Substance Abuse Among Substance Abuse Among Healthcare ProvidersHealthcare Providers

Dennis IsonDennis Ison

Professor D. FahringerProfessor D. Fahringer

April 20, 2006April 20, 2006

BackgroundBackground

1958 – Abuse among providers first 1958 – Abuse among providers first recognized by The Federation of recognized by The Federation of State Medical Boards (FSMB)State Medical Boards (FSMB)

1974 - AMA acknowledged substance 1974 - AMA acknowledged substance abuse as an illness and developed a abuse as an illness and developed a model legislation to offer a beneficial model legislation to offer a beneficial option of discipline for providers with option of discipline for providers with addiction. addiction.

IntroductionIntroduction

FSMB - FSMB - inability to practice medicine with inability to practice medicine with skill and safety by reason of mental illness, skill and safety by reason of mental illness, physical illness, and substance abuse, physical illness, and substance abuse, including alcohol and other drugs that including alcohol and other drugs that impair abilitiesimpair abilities

AAPA - AAPA - one who is unable to practice skill one who is unable to practice skill and safety to patients because of physical and safety to patients because of physical and mental illness including deteriorations and mental illness including deteriorations through the aging process, loss of motor through the aging process, loss of motor skills, or excessive use or abuse of drugs skills, or excessive use or abuse of drugs including alcoholincluding alcohol

PrevalencePrevalence

http://www.http://www.sfgatesfgate.com/.com/cgicgi-bin/article.-bin/article.cgicgi?f=/c/a/2006/03/10/BAG5EHLV451.DTL&fe?f=/c/a/2006/03/10/BAG5EHLV451.DTL&feed=ed=rssrss..bayareabayarea

Zamora, J. H. (2006). Zamora, J. H. (2006). Allegedly Drunken Surgeon Arrested in Operating Room. Allegedly Drunken Surgeon Arrested in Operating Room. San Francisco Chronicle. San Francisco Chronicle.

B-3.B-3.  

Risk FactorsRisk Factors

Genetics & Familial ComponentsGenetics & Familial Components College AtmosphereCollege Atmosphere Educational & Career ExpectationsEducational & Career Expectations Opportunity & Availability of Opportunity & Availability of

SubstancesSubstances Pharmaceutical Knowledge Provides Pharmaceutical Knowledge Provides

ImmunityImmunity Self-treatment Self-treatment

SpecialtiesSpecialties

High RiskHigh Risk Anesthesiologists – Access to NarcoticsAnesthesiologists – Access to Narcotics Residents – Recreation, Performance or Residents – Recreation, Performance or

STST Others – ER specialists & PsychiatristsOthers – ER specialists & Psychiatrists

Low Risk (in general)Low Risk (in general) Pediatricians, Pathologists, Radiologists Pediatricians, Pathologists, Radiologists

& OBGYNs & OBGYNs

Drug of ChoiceDrug of Choice

Opioids – Younger AnesthesiologistsOpioids – Younger Anesthesiologists Alcohol – Older Anesthesiologists & Alcohol – Older Anesthesiologists &

Female PhysiciansFemale Physicians

Over All - Benzodiazepines & opiates Over All - Benzodiazepines & opiates > Recreational Drugs, such as > Recreational Drugs, such as Marijuana & Cocaine Marijuana & Cocaine

IdentifiersIdentifiers

Marital Problems (undetected)Marital Problems (undetected) Legal Problems - Domestic Violence, Legal Problems - Domestic Violence,

Charges of Irregularities in Prescription Charges of Irregularities in Prescription Writing, AIs or DUIs, Elicit Drug Possession Writing, AIs or DUIs, Elicit Drug Possession & Bankruptcy& Bankruptcy

Personality Changes - Mood D/Os, Personality Changes - Mood D/Os, Confusion, Memory Loss, Anxiety, Confusion, Memory Loss, Anxiety, Depression, Lack of Impulse Control, Depression, Lack of Impulse Control, Suicidal Thoughts or Gestures Suicidal Thoughts or Gestures

PerformancePerformance

No Longer Available for Extra Shifts No Longer Available for Extra Shifts Increase # of “Call-ins”Increase # of “Call-ins” Using Personal Time ExcessivelyUsing Personal Time Excessively Increased Tardiness & AbsenteeismIncreased Tardiness & Absenteeism Inconsistent Work HabitsInconsistent Work Habits Decrease in Efficiency Decrease in Efficiency Increase in Personal Phone Calls Increase in Personal Phone Calls

