General News Research — 12 December 2013

Substance use disorders (SUDs) are increasing among medical residents, with the risk for relapse “very high,” new research suggests.

A retrospective cohort study of more than 44,000 anesthesiology residents who began training programs between 1975 and 2009 showed that 384 (0.86%) had a confirmed SUD during their training. Of these, 43% experienced at least 1 relapse after detection and treatment.

In addition, 28 of the study participants died during training, with all of the deaths directly related to an SUD.bigstockphoto_Stethoscope_130135

“In terms of an absolute number, it’s not a great number of residents affected. But looking at the about 6000 anesthesiology residents that are in training each year, that’s about 20 people a year who develop this problem and 1 or 2 who die from this problem,” lead author David O. Warner, MD, professor of anesthesiology at Mayo Clinic in Rochester, Minnesota, told Medscape Medical News.

Dr. Warner added that the incidence rate also increased significantly during the study period.

Intravenous opioids were the most used substance in the study, but marijuana use, excessive alcohol use, and prescription opioid use were also high.

The study was published in the December 4 issue of JAMA.

Wake-up Call for Other Specialties?

“We don’t know what drugs other specialties might abuse or whether the problem is more serious in anesthesiology than elsewhere. But I think it would be good for other specialities’ societies to analyze and report these data to see if our findings are generalizable among other physicians,” said Dr. Warner.

According to investigators, data regarding the epidemiology of SUDs in physicians in general, and anesthesiologists in particular, are limited.

Still, because of their easy access to substances such as intravenous opioids, anesthesiologists have drawn particular attention, the investigators note.

“The specialty has been aware of this particular problem for some time, and the professional societies have developed some outreach materials to try and educate the residents in training about the potential and seriousness of this issue,” said Dr. Warner.

“But we haven’t known the magnitude of the problem and what the outcomes for people who develop these problems might be.”

As reported by Medscape Medical News, a recent study showed that a group of addicted physicians, including anesthesiologists, cited self-medication to help manage physical pain and emotional problems as the top reason for their abuse of prescription drugs.

Pain, Stress Factors?

“We don’t really know among anesthesiology folks why they do this,” said Dr. Warner.

“Addiction is a disease characterized by denial and evasion. So I think what the real reasons might be is a very interesting question. Certainly self-medicating for pain or for stress is quite plausible,” he added.

For the current study, the investigators examined data from the American Board of Anesthesiology (ABA) on 44,612 physicians (84% men) who began anesthesiology residency programs between July 1975 and July 2009.

Possible SUD was flagged in the ABA data through Clinical Competence Reports, examination applications, direct communications with the residents, and the Disciplinary Action Notification Service. Follow-up was conducted periodically until the end of residency training. Follow-up to assess relapse was conducted through December 2010.

This article first appeared on ‘MedScape‘ on 11 December 2013.


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