Risk and Outcomes of Substance Use Disorder among Anesthesiology Residents

Abstract

Background The goal of this work was to evaluate selected risk factors and outcomes for substance use disorder (SUD) in physicians enrolled in anesthesiology residencies approved by the Accreditation Council for Graduate Medical Education. Methods For each of 384 individuals with evidence of SUD while in primary residency training in anesthesiology from 1975–2009, two controls (n=768) who did not develop SUD were identified and matched for gender, age, primary residency program, and program start date. Risk factors evaluated included location of medical school training (United States vs other) and anesthesia knowledge as assessed by In-Training Examination performance. Outcomes (assessed to December 31, 2013, with a median follow-up time of 12.2 years and 15.1 years for cases and controls, respectively) included mortality and profession-related outcomes. Results Receiving medical education within the United States, but not performance on the first in-training examination, was associated with an increased risk of developing SUD as a resident. Cases demonstrated a marked increase in the risk of death after training (hazard ratio 7.9 [95% CI, 3.1–20.5]), adverse training outcomes (including failure to complete residency (odds ratio 14.9 [9.0–24.6]) or become board certified (odds ratio 10.4 [7.0–15.5]), and adverse medical licensure actions subsequent to residency (hazard ratio 6.8 [3.8–12.2]). As of the end of follow-up, 54 (14.1%) cases were deceased compared with 10 (1.3%) controls; 28 cases and no controls died during residency. Conclusions The attributable risk of SUD to several adverse outcomes during and after residency training, including death and adverse medical license actions, is substantial.

Non-opioid anesthetic drug abuse among anesthesia care providers: a narrative review

“…7 It has been suggested that anesthesia providers are at increased risk for substance abuse relative to other medical specialties as a result of high levels of work-related stress, easier access to controlled substances, chronic exposure to trace quantities of addictive substances, and a variety of other potential contributing factors. 8,9 Additionally, previous reports have indicated that anesthesiologists are overrepresented in drug treatment programs relative to their proportion among medical specialties and are more likely to abuse substances with a higher risk of relapse. 2,10,11 In addition to anesthesiology, other specialties, such as family medicine, internal medicine, and surgery, are overrepresented when compared with obstetrics and gynecology or pediatrics.…”

“…1 Traditionally, opioids have been the most commonly abused anesthesia medication by anesthesia care providers (ACPs). 1,9,13 Previous reports have documented opioids as the substances abused in 62% 9 and 66% 13 of cases. Nevertheless, non-opioid anesthesia medications also represent a significant source of abuse and are a potentially underappreciated cause of morbidity, mortality, and professional demise among ACPs.…”

Anesthetic substance abuse: international perspectives and parallels

“…3,4 The most divergent result in Australasia, however, has been the high incidence of propofol abuse, particularly over the last decade. In the most recent ten-year survey of Australasian anaesthetists, 61 cases were reported, an incidence of 1.2 cases per 1,000 anaesthetist years.…”

Substance use disorder in Canadian university departments of anesthesia

“…3 Those with SUD were 15 times more likely not to complete their training, ten times more likely not to become Board (ABA) certified, and seven times more likely to have adverse medical licensure actions. The risk of death after training was 7.9 times higher in the SUD cases.…”

“…2 The analysis for that study integrated anonymized data from the American Board of Anesthesiology (ABA), the National Death Index, and the Disciplinary Action Notification Service of the Federation of State Medical Boards. The overall incidence of SUD during anesthesia training was 0.86%, with 384 SUD cases identified.…”