Abstract
Addiction is a global problem impacting individuals, families, communities, and societies. It involves relapse, no definite cure, and continuous therapy. Anesthesiologists and surgeons are at higher risk of drug abuse due to various factors. More than 40% of anesthesiologists who participate in Physician Health Programs are there due to intravenous drug use. This prevalence of substance abuse is alarming, with 7 to 18% facing death or overdose due to factors including direct access to potent drugs, mental health issues, lack of control over drugs, peer influence, and risk of relapse post-treatment. The mortality rate for substance abuse in anesthesiologists is 26-38%. Substance abuse affects clinical judgments leading to errors, communication issues, adverse events, and impairment increases the risk of medical errors, which jeopardizes patient safety. Impaired practitioners may struggle to resume practice due to safety concerns related to their substance use history. Studies have reported varying prevalence rates of substance use disorders and burnout among physicians. Research has found a 13 to 14% lifetime prevalence and 1% 1-year prevalence of substance use disorders and burnouts among anesthesiologists and surgeons. Addressing these issues involves implementing comprehensive drug testing programs, monitoring programs, early intervention, and prevention strategies, promoting a supportive workplace culture for physicians, and confidential counseling and support services to report mental health concerns without fear. Stress management and well-being training programs can prevent substance abuse, encourage self-care, and maintain a healthy work-life balance.
Keywords:
Addiction, physicians, anesthesiologists, patient safety, substance abuse, surgeonsReferences
Koob GF, Volkow ND. Neurobiology of addiction: a neurocircuitry analysis. Elsevier BV. 2016; 3(8): 760–773. https://doi.org/10.1016/s2215-0366(16)00104-8
Heilig M, MacKillop J, Martínez D, Rehm J, Leggio L, Vanderschuren LJMJ. Addiction as a brain disease revised: why it still matters, and the need for consilience. Neuropsychopharmacol. 2021; 46(10): 1715–1723. https://doi.org/10.1038/s41386-020-00950-y
Bryson EO, Silverstein JH. Addiction and substance abuse in anesthesiology. Anesthesiology. 2008; 109(5): 905–917. doi: 10.1097/ALN.0b013e3181895bc1
Booth JV, Grossman D, Moore J, Lineberger CK, Reynolds JD, Rêves JG, Sheffield D. Substance abuse among physicians: a survey of academic anesthesiology programs. Anesthesia & Analgesia. 2002; 95(4): 1024–1030. https://doi.org/10.1213/00000539-200210000-00043
Hughes PH, Storr CL, Brandenburg NA, Baldwin DC, Anthony JC, Sheehan DV. Physician substance use by medical specialty. Journal of Addictive Diseases. 1999; 18(2): 23–37. https://doi.org/10.1300/j069v18n02_03
Gold MS, Melker RJ, Dennis DM, Morey TE, Bajpai LK, Pomm R et al. Fentanyl abuse and dependence: further evidence for second-hand exposure hypothesis. J Addict Dis. 2006; 25(1): 15–21.
McAuliffe PF, Gold MS, Bajpai L, Merves ML, Frost-Pineda K, Pomm RM et al. Second-hand exposure to aerosolized intravenous anesthetics propofol and fentanyl may cause sensitization and subsequent opiate addiction among anesthesiologists and surgeons. Med Hypotheses. 2006; 66(5): 874–882.
Merlo LJ, Goldberg BA, Kolodner D, Fitzgeral K, Gold MS. Fentanyl and propofol exposure in the operating room: sensitization hypotheses and further data. J Addict Dis. 2008; 27(3): 67–76.
