Addiction treatment resource
list
Homewood Centre
(special program for health professionals)
Guelph, Ontario
800-265-8310
www.homewood.org
The Orchard Recovery and
Addiction Treatment Centre
Bowen Island, BC
866-233-2299
www.orchardrecovery.com
Recovery Acres Centre
(men only)
Calgary, AB
403-245-1196
recoveryacres.org
Aventa Centre
(women only)
Calgary, AB
403-245-9050
www.aventa.org
Le Portage Rehabilitation
Services
St. Philippe-de-la Prairie, Quebec
514-939-0202
William J Farley Center
Williamsburg, VA
800-582-6066
www.farleycenter.com
|
Hugh Laurie of House |
He was in even more pain after
the accident, so he asked a colleague for a Vicodin
script. Soon he was hooked again, but at least he was
functioning. That is until he helped himself to another
colleague's prescription pad. Soon the cops were involved
and staff physicians found themselves closing ranks.
After all, he's the best diagnostician they've got.
The above tale is fictional, part
of the latest season of popular medical drama House,
in which Dr Gregory House (Hugh Laurie) nearly gets
thrown in the slammer for double-doctoring, until his
boss lies for him and slips him a new Vicodin
script. But it could just as easily be torn from the
pages of the local College's disciplinary committee
report. Physician drug addiction is a big problem and
it's not getting any better.
WHAT
CAN YOU DO?
Suspecting substance abuse in a colleague is never easy,
but with an incidence of 8% (around the same as the
general population), you're probably going to run into
it at some point. Still, old stigmas die hard. "Unfortunately,
addiction is still viewed as a moral issue," said Dr
Penelope Ziegler during a presentation at the recent
AMA/CMA International Conference on Physician Health
in November.
Dr Ziegler specializes in treating
addicted healthcare professionals at the William J Farley
Center, an inpatient treatment facility in Williamsburg,
VA. Ingrained attitudes, she said, are a big reason
substance abuse among physicians remains so poorly understood
and treated. "Physicians are often inadequately educated
about chemical dependency in medical professionals and
can be very intolerant of addiction in their peers,"
she said, adding that this same mentality affects addicted
physicians themselves as well. "Physicians rely heavily
on their intellect to solve problems, so there's a strong
denial component among addicts. Admitting they have
a disease they alone cannot cure is a very difficult
barrier to break through."
According to Dr Ziegler, another
major barrier to proper assessment and treatment is
what she called a 'conspiracy of silence.' "There's
this notion that [an addicted doctor's] confidentiality
is inviolable or that they shouldn't be reported, unless
a very serious event occurs. This is all fear-based,
of course, since the outcome is unknown and it's worried
that exposing a chemical dependency might end the implicated
doctor's career," she said.
Despite improvements over the years,
Dr Ziegler notes that many doctors lack the skills to
identify substance abuse, in many cases mistaking inappropriate
conduct for behavioural problems.
"There's rarely a single observation
that will clearly identify an addicted colleague," wrote
Dr Michael Kaufmann in the Ontario Medical Review. "As
with other illnesses, an accurate diagnosis is made
by a physician familiar with the signs and symptoms
of chemical dependence." (See Tell-tale signs your colleague's
hooked)
Tell-tale signs your colleague's
hooked
- Loss of efficiency and reliability
- Increased sick time
- Increasing personal and professional
isolation
- Uncharacteristic deterioration
of handwriting and charting
- Heavy 'wastage' of drugs
- Inappropriate prescription
of large narcotic doses
- Insistence on personal administration
of parenteral narcotics to patients
- Long sleeves when inappropriate
- Alcohol on the breath
Adapted from "Paying attention
to substance abuse in physicians," Canadian
Journal of Diagnosis 1993;10(4):76-88.
|
BACK
INTO THE ABYSS
Dr Ziegler laments underfunding of treatment programs
for doctors, warning that we all pay the price when
they relapse.
The topic of relapse was dealt
with in another workshop at the conference given by
Dr Mick Oreskovich, medical director of the Washington
Physician Health Program (WPHP). Dr Oreskovich presented
findings from a 2005 JAMA study that looked at
relapse risk factors in 292 physicians enrolled in the
WPHP over an 11-year period. It confirmed that chemically
dependent healthcare professionals are at higher risk
of relapse if their drug of choice is a major opioid,
such as fentanyl, sufentanil, morphine or meperidine.
(Doctors are believed to be more likely than the general
population to get hooked on opioids and other prescription
meds.)
"A quarter of the study's participants
had a relapse, the likelihood of which was almost doubled
if their drug of choice was a major opioid," said Dr
Oreskovich.
Moreover, Dr Oreskovich noted that
the risk of relapse among major opioid users was even
higher if the physician had a family history of substance
abuse or coexisting psychiatric illness. The combination
of all three factors drastically increased the risk
of relapse. He recommended that these factors be considered
when monitoring physicians returning to the workplace
after major opioid addiction treatment, especially in
the case of anesthetists who decide to continue practising
anesthesia, for whom there was also a markedly increased
risk of relapse.
However, Dr Oreskovich stressed
that as compelling as the study's data may be, it shouldn't
be used to predict the outcome of a physician's recovery.
He pointed out that the best predictors of successful
recovery and reduced risk of relapse were length of
treatment and active monitoring. Also, that among the
physicians who did not relapse after followup of five
years or more, 100% returned to practising medicine,
as opposed to only 61% who did relapse. "This underscores
the importance of allocating the resources to monitor
a physician recovering from substance abuse," he said.
To get help for yourself or
a colleague, contact your local physician health program
(for a full listing of Health Resources click
here).
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