2 Substance Abuse In HCPs

Question 1

What are the different causes of clinician impairment?

Answer 1

Substance abuse and dependence
Psychiatric disorders
Disruptive behavior
Sexual misconduct
Incompetence
Inappropriate prescribing***
Physical/medical disability

Question 2

What are the different consequences of clinician impairment?

Answer 2

Community
Family
Financial
Legal
Physical and Mental Health
Professional (public/patient safety, decreased quality of patient care, increased medical legal risk)

Question 3

How is physician impairment defined by the AMA?

Answer 3

The inability to practice medicine with reasonable skill and safety to patients by reason of physical or mental illness, including alcoholism and drug dependence

Question 4

_____ of health care professions are impaired due to substance use

Answer 4

~10%

Similar to rates in general population

Question 5

General signs of an abuse problem

Answer 5

Substitution

Preoccupation

Isolation

Compulsion

Denial

Question 6

Giving up important activities

Answer 6

Substitution

Question 7

Drinking or using regularly

Answer 7

Preoccupation

Question 8

Avoiding people in order to use

Answer 8

Isolation

Question 9

Legal, family, or health consequences associated with use

Answer 9

Compulsion

Question 10

Distortions in thinking related to one’s use

Answer 10

Denial

Question 11

Risk factors for substance abuse in the general population

Answer 11

Family history
Childhood abuse
Age of first use
Drug of choice

Question 12

Risk factors for substance abuse specific to health care providers

Answer 12

High standards (some unrealistic)
Pressures (social, economic, and role pressure)
Access to controlled substances
Notion of “occupational hazard” (BS)
Self-treatment
Chronic stress

Question 13

What is the greatest predictor for substance abuse in health care providers?

Answer 13

Conduct in professional training

Question 14

What are the different components of substance abuse treatment for health care providers?

Answer 14

Screening, intervention, assessment, and referral
—> Inpatient (Detox or rehab)
—> Out-patient residential
—> Out-patient rehab (intensive out-patient)
—> Therapy
—> Non-judgmental support

Question 15

What types of therapy are generally used for substance abuse?

Answer 15

Individual counseling and group therapy

12-Step Model (acceptance, willingness, inventory, amends, service, etc)

Question 16

What did the 1990 AAPA position paper on Physician Assistant Impairment (amended in 1992 and reaffirmed in 2013) conclude?

Answer 16

“Physician assistants have an ethical responsibility to protect patients and the public by identifying and assisting impaired colleagues. “Impaired” means being unable to practice medicine with reasonable skill and safety because of physical or mental illness, loss of motor skills, or excessive use or abuse of drugs and alcohol. PAs should be able to recognize impairment in physician supervisors, PAs, and other health care providers and should seek assistance from appropriate resources to encourage these individuals to obtain treatment.”

Question 17

What is your main responsibility as a HCP when it comes to substance abuse?

Answer 17

Protect public and patient safety

Early identification and assistance

Question 18

Scenario: Colleague with alcohol on breath, continual tardiness, interpersonal difficulties, tremor, and difficulty processing.

What do you do?

Answer 18

1. Define nature of impairment
2. Informal discussion with colleague
3. Subsequent follow-up; bring in another colleague
4. Enlist expert if no change occurs
5. Report to Chief of Staff, Dept Chair, Medical Supervisor
6. Finally, may file formal complaint with State Board

Question 19

Scenario: Supervising physician caught using office’s controlled substances

What do you do?

Answer 19

Recognize criminal nature of activity

Mandatory reporting to board
• Voluntary or involuntary
• Self-referral strongly encouraged

Know your state laws! There is always a list of reportable offenses

Question 20

Scenario: You get a DUI

What do you do?

Answer 20

Mandatory reporting under ARS32-3208 if DUI, extreme DUI, or Aggravated DUI

AZ DUI - can be either Class I misdemeanor or Class 4 Felony (depending on BAC, record, moving violations etc)

Question 21

Once you are reported to the board for possible impairment…

Answer 21

Case usually confidential if no related criminal charges, no adverse patient consequences, or statutory violations

Otherwise, Monitored Aftercare Program (MAP) participation under probationary order

Will request professional assessment

If chemical dependency is found, treatment is required

Question 22

Violations of Unprofessional Conduct may receive…

Answer 22

Warning
Advisory Letter
Letter of Reprimand
Decree of Censure
License Suspension
License Revocation

Question 23

The result of a board report for unprofessional conduct will be much more favorable if…

Answer 23

You self-report

Ostrich approach doesn’t work

Question 24

The majority of board actions are due to…

Answer 24

Improper prescribing or dispensing of controlled substances

Question 25

What are the parameters for Arizona’s Monitored Aftercare Program?

Answer 25

5-year contract
Random drug testing (daily check)
Professional monitoring group attendance (monthly, bimonthly)
12-step meeting attendance (90/90, then 3/week)
No self-medication
Communication between individual, counselor, PCP and board

AZ success rates 80-90%

Question 26

Reasons for relapse during MAP in Arizona clinicians

Answer 26

Dishonesty to self
Not working a recovery program
Denial of addiction
Failure to cope with stress
Lack of spiritual program