Doctors, nurses, pharmacists, addiction treatment specialists, and other health care professionals (HCPs) are entrusted with the care of the people they treat, which includes those who are battling drug or alcohol addiction.
But what happens when people in the medical field, who have been charged with the responsibility to take care of others, need help for substance addiction themselves?
While health care professionals are the least likely to be suspected of having substance abuse issues, it is not uncommon that they do.
The medical director of the National Health Service in England warned in June 2017 that more general practitioners in the United Kingdom are seeking help from specialists for substance abuse and mental health disorders.
The Physician Health Program’s website offers some perspective on how widespread the problem of addicted health care professionals is.
Doctors struggle with drug and alcohol addictions at similar or higher rates as the general population, it reports, and alcohol is the most commonly abused drug among physicians. Doctors also have higher rates of prescription drug abuse than the general population. Opioids and benzodiazepines are the most commonly abused prescription drugs in this group, according to PHP’s report.
Doctors are prone to drug and alcohol abuse, according to Peter Grinspoon, a primary care physician and Harvard Medical School instructor. He has written about his addiction to prescription opiates as well as the time he was charged with three felony counts of fraudulent prescribing, according to his account published in the Los Angeles Times.
“It’s estimated that rates of addiction among the general population run from 8 percent to 10 percent among physicians, the rates start at 10 percent and rise to 15 percent. What appears to account for the difference is physician distress, and in the case of drug abuse, plentiful access,” Grinspoon writes.
Access To Drugs Plays a Big Role
Grinspoon describes just how much plentiful access he had. He writes: “My access to prescription medications was virtually unlimited. Drug companies send doctors free samples. Patients bring in their unused painkillers for disposal. Colleagues freely write a script or two as a professional courtesy. And I foolishly made illegal use of my own prescription pad.”
The U.S. Drug Enforcement Administration (DEA) also lists access as a key reason why drug-impaired HCPs is an issue.
“Many [health care professionals] have easy access to controlled substance medications, and some will divert and abuse these drugs for reasons such as relief from stress, self-medication, or to improve work performance and alertness,” the federal agency reports on its site.
A January 2014 Medscape article titled, “Drug Abuse Among Doctors: Easy, Tempting, and Not Uncommon,” explains why physicians have access to potent, in-demand drugs.
Their prescribing privileges, networks of professional contact, and proximity to hospital and clinic supplies make it easy for them to get the drugs. The availability of such drugs in large amounts in their work environment is also a contributing factor.
Self-Medication Is Common Practice
Like everyone else, medical professionals face daily challenges that prompt some to use addictive substances. These include painkillers, antidepressants, and other prescription drugs that can help them cope with long hours, heavy workloads, the pressure to compete, burnout, and patient outcomes, which are not always predictable or favorable.
These increasing demands lead some doctors to self-medicate as they manage an underlying mental health disorders, such as depression and anxiety, among many others.
Lisa Merlo, Ph.D., of the University of Florida’s Center for Addiction Research and Education, who has researched the issue, told Medscape that physicians are more likely than the general public to misuse prescription drugs.
For the study, Merlo interviewed 55 physicians who were being monitored by their state physician health programs for substance abuse problems.
“Of those, 38 doctors (69 percent) abused prescription drugs. In describing their motivation, most said they turned to prescription drugs to relieve stress and physical or emotional pain,” the article said.
Who Helps Addicted Medical Professionals When They Need Help?
According to the Physicians Health Program, by the time physicians receive treatment for substance addiction, their illness is in the advanced stages, and they already have faced threats to their medical license and professional reputation, among other things.
Fear of sanctions, punishment, and being shamed keep many addicted medical professionals from seeking the help they need. But they do have options and help, and it’s important that they receive help as soon as possible for their substance dependence.
Physicians and others who are struggling with addictions can seek help privately under the Health Insurance Portability and Accountability Act (HIPAA) as well as Title 42 of the Code of Federal Regulations (42 CFR).
There are physician health programs that help doctors with substance abuse problems. Medical professionals who enter a traditional model of treatment, they will find it is similar to the one used for non-medical professionals.
Depending on the person’s condition and situation, they may have to start and complete a medical detox program before they can start an addiction treatment program. It is vital that they receive a customized care plan from a rehabilitation facility that understands the specific needs and unique challenges of their industry.
Aftercare programs are essential as well to ensure continued support during recovery from substance abuse.
People in the medical field who are struggling with substance abuse and addiction can see their primary care physician or mental health professionals, such as a psychologist or psychiatrists, for help with their problems.
Treatment Saves More Than One Life
Medical professionals who receive treatment for their substance use challenges are saving their lives as well as those of the people they treat. Because getting treatment can save more than one life and keep everyone safe, it would be understandable to expect that colleagues of addicted medical professionals would be more willing to report drug impairment in their workplaces.
Not so, says the DEA.
“Health care professionals often avoid dealing with drug impairment in their colleagues,” the agency says, which notes that drug-impaired medical professionals are one source of controlled substances diversion. “There is a natural reluctance to approach a co-worker suspected of drug addiction. There is the fear that speaking out could anger the co-worker, resulting in retribution, or could result in a colleague’s loss of professional practice.”
If a medical professional recognizes the signs or symptoms of drug or alcohol intoxication or suspects that a colleague is impaired or under the influence, the DEA supports the person by showing concern for the colleague and encouraging the impaired colleague to seek drug treatment help.
Some signs of drug impairment, according to the DEA, are:
- Work absenteeism or absences without notification and an excessive number of sick days used
- Frequent disappearances from the work site, having long unexplained absences, making improbable excuses, and taking frequent or long trips to the bathroom or to the stockroom where drugs are kept
- Excessive amounts of time spent near a drug supply. They volunteer for overtime and are at work when not scheduled to be there
- Unreliability in keeping appointments and meeting deadlines
- Work performance that alternates between periods of high and low productivity and may suffer from mistakes made due to inattention, poor judgment, and bad decisions
- Confusion, memory loss, and difficulty concentrating or recalling details and instructions; Ordinary tasks require greater effort and consume more time.
- Interpersonal relations with colleagues, staff, and patients suffer; rarely admits errors or accepts blame for errors or oversights
- Heavy “wastage” of drugs
- Sloppy record-keeping, suspect ledger entries, and drug shortages
- Inappropriate prescriptions for large narcotic doses
- Insistence on personal administration of injected narcotics to patients
- Progressive deterioration in personal appearance and hygiene
- Uncharacteristic deterioration of handwriting and charting
- Wearing long sleeves when inappropriate
- Personality change—mood swings, anxiety, depression, lack of impulse control, suicidal thoughts or gestures
- Patient and staff complaints about the health care provider’s changing attitude/behavior
- Increasing personal and professional isolation
Source: U.S. Department of Justice, Drug Enforcement Administration, Diversion Control Division
Treatment options for addicted medical professionals include state licensing boards, employee assistance programs (EAPs), state diversion programs, and peer assistance organizations.
According to the DEA, these programs and organizations will refer individuals and their families to the proper counseling and treatment services. “These services will maintain the confidentiality of those seeking assistance to the greatest extent possible,” the DEA writes.