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Doctors who practice under the influence of illicit substances not only jeopardize their license, but also pose a great risk to their patients. Several factors may contribute to a physician’s decision to misuse substances. Specialized treatment options can guide physicians toward a substance-free life and allow them to return to work.
Drug addiction has been a longstanding problem for doctors. Dr. William Stewart Halsted, also known as “the Father of American Surgery,” became addicted to cocaine while experimenting with the drug as a surgical anesthetic. Physicians treated him with morphine, which led to a second addiction.
Addiction is the most common cause of impairment among physicians. A 2013 study by the University of Florida reported that 10 to 15 percent of doctors developed a substance use disorder at some point in their lives.
WHY DO DOCTORS USE DRUGS?
Similar to the general population, doctors resort to painkillers, antidepressants and other prescription medicines as a coping mechanism for stress. Doctors have easy access to drugs, opening the door for self-medication and abuse.
INCREASED DRUG AVAILABILITY
Medical practitioners are more susceptible to prescription drug abuse because of their access to medications. A 2014 review published in the Medical Student Research Journal stated that physicians have a higher rate of prescription drug abuse than the general population.
In fact, their access to a plethora of prescription drugs and clinical supplies not only acts as an influencer for drug misuse, but also as a driving force. Access is paramount to an addict. Doctors with a substance use disorder may put in long hours and outperform others at work to discourage suspicions and maintain their privileged access to drugs.
A CONSPIRACY OF SILENCE
A doctor’s failure to report an impaired colleague contributes to the colleague’s addiction and puts their patients at risk. A 2010 study published in the Journal of the American Medical Association surveyed more than 1,800 physicians to learn about their experiences with colleagues who were incompetent to practice or impaired by alcohol, drugs or mental illness.
Out of the 1,891 physicians who responded, 17 percent personally knew of an impaired or incompetent physician within their circle in the past three years. However, only 67 percent of this group reported their incompetent colleagues to a relevant authority.
The same study discovered that physicians working in small practices are less likely to report an incompetent colleague. Among doctors who were aware of an impaired or incompetent associate, only 44 percent of those in a solo or two-person practice filed a report, compared to 77 percent of those working at universities or medical schools.
Long hours and a heavy patient load take a toll on physicians. Many doctors misuse sedatives and opiates to relieve stress, insomnia or fatigue. The transition between use and misuse can be quick.
A 2014 study published in the Journal of Addiction Medicine asked 55 physicians being monitored for substance-related impairment why they misused prescription drugs. A female doctor said she started using narcotics to relieve her sinusitis and eventually transitioned to using the drug to relieve pain and stress.
Some doctors admitted to misusing drugs because they provide an escape from their tedious lives. One doctor explained that while prescription drugs eased his pain, they also made him worry less about marital stress.
SELF-MEDICATION AND PAIN MANAGEMENT
Most physicians who reported a history of self-medication in the Journal of Addiction Medicine study suffer from chronic pain related to surgery or trauma. Some doctors misuse prescription drugs to treat their anxiety or depression. Their profession allows them to freely prescribe most drugs to themselves. This habit may eventually lead to a drug addiction.
Many of the physicians surveyed revealed that their medical use transitioned to recreational use over time. Moreover, they admitted to trying new drugs beyond the original substances of abuse.
A physician disclosed that he started using opiates after a leg surgery and subsequently transitioned to cough syrup, which became his drug of choice. Another physician reported using Percocet recreationally after being prescribed the drug to manage his pain following surgery.
Recreational use was also common among the physicians surveyed in the 2014 study. Most reported that they misused prescription pills to enhance the effects of other substances such as alcohol. However, some doctors admitted they had to take prescription medications to reverse the effects of other drugs.
In fact, prescription drugs allowed them to function properly after taking illegal drugs. One doctor reported taking Xanax to wean off cocaine, then started using GHB, benzodiazepines and opiates. Another physician mixed cocaine with alcohol and took benzos to come down from the high.
Many of the physicians surveyed admitted to misusing prescription drugs simply to avoid withdrawal symptoms from other substances. One doctor admitted to taking narcotics and benzos at work to avoid the withdrawal symptoms associated with the drugs.
