4. in order to practice medicine in any

4. Palhares-Alves HN, Vieira DL, Laranjeira RR, Vieira JE, Nogueira-Martins LA. Clinical and demographic profile of anesthesiologists using alcohol and other drugs under treatment in a pioneering program in brazil. Rev Bras Anestesiol. 2012;62(3):356-364. doi: 10.1016/S0034-7094(12)70136-8 doi.

3. Oreskovich MR, Caldeiro RM. Anesthesiologists recovering from chemical dependency: Can they safely return to the operating room? Mayo Clinic Proceedings. 2009;84(7):576-580. https://www.sciencedirect.com/science/article/pii/S0025619611607453. doi: 10.1016/S0025-6196(11)60745-3.

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2. Bryson EO. Addiction and substance abuse in anesthesiology. Anesthesiology. 2008;109(5):905-917. http://www.ncbi.nlm.nih.gov/pubmed/18946304. doi: 10.1097/ALN.0b013e3181895bc1.

1. Jungerman FS, Palhares-Alves HN, Carmona MJC, Conti NB, Malbergier A. Anesthetic drug abuse by anesthesiologists. Revista brasileira de anestesiologia. 2012;62(3):375-386. http://www.ncbi.nlm.nih.gov/pubmed/22656683. doi: 10.1016/S0034-7094(12)70138-1.

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                Efforts should be made to prevent substance abuse among anesthesiologists including stricter drug control. Stricter drug control would make it more difficult for these individuals to divert drugs from patients to themselves.2 Frequent drug screening of these individuals could also serve as a deterrent to giving in to experimental drug abuse in the work place.2 Even if these interventions do not decrease the instance of drug abuse among anesthesiologists, they could aid in earlier detection of addiction which would, in turn, prevent harm to patients and decrease substance abuse related physician mortality.

There is some hesitation as to whether or not anesthesiologists who are discharged from rehabilitation programs should be allowed to return to practice within their specialty. This hesitation stems from the potential for these individuals to relapse once they regain access to the same highly addictive opioids upon return to practicing.4 Whether or not these individuals should be allowed to return to anesthesiology is still up for debate but should be evaluated on a case-by-case basis.4 An alternative option is for the individuals to switch to a different specialty to diminish that risk of relapse.4

The American Board of Anesthesiology (ABA) requires anesthesiologists to possess an unrestricted medical license in order to practice medicine in any state.2 In order to allow for the rehabilitation of anesthesiologists struggling with substance abuse, the ABA does not consider participation in a treatment program for impaired physicians a restriction of licensure.2 This exception should help mitigate some of those fears preventing physicians from admitting their problem with substance abuse and accepting assistance for their addiction.

There are serious risks and consequences associated with drug abuse among anesthesiologists. Most pressing is the risk is of death due to overdose or suicide especially in the younger physicians who use more potent opioids during their residencies.1 Rates of death and suicide are typically the highest during the first five years following graduation from medical school.1 Other consequences relate to legal issues surrounding the drug abuse. If a physician is reported to a state medical board, his or her medical license is placed in jeopardy. Whether or not an individual’s medical license is revoked or suspended is up to each state’s medical licensing board.2 In addition, federal, local or state authorities may press criminal charges for possession or diversion of controlled substances.2 In certain states, if physicians seek help for substance abuse through medical societies outside of their state medical board, they may be given the option to enroll in a rehabilitation program.2 These programs are voluntary, however, failure to participate often provokes the medical societies to report the physicians to the state medical board.2 The threat of such legal consequences often discourages physicians from seeking help from their addictions.

Research has suggested that psychopathology is a comorbidity for substance abuse.2 A large percentage of substance abusers in the medical field have been diagnosed with some personality or other psychological disorder.2 Substance abuse tends to become a coping mechanism for such disorders, acting as a form of self-medication.2 Those with similar personality traits tend towards using drugs of the same class to self-medicate which serves as evidence for the relationship between the two.2 For example, individuals diagnosed with attention deficit disorder or attention deficit hyperactivity disorder typically choose amphetamines.2 Those diagnosed with depression and anxiety tend towards using opioids.2 Given this evidence, individuals suspected of substance abuse should concurrently be evaluated and treated for comorbid psychopathologies.2

As opposed to other specialists, anesthesiologists possess access to such narcotics which they are physically administering to patients.3 Since they are responsible for administration of these drugs, it is likely easier for them to fly under the radar should they choose to defer a small amount of a drug from a patient to him or herself. Anesthesiology tends to be one of the high stress specialties as the provider must be constantly vigilant during every moment of every surgery to monitor patient vitals.1,3 Surgeries may take several hours and the combination of the physical and mental strain may also provoke individuals to take advantage of that access to high-potency narcotics.

One explanation surrounds the fact that anesthesiologists are exposed to the use of high-potency opioids by nature of the specialty itself.3 Researchers have eluded to the possibility that exposure to potential drugs of abuse in the workplace increases the occurrence of abuse of those drugs.3 It has been hypothesized that substance abuse of opioids by anesthesiologists may be promoted by an unintentional sensitization process in the work place.1,2 The basis for this hypothesis is that there are trace amounts of the potent opioids being emitted into the air of operating rooms through exhalation of anesthetized patients.1,2 The anesthesiologist inhales these aerosolized particles which are enough to activate his or her reward system in the brain.1,2 Repeated exposure sensitizes the reward pathways to promote curiosity and the affinity to experiment with substances.1,2

The prevalence of substance abuse among physicians and other healthcare professionals is somewhat greater than the general population. This predominantly includes abuse of alcohol, opioids and tranquilizers.1 The percentage of individuals who fall into this category differs greatly across specialties, according to medical literature. The top five specialties that pose the greatest risk of substance abuse from highest to lowest are as follows: family medicine, internal medicine, anesthesiology, emergency medicine and psychiatry.1 Although anesthesiology falls at number three on this list, anesthesiologists constitute the majority of physicians who are partaking in chemical dependency treatments as well as monitoring programs.3 Historically, the drug of choice for anesthesiologists has been an opioid.2 These individuals tend to use injectable narcotics like sufentanil, fentanyl, ketamine and morphine.2,3 Several etiologies surrounding this incidence have been explored including environmental factors and comorbid psychiatric conditions.

Substance Abuse and Addiction Among Anesthesiologists