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The statement that anesthetists are more likely to misuse drugs is a controversial one. But now there’s research to back up the claim.
One recent mortality study shows that the adjusted risk of drug-related suicide was more than two times greater in anesthesiologists than in internists, and the risk of all drug-related causes of death was almost three times greater in anesthesiologists.1 The same study showed that anesthesiologists are overrepresented in substance abuse programs for physicians.
"The risk is about one in 10 that anesthetists will develop a substance abuse problem sometime in their career," says Diana Quinlan, CRNA, MA, chairwoman of the Peer Assistance Advisors Committee of the American Association of Nurse Anesthetists in Park Ridge, IL. Quinlan points to a survey of 10% of the national certified registered nurse anesthetist (CRNA) population in which 9.8% of the CRNAs surveyed admitted to misusing anesthesia substances.2
What’s the reason for the increased use among anesthetists? Access and stress, Quinlan maintains.
In about 70% of drug abuse cases involving anesthesiologists, the physicians have used fentanyl and/or sufentanil, according to a publication from the Park Ridge, IL-based American Society of Anesthesiologists (ASA) titled Chemical Dependence in Anesthesiologists: What You Need to Know When You Need to Know It.3
"Over a six- to 12-month period, a fentanyl addict may attain a habit of 80-100 ml of fentanyl per day," the ASA says. "Within weeks of the onset of addiction to sufentanil, daily use may be as much as 10-20 ml. A 10th of these doses would kill a person who is drug-naive."
Frequently, addiction becomes apparent within weeks, the ASA says. "Unless the disease is recognized and treated appropriately, it will result in social, psychological, and physical harm to the abuser, and may end in death," the association warns. (See "What to look for inside the hospital," in this issue.) It’s important to identify an addict before the professional suffers impairment, the ASA points out. However, identification can be difficult because signs are subtle. "Individual family members and colleagues typically see only a part of the constellation of clues, making it easier for the addicted individual to hide the disease," the association says.
Expect denial, the association warns. Providers often fear losing their jobs, their practices, and the respect of others, the ASA points out.
Not everyone agrees with the research that points to increased abuse among anesthetists. For example, the 2000 Anesthesiology study didn’t study other subpopulations of physicians other than internists, says William P. Arnold III, MD, associate professor of anesthesiology at the University of Virginia Health System in Charlottesville and chair of the ASA’s Task Force on Chemical Dependence.
When anesthetists become addicted, their disease becomes apparent more quickly than in other professionals because fentanyl and sufentanil are the most potent, mind-altering drugs used in medicine, Arnold says. "I am firmly convinced that the rate of onset of addiction is directly related to the potency of drug of abuse," he says.
1. Alexander BH, Checkoway H, Nagahama SI, et al. Cause-specific mortality risks of anesthesiologists. Anesthesiology 2000; 93:922-930.
2. Bell D, McDonough JP, Ellison JS, Fitzhugh EC. Controlled drug misuse by certified registered nurse anesthetists. AANA J 1999; 67:133-140.
3. Excerpted from Chemical Dependence in Anesthesiologists: What You Need to Know When You Need to Know It, copyright 1999 of the American Society of Anesthesiologists. A copy of the full text can be obtained free on the web site (www.ASAhq.org/ProfInfo/chemical.html) or for $2 per copy from ASA, 520 N. Northwest Highway, Park Ridge, IL 60068-2573.
Providers can contact the American Society of Anesthesiologists to be provided with appropriate treatment telephone numbers for their locality and, if possible, the name of a confidential consultant who can provide additional information and resources. Contact:
• American Society of Anesthesiologists, 520 N. Northwest Highway, Park Ridge, IL 60068-2573. Telephone: (847) 825-5586.