Precautions Addressing Substance Use Disorder in Anesthesiologists

According to a study conducted in 2020, at least 1.6% of anesthesiologists are likely to suffer from substance use disorder during their careers [1]. Alcohol, opioids, and anesthetics are some of the substances that these physicians abuse most often [1]. Were substance use disorder considered an occupational hazard, anesthesiologists would rank among the most endangered workers in the United States [1]. 

Notwithstanding an individual’s profession, substance use disorder exposes its sufferers to severe risks. It is particularly dangerous for anesthesiologists, given the responsibility that they wield over the lives and health of other people [2]. Substance use disorder can impede an anesthesiologist’s training and result in severe professional consequences, such as failure to become certified in a subspecialty or to complete residency [2]. With the trajectory of anesthesiologists’ own lives – as well as the lives of others – in danger, the importance of curbing substance use disorder among them cannot be understated.  

Different types of policies serve to address this problem, with varying degrees of success. For instance, educational programs have been created to educate anesthesiologists about how to identify the disorder and intervene when they recognize it in their peers [2]. Identification can be difficult, given how anesthesiologists are cognizant of the signs of substance use disorder and thus more aware of how to hide them from others [3]. A pivotal warning sign to look out for is a change in the suspected individual’s functional capacity: substance abuse impedes people’s ability to carry out certain duties [3].  

Other warning signs are the replacement of a syringe or ampule’s contents with saline and the taking of narcotics from disposal containers [3]. Anesthesiologists with substance use disorder may also report that a case is opioid-based but then only administer beta-blockers and inhalational agents to the patient, taking the opioid medication for their own use [3]. To prevent these actions, some medical facilities conduct regular inspections of dispenser transactions and anesthetic records [2]. Meanwhile, to combat the removal of substances from waste, greater security measures may be wise. 

A more recent innovation has been the randomized substance testing of anesthesiologists, among other personnel, in medical institutions [2]. This strategy is not widely used – it appears to occur in a limited amount of civilian hospitals – but a study of anesthesiology residents at Massachusetts General Hospital suggests that it could be helpful in disincentivizing substance abuse and identifying it when it does occur [2, 4]. The experiment reported no cases of substance use over its 1,002-resident-year testing period, compared with four cases during the previous 719 resident years [4]. This was a limited study, however, so further research must occur to fully understand the beneficial effects of drug testing, if any, on substance use disorder among anesthesiologists and other physicians [4]. 

While submitting anesthesiologists to randomized testing may help identify those who suffer from substance abuse, the pathways to voluntary confession should also be improved to give physicians who wish to seek help an easy way to do so. It typically takes years for substance abuse to become apparent [5]. Giving anesthesiologists an option to disclose their disorder to a helpful, responsible authority could help challenge the stigma associated with the disorder and, ultimately, encourage anesthesiologists to openly seek help [6].  

Because of the incompleteness of current strategies, such as educational and surveillance programs, a multi-faceted approach that employs several of the aforementioned precautions may be the best way to address substance use disorder among anesthesiologists [2]. Through trial and error, medical institutions may be able to combat this problem and improve the health of their patients and their personnel. 

References 

[1] D. O. Warner et al., “Substance Use Disorder in Physicians after Completion of Training in Anesthesiology in the United States from 1977 to 2013,” Anesthesiology, vol. 133, p. 342-349, August 2020. [Online]. Available: https://doi.org/10.1097/ALN.0000000000003310. 

[2] E. O. Bryson, “The opioid epidemic and the current prevalence of substance use disorder in anesthesiologists,” Current Opinion in Anesthesiology, vol. 31, no. 3, p. 388-392, June 2018. [Online]. Available: https://doi.org/10.1097/ACO.0000000000000589. 

[3] L. G. Lefebvre and I. M. Kaufmann, “The identification and management of substance use disorders in anesthesiologists,” Canadian Journal of Anesthesia, vol. 64, p. 211-218, November 2016. [Online]. Available: https://doi.org/10.1007/s12630-016-0775-y. 

[4] M. G. Fitzsimons et al., “Reducing the Incidence of Substance Use Disorders in Anesthesiology Residents: 13 Years of Comprehensive Urine Drug Screening,” Anesthesiology, vol. 129, p. 821-828, October 2018. [Online]. Available: https://doi.org/10.1097/ALN.0000000000002348. 

[5] D. Volquind et al., “Occupational Hazards and Diseases Related to the Practice of Anesthesiology,” Brazilian Journal of Anesthesiology, vol. 63, no. 2, p. 227-232, March-April 2013. [Online]. Available: https://doi.org/10.1016/j.bjane.2012.06.006. 

[6] S. J. S. Bajwa and J. Kaur, “Risk and safety concerns in anesthesiology practice: The present perspective,” Anesthesia Essays and Researchers, vol. 6, no. 2, p. 227-232, March-April 2013. [Online]. Available: https://doi.org/10.1016/j.bjane.2012.06.006.