Physicians and Substance Abuse

January 30, 2010 in Medical Ethics by RangelMD

Physicians just can’t get a break. Either they are supposed to be more perfect than God or they are “addicted to every drug under the sun” as the UK Telegraph puts it in an article about  a medical clinic specifically set up to see health care staff in London. Apparently, the clinic has seen its share of physicians with mental health and substance abuse problems.

In its first year the clinic has treated NHS staff hooked on drugs including heroin, ketamine, a horse tranquilliser, . . . . said Dr Clare Gerada, medical director of the Practitioner Health Programme.

The service also uncovered six cases of undiagnosed psychosis, in which sufferers see things or hear voices.  Two thirds of the 184 treated in the first 12 months had mental health problems, while one in three who came to the specialist service had some form of addiction. Of these 51 were alcoholics and 16 drug addicts.

The drug additcted zombie doctor will see you now!

Your London medical staff will see you now.

Drug addicted, psychotic, zombie doctors are practicing medical care in London! Or not. Drawing over-generalizations from headlines like this is like assuming that everyone in London is dead after reading an article on the number of bodies in the London city morgue. That’s not to say that it isn’t necessarily true. Zombie doctors might be out there but doing a very good job taking care of the population in London being that everyone is dead and all since it’s hard to screw up the medical care of someone who has passed on to brain eating. But I digress.

The reality is that doctors don’t have an overall higher rate of substance abuse and addiction than the general population  (at least according to US statistics which don’t take into account the sheer number of English zombie doctors out wandering the hillsides). What is different is that doctors use/abuse substances in different ratios.  Doctors are less likely to use tobacco and illicit drugs but more likely to have used alcohol than the general population according to a 1992 JAMA study. This is probably consistent with the substance abuse rates of other over-educated, high-pressure, snobby, “establishment” type professions like lawyers, politicians, and business professionals who will never touch a joint but have no problem with the five martini dinner.

What about the fact that physicians appear to have easier access to controlled medications than the general population? The same 1992 JAMA study did find that while physicians were more likely to use prescription mild opiate pain medications and benzodiazepine sedatives, the use of these medications was mostly for legitimate clinical reasons and daily use of these medications was rare. This usage pattern is probably much more reflective of physician’s awareness and acceptance of the role of these medications for various medical conditions than it is the ease of acquiring these medications. Ergo, it’s a fallacy to think that the availability of substances is what drives abuse and addiction just as there is no proof that the mere availability of seat belts, condoms, or firearms leads in turn to reckless driving, sexual promiscuity, or criminal activity.

ER physicians and anesthesiologists appear to have the greatest risk of developing substance abuse problems compared to the profession as a whole. I.e they are over-represented but the overall abuse rates of narcotics and other controlled medications in these professions are still less than that of the general population.

The idea that physicians as a whole or that certain medical specialists are at higher risk for substance abuse than everyone else appears to be “based on folklore” as a result of ignorance, prejudice, and fallacies of thought. But there are other truths intermingled with this issue. One is that physicians appear to be much more reluctant to seek treatment for substance abuse and psychiatric conditions not only because of the stigmata attached but because of the fear of and perception (mostly true) that various licensing bodies will persecute physicians under the guise of “protecting the public” even in cases where there were no patient, safety, or quality of care issues or occurrences were involved.

This is unfortunate since the other truth is that physicians have phenomenally high recovery rates and low relapse rates from substance abuse compared to the general population. A 2008 study found that 79% of physicians were clean and sober and licensed and working 5 years after undergoing treatment for substance abuse and only 10% had had their licenses revoked (presumably for substance abuse). A 2005 retrospective review of data on 233 physicians with substance abuse problems found a 91% rate of recovery at 6 years (J Addict Dis. 2005).  Compare this to recovery rates as low as 14% for alcoholics and 20% for other substance abuse at 5 years for the general population.

The take home message (THM) here is that even though physicians are not more likely than everyone else to be pill-popping, funny cigarette smoking, boozers, they do have much greater potential for recovery from substance abuse than everyone else and as such should be allowed every opportunity to be treated without undue hindrance I.e. without the fear of irrational and excessively punitive measures masquerading as “treatment” options imposed by various licensing bodies and medical societies or the fear of being ostracized and marginalized by the medical community because of the ignorance and prejudice and stigmata of having a substance abuse problem. It’s a problem that about 15% of any population has but either physicians are not supposed to have it and if they do, are a lot worse off for it and that is total rubbish.

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