Nearly 1% of anesthesiology residents showed substance use disorders, including some who died as a result, and nearly half of those caught had a relapse, says a new report. "This is still a big problem within our specialty," says the study author.
While in residency training, nearly 1% of anesthesiologists exhibited substance use disorders, including some who died as a result, says a report that bolsters a perception that this specialty group has a unique and disturbing problem with drugs and alcohol.
Of those anesthesiology residents who were caught but survived their addiction episodes, perhaps undergoing treatment that continued their medical careers, nearly half experienced a relapse over the next 30 years, according to the report published in Tuesday's Journal of the American Medical Association.
"I hope this increases awareness that this is still a big problem within our specialty," says lead author David Warner, MD, of the Mayo Clinic Department of Anesthesiology in Rochester, MN.
In the 1990s, highly publicized addiction-related deaths of several anesthesiology residents prompted major efforts to educate residents and their spouses, and the numbers of addiction cases seemed to drop. Now, however, those numbers are back up, and Warner says the threat of substance abuse has not gotten across to residents. "I don't think there's a good perception that this is still what I consider a big problem."
To tackle this research, he and colleagues looked at disciplinary records for 41,612 people who began anesthesiology residency training in teaching hospitals between 1975 and 2009. Of 49 residents who had died as of Dec. 31, 2010, and for whom the cause of death was known, substance abuse disorder was related to the cause of death for 44.
Residency program directors are required to report disciplinary records to the American Board of Anesthesiology, which reviews applicants for board certification. Warner, a member of the ABA's board of directors, says the data seemed to present an opportunity to research "the perception, whether true or not, that anesthesiologists have more access to these kinds of drugs and are more prone to develop substance use disorders.
"It also interests me personally because we have contact with these doctors through the board, and we see the consequences of this behavior," he says.
This research did not look at anesthesiologists who developed substance use disorders after their residency, although that project is among those next on his list, Warner says.
He adds that it's also unclear whether anesthesiologists have a higher rate of drug or alcohol addiction than other physician specialties. "This is the first real data on what the incidence and outcomes are of substance use of any population of physicians," he says, emphasizing that he hopes it will prompt more studies in other specialties.
Warner and his research team also amassed reports from the Federation of State Medical Boards, death records from the Social Security Administration, and several other sources. They discovered that 0.86% of anesthesiology residents had evidence of addiction, mostly to intravenous opioids but also to alcohol and other controlled pharmaceutical products.
"It's important to recognize that the actual incidence of this is probably higher than what we found, because some of these people are never caught. We're probably looking at the lower limit," Warner says.
The incidence of anesthesiology residents' substance use disorders seemed to plummet around the year 2000, he says. But the incidence has since climbed back up so that now, "the highest rates of use have been in the last five years. Things are just as bad as they ever were in terms of the incidence."
It's important to look at substance abuse among anesthesiologists, he says, because they have a somewhat "unique ready personal access to potent narcotics and hypnotics, and unlike most physicians, we personally administer the drugs, draw them up in a syringe, and give it in an intravenous line."
That's not the usual practice for the majority of other physician groups, who may prescribe a drug but not personally administer it.
He adds that "physician impairment is potentially a patient safety issue, and we want to do everything we can to protect our patients, another area I think we need to think about."
Warner says that residents whose substance use disorders are detected are usually caught stealing or diverting drugs, similar to the manner in which the catheterization lab tech at Exeter Hospital in New Hampshire, David Kwiatkowski, diverted fentanyl through syringes set out for patient use.
"Some are actually caught using, or someone finds needles in the call room," Warner says.
What happens to these residents after they're caught is what Warner thinks should be up for discussion. Currently, "the majority go into some sort of treatment program, whether inpatient or outpatient, and the majority attempt to return to residency and continue training, and some go into another medical specialty."
But of those who were caught and survived their residency, 43% "would eventually relapse to at least one more incident of substance abuse, which is not inconsistent with this kind of disease in the general population. "
Warner says that he worries that substance abuse is a much bigger problem than revealed in this study, because despite all sorts of mitigation programs, it persists.
"The nature of addiction is that addicts are highly motivated, and if motivated enough, can find away to beat most systems you set up. You can't believe how creative these folks can be. Your brain wants the drug, and will do whatever it takes to get the drug, and these are not stupid people."
What should hospitals and physician groups do about young doctors caught abusing drugs? That's controversial, Warner says. "Should they be treated, and if so, should they return to practice, or counseled and go into another specialty? I don't have the answers and there's a wide variety of opinions, from those who think everyone can be treated and they'll be just fine, to those who think there should be a one-strike-and-you're-out policy."