get access to prescription drugs if they choose.
Dr. Merlo, the new study’s lead author, encourages medical schools and hospitals to talk with medical students abut prescription drug abuse from the beginning of their training. This may help physicians to understand that they run the same risk of drug abuse as the rest of the population, and that they need to seek qualified medical advice for physical or emotional distress just as they would encourage their patients to do.