TRENDS AND COMMON SUBSTANCES OF ABUSE
A 2009 study by Mayo Clinic researchers observed a cohort of 904 physicians enrolled in physician health programs over five years. They found that 50.3 percent of the doctors misused alcohol, while nearly 36 percent abused opioids.
Half of the cohort admitted to misusing multiple substances, and 17 percent reported undergoing previous addiction treatment. The research pointed out that the rate of incidence of addiction was higher in professions such as anesthesiology, emergency medicine and psychiatry. Despite the prevalence of alcohol addiction, only 10 percent of anesthesiologists sought treatment for their alcohol use disorder.
In the Journal of Addiction Medicine study, all doctors who misused prescription medications had a history of illegal drug and alcohol use. In fact, 94 percent of the doctors who admitted to prescription drugs misuse consumed alcohol at least once in their lifetimes.
Out of the 55 clinicians who responded to the survey, 69 percent reported misusing prescription drugs. The most popular prescription medications used by this group were opiates, sedatives and stimulants.
IDENTIFYING AN IMPAIRED DOCTOR
For many doctors, a change in work performance is not apparent until late in the timeline of substance use. Determining that a physician is struggling with substance abuse is often the first step in helping them. However, this may be difficult because medical professionals are typically good at covering up their addiction and rarely think they need outside help.
One in 10 doctors will develop a substance use disorder throughout their careers, so it is likely that patients will encounter an impaired doctor. While it may be difficult to tell if a doctor is under the influence of drugs or alcohol, a few physical, social and emotional changes may indicate substance abuse.
Some typical signs of an underlying drug addiction in a doctor include:
- Withdrawal from social settings with colleagues
- Decreased performance at work
- Increase in time spent at work
- Change in diet or appearance
- Frequent absences
- Increased anxiety, defensiveness, depression or disruptive behaviors
- Unusual drug orders
- Mood swings
- Sexual promiscuity
- Smell of alcohol
- Heavy drinking at events
- Law enforcement troubles
- Excessive sweating
- Patient complaints
- High incidence of illness or injury
- Isolation at work
- Slurred speech or tremors
- Difficulty walking
- Lack of coordination
- Memory impairment
Encouraging physicians with a substance use disorder to seek the treatment may save their careers.
ADDICTION TREATMENT FOR DOCTORS
Due to the nature and high demands of their work, physicians require a specialized team of experts to provide them with the proper treatment. Impaired doctors typically deny their addiction when confronted, which may hinder early detection.
The Mayo Clinic study reported that 95 percent of physicians are enrolled in treatment plans similar to 12-step programs. More than three out of four of these physicians stayed in residential treatment centers for an average of 72 days, while 22 percent enrolled in outpatient programs.
CAN DOCTORS RETURN TO WORK AFTER TREATMENT?
According to the Mayo Clinic study, physicians in recovery boast 74 to 90 percent abstinence rates, which is higher than the general population. These high rates may be due to their determination to maintain their license.
With proper monitoring, a solid addiction recovery program and enrollment in a state PHP, physicians can return to work. Through contracts, the PHPs will ensure that physicians are compliant with activities that promote long-term abstinence from substance use.
- Winter, F.D. (2011). Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted by Gerald Imber, MD. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246868/
- Merlo, L.J. et al. (2013, September). Reasons for Misuse of Prescription Medication Among Physicians Undergoing Monitoring by a Physician Health Program. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790148/#__articleid729968aff-info
- Dumitrascu, C.I. (2014, January). Substance Use Among Physicians and Medical Students. Retrieved from http://msrj.chm.msu.edu/wp-content/uploads/2014/04/MSRJ-Winter-2014-Substance-Use-Among-Physicians-and-Medical-Students.pdf
- Reese, S. (2014, January 29). Drug Abuse Among Doctors. Retrieved from http://www.medscape.com/viewarticle/819223_2
- DesRoches, C.M. (2010, July 14). Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=186214
- Berge, K.H., Seppala, M.D. & Schipper, A.M. (2009, July). Chemical Dependency and the Physician. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704134/
- Skerrett, P.J. (2012, November 6). Doctors aren’t immune to addiction. Retrieved from http://www.health.harvard.edu/blog/doctors-arent-immune-to-addiction-201211165538
- Federation of State Medical Boards. (2011, April). Policy on Physician Impairment. Retrieved from https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/grpol_policy-on-physician-impairment.pdf