Deborah Brauser
December 09, 2013
Doctors who report they abuse prescription drugs cite self-medication to help manage physical pain and emotional problems as the number 1 reason for this habit, new research shows.
In the study, substance-impaired doctors participated anonymously in guided group discussions as part of a monitored state physician health program (PHP). In addition to helping manage physical and emotional pain, physicians also cited stress, recreational use, and withdrawal prevention as the main reasons for abusing prescription medications.
Opiates and sedatives were the prescription drugs most commonly misused by the study participants.
“Substance-related impairment of physicians is a small but serious problem, with significant consequences for patient safety and public health,” write the investigators, led by Lisa J. Merlo, PhD, from the McKnight Brain Institute and the University of Florida in Gainesville.
“Prevention efforts targeting prescription drug misuse among physicians should be initiated during medical training, with continuing education requirements throughout the physicians’ careers,” they add.
The study was published in the October Issue of the Journal of Addiction Medicine.
High Rate of Misuse
According to the researchers, 10% to 15% of physicians will experience a substance use disorder during their lifetime. Although this rate is similar to that in the general population, more physicians appear to misuse prescription drugs.
“Understanding the reasons…would help educators, administrators, colleagues, and providers more successfully identify, treat, and monitor addicted physicians,” the investigators write.
The study included 55 substance-dependent physicians (94.5% men; mean age, 53 years; 72% white, 21% Latino, 7% other) who were participating in a Florida PHP.
A total of 21.8% of the participants listed their specialty as family/general medicine, 16.4% listed internal medicine, 14.5% listed anesthesiology, 14% listed surgery, and 10.9% listed psychiatry. Pediatrics, obstetrics/gynecology, and “others” made up the remaining specialties.
All participated in guided group discussions between December 2008 and March 2009. Beforehand, they filled out a demographic questionnaire, which also asked about substance use patterns and work history.
Results showed that 69% of the physicians had misused prescription drugs sometime in the past. The others reported only using illicit drugs and/or alcohol. Interestingly, all of those who reported misusing prescription drugs also had a history of using illicit drugs or alcohol.
Those who cited managing physical pain as the main reason for prescription drug misuse commonly reported having severe chronic pain due to trauma or surgery.
Health Provider Mistrust
Several of the physicians who said that they misused drugs to manage emotional pain and/or psychiatric symptoms reported that it was because they had trouble trusting the recommendations from their treating provider.
Many of those who listed stressful situations as reasons explained that that included work and personal problems, including malpractice suits, financial problems, and juggling work-child responsibilities.
The researchers note that recreational use was also an important factor for many of these doctors, with most reporting using prescription drugs to enhance the effect of another substance.
Finally, other participants reported using prescription drugs as a way to prevent or alleviate withdrawal symptoms.
“Indeed, the issue of withdrawal seemed to become more salient to the physicians as their addiction progressed,” write the investigators.
They note that although the study population was small and was composed mainly of men and so may not be representative of all clinicians who abuse prescription drugs, “there is inherent value in obtaining such in-depth data from physicians.”
As reported at the time by Medscape Medical News, Dr. Merlo presented part of this research at the 2011 annual meeting of the American Academy of Addiction Psychiatry.
“We know that [PHPs] work, and we know that monitoring is associated with really good outcomes. It’s just getting people into the system that’s been the challenge,” she told meeting attendees at the time.
“And the most important reason for research into this area is that it’s showing that these professionals can be helped and shouldn’t just lose their license,” she added.
Disease of Denial
“This was really interesting,” David O. Warner, MD, professor of anesthesiology at the Mayo Clinic in Rochester, Minnesota, told Medscape Medical News.
Dr. Warner was not involved with this research but recently published a study in JAMA examining the incidence of substance use disorder (SUD) among 44,612 anesthesiology residents between 1975 and 2009. Results showed that 0.86% of these residents had a confirmed SUD during training.
“We don’t really know among the anesthesiology folks why they do this. Anecdotally, many of the stories revolved around, ‘Well, I’m around these drugs every day and just wanted to see what it was like.’ Whether that’s actually accurate or not, no one knows,” he said.
“Addiction is a disease and is characterized by denial and evasion. So I think what the real reasons might be is a very interesting question. Certainly self-medicating for pain or for stress is quite plausible.”
The study was funded by a grant from the National Institute on Drug Abuse (NIDA) and by the Professionals Resource Network, “an integral arm of the Florida Medical Association.” The study authors have disclosed no relevant financial relationships.
J Addict Med. 2013;7:349-353. Full article