A study by the American Board of Anesthesiology (ABA) and the Mayo Clinic found that nearly one in every 100 anesthesiology residents entering primary training from 1975 to 2009 developed substance use disorder (SUD) during training. The incidence of this disorder is continuing to increase and the risk of relapse or death is high. The Journal of the American Medical Association has published the manuscript “Substance Use Disorder Among Anesthesiology Residents, 1975-2009” in its December 4 issue on medical education.
David O. Warner, M.D., a Director of the ABA and anesthesiologist at the Mayo Clinic in Rochester, Minnesota, found that anesthesiologists are not invulnerable to SUD, though only indirect evidence supports SUD being more common in anesthesiologists than in other physicians. “Although relatively few anesthesiology residents develop SUD, the incidence is continuing to increase,” said Dr. Warner. “The problem is as serious now as it has been at any time over the period of study, and the consequences can be severe. Residents who develop substance use problems are at high risk for relapse after treatment or, in some cases, die as a result of the disorder.”
During the study period, 384 (0.86 percent) of the 44,612 residents had SUD confirmed during training. The rates of incidence were initially high, followed by a period of lower rates in 1996-2002. However, the highest rates have occurred since 2003. The most common substances used were intravenous opioids, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. Of the total study group, 28 individuals (7.3 percent) died of SUD-related problems during the training period.
Dr. Warner and the other research team members estimated that nearly 43 percent of the survivors experienced at least one relapse within 30 years after the initial incident. At least 11 percent of the physicians with evidence of SUD during the residency program eventually died of a SUD-related cause, but rates of relapse and death did not depend on the type of substance used.
“While we have no direct data to show harm to patients, impaired physicians may put patients at risk – and certainly put themselves at risk. It’s incumbent upon us as a profession to do what we can to identify and address substance use disorders as quickly as possible to protect both the involved physicians and their patients,” says Dr. Warner.
“This is the first of many studies that should be done to better understand substance use disorders,” said Dr. Andrews, Secretary of the ABA Board of Directors. “The ABA has high hopes that this important research will serve to stimulate a wider conversation across the practice of anesthesiology and shape the future of how we respond to this serious issue.”