To the Editor
All too often health care providers fail to comprehend the impact disease may have on the commission of illegal acts. I take distinct exception to the view Locke(1) recently espoused, in which she felt “substance-abusers in the medical field … should go to jail just like we insist (on) our common folk” for possession of illegal drugs. Neither do I subscribe to her belief that “one of the big factors affecting patient safety today is the problem of the substance abuser being allowed to … administer anesthetics,” since it is estimated that only about 1% of anesthesia personnel noticeably abuse drugs.(2)
Not to detract from the potential for great harm an impaired provider could inflict during critical procedures (such as an anesthetic), drug abuse is a bona-fide medical and social disease. (3) It is both a symptom of and a response to maladaption to complex stresses in our environment. Some patients (yes, patients) arise from the combination of highly stressful occupations, perceived low self-worth, and both ready access and exposure to mood altering drugs. Few people more frequently fit this mold as do we anesthesia care providers: we strive each day to care for the most acute of medical situations, to clamor for some acknowledgement of our expertise from our peers, and yet not be taken in by the almost magical charms of the potent substances we inject into our patients and their effect. Chemical dependency is indeed a unique “occupational hazard’ for anesthesia personnel, as described by Ward in his recent eloquent editorial. (4)Not an excuse for the illegal ramifications of abusing drugs, we still need to treat the disease (drug abuse) in order to obtain the best outcome (long-term survival, productivity to society, reestablishment of family/social/professional activities, etc. ). Incarceration and other civil penalties must take a back seat role, whether the abuser is a physician, nurse or just “common folk”: a distinction only must be made between the drug abuser and the non-abuser manufacturer/distributor.
Studies such as the California Physicians’ Diversion Program have demonstrated that anesthesiologists (both attending and resident level) can have a good chance of recovery, contradicting pessimism about recovery in this specific field. (5) Although the specific return to the specialty anesthesiology may not be prudent in all those addicted to drugs. (particularly for residents early in their careers (6) ), redirection into other medical fields may be appropriate in some cases, allowing continued rehabilitation while maintaining productivity and self-worth. This goal, however, cart only be achieved if the following occurs: expeditious identification of the drug abuser, removal from stressful medical environment, compassionate but firm and direct treatment from all health care providers involved, and-ultimately-appropriate and guided reentry into the medical (or nursing) field.
Timothy B. Gilbert, M.D.
Assistant Professor of Anesthesiology and Critical Care Division of Cardiothoracic Anesthesiology
The University of Maryland Medical System Baltimore, MD
- Locke MR. Reflections on patient safety. APSF Newsletter, Winter 1992-3:51.
- Gravenstein JS, Kory WP, Marks RG. Drug abuse by anesthesia personnel. Anesth Analg 1983;62:467-72.
- Spiegelman WG, Saunders L, Mazze N. Addiction and anesthesiology. Anesthesiology i984;60:33541.
- Ward CF. Substance abuse: now, and for some time to come. Anesthesiology 1992;77.619-22.
- Pelton C, Ikeda RM. The California Physicians Diversion Program’s experience with recovering anesthesiologists. J Psychoactive Drugs 1991;23:427-31.
- Menk EJ, Baumgarten RK, Kingsley CP, Culling RD, Middaugh R. Success of reentry into anesthesiology training programs by residents with a history of substance abuse. JAMA 1990;264:2741-2.