The incidence of this disorder is continuing to increase and the risk of relapse or death is high. The study appears in the Dec. 4 issue of JAMA, a medical education theme issue.
MULTIMEDIA ALERT: Video of Dr. Warner is available for download from the Mayo Clinic News Network.
Substance use disorder is a serious public health problem, and physicians are not immune. Anesthesiologists have ready access to potent drugs such as intravenous opioids, although only indirect evidence exists that SUD is more common in anesthesiologists than in other physicians, according to background information in the article.
“Although relatively few anesthesiology residents develop SUD, the incidence is continuing to increase,” says David Warner, M.D., of Mayo Clinic’s Department of Anesthesiology, and the ABA Board of Directors and chair of the Research and Credentials committees. “The problem is as serious now as it has been at any time over the period of study, and the consequences can be severe. Residents who develop substance use problems are at high risk for relapse after treatment or, in some cases, die as a result of the disorder.”
Of the 44,612 residents who entered training during the study period, 0.86 percent had SUD confirmed during training. During the study period, an initially high rate was followed by a period of lower rates in 1996–2002, but the highest rates have occurred since 2003. The most common substance used was intravenous opioids, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. Twenty-eight individuals died during the training period; all deaths were related to SUD.
The researchers estimated that approximately 43 percent of survivors experienced at least one relapse by 30 years after the initial episode. Risk of death was also high; at least 11 percent of those with evidence of SUD died of a cause directly related to the disorder. Rates of relapse and death did not depend on the category of substance used.
“While we have no direct data to show harm to patients, impaired physicians may put patients at risk — and certainly put themselves at risk. It’s incumbent upon us as medical professionals to do what we can to identify and address substance use disorders as quickly as possible to protect both the involved physicians and their patients,” says Dr. Warner.
(doi:10.l001/jama.2013.281954; study available to the media at http://media.jamanetwork.com)
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