A substance use disorder (SUD) is a brain disease marked by an inability to control the use of a legal or illegal drug despite harmful effects.1 According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), SUD criteria include tolerance, craving and inordinate time spent taking or seeking a drug.2 Despite health professionals’ role in preventing and treating SUDs,3 they are not immune to developing a SUD. Indeed, approximately 10 to 15 percent of physicians may develop a SUD at some point during their careers,4 and the incidence of SUDs in anesthesiologists is 2.7 higher than in other physician groups.5 Anesthesiology practitioners are at high risk for SUDs given the prevalence of overwork in the specialty and easier access to drugs.6 Though alcohol abuse is the most common SUD among anesthesiologists, anesthesia providers may even abuse their own anesthetic drug supply.6 The misuse of anesthetic drugs by anesthesia providers is an important issue because of the drugs’ high dependence potential, the impact of SUDs on medical practice and the need for treatment and policy changes.
Anesthesiology practitioners face unique risk factors for developing SUDs. Among health professionals, risk factors for developing a SUD include a biological parent’s history of SUD, child abuse, dysfunctional family dynamics, having another psychiatric disorder, being male, experimenting with drugs at a young age, having peers who use drugs, tending to self-medicate and feeling professional immunity from addiction.7 For anesthesia providers in particular, risk factors include direct contact with drugs, daily exposure to highly potent and addictive opaites and sedatives, immediate availability of drugs and training that allows discretion (i.e., ability to remove drugs in small amounts and self-administer them).7 In fact, the ability for anesthesia providers to use anesthetic drugs discretely may have contributed to one study’s finding that 18 percent of anesthesia trainees died or nearly died without family or work colleagues being aware of there being a SUD.7 Commonly abused drugs include opiates, such as fentanyl and sufentanil, as well as non-opiate drugs.6 According to several studies, non-opiate drugs commonly abused by anesthesiology practitioners include propofol,6,8,9 inhalational drugs,6,8 ketamine8 and benzodiazepines (BZDs).8 A survey study of 126 anesthesiology training programs in the United States showed that the percentage of anesthesia providers abusing propofol had increased fivefold since previous studies.9 Of the 25 reported individuals abusing propofol, seven died as a result of the propofol abuse.9 Additionally, a recent case report by Luo et al. described a 28-year-old anesthesiologist who had begun to abuse sevoflurane, an inhaled anesthetic, after four years of occupational exposure.10 Clearly, anesthesia providers are at risk for developing SUDs, especially given the constant presence of opiates and non-opiate anesthetic drugs.
SUDs threaten the safety of anesthesia providers as well as their patients. SUDs remain one of the most common sources of impairment among resident and attending anesthesiologists.11 Suspicious behaviors of drug abuse might include offering to prepare drugs for day lists before going home after a night shift, offering to draw up drugs for cases in other areas of the hospital, requesting extra shifts or frequent appearances in the hospital when not on call.7 As the SUD progresses, neglect of personal and professional duties can lead to decreased work performance, potential patient harm and hospital liability.8 Changes in work quality may include difficulty finding the person when on call, frequent requests for breaks, clinical mistakes, serious incidents with patients and even patient pain from inadequate doses of opiates.7
Because of the effects SUDs can have on anesthesiology professionals and their practices, health professionals and policymakers should aim to prevent SUD development and provide treatment.8 While one article recommends mandatory education about drug abuse during anesthesiology training,4 some researchers suggest that random drug screening for all anesthesia providers may be warranted.12,13 Also, future policies should aim to control or monitor propofol and inhalation anesthetics along with opiates.9 Adequate education, prevention and treatment may be steps toward a solution for anesthetic drug abuse by anesthesiology practitioners.
1. Mayo Clinic. Drug addiction (substance use disorder). 2019; https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Publishing; 2013.
3. Substance Abuse and Mental Health Services Administration. Health Care Systems and Substance Use Disorders. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: US Department of Health and Human Services; November 2016.
4. Booth JV, Grossman D, Moore J, et al. Substance Abuse Among Physicians: A Survey of Academic Anesthesiology Programs. Anesthesia & Analgesia. 2002;95(4):1024–1030.
5. Skipper GE, Campbell MD, Dupont RL. Anesthesiologists with substance use disorders: A 5-year outcome study from 16 state physician health programs. Anesthesia & Analgesia. 2009;109(3):891–896.
6. Jungerman FS, Palhares-Alves HN, Carmona MJ, Conti NB, Malbergier A. Anesthetic drug abuse by anesthesiologists. Brazilian Journal of Anesthesiology (English Edition). 2012;62(3):375–386.
7. Mayall R. Substance abuse in anaesthetists. BJA Education. 2015;16(7):236–241.
8. Zuleta-Alarcón A, Coffman JC, Soghomonyan S, Papadimos TJ, Bergese SD, Moran KR. Non-opioid anesthetic drug abuse among anesthesia care providers: A narrative review. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2017;64(2):169–184.
9. Wischmeyer PE, Johnson BR, Wilson JE, et al. A Survey of Propofol Abuse in Academic Anesthesia Programs. Anesthesia & Analgesia. 2007;105(4):1066–1071.
10. Luo A, Zhang X, Li S, Zhao Y. Sevoflurane addiction due to workplace exposure: A case report and literature review. Medicine (Baltimore). 2018;97(38):e12454.
11. Katz JD. The impaired and/or disabled anesthesiologist. Current Opinion in Anesthesiology. 2017;30(2):217–222.
12. Rice MJ, Grek SB, Swift MD, Nance JJ, Shaw AD. The Need for Mandatory Random Drug Testing in Anesthesia Providers. Anesthesia & Analgesia. 2017;124(5):1712–1716.
13. Gavin K. Would Not-For-Cause Randomized Drug Testing Reduce the Incidence of Drug Misuse Among Certified Registered Nurse Anesthetists? Web: University of Southern Mississippi; December 2015.