Substance Abuse Among Anesthesiologists
Although it can be difficult to accept, physicians are at risk for the same challenges and illnesses as other people, including drug addiction. Anesthesiologists, in particular, have consistently been shown to have an unusually high rate of drug abuse compared to other physicians. A survey of 260 anesthesiologists from the Medical College of Wisconsin graduating between 1958 and 1988 reported that 32 percent used drugs to “get high” and 15.8 percent had been drug dependent.
Physician health programs (PHPs), which are responsible for managing and monitoring addicted physicians, report that anesthesiologists show up in their programs with substance abuse at approximately 2.5 times the rate of other specialties. Anesthesiologists have also been reported to be similarly over-represented in substance abuse treatment centers that specialize in treating physicians. As a result of the high rates of substance abuse among anesthesiologists, some disability insurance companies have even decided to discontinue coverage for anesthesiologists.
Why are anesthesiologists particularly vulnerable to drug abuse? Studies point to the following factors:
• The proximity to large quantities of addictive drugs
• The relative ease of diverting drugs for personal use
• A high-stress work environment
• Control-oriented personality
• Workplace exposure that sensitizes the brain to substance abuse
Drug Abuse Trends Among Anesthesiologists
Dr. Gregory Skipper, the former medical director of the Alabama Physician Health Program and current Director of Professional Health Services at Promises Treatment Centers, and colleagues completed a longitudinal cohort study involving 904 physicians consecutively admitted to one of 16 state physician health programs between 1995 and 2001. They analyzed a subset of the data involving 102 anesthesiologists and compared them with other physicians. The main outcome measures included relapse (defined as any unauthorized addictive substance use, including alcohol), return to anesthesiology practice, disciplinary actions, physician death and patient harm.
The researchers uncovered a number of drug use trends among anesthesiologists:
• The primary drug of choice among anesthesiologists is opioids, such as fentanyl, sufentanil, meperidine and morphine (whereas alcohol is the primary substance of abuse among other physicians).
• Anesthesiologists had a higher rate of IV drug use compared to other physicians (41 percent vs. 10 percent).
Treatment & Monitoring Help Addicted Anesthesiologists Successfully Return to Work
Although anesthesiologists are at increased risk of drug addiction, research suggests that they respond exceedingly well to drug rehabilitation treatment and long-term monitoring. PHPs have achieved remarkable outcomes with physicians and are equally effective for anesthesiologists. Most physicians managed and monitored by PHPs have reported 75 to 90 percent success rates five or more years after completing substance abuse treatment.
Despite these statistics, controversy remains surrounding anesthesiologists’ prognoses and ability to return to the operating room. Even with strict monitoring in place, some argue that anesthesiologists should not be permitted to return to anesthesiology practice after receiving substance abuse treatment. These conclusions stem from two poorly designed surveys of training program directors regarding substance-abusing residents, which reported very poor outcomes among addicted anesthesiologists.
In contrast, according to Dr. Skipper’s research, which is the first long-term outcome study based on actual data from records of anesthesiologists, most anesthesiologists can safely return to practice if certain safeguards are in place. In his study, anesthesiologists who were treated and monitored for substance use disorders under the supervision of PHPs had excellent outcomes similar to other physicians. At the end of the five-year follow-up period, 71 percent of anesthesiologists and 64 percent of nonanesthesiologists had completed their contracts and were no longer required to be monitored.
Although they face greater stigma, the research shows that anesthesiologists:
• Were less likely to fail a drug test during monitoring
• Were as likely to complete treatment and return to practice
• Experienced suicide risks, relapse rates and disciplinary rates that were no higher than other physicians
• Did not put their patients at risk of significant harm from relapse
Addiction Treatment for Addicted Anesthesiologists
Treatment for addicted anesthesiologists typically involves specialized drug rehabilitation programs that provide comprehensive assessments, intensive individual and group therapy for professionals, 12-Step support, and extensive aftercare and relapse prevention planning. Certain long-term monitoring measures have proven particularly effective in deterring substance abuse among anesthesiologists:
- Long-acting natlrexone administration
- Regular periodic hair testing (which is more accurate, particularly in detecting opioid abuse, than urine testing)
- Enhanced security measures in and around the operating room (e.g., using witnesses for drug access and disposal, automated distribution devices, monitoring cameras, and spectrometric scanning of waste)
There is a growing body of evidence that the stigma against anesthesiologists returning to work is unwarranted. Although any incidence of overdose, suicide or patient harm is unacceptable, and re-entry must be handled on a case-by-case basis, studies show that addicted anesthesiologists who receive substance abuse treatment and are managed by PHPs have good long-term outcomes, on par with other physicians.