9th August 2017

Doctors and drug abuse: Why addictions can be so difficult

Allegations that Dr. Carmen A. Puliafito used methamphetamine and ecstasy while he was dean of USC’s medical school have opened a window into the pervasiveness of drug use and addiction among physicians and the challenges they face when confronting it.

Between 8% and 12% of people — whether they are doctors or not — will develop a substance abuse problem at some point in their lives, said Dr. Lisa Merlo, a psychiatry professor at the University of Florida College of Medicine who studies addiction among healthcare professionals.

As with most addicts, doctors are most commonly addicted to alcohol, followed by opiates.

The physicians with the most addiction problems tend to be anesthesiologists, emergency room doctors and psychiatrists; men are more likely to be referred for treatment than women, she said. Physicians who are stressed and working long hours may turn to drugs as a coping strategy, experts say.

Seppala, with the Hazelden Betty Ford Foundation, said a doctor’s marriage might fall apart, his personal life in shambles, but signs of distress won’t always appear at work.

If doctors are injecting drugs, they remember to wear long-sleeved shirts in the operating room, he said. They know which eye drops will make their pupils appear normal. Seppala said an emergency room physician from California who became addicted to methamphetamine worked up to the day he was admitted to rehab.

The challenge of getting doctors into treatment

Many state medical boards run special rehab programs for physicians. If doctors are reported because of a drug problem and they complete the state program, the medical board won’t go after their license.

The philosophy behind these so-called physician health programs is that doctors will come forward earlier for help if they know it won’t endanger their career. Many programs are also confidential, so patients can’t find out if their doctors were treated for abuse.

California ran such a program until 2008, but several state audits found it was failing. Physicians weren’t always forced to temporarily stop practicing after testing positive for a drug and entering into rehab, and one audit found one-quarter of scheduled drug tests were not administered.

Only a small fraction of the state’s doctors participated. The program had an average of 250 doctors enrolled out of the 125,000 doctors licensed in California in 2008, according to state data.

On the other hand, the medical board took action against 43 physicians for drug or alcohol abuse in the 2015-16 fiscal year, including some whose licenses were revoked or suspended, according to the board’s latest annual report.

Studies have found that recovery rates among doctors are higher than in the general population. Many physicians are highly motivated to return to their careers, experts say. The five-year recovery rate for addicts who participate in physician health programs is 80%, said Merlo, compared with 40% after one year in the general population.

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