Track medical substance-use data, association board member says
A study by Mayo Clinic researchers shows nearly 1 in every 100 of anesthesiology specialists-in-training developed substance-use disorder during their residency programs.
In addition "at least 11 percent" of those with confirmed substance use disorders eventually die "of a cause directly related to the disorder," says an announcement of a study appearing in the Dec. 4 issue of the Journal of the American Medical Association .
"That's a pretty high mortality rate for a disease," saidDr. David Warner of the Mayo Clinic, a member of the American Board of Anesthesiology's Board of Directors and co-author of the study.
He said about 50 to 60 anesthesiology residents nationwide develop a substance-use disorder each year, and about five or six die each year.
"Impairment of any health professional could certainly put patients at risk," Warner said.
Another striking problem in the medical profession in general, Warner said, is the lack of available data about substance abuse.
"We really don't know how common a problem this is," he said. Researchers studied anesthesiology residents as a starting point because detailed data has been collected.
"We all know of examples of incidents that have occurred. But we don't know how often, we don't know who is more likely to do this, we really haven't known what happens to these people should they try to go back and practice — how successful treatment might be."
Anesthesiologists are particularly at risk, Warner and colleagues have suspected, because they directly handle potent drugs, such as narcotics, as part of their everyday jobs.
"We've assumed that, but we don't really know if that's true or not," Warner said. "I don't have any data really to compare with any other specialty to say that this is more, or less, of a problem in anesthesiologists than any other physicians."
Better data is needed so better tracking methods can be developed to learn if intervention methods are working, he said.
"And so, I think it would be a really good idea of professional societies, or credentialing agents for all health-care professions could come up with methods to try to track this," Warner declared.
The Mayo study, Warner said, demonstrated rates of relapse have remained steady among anesthesiology residents, despite efforts to prevent relapse.
A total of 44,612 residents entered training during the study period, which ran from 1975 to 2009. Rates of substance use disorder dropped for a few years (1996 to 2002) after education programs were instituted, Warner said. But they have climbed steadily since then.
Intravenous opioids, alcohol, marijuana, cocaine, anesthetics/hypnotics and oral opioids were all cited as problems. Of those studied, 28 died during their training period — Mayo's announcement of the study noted, "all deaths were related to substance use disorder."
If so many people are still dying and the incidence is going up, "we need to do something to try to address this problem," Warner said.
It's unknown how many anesthesiologists in general eventually have the same problem. Among those residents who develop a problem during their residencies, data kept about them shows that 43 percent "experienced at least one relapse by 30 years after the initial episode."
"It"s concerning," Warner said.
First he said, "they may be taking the drugs that are supposed to be given to you — and using it on themselves so that you may not have adequate pain relief."
Second, he said, "after they've given themselves your drug, they're probably not going to be able to perform as well as they should."
Prevention efforts have improved significantly.
"When I was training 30 years ago, I would go to a drawer and take out a bottle of narcotic and I would go use it in my patient…I would just write down how many bottles I took. It was a very lax system." Warner said. These days, there's a strict sign-out procedure, automated machines to dispense the drugs, documentation is precise and random audits are done to verify no drugs are missing.
Researchers plan to study the wider population of practicing anesthesiologists next because data on them is now being kept.