Substance use is one of the most frequent causes of impairment among physicians, and some reports estimate that 10% to 15% of doctors will have a substance use disorder in their lifetime. “Substance-related impairment among physicians is a serious problem, with significant consequences for patient safety and public health,” says Lisa J. Merlo, PhD, MPE. “The rate of physician substance use is similar to that of the general population, but physicians are more likely to misuse prescription drugs. Understanding the reasons for prescription drug misuse may help us more successfully identify, treat, and monitor addicted physicians.”
A key challenge to treating substance use disorders is that most physicians do not refer themselves for treatment, making it difficult to collect data on this issue. One strategy is to partner with physician health programs (PHPs) to recruit study participants. PHPs were established to ensure that distressed or impaired physicians are treated and monitored for the long term so that they can safely return to practice. “Studies have shown that nearly 80% of physicians who participate in PHPs remain substance free—with no relapse—at 5 years follow-up,” Dr. Merlo says. “Unfortunately, many doctors with substance use disorders have these problems for years before they seek help or are referred to a PHP.”
Exploring the Issue
Despite the impact of substance use among physicians, few analyses have looked at prescription drug misuse in this population. Studies have suggested that access to prescription medications may increase the risk of substance abuse among physicians. However, Dr. Merlo says that more information is needed to understand the reasons for prescription drug misuse among physicians and to develop better mechanisms for prevention and intervention.
In the Journal of Addiction Medicine, Dr. Merlo and colleagues had a study published that assessed the reasons for prescription drug misuse among physicians being monitored for substance-related impairment by a PHP. Using guided focus group discussions, the research team analyzed responses of 55 physicians—the vast majority of whom were male—who were being monitored by their PHP because of substance-related impairment (Table 1). Participation in the study was anonymous.
All participants involved in the analysis were diagnosed with substance dependence, and nearly 70% had abused prescription drugs, in addition to alcohol and/or illicit drugs (Table 2). Several themes emerged, three of which were related to “self-medication” using prescription drugs. Physicians reported using medications for self-treatment to manage physical pain, emotional and psychiatric distress, and stressful situations. Other reasons for prescription drug misuse included recreational purposes and avoiding withdrawal symptoms.
“Physicians need to understand that it’s okay to get help for these problems.
PHPs can actually save their careers.”
“Many participants initially developed their drug habit while using medications prescribed for chronic pain after trauma or surgery,” says Dr. Merlo. “Some found that these drugs were effective for longstanding problems with anxiety or depression. Others reported that they used medications to relieve stress relating to their personal or professional life. In many cases, physicians reported having the mentality that they should be able to handle these issues because they are doctors.”
Dr. Merlo says that findings from the study should help increase awareness of the problem of drug misuse among physicians and may be helpful for developing interventions to prevent and recognize drug abuse. “PHPs can be valuable resources for physicians because they offer access to long-term treatment, monitoring, and drug screening,” she says. “There is a high success rate in achieving long-term freedom from substance abuse with PHPs and suffering even one relapse after enrolling in these programs is rare. That said, efforts are needed to ensure that physicians know that PHPs exist and that they should be used when needed. Physicians need to understand that it’s okay to get help for these problems. PHPs can actually save their careers.”
The study also supports the concept that physicians may require different methods of prevention and intervention to be most effective. “Prevention efforts that target prescription drug misuse by physicians should start during medical training,” says Dr. Merlo. “It should also be a requirement as they continue their education and throughout their careers. When educating physicians, we should give strong messages that they need to seek qualified medical care for pain and other medical problems but also for psychiatric or emotional concerns. They shouldn’t feel like they need to try to treat themselves. Ultimately, physicians are just like anyone else, and they experience the same life challenges. By helping physicians learn about the signs of substance abuse and informing them that programs are available to help, we’ll hopefully be able to curb the problem of substance-related impairment in the future.”
Merlo LJ, Singhakant S, Cummings SM, Cottler LB. Reasons for misuse of prescription medication among physicians undergoing monitoring by a physician health program. J Addict Med. 2013;7:349-353. Available at: http://journals.lww.com/journaladdictionmedicine/Abstract/2013/09000/Reasons_for_Misuse_of_Prescription_Medication.7.aspx.
Cummings SM, Merlo L, Cottler L. Mechanisms of prescription drug diversion among impaired physicians. J Addict Dis. 2011;30:195-202.
Cottler LB, Ajinkya S, Merlo LJ, Nixon SJ, Ben Abdallah A, Gold MS. Lifetime psychiatric and substance use disorders among impaired physicians in a physicians health program: comparison to a general treatment population: psychopathology of impaired physicians. J Addict Med. 2013;7:108-112.
Merlo LJ, Cummings SM, Cottler LB. Recovering substance-impaired pharmacists’ views regarding occupational risks for addiction. J Am Pharm Assoc. 2012;52:480-491.