Volume 6, No. 1 • Spring 1991

Impaired Providers Potential Danger to Patients, More to Selves

James E Arens, M.D.

The panel in Las Vegas on “Substance Abuse among Anesthesiologists” focused primarily on the problem of abuse of fentanyl and its cogeners, and did not address such issues as alcoholism. Although narcotic addiction is a legitimate topic for the Anesthesia Patient Safety Foundation, there is no objectively documented evidence that anesthesiologists addicted to narcotics have harmed any patient. However, there is strong evidence that an addicted anesthesiologist is a safety hazard to himself.

Prevention of the problem is focusing on education of our specialty and upon developing of a simple, reliable, inexpensive test for the identification of fentanyl and its relatives in urine and/or blood. Once such a test becomes available, randomized drug screening will be seriously considered by this specialty.

A registry is also being developed to determine the incidence of recurrence once an addicted physician has undergone therapy. Hopefully, adequate information will be developed to provide insight into the current dilemma of whether an anesthesiologist, once addicted to fentanyl, should be allowed to re-enter the specialty.

Thus, at present the addicted anesthesiologist could potentially be a hazard to patient safety. The primary safety hazard today for such an addicted physician is to the addict and not the patient. The most frightening aspect is frequently the hazard is not re-addiction, but rather death of the afflicted anesthesiologist.

The ASA patient safety videotape, “The Impaired Practitioner,” is available from Burroughs-Wellcome representatives.

James E Arens, M.D. Past President, ASA