Substance use disorder among anesthesiology residents, 1975-2009

Abstract

Importance: Substance use disorder (SUD) among anesthesiologists and other physicians poses serious risks to both physicians and patients. Formulation of policy and individual treatment plans is hampered by lack of data regarding the epidemiology and outcomes of physician SUD.

Objective: To describe the incidence and outcomes of SUD among anesthesiology residents.

Design, setting, and participants: Retrospective cohort study of physicians who began training in United States anesthesiology residency programs from July 1, 1975, to July 1, 2009, including 44,612 residents contributing 177,848 resident-years to analysis. Follow-up for incidence and relapse was to the end of training and December 31, 2010, respectively.

Main outcomes and measures: Cases of SUD (including initial SUD episode and any relapse, vital status and cause of death, and professional consequences of SUD) ascertained through training records of the American Board of Anesthesiology, including information from the Disciplinary Action Notification Service of the Federation of State Medical Boards and cause of death information from the National Death Index.

Results: Of the residents, 384 had evidence of SUD during training, with an overall incidence of 2.16 (95% CI, 1.95-2.39) per 1000 resident-years (2.68 [95% CI, 2.41-2.98] men and 0.65 [95% CI, 0.44-0.93] women per 1000 resident-years). During the study period, an initial rate increase was followed by a period of lower rates in 1996-2002, but the highest incidence has occurred since 2003 (2.87 [95% CI, 2.42-3.39] per 1000 resident-years). The most common substance category was intravenous opioids, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. Twenty-eight individuals (7.3%; 95% CI, 4.9%-10.4%) died during the training period; all deaths were related to SUD. The Kaplan-Meier estimate of the cumulative proportion of survivors experiencing at least 1 relapse by 30 years after the initial episode (based on a median follow-up of 8.9 years [interquartile range, 5.0-18.8 years]) was 43% (95% CI, 34%-51%). Rates of relapse and death did not depend on the category of substance used. Relapse rates did not change over the study period.

Conclusions and relevance: Among anesthesiology residents entering primary training from 1975 to 2009, 0.86% had evidence of SUD during training. Risk of relapse over the follow-up period was high, indicating persistence of risk after training.

Figure 1. Ascertainment of SUD Cases

A total of 45 581 unique individuals were added to the American Board of Anesthesiology (ABA) data set over the period of study (1975–2009), with 44 612 participating in primary anesthesiology training and an additional 969 participating in only pain or critical care medicine subspecialty training. The substance use disorder (SUD) flag could be set either during or after training. Deceased individuals could have died during or after training. Methods of ascertainment are shown for the 384 individuals who used substances during primary anesthesiology training (ie, not including those who may have used substances during pain or critical care subspecialty training). NDI indicates National Death Index; DANS, Disciplinary Action Notification Service.

Figure 2

Incidence of Substance Use Disorder (SUD) According to Year of First Substance Use for Residents Entering Anesthesiology Training in 1975–2009 and Number of Residents Enrolled Each Year

Figure 3. Relapse of SUD

Relapse incidence is shown for individuals in whom SUD was detected in residency and who survived their initial episode (n = 310), showing the percentage of residents who relapsed as a function of the time that their initial episode was apparent. To compare relapse rates over the earlier and later periods of the study, data are shown for individuals whose date of first use was from 1975 to 1994 (n = 114) and from 1995 to 2009 (n = 196), as well as for the entire study period (1975–2009; n = 310). Rates did not differ between the 1975–1994 and 1995–2009 periods. Numbers at risk are those who had not relapsed and were not censored at the time of last follow-up (December 31, 2010) in each group at each time point.