Buprenorphine Maintenance Therapy in Opioid-Addicted Health Care Professionals Returning to Clinical Practice: A Hidden Controversy

Abstract

It remains controversial whether it is safe for recovering health care professionals to return to clinical practice after treatment for drug addiction. One specific component of reentry that remains particularly contentious is the use of pharmacotherapeutics, specifically buprenorphine, as opioid substitution therapy for health care professionals who wish to return to clinical work. Because health care professionals are typically engaged in safety-sensitive work with considerable consequences when errors occur, abstinence-based recovery should be recommended until studies demonstrate that it is safe to allow this population to practice while undergoing opioid substitution therapy.

Opioid Substitution Therapy for Dependent Health Care Practitioners: Approach With Caution

“…1 We interpreted this as an example of alcohol-induced rhabdomyolysis and shared that interpretation with readers of the Proceedings. We further speculated that improvements in the patient's condition while under our care might have been the result of corticosteroid treatment.…”

“…To the Editor: In their article entitled "Buprenorphine Maintenance Therapy in Opioid-Addicted Health Care Professionals," 1 Hamza and Bryson draw a distinction between a "harm reduction and damage control model" of opioid-addiction management and treatment for which abstinence (including, very specifically, abstinence from prescribed agonists) defines both the treat-…”

Neuropsychological impairment associated with substance use by physicians

“…Chronic methadone exposure has also been linked to increased impulsivity, non-planning impulsivity, and lower cognitive flexibility compared to healthy controls [60]. Similarly, research has demonstrated that buprenorphine can impair higher cerebral functioning, though to a lesser extent than methadone [61]. As a result, when considering treatment options for healthcare professionals, opioid substitution therapy may not be advisable, due to the possibility of impaired cognitive functioning.…”

“…As a result, when considering treatment options for healthcare professionals, opioid substitution therapy may not be advisable, due to the possibility of impaired cognitive functioning. Hamza and Bryson [61] suggest that opioid agonist medication should be avoided within this demographic due to safety concerns. This position is supported by others who believe it is inadvisable for healthcare professionals working in emergency or critical care settings to use these medications lest they impair decisionmaking ability when speed is paramount [62].…”

My Story: How one Percocet Prescription Triggered my Addiction

“…Physicians enrolled in these programs receive support of an intensity, duration, and quality that surpasses that available to the general public [4]. The decision to allow a physician to return to work prior to abstinence or while undergoing therapy, such as with naltrexone, methadone, or buprenorphine, varies by state [5].…”