Objective:The objective of the article is to present the available data from the literature on substance use disorders in healthcare professionals. Prevalence, risk factors, treatment options, and reentry into clinical practice are discussed.Introduction:Impairment of a healthcare professional is th

Impaired healthcare professional.

Context Substance use disorders among physicians are important and persistent problems. Considerable debate exists over whether use of major opioids, especially among anesthesiologists, is associated with a higher relapse rate compared with alcohol and nonopioids. Moreover, the risk factors for relapse with current treatment and monitoring strategies are unknown. Objective To test the hypothesis that chemically dependent health care professionals using a major opioid (eg, fentanyl, sufentanil, morphine, meperidine) as drug of choice are at higher risk of relapse. Design, Setting, and Participants Retrospective cohort study of 292 health care professionals enrolled in the Washington Physicians Health Program, an independent posttreatment monitoring program, followed up between January 1, 1991, and December 31, 2001. Main Outcome Measure Factors associated with relapse, defined as the resumption of substance use after initial diagnosis and completion of primary treatment for chemical dependency. Results Twenty-five percent (74 of 292 individuals) had at least 1 relapse. A family history of a substance use disorder increased the risk of relapse (hazard ratio [HR], 2.29; 95% confidence interval [CI], 1.44-3.64). The use of a major opioid increased the risk of relapse significantly in the presence of a coexisting psychiatric disorder (HR, 5.79; 95% CI, 2.89-11.42) but not in the absence of a coexisting psychiatric disorder (HR, 0.85; 95% CI, 0.33-2.17). The presence of all 3 factors— major opioid use, dual diagnosis, and family history—markedly increased the risk of relapse (HR, 13.25; 95% CI, 5.22-33.59). The risk of subsequent relapses increased after the first relapse (HR, 1.69; 95% CI, 1.13-2.53). Conclusions The risk of relapse with substance use was increased in health care professionals who used a major opioid or had a coexisting psychiatric illness or a family history of a substance use disorder. The presence of more than 1 of these risk factors and previous relapse further increased the likelihood of relapse. These observations should be considered in monitoring the recovery of health care professionals.

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Risk factors for relapse in health care professionals with substance use disorders.

BackgroundThe health-related effects of the operating room environment are unclear. The authors compared mortality risks of anesthesiologists to those of internal medicine physicians between 1979 and 1995.MethodsThe Physician Master File database, a listing of all US physicians, was used to identify

Cause-specific Mortality Risks of Anesthesiologists

Despite substantial advances in our understanding of addiction and the technology and therapeutic approaches used to fight this disease, addiction still remains a major issue in the anesthesia workplace, and outcomes have not appreciably changed. Although alcoholism and other forms of impairment, such as addiction to other substances and mental illness, impact anesthesiologists at rates similar to those in other professions, as recently as 2005, the drug of choice for anesthesiologists entering treatment was still an opioid. There exists a considerable association between chemical dependence and other psychopathology, and successful treatment for addiction is less likely when comorbid psychopathology is not treated. Individuals under evaluation or treatment for substance abuse should have an evaluation with subsequent management of comorbid psychiatric conditions. Participation in self-help groups is still considered a vital component in the therapy of the impaired physician, along with regular monitoring if the anesthesiologist wishes to attempt reentry into clinical practice.

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Addiction and Substance Abuse in Anesthesiology

https://www.ophed.net/system/files/2009/07/impaired-physician-1966-1966.pdf

Identifying and assisting the impaired physician.

Of 100 physicians who entered into a continuing care contract during a five-year period with the Impaired Physicians Program of the Medical Association of Georgia, seventy-seven have maintained documentable abstinence from all mood-altering substances. One physician was lost to follow-up. Twenty-two relapsed, eighteen of whom have undergone another treatment for chemical dependence. Only one physician in the relapse group has been involved in a pattern of chronic relapsing behavior.

Relapse and recovery: five to ten year follow-up study of chemically dependent physicians--the Georgia experience.

Substance abuse among health professionals.

Impaired anesthesiologists (IAs) seen by the Medical Association of Georgia Impaired Physicians Program were compared to all other impaired physicians seen by the program. Anesthesiologists were the specialists most overrepresented in the program. When each IA was matched to a control with respect to age, sex, race, professional activity status, and year of admission to the program, the IAs were found to be more likely to abuse drugs than alcohol, to abuse narcotics, and to abuse drugs intravenously. The authors recommend tighter control of narcotics and surveillance of all anesthesia personnel in order to reduce the risks to patients associated with chemical dependence.

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Papers

Relapse and recovery: five to ten year follow-up study of chemically dependent physicians--the Georgia experience.

Substance abuse among health professionals.

Addiction in Anesthesiologists: Drug Access and Patterns of Substance Abuse