Physician Substance Use by Medical Specialty

Abstract

Self-reported past year use of alcohol, tobacco, marijuana, cocaine, and two controlled prescription substances (opiates, benzodiazepines); and self-reported lifetime substance abuse or dependence was estimated and compared for 12 specialties among 5,426 physicians participating in an anonymous mailed survey. Logistic regression models controlled for demographic and other characteristics that might explain observed specialty differences. Emergency medicine physicians used more illicit drugs. Psychiatrists used more benzodiazepines. Comparatively, pediatricians had overall low rates of use, as did surgeons, except for tobacco smoking. Anesthesiologists had higher use only for major opiates. Self-reported substance abuse and dependence were at highest levels among psychiatrists and emergency physicians, and lowest among surgeons. With evidence from studies such as this one, a specialty can organize prevention programs to address patterns of substance use specific to that specialty, the specialty characteristics of its members, and their unique practice environments that may contribute risk of substance abuse and dependence.

Health risk behaviors and morbidity among hospital staff − comparison across hospital ward medical specialties in a study of 21 Finnish hospitals

“…Our findings are in agreement with earlier mainly cross-sectional studies focused on specialized physicians, as they show higher rates of self-reported burnout, mental disorders, and smoking among psychiatrists when compared to other physicians (3)(4)(5)(6)(7)(8)(9)(10), and studies showing more favorable health behaviors among surgeons and pediatricians (7)(8)(9)(10)(11)(12). We found that the differences between specialties in our study with the majority of participants being nurses were quite similar to those reported for physicians.…”

“…In hospital settings, there is some evidence to suggest differences in health and health behaviors between staff working in different specialties (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Studies of physicians show elevated rates of "burnout", mental disorders, substance use, and suicide among psychiatrists, anesthesiologists, and physicians working in emergency or primary care although the association is not robust (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In contrast, surgeons and pediatricians have reported lower rates of substance use (7), although this is not a universal finding (9,10).…”

“…Studies of physicians show elevated rates of "burnout", mental disorders, substance use, and suicide among psychiatrists, anesthesiologists, and physicians working in emergency or primary care although the association is not robust (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In contrast, surgeons and pediatricians have reported lower rates of substance use (7), although this is not a universal finding (9,10). Surgeons have also been shown to have higher (11) and lower (12) risk of death from ischemic heart disease when compared to other medical specialists.…”

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

“…18 Studies pre-dating the 1980s identified meperidine, a synthetic opioid, to be the most frequently abused controlled substance, followed closely by benzodiazepines and barbiturates. 19 In line with our results, fentanyl has since superseded meperidine as the opioid most often implicated in reported cases of chemical dependence. 3,10,20 There were two cases of propofol abuse reported in our results.…”

Anesthesiologists Recovering From Chemical Dependency: Can They Safely Return to the Operating Room?

“…[5][6][7] This postulate is supported by data on major opioid use by anesthesiologists (morphine, meperidine, fentanyl, and other injectable narcotics) and minor opioid use by family physicians (hydrocodone, oxycodone, codeine, and other oral drugs). [5][6][7] In contrast with physicians in other specialties who primarily administer medications by proxy and therefore do not touch drugs or have them in their possession, anesthesiologists directly administer fentanyl, sufentanil, alfentanil, and remifentanil on a daily basis; although protocols to prevent diversion are typically in place at every hospital and outpatient surgical center, they are not fail-safe. 8 If use of major opioids results in a more aggressive manifestation and progression of addiction, that would partly account for the overrepresentation of anesthesiologists in physician treatment and monitoring programs.…”