Curbside Consultation

Caring for the Physician Affected by Substance Use Disorder

 

Am Fam Physician. 2021 Mar 1;103(5):302-304.

Case Scenario

A 34-year-old physician, H.M., is an established patient in my practice. H.M. presents for a follow-up visit after finishing inpatient treatment for opioid use disorder. Your patient shares that six weeks ago they were approached by their medical director to discuss concerns from the clinic staff about H.M.'s behavior, which included late arrivals to work, unexpected absences, mood swings, and weight loss. After the meeting, H.M. agreed to an evaluation by a physician health program, and an opioid use disorder was diagnosed. Inpatient treatment was recommended, and H.M. is still on a medical leave of absence. H.M. is currently prescribed sertraline (Zoloft), 50 mg by mouth daily, and buprenorphine/naloxone (Suboxone), 8 mg/2 mg sublingually daily. H.M.'s aftercare plan includes attending community recovery meetings, focusing on self-care, and spending time with their spouse and children. H.M. reports “feeling better than I have in years” and states that they have had no cravings for opioids. The patient is attending cognitive behavior therapy sessions for treatment of depression and opioid use disorder and is enrolled in the state's physician health program.

As a family physician, what role do I play in supporting H.M.'s recovery from substance use disorder (SUD)?

Commentary

Physicians are not impervious to SUDs. Studies have suggested that the prevalence of SUDs among physicians is 10% to 15%, similar to the general population.1 Alcohol use disorder is the most common type of SUD in physicians, and a national survey of U.S. physicians for all specialties found that female physicians reported alcohol use disorder at a higher rate than male physicians.2 In addition, some medical specialists, such as anesthesiologists, may experience higher rates of nonalcohol SUD because of occupational exposure and access to medications in the workplace.3 There are limited published data on this topic, and reporting bias is likely because of the sensitivity around an SUD diagnosis for practicing physicians; therefore, the true prevalence of SUD among physicians is unknown. Physicians experience several risk factors for the development of SUDs, including high levels of work-related stress; exposure to illness, trauma, and death; and untreated depression or other mental illness.4 With evidence-based treatment and peer and professional support, physicians who have an SUD can recover their health and continue meaningful careers in medicine.

Impairment vs. Illness

Physicians are considered safety-sensitive workers. Health systems, medical licensure boards, and physician health programs may work in tandem to ensure public safety while assisting ill and impaired physicians. The primary purpose of categorizing physicians as safety-sensitive workers is to protect patients from any undue harm that might be caused by the health care professional who has not yet received help for a potentially impairing medical condition. Impairment is a functional classification; an impaired physician is one who is unable to care for patients safely and effectively. A physician with an SUD is an individual with an illness, but this alone does not qualify as impairment. Physicians who are impaired by an SUD should be identified and offered assistance; this process often requires the expertise

Address correspondence to Ruchi M. Fitzgerald, MD, at Ruchi_m_fitzgerald@rush.edu. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Baldisseri MR. Impaired healthcare professional. Crit Care Med. 2007;35(2 suppl):S106–S116....

2. Oreskovich MR, Shanafelt T, Dyrbye LN, et al. The prevalence of substance use disorders in American physicians. Am J Addict. 2015;24(1):30–38.

3. Booth JV, Grossman D, Moore J, et al. Substance abuse among physicians: a survey of academic anesthesiology programs. Anesth Analg. 2002;95(4):1024–1030.

4. Merlo LJ, Trejo-Lopez J, Conwell T, et al. Patterns of substance use initiation among healthcare professionals in recovery. Am J Addict. 2013;22(6):605–612.

5. Federation of State Medical Boards. Policy on physician impairment. April 2011. Accessed December 7, 2020. http://www.fsmb.org/siteassets/advocacy/policies/physician-impairment.pdf

6. American Society of Addiction Medicine. Public policy statement on physicians and other healthcare professionals with addiction. February 6, 2020. Accessed January 4, 2021. https://www.asam.org/docs/default-source/public-policy-statements/2020-public-policy-statement-on-physicians-and-other-healthcare-professionals-with-addiction_final.pdf?sfvrsn=5ed51c2_0

7. Johnson BA. Dealing with the impaired physician [Curbside Consultation]. Am Fam Physician. 2009;80(9):1007–1008. Accessed December 7, 2020. https://www.aafp.org/afp/2009/1101/p1007.html

8. Candilis PJ, Kim DT, Sulmasy LS; ACP Ethics, Professionalism and Human Rights Committee. Physician impairment and rehabilitation: reintegration into medical practice while ensuring patient safety: a position paper from the American College of Physicians. Ann Intern Med. 2019;170(12):871–879.

9. Federation of State Physician Health Programs. Accessed December 7, 2020. https://www.fsphp.org/

10. McLellan AT, Skipper GS, Campbell M, et al. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ. 2008;337:a2038.

11. Bundy C. Opioid use disorder in physicians. N Engl J Med. 2019;381(23):2280–2281.

12. Coffa D, Snyder H. Opioid use disorder: medical treatment options. Am Fam Physician. 2019;100(7):416–425. Accessed December 7, 2020. https://www.aafp.org/afp/2019/1001/p416.html

13. 106th Congress, Rep. Tom Bliley, sponsor. H.R. 2634—Drug Addiction Treatment Act of 2000 (introduced July 20, 1999). Latest action July 27, 2000. Accessed January 4, 2021. https://www.congress.gov/bill/106th-congress/house-bill/2634

14. Substance Abuse and Mental Health Services Administration. Statutes, regulations, and guidelines: Drug Addiction Treatment Act of 2000 (DATA 2000). Updated October 7, 2010. Accessed January 4, 2021. https://www.samhsa.gov/medication-assisted-treatment/statutes-regulations-guidelines#DATA-2000

15. Winslow BT, Onysko M, Hebert M. Medications for alcohol use disorder. Am Fam Physician. 2016;93(6):457–465. Accessed December 7, 2020. https://www.aafp.org/afp/2016/0315/p457.html

16. DeVeau J. Physician burnout and stress while interacting with patients. Am Fam Physician. 2019;100(9):537–539. Accessed January 4, 2021. https://www.aafp.org/afp/2019/1101/p537.html

17. Medscape. Accessed December 7, 2020. https://www.medscape.com/slideshow/2020-physician-covid-experience-6013151

18. Dyrbye LN, Shanafelt TD, Sinsky CA, et al. Burnout among health care professionals: a call to explore and address this underrecognized threat to safe, high-quality care. July 5, 2017. Accessed December 7, 2020. https://nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-underrecognized-threat-to-safe-high-quality-care/

19. Leshner AI, Mancher M; National Academies of Sciences, Engineering, and Medicine. Medications for Opioid Use Disorder Save Lives. National Academies Press; 2019.

20. Zoorob R, Kowalchuk A, Mejia de Grubb M. Buprenorphine therapy for opioid use disorder. Am Fam Physician. 2018;97(5):313–320. Accessed December 7, 2020. https://www.aafp.org/afp/2018/0301/p313.html

This series is coordinated by Caroline Wellbery, MD, associate deputy editor.

A collection of Curbside Consultation published in AFP is available at https://www.aafp.org/afp/curbside.

Please send scenarios to Caroline Wellbery, MD, at afpjournal@aafp.org. Materials are edited to retain confidentiality.

 

 

Copyright © 2021 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Jul 2021

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article