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Examining substance abuse and relapse among impaired physicians
- Lisa J Merlo, Mark S. Gold (11 November 2008)
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Lisa J Merlo, Assistant Professor McKinght Brain Institute, University of Florida, Gainesville, FL 32610, Mark S. Gold
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To the Editor: The articles by McLellan et al.1 and Brewster et al.2 in the November issue of BMJ reported outcomes of physicians enrolled in Physician Health Programs (PHPs) in the United States and Canada. Given the significant public health impact of physician impairment, this research is extremely important. Although some argue that impaired physicians should be met with harsh punishments and subjected to extremely strict regulatory measures, the current findings provide additional support for the use of appropriate treatment and monitoring procedures. Outcomes for the physicians followed in these studies were remarkably positive. Across the studies, more than ¾ of physicians successfully completed their contract and were able to return to work. This success rate far exceeds that seen among the general population, and is consistent with previous research on this topic.3,4 However, the reports would have been strengthened by inclusion of more data describing the physicians involved in the monitoring programs. Previous research has demonstrated an overrepresentation of anesthesiologists among impaired physicians, particularly when examining those for whom opiates are the drug of choice; in addition, past research has suggested that relapse rates may be higher among this specialty, perhaps due to various “occupational hazards” associated with the practice of anesthesiology (for a review, see 5). Substance-induced mortality (including suicide) is also higher among anesthesiologists.6 As a result, more research is needed to replicate these findings and clarify the factors that contribute to the decreased success of treatment for these physicians. In order to adequately treat these physicians and protect the public from undue harm, predictors of relapse should be considered when developing the treatment and monitoring plans. Similarly, results of the Brewster et al. study were consistent with previous research demonstrating significantly higher rates of smoking among impaired physicians compared to non-impaired physicians or the general public.7 Cigarette smoking may represent a risk factor for other substance abuse among this population, which may warrant further attention in future studies. Lisa J. Merlo, Ph.D.
Mark S. Gold, M.D.
References 1. McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ 2008;337:a2038. 2. Brewster JM, Kaufmann IM, Hutchinson S, MacWilliam C. Characteristics and outcomes of doctors in a substance dependence monitoring programme in Canada: a prospective descriptive study. BMJ 2008;337:a2098. 3. Gallegos KV, Keppler JP, Wilson PO. Returning to work after rehabilitation: aftercare, follow-up and workplace reliability. Occup Med 1989;4:357-71. 4. Femino, J, Nirenberg, TD. Treatment outcome studies on physician impairment: a review of the literature. R I Med 1994;77:345-50. 5. Merlo LJ, Gold MS. Prescription opioid abuse and dependence among physicians: hypotheses and treatment. Harvard Rev Psychiatry 2008;16:181- 94. 6. Alexander BH, Checkoway H, Nagahama SI, Domino KB. Cause-specific mortality risks of anesthesiologists. Anesthesiology 2000;93:922-30. 7. Merlo LJ, Goldberger BA, Kolodner D, Fitzgerald K, Gold MS. Fentanyl and propofol exposure in the operating room: sensitization hypotheses and further data. J Addict Dis 2008;27:67-76. Competing interests: None declared |
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