Substance Abuse Among Anesthesiologists

In 1956 the American Medical Association declared alcoholism to be an illness and, in 1987, extended the definition to include dependence on all drugs. Alcoholism and other forms of impairment impact anesthesiologists at similar rates to other professions. However, addiction to opioid remains the most common for anesthesia personnel. The question at hand is do individuals seek careers in anesthesiology for increased access to drugs or do the develop an addiction during their residency or in practice?

Between  1991–2001, 80% of U.S. anesthesiology residency programs reported experience with impaired residents, and 19% reported at least one pretreatment fatality. There have been many theories concerning the etiology of chemical dependence including biochemical, genetic, psychiatric, and, more recently, exposure-related theories. Factors that have been proposed to explain the high incidence of drug abuse among anesthesiologists include the proximity to large quantities of highly addictive drugs, the relative ease of diverting particularly small quantities for personal use, the high stress environment in which anesthesiologists work.

This past summer I had the opportunity to shadow a Cardiothoracic Physician Assistant for a few days. She had done several clinical rotations during Physician Assistant school, one being anesthesiology. She shared horror stories of anesthesiologists getting high during a surgery, or ODing in the call room. What I found interesting is that Nurse Anesthesiologists were more likely to steal drugs and use them outside of the hospital while Anesthesiologist residents and practicing physicians were more likely to use during their shift. Dr. Ott-Walter shared a similar story - Opium, especially morphine only lasts for 6-8 hours and often times surgical procedures will last more than 8 hours. One anesthesiologist was coming off a high during a procedure and was starting to go through withdraw. He made a decision to shoot up behind the curtain but instead of injecting an opioid, he injected a stimulant that is medically used to wake people up after surgery. Minutes later the anesthesiologist went into cardiac arrest and the surgeons had to stop the procedure to assist the anesthesiologist. Opioid use among anesthesia personnel is typically not suspected by friends and relatives and signs often go unnoticed. 

So is addiction related to genetics or is opioid use an exposure-related phenomenon? 

"Considerable research has been done in mice suggesting a genetic basis for addiction. Mutant mice with α4 nicotinic subunits that contained a single point mutation resulting in hypersensitive nicotinic acetylcholine receptors. The majority of individuals who experiment with psychoactive substances do not become dependent but there is a small subset of individuals taht do. These individuals typically exhibit pre-existing co-morbid traits such as novelty-seeking and antisocial behavior. Genetic susceptibility plays a role in the transition from substance use to dependence and from chronic use to addiction. 

 It has been suggested that emotional stress and access to agents may play much less of a role in the development of addiction than was previously thought. However some researchers hypothesize that increased risk of addiction in certain occupational setting is related to exposures that sensitize the reward pathways in the brain to promote substance abuse. Anesthesiologists who become addicted through such sensitization may continue to use the opiods to alleviate the withdrawal they feel when away from the exposure."

At first I expected opioid use was exposure related among anesthesiologists because they have the highest rate of opioid treatment compared to other practicing physician specialties. Anesthesiologists have the most access to fentanyl and sufentanil, making them more susceptible to use and abuse. Although research hasn't exactly pinpointed genetic mark-ups of addiction and dependence, there is a strong association between genetic make-up and addiction. Some individuals argue that addiction and dependence is more common among thrill-seeking individuals. I don't believe that plays a role in this particular situation. A typical opioid user is a white, middle-aged female with a family that had a valid prescription for morphine or another type of painkiller and once that prescription ran out, they turned to heroin use. I believe this is the case among anesthesiologists as well, indicating that both our genetic make-up and exposure play a role in addiction.







Information found at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766183/