Chemical Dependency and the Physician

Abstract

Although the nature and scope of addictive disease are commonly reported in the lay press, the problem of physician addiction has largely escaped the public's attention. This is not due to physician immunity from the problem, because physicians have been shown to have addiction at a rate similar to or higher than that of the general population. Additionally, physicians' addictive disease (when compared with the general public) is typically advanced before identification and intervention. This delay in diagnosis relates to physicians' tendency to protect their workplace performance and image well beyond the time when their life outside of work has deteriorated and become chaotic. We provide an overview of the scope and risks of physician addiction, the challenges of recognition and intervention, the treatment of the addicted physician, the ethical and legal implications of an addicted physician returning to the workplace, and their monitored aftercare. It is critical that written policies for dealing with workplace addiction are in place at every employment venue and that they are followed to minimize risk of an adverse medical or legal outcome and to provide appropriate care to the addicted physician.

Diversion of Drugs Within Health Care Facilities, a Multiple-Victim Crime: Patterns of Diversion, Scope, Consequences, Detection, and Prevention

“…6,13,16 Mayo Clinic is no exception in this regard; thus, it is not surprising that concerted efforts to detect drug diversion began in the Department of Anesthesiology. Detection has often been precipitated by personnel underperformance or behavioral changes at work, frequent unexplained work absences, patients who seem to be undermedicated in the period after surgery despite documentation of administration of seemingly adequate narcotic dosages, and, rarely, HCW death related to a CS.…”

Substance abuse: a national survey of Canadian residency program directors and site chiefs at university-affiliated anesthesia departments

“…Previous literature suggests that up to 12% of physicians will suffer from substance abuse during their career. 2,3 Abuse patterns, however, are not distributed evenly across specialties. Surveys conducted from the early 1980s-2008 suggest that anesthesiologists may be at highest risk, particularly during the earlier stages of their career.…”

Opioid-Abusing Health Care Professionals: Options for Treatment and Returning to Work After Treatment

“…10 Such high success rates among HCPs are related to multiple factors, including the individual's motivation to maintain licensure and professional practice, the extensive treatment provided to this group, and the long-term monitoring established by state PHPs. 11 In fact, one can clearly make the argument that reported success rates are so high that introducing opioid maintenance to this paradigm would not be appropriate. Individual and large collaborative studies of state PHPs have demonstrated that under ideal circumstances, 80% of physicians being monitored for the 5 years after abstinence-based, 12-step treatment do not have a single relapse.…”