Q: Are most people surprised to hear about someone who works in health care stealing and abusing drugs?
Dr. Sinha — I think an even better question is, "Why should this be a surprise?" We expect healthcare providers to be somehow cut from different cloth, but believe me, they're not. They aren't immune to addiction or abuse. Their work is stressful and involves long hours, and their relatively easier access to prescription painkillers and other potent medications may make drug diversion even more likely. The incidence rate of substance abuse among providers might be above 10%. The research that we have has shown that alcoholism, drug addiction, suicide attempts and divorce rates are all much higher among medical professionals than in the general population. So we need to also ask the question, "How can we help these people?"
Q: Can we identify who's at risk for on-the-job addictions?
Dr. Sinha — There are no easy answers, and there can be an indefinite drift into drinking and drugs based on prior use, but there are some predictors. Among the general population, the single biggest statistical predictor is that a person whose parent abused drugs has a higher probability. Also, drug-abusing peers or friends can lead you down that path. This is true among providers, too, but keep in mind that it's more likely to emerge at a certain point in a career, a number of years after training. Look at physicians. As a med student, as a resident, you can't be a drug addict: you'll flunk out. But 3 to 5 years post-training is when this tends to begin. You may be depressed, you may be curious. Anesthesia especially has access. Open the drawer and the good stuff is right in there. The pharmacist who sends syringes to the OR, how do you know he's sending the right-labeled strength? Could he be skimming? And who's going to watch over our shoulders all day? It's not as though you can have a camera pointed at everybody in the facility who handles drugs.
Q: Why does this sort of problem so often get overlooked or swept under the rug?
Dr. Sinha — A critical risk with substance-abusing colleagues, especially those with whom we've worked closely or over the long term, is that we may start rationalizing their behavior and making excuses for them. "John's acting weird because he and Mary have been having problems." Administrators who have suspicions or proof may prefer to ask them to resign, to avoid the possibility of the facility ending up in the news. But there are warning signs, and we should be acting on them. Substance abuse has a progressive effect, and left untreated it can be fatal. Besides the obvious risks to patient safety, narcotics quite literally take away the body's desire to breathe.
Q: Is it difficult for providers who are struggling with addiction to seek help on their own?
Dr. Sinha — Yes, there are a number of reasons why they may hesitate to ask for help. From a physician's viewpoint, there's an overachiever's invincibility syndrome, which is not that different from "I can quit any time," but combined with an inability to relate to others. Also, there's a massive sense of self-worth locked up in the educational and professional levels they've reached. An arrest, a revoked license would cost us our income and our ability to help people The shame, embarrassment and financial fallout make it difficult to declare an addiction. But isn't walking up to the chief and saying, "I've got a problem, and I need help," better than being found out, or found comatose or dead with a needle in your arm? You'll probably be sent to inpatient rehab, but most probably you'll make your way back to clinical practice.
Q: What are the prospects for treatment like?
Dr. Sinha — Recovery is hard but it's possible, and the prognosis for complete recovery is good. Addiction treatment programs work, especially when they include peer monitoring, oral opiate blockers and support from family and friends. Research shows that anesthesiologists who are clean for 1 year have a 90% success rate from then on. That's only 1 in 10 falling back into substance abuse. After 2 years, it's 98%, or 1 in 50. Maybe they're not cleared to work in high-risk areas such as cardiac cases again, on cases that demand frequent use of narcotics and create a temptation for diversion, or on overnight call, but consider the alternatives.