Document Detail


Substance use disorder among anesthesiology residents, 1975-2009.
MedLine Citation:
PMID:  24302092     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
David O Warner; Keith Berge; Huaping Sun; Ann Harman; Andrew Hanson; Darrell R Schroeder
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  310     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-04     Completed Date:  2013-12-13     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2289-96     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesiology / education*
Cohort Studies
Female
Humans
Incidence
Internship and Residency / statistics & numerical data*
Kaplan-Meier Estimate
Male
Recurrence
Retrospective Studies
Students, Medical / psychology*
Substance-Related Disorders / mortality*
Survivors / psychology
United States / epidemiology
Grant Support
ID/Acronym/Agency:
KL2 TR000136/TR/NCATS NIH HHS; UL1TR000135/TR/NCATS NIH HHS
Comments/Corrections

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