Van Aken H, Staender S, Mellin-Olsen J, Pelosi P. Patient safety in anaesthesiology. Best Pract Res Clin Anaesthesiol. 2011; 25(2): ix–x. doi: 10.1016/j.bpa.2011.02.012
Oreskovich MR, Shanafelt T, Dyrbye LN, Tan L, Sotile W, Satele D, et al. The prevalence of substance use disorders in American physicians. Am J Addict. 2015; 24(1): 30–38. doi:
DeFord S, Bonom J, Durbin T. A review of literature on substance abuse among anaesthesia providers. J Res Nurs. 2019; 24(8): 587–600. https://doi.org/10.1177/1744987119827353
Oreskovich MR, Caldeiro RM. Anesthesiologists recovering from chemical dependency: Can they safely return to the operating room? Mayo Clin Proc. 2009; 84(7): 576–580. https://doi.org/10.4065/84.7.576
Shanafelt TD. Suicidal ieation among American surgeons. Arch Surg. 2011; 146(1): 54. https://doi.org/10.1001/archsurg.2010.292
Franke AG, Bagusat C, Dietz P, Hoffmann I, Simon P, Ulrich R, et al. Use of illicit and prescription drugs for cognitive or mood enhancement among surgeons. BMC Med. 2013; 11(1). https://doi.org/10.1186/1741-7015-11-102
Buhl A, Oreskovich MR, Meredith CW, Campbell MD, DuPont RL. Prognosis for the recovery of surgeons from chemical dependency: A 5-year outcome study. Arch Surg. 2011; 146(11): 1286–1291.
Berge KH, Seppala MD, Schipper AM. Chemical dependency and the physician. Mayo Clin Proc. 2009; 84(7): 625–631.
Kaiser Permanente Washington Health Research Institute. Publications. Available at: https://www.kpwashingtonresearch.org/sparc/implementation/publications; Accessed 20 July 2024.
American Society of Anesthesiologists (ASA). Guidelines for the ethical practice of anesthesiology. 2020.
Oreskovich MR, Kaups KL, Balch CM, Hanks JB, Satele D, Sloan J et al. Prevalence of alcohol use disorders among American surgeons. Arch Surg. 2012.
Talbott GD, Benson EB, Burroughs M. Medical professionals and substance abuse: An analysis of risk factors and mitigation strategies. J Addict Med. 2019.
Bryson EO. The impact of stress and access to drugs on anesthesiologists' substance abuse rates. Anesth Analg. 2008.
Lowinson JH, Ruiz P, Millman RB, Langrod JG, eds. Substance abuse: A comprehensive textbook. 2005.
National Institute on Drug Abuse (NIDA). Healthcare workers and substance abuse: A resource guide. 2021.
Collins GB, McAllister MS, Jensen M, Gooden TA. Chemical dependency treatment outcomes of residents in anesthesiology: Results of a survey. Anesth Analg. 2005;101(5):1457-62.
Center for Substance Abuse Treatment. Substance abuse treatment for persons with co-occurring disorders. Treatment Improvement Protocol (TIP) Series 42. 2009.
Paris RT, Canavan DI. Physician substance abuse impairment: A critical review. Crit Care Med. 1999;18(1):1-7..
Hughes PH, Brandenburg N, Baldwin DC, et al. Prevalence of substance use among US physicians. JAMA. 1992267(17):2333-9.
Spickard A, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA. 2002.
Shapiro J, Galowitz P. Peer support for clinicians: A programmatic approach. Acad Med. 2016.
Warner DO, Berge K, Sun H, Harman A, Hanson A, Schroeder DR. Substance use disorder among anesthesiology residents, 1975-2009. JAMA. 2013; 310: 2289–2296.
McLellan A, Lewis D, O'Brien C, Kleber H. Drug dependence, a chronic medical illness: Implications for treatment, insurance and outcomes evaluation. JAMA. 2000; 284: 1689-1695.
Kest B, Sarton E, Dahan A. Gender differences in opioid-mediated analgesia: Animal and human studies. Anesthesiology. 2000; 93: 539-547.
McDowell S, Ferner HS, Ferner RE. The pathophysiology of medication errors: How and where they arise. 2009. https://doi.org/10.1111/j.1365-2125.2009.03416.x
Croke EM. Nurses, negligence, and malpractice. American Journal of Nursing. 2003;103(9):p 54-63. https://doi.org/10.1097/00000446-200309000-00017
How to Cite
License
Copyright (c) 2024 Niragh Sikdar, Mustafa Al Jnainati, Megha Mahida, Jana Al Jnainati, Anish Butani, Aishwarya Govindarajan, Maheen Nasir
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright© by the author(s). Published by the Evidence Journals. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.