Surgeon working under the influence of methadone

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Hello everyone,

I know I am just starting medical school, and I shouldn't be here. I need advice or education. I was in a heated debate yesterday with an old high school friend who has been using methadone for 5 years to avoid using heroin. My mother was a zombie on methadone (before she died from an overdose). He was bragging to me that he personally knows a surgeon that uses methadone on a regular basis and his patients have no idea.

Is this ethical to be under the influence of a narcotic and not let patients know? Am I wrong? Can people perform tasks such as surgery while on it? Any input or clarification would be very helpful for my understanding. Thanks!

It's not unethical, if it is part of a program, not escalating, and overseen by an appropriate physician. At the same time, if ANYTHING goes wrong (including common effects postoperatively, which can reasonably be expected), and the patients know about the drug use, the patients WILL sue, and the surgeon WILL lose. Irrespective of "addiction treatment" and prescribed and no impairment and all that, if it is known that s/he is "on drugs", s/he will lose.

It's similar to the following: guy has been drinking, but is not visibly intoxicated. He's driving home, and is waiting at a red light. He gets the green, and starts driving through. A car load of kids is speeding (75 in a 35) and cleanly t-bones him on the passenger side. Guy is not injured. Police get there. It appears - clearly - that the car full of kids are at fault. Officer smells alcohol (or says he does). Officer does field sobriety tests, and an alcohol breath test. Drinking guy passes the field sobriety tests, but blows a 0.11. The whole accident will be placed on him, no questions asked.

I know of a guy that is an alcoholic and a doctor. He did 10 years of monitoring, and voluntarily did 10 more. Never failed. He said that, if he got in an accident, the first thing he would do would be to test, because, if the other person found out he'd been impaired, that would be the first thing they would say - even though he had 20+ years sober.

Thanks for your reply. I suppose that the small number of people that I've seen on it just handled it a lot worse. It was definitely no "buzz" like you might receive from a drink or two. They were completely incapacitated. They were on it for some time, too (over a year), so, i thought their dosage would be somewhat stable. So, I just assumed everyone reacted that way on it.

I start medical school this July, so I don't fully understand how methadone works in the body besides activating the same neuroreceptors as heroin. So, I just assumed it made everyone high and not functioning/making decisions at normal capacity......This pup has a lot to learn! Thanks for your insight!

Originally Posted by Apollyon

It's not unethical, if it is part of a program, not escalating, and overseen by an appropriate physician. At the same time, if ANYTHING goes wrong (including common effects postoperatively, which can reasonably be expected), and the patients know about the drug use, the patients WILL sue, and the surgeon WILL lose. Irrespective of "addiction treatment" and prescribed and no impairment and all that, if it is known that s/he is "on drugs", s/he will lose.

I agree with this, or at the very least, this is how you have to expect things will go.

It's similar to the following: guy has been drinking, but is not visibly intoxicated. He's driving home, and is waiting at a red light. He gets the green, and starts driving through. A car load of kids is speeding (75 in a 35) and cleanly t-bones him on the passenger side. Guy is not injured. Police get there. It appears - clearly - that the car full of kids are at fault. Officer smells alcohol (or says he does). Officer does field sobriety tests, and an alcohol breath test. Drinking guy passes the field sobriety tests, but blows a 0.11. The whole accident will be placed on him, no questions asked.

But I disagree here. Running a red light and t-boning someone isn't the drunk guy's fault. He'll get hit with a DUI of course, but it's a stretch to say that the sole blame is going to land on him.

So, I hear horror stories about methadone and has seen a few myself (my mother). What is the medical field's consensus toward its use?

Originally Posted by TheProwler

But I disagree here. Running a red light and t-boning someone isn't the drunk guy's fault. He'll get hit with a DUI of course, but it's a stretch to say that the sole blame is going to land on him.

It's not right, but that's what happens. Even if it's not 100%, the majority (heavily) will go on the DUI-er.

If you can ask a police officer on the low-key, do it.

Originally Posted by Apollyon

It's not right, but that's what happens. Even if it's not 100%, the majority (heavily) will go on the DUI-er.

If you can ask a police officer on the low-key, do it.

What a police officer says does not mean that much. With a lawyer and some decent evidence (witnesses, cameras...) things will be different. Of course, a bad situation to be in anyway.

You absolutely would not be allowed to practice surgery by any institution while on methadone, as by definition you would be considered impaired

Originally Posted by droliver

You absolutely would not be allowed to practice surgery by any institution while on methadone, as by definition you would be considered impaired

Indeed, on reflection, you are correct. What gets me are how people think that medical boards and credentialing committees are NOT conservative, when