SuicideSuicide

Most Common Death in Young PhysiciansMost Common Death in Young Physicians Depression, Drug Abuse, Alcoholism, Depression, Drug Abuse, Alcoholism,

Marital Conflict, Single, Divorced or Marital Conflict, Single, Divorced or Widowed & FemaleWidowed & Female

More than 1/3 of physicians that committed More than 1/3 of physicians that committed suicide are believed to have had a drug suicide are believed to have had a drug problem at some time in their lives problem at some time in their lives

More than 1/2 had prescribed a More than 1/2 had prescribed a psychoactive drug for themselves psychoactive drug for themselves

ConfrontationConfrontation

Someone w/ Influence & Authority Someone w/ Influence & Authority Caring, Professional, & Well-Caring, Professional, & Well-

organized Intervention organized Intervention

EvaluationEvaluation

VP of Medical Affairs or Admin. on CallVP of Medical Affairs or Admin. on Call Meeting w/ the provider to observe conduct, Meeting w/ the provider to observe conduct,

appearance & demeanorappearance & demeanor Submission to a Drug ScreenSubmission to a Drug Screen Participation in a Rehabilitation Program Participation in a Rehabilitation Program

Conard, Jane & S. Allan Adelman. 2004. Conard, Jane & S. Allan Adelman. 2004. Impaired Practitioner Policy. Impaired Practitioner Policy. Journal of Health Law. 37(4): 693-Journal of Health Law. 37(4): 693-700.700.

  

TreatmentTreatment

Provider Self-healing vs. Help from OthersProvider Self-healing vs. Help from Others Referral Self-report or Encouragement Referral Self-report or Encouragement

from Othersfrom Others Prevent Patient HarmPrevent Patient Harm Recognition of a Problem Recognition of a Problem Identify the Specific ProblemIdentify the Specific Problem Acknowledge That One Needs HelpAcknowledge That One Needs Help Help is Available Help is Available

Treatment (cont.)Treatment (cont.)

Education about Alcoholism & Drug Education about Alcoholism & Drug AbuseAbuse

Stress Management Skills EducationStress Management Skills Education Encounter & Discussion GroupsEncounter & Discussion Groups Workshops & CounselingWorkshops & Counseling Long-term & ComprehensiveLong-term & Comprehensive Consistent, Rigid & Comprehensive Consistent, Rigid & Comprehensive

MonitoringMonitoring

Treatment BarriersTreatment Barriers

Accepting the Patient RoleAccepting the Patient Role Stigma Bound ProblemsStigma Bound Problems Fear of Confidentiality BreechesFear of Confidentiality Breeches Jeopardy to their Reputation, Jeopardy to their Reputation,

Professional Accreditation, & Professional Accreditation, & EmploymentEmployment

Public Disclosure Public Disclosure

Treatment OutcomesTreatment Outcomes

Recovery 73% - 91%Recovery 73% - 91% Education & PreventionEducation & Prevention Mandatory TreatmentMandatory Treatment Frequent Urine CheckingFrequent Urine Checking Peer Assistance Programs Peer Assistance Programs

DentistryDentistry

Alcoholism & SuicideAlcoholism & Suicide Universal Knowledge vs. Urban Universal Knowledge vs. Urban

LegendLegend

ConclusionConclusion

IdentificationIdentification ConfrontationConfrontation TreatmentTreatment PreventionPrevention

Don’t DrinkDon’t Drink Don’t Do DrugsDon’t Do Drugs Don’t CurseDon’t Curse Go To Church on SundayGo To Church on Sunday

REFERENCESREFERENCES

Blondell, Richard. 2005. Blondell, Richard. 2005. Taking a Proactive Approach to Physician Impairment. Taking a Proactive Approach to Physician Impairment. Postgraduate Medicine. 118(1): 16-8.Postgraduate Medicine. 118(1): 16-8.

Bohigian, George. Et al. 2005. Bohigian, George. Et al. 2005. The Impaired and Disruptive Physician: The Missouri’s Physicians Health Programs – An Update (1995-The Impaired and Disruptive Physician: The Missouri’s Physicians Health Programs – An Update (1995-2002).2002). Journal of Addictive Diseases. 24(1): 13-23. Journal of Addictive Diseases. 24(1): 13-23.

