Anesthesiologists And Drug Addiction

The problem of chemical dependency is particularly prevalent in anesthesiology. Among physicians, anesthesiologists, who primarily abuse major opioids, reportedly have the highest incidence of drug addiction.1 They comprise approximately 4% of all US physicians but make up about 12 to 15% of all doctors currently in addiction treatment programs.2 However, the significance of the prevalence of drug addiction in anesthesiology, as compared to other specialties, is somewhat controversial. Anesthesia departments are better trained than others to detect early signs of addiction. Increased awareness of drug abuse, rather than greater frequency, may lead to an unusually high statistical representation of drug-abusing anesthesiologists. Moreover, another study found the highest levels of self-reported drug dependence not among anesthesiologists, but among psychiatrists (who abuse benzodiazepines) and emergency room doctors (who take illicit drugs).3 Regardless of drug or practice environment, physician substance abuse is a serious and universal problem.

There are several reasons why anesthesiologists are three times more likely than other physicians to start abusing drugs. They regularly administer highly addictive drugs (like fentanyl and sufentanil) that most physicians never prescribe. They are among the few specialists that actually prepare and dose intravenous narcotics themselves (usually done by a pharmacist). As a result, they have easy access to controlled substances, whether by blatant stealing, falsifying records, or switching syringes. They may become especially curious about the effects of the drugs they administer and want to experience what the patient feels. Finally, anesthesiologists are often under a great deal of stress. They have to cope with responsibility for a patient's life, pressure for rapid turnover time, anxiety that a minor error can cause a patient to die, and fatigue. The sheer strain of this specialty may cause an anesthesiologist to be susceptible to chemical dependency.

Because physician drug addiction is a concern in every specialty, this issue should not discourage medical students from considering anesthesiology. But medical students who have a personal history of substance abuse, whether of alcohol or illicit drugs, should be wary of the possible occupational hazard in anesthesiology. Because of the daily temptation, recovery and re-entry into the operating room environment can be exceptionally difficult. Most departments of anesthesiology have developed excellent mechanisms to identify individuals who may be susceptible to addiction. After all, the consequences are quite damaging. Depending on the point of their career, addicted anesthesiologists can lose their medical license, job, residency program position, or, at the worst, their life. A recent mortality study found that anesthesiologists are, compared to internists, at twice the risk of drug-related suicide and three times the risk of any drug-related death.4 Although anesthesiologists are recognized as leaders in patient safety, their occupation can, at times, place their own lives at risk.

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