Extra Topic 3.5 -- Physician Substance Abuse

Question 1

How would you react to this information?

(Your partner has been acting strange the last several weeks. He is always volunteering to give breaks and take extra weekend call. The pharmacy administrator confides in you that he has been administering inappropriately large doses of narcotics for the procedures being performed and is concerned that he may be diverting narcotics for personal use.)

Answer 1

This pattern of behavior is concerning due to risk that drug abuse poses to the health and well-being of the using physician and his patients, as well as exposure of the hospital, staff, and anesthesia department to significant liability.

Therefore, I would immediately share my concern with the head of the anesthesia department and medical staff committee.

Ideally, there would already be policies and procedures in place to help potentially addicted physicians.

A good hospital policy would involve an intervention with my partner to encourage him to undergo a multidisciplinary medical evaluation by a team of experts at an experienced inpatient or residential treatment program.

Question 2

What is the difference between narcotic abuse, addiction, and dependence?

(Your partner has been acting strange the last several weeks. He is always volunteering to give breaks and take extra weekend call. The pharmacy administrator confides in you that he has been administering inappropriately large doses of narcotics for the procedures being performed and is concerned that he may be diverting narcotics for personal use.)

Answer 2

Narcotic abuse is defined as = the use of a psychoactive substance in a manner detrimental to the individual or society but not meeting the criteria for dependence.

Addiction is = a medical disease manifested by compulsive use of an addictive drug with loss of control and irrepressible craving.

Dependence = is a physiological state of adaptation to a specific psychoactive substance characterized by the emergence of a withdrawal syndrome during abstinence.

Question 3

What is the incidence of substance abuse among anesthesiologists?

(Your partner has been acting strange the last several weeks. He is always volunteering to give breaks and take extra weekend call. The pharmacy administrator confides in you that he has been administering inappropriately large doses of narcotics for the procedures being performed and is concerned that he may be diverting narcotics for personal use.)

Answer 3

In 1994-95 the reported incidence among anesthesia residents was 0.40 percent with faculty incidence at 0.10 percent.

Opioids are the drug of choice for anesthesiologists, with fentanyl and sufentanil being the most commonly used, followed by meperidine and morphine.

Question 4

Is substance abuse more common among anesthesiologists compared to other physicians?

(Your partner has been acting strange the last several weeks. He is always volunteering to give breaks and take extra weekend call. The pharmacy administrator confides in you that he has been administering inappropriately large doses of narcotics for the procedures being performed and is concerned that he may be diverting narcotics for personal use.)

Answer 4

Anesthesiologists are over-represented in addiction treatment programs at a rate about three times higher (12-15 percent of physicians in treatment programs) than would be expected based on the percentage of U.S. anesthesiologists.

This may be due to easy access to drugs, being accustomed to giving large doses of mood-altering parenteral substances with immediate results, or because there is more awareness in anesthesiology.

Question 5

What are the signs, symptoms, and/or behaviors associated with opioid addiction?

(Your partner has been acting strange the last several weeks. He is always volunteering to give breaks and take extra weekend call. The pharmacy administrator confides in you that he has been administering inappropriately large doses of narcotics for the procedures being performed and is concerned that he may be diverting narcotics for personal use.)

Answer 5

The signs and symptoms of opioid addiction include:

1. unusual changes in behavior,
2. signing out increasing quantities of narcotics,
3. frequent breakage of narcotic vials,
4. a desire to work alone,
5. volunteering for extra cases,
6. frequent bathroom breaks,
7. pinpoint pupils,
8. charting irregularities, and
9. signs and symptoms of withdrawal, such as diaphoresis, tremors, mydriasis, rhinorrhea, myalgia, nausea, and vomiting.
10. Other signs of opioid abuse/addiction include – the apparent administration of inappropriately high doses of narcotics for the specific procedures being performed, and
11. an excessive number of post-operative patients experiencing pain that is disproportionate to charted narcotic dosing.

Question 6

How can you reduce the risk of substance abuse in your anesthesia department?

(Your partner has been acting strange the last several weeks. He is always volunteering to give breaks and take extra weekend call. The pharmacy administrator confides in you that he has been administering inappropriately large doses of narcotics for the procedures being performed and is concerned that he may be diverting narcotics for personal use.)

Answer 6

The incidence, morbidity, and mortality of substance abuse may be reduced by policies that promote physician emotional and physical health, and facilitate the early identification of physicians at risk.

Specifically, each department should –

provide at least one designated, educated member to whom anyone can go for help or information;

ensure physician accountability by monitoring narcotic check-out, utilization, and waste;

aid physicians in stress management; and

provide better addiction-related education to physicians, residents, and medical students.