Boisaubin, Eugene & Ruth Levine. 2001. Boisaubin, Eugene & Ruth Levine. 2001. Identifying and Assisting the Impaired Physician.Identifying and Assisting the Impaired Physician. American Journal of the Medical Sciences. American Journal of the Medical Sciences. 322(1): 31-6.322(1): 31-6.

Bostrom, Andrea. Et al. 2004. Bostrom, Andrea. Et al. 2004. Impaired Practice and the law in Michigan.Impaired Practice and the law in Michigan. URL: URL: http://www.http://www.minursesminurses.org/.org/contedconted//CEModuleCEModule--ImpairedpracticeImpairedpractice.doc.doc , no , no date given, accessed 12/4/05. Michigan Nurses Association. date given, accessed 12/4/05. Michigan Nurses Association.

  Broquet, Karen & Rockey, Paul. 2004. Broquet, Karen & Rockey, Paul. 2004. Teaching Residents and Program Directors About Physician Impairment. Teaching Residents and Program Directors About Physician Impairment. Academic Psychiatry. Academic Psychiatry.

28: 221-5. 28: 221-5.   Collins, Greg. 1998. Collins, Greg. 1998. New Hope for Impaired Physicians: Helping the Physician While Protecting the Patient.New Hope for Impaired Physicians: Helping the Physician While Protecting the Patient. Cleveland Clinic Journal of Cleveland Clinic Journal of

Medicine. 65(2): 101-6.Medicine. 65(2): 101-6.  Conard, Jane & S. Allan Adelman. 2004. Conard, Jane & S. Allan Adelman. 2004. Impaired Practitioner Policy. Impaired Practitioner Policy. Journal of Health Law. 37(4): 693-700.Journal of Health Law. 37(4): 693-700.  Ethics Committee of the AAO-HNS. 1996. Ethics Committee of the AAO-HNS. 1996. Chapter 7: The Impaired Physician. Chapter 7: The Impaired Physician. Ethics Committee of the AAO-HNS. 115(3): 213-7.Ethics Committee of the AAO-HNS. 115(3): 213-7.  Frank, E. & A. Dingle. 1999. Frank, E. & A. Dingle. 1999. Self-Reported Depression and Suicide Attempts Among U.S. Women Physicians. Self-Reported Depression and Suicide Attempts Among U.S. Women Physicians. Am J Psychiatry. 156: Am J Psychiatry. 156:

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Hagan III, John. 2002. When Good Docs Go Bad. Missouri Medicine. 99(4): 153-4.

Kitz, P. Et al. 2005. Evidence of Addiction By Anesthesiologists as Documented By Hair Analysis. Forensic Science International. 153(1): 81-4. Kober, Charles. 1993. Physician Assistant Impairment Issues. Physician Assistant. 73-8. Krebs-Markrich, Julia & Karen Perrine. 1996. Defending the Impaired Physician. Virginia Medical Quarterly. 123(4): 14-6. O’Connor, Patrick & Anderson Spickard, Jr. 1997. Physician Impairment By Substance Abuse. Medical Clinics of North America. 81(4): 1037-49.

Psychiatric News. 2004. Impaired Physicians Get More Attention. Psychiatric News. 39(20): 11.  Schernhammer, Eva.2005. Taking Their Own Lives - The High Rate of Physician Suicide. NEJM. 352(24): 2473-6.  

Strang, John. Et al.1998. Missed Problems and Missed Opportunities for Addicted Doctors. BMJ. 31(6): 405-6.   Truman, John. 2005. Drug and Alcohol Use in Emergency Medicine Residency: Impaired Resident. Physician Wellness/Resident’s Perspective. 46(2): 148-150.  Uretsky, Samuel. 2004. Addicts in the OR? Drug Abuse Among Healthcare Professionals. Medhunters. Virshup, Bernard. Et al.1993. The Primary Prevention of Addiction in the Physician. The Journal of Primary Prevention. 14(1): 29-49.

Zamora, J. H. (2006). Allegedly Drunken Surgeon Arrested in Operating Room. San Francisco Chronicle. B-3.