David O Warner1, Keith Berge, Huaping Sun, Ann Harman, Ting Wang. 1. From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota (D.O.W., K.B.) the American Board of Anesthesiology, Raleigh, North Carolina (D.O.W., H.S., A.H., T.W.).
Abstract
BACKGROUND: Substance use disorder among physicians can expose both physicians and their patients to significant risk. Data regarding the epidemiology and outcomes of physician substance use disorder are scarce but could guide policy formulation and individual treatment decisions. This article describes the incidence and outcomes of substance use disorder that resulted in either a report to a certifying body or death in physicians after the completion of anesthesiology training. METHODS: Physicians who completed training in U.S. anesthesiology residency programs from 1977 to 2013 and maintained at least one active medical license were included in this retrospective cohort study (n = 44,736). Substance use disorder cases were ascertained through records of the American Board of Anesthesiology and the National Death Index. RESULTS: Six hundred and one physicians had evidence of substance use disorder after completion of training, with an overall incidence of 0.75 per 1,000 physician-years (95% CI, 0.71 to 0.80; 0.84 [0.78 to 0.90] in men, 0.43 [0.35 to 0.52] in women). The highest incidence rate occurred in 1992 (1.79 per 1,000 physician-years [95% CI, 1.12 to 2.59]). The cumulative percentage expected to develop substance use disorder within 30 yr estimated by Kaplan-Meier analysis equaled 1.6% (95% CI, 1.4 to 1.7%). The most common substances used by 353 individuals for whom information was available were opioids (193 [55%]), alcohol (141 [40%]), and anesthetics/hypnotics (69 [20%]). Based on a median of 11.1 (interquartile range, 4.4 to 19.8) yr of follow-up, the cumulative proportion of survivors estimated to experience at least one relapse within 30 yr was 38% (95% CI, 31 to 43%). Of the 601 physicians with substance use disorder, 114 (19%) were dead from a substance use disorder-related cause at last follow-up. CONCLUSIONS: A substantial proportion of anesthesiologists who develop substance use disorder after the completion of training die of this condition, and the risk of relapse is high in those who survive. : WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Substance use disorders among anesthesiologists are common and hazardous to both the involved physicians and their patientsThe incidence of substance abuse among U.S. anesthesiologists remains unclear, as does the relapse risk and consequent mortality WHAT THIS ARTICLE TELLS US THAT IS NEW: The estimated cumulative 30-yr incidence of substance abuse among graduates of U.S. residency programs is about 1.6%, with opioids and alcohol being the most commonly abused substancesA substantial proportion of anesthesiologists who develop substance use disorder die of the condition, and the risk of relapse is high in those who survive at approximately 40.
BACKGROUND: Substance use disorder among physicians can expose both physicians and their patients to significant risk. Data regarding the epidemiology and outcomes of physician substance use disorder are scarce but could guide policy formulation and individual treatment decisions. This article describes the incidence and outcomes of substance use disorder that resulted in either a report to a certifying body or death in physicians after the completion of anesthesiology training. METHODS: Physicians who completed training in U.S. anesthesiology residency programs from 1977 to 2013 and maintained at least one active medical license were included in this retrospective cohort study (n = 44,736). Substance use disorder cases were ascertained through records of the American Board of Anesthesiology and the National Death Index. RESULTS: Six hundred and one physicians had evidence of substance use disorder after completion of training, with an overall incidence of 0.75 per 1,000 physician-years (95% CI, 0.71 to 0.80; 0.84 [0.78 to 0.90] in men, 0.43 [0.35 to 0.52] in women). The highest incidence rate occurred in 1992 (1.79 per 1,000 physician-years [95% CI, 1.12 to 2.59]). The cumulative percentage expected to develop substance use disorder within 30 yr estimated by Kaplan-Meier analysis equaled 1.6% (95% CI, 1.4 to 1.7%). The most common substances used by 353 individuals for whom information was available were opioids (193 [55%]), alcohol (141 [40%]), and anesthetics/hypnotics (69 [20%]). Based on a median of 11.1 (interquartile range, 4.4 to 19.8) yr of follow-up, the cumulative proportion of survivors estimated to experience at least one relapse within 30 yr was 38% (95% CI, 31 to 43%). Of the 601 physicians with substance use disorder, 114 (19%) were dead from a substance use disorder-related cause at last follow-up. CONCLUSIONS: A substantial proportion of anesthesiologists who develop substance use disorder after the completion of training die of this condition, and the risk of relapse is high in those who survive. : WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Substance use disorders among anesthesiologists are common and hazardous to both the involved physicians and their patientsThe incidence of substance abuse among U.S. anesthesiologists remains unclear, as does the relapse risk and consequent mortality WHAT THIS ARTICLE TELLS US THAT IS NEW: The estimated cumulative 30-yr incidence of substance abuse among graduates of U.S. residency programs is about 1.6%, with opioids and alcohol being the most commonly abused substancesA substantial proportion of anesthesiologists who develop substance use disorder die of the condition, and the risk of relapse is high in those who survive at approximately 40.
Authors: Anoushka M Afonso; Joshua B Cadwell; Steven J Staffa; David Zurakowski; Amy E Vinson Journal: Anesthesiology Date: 2021-05-01 Impact factor: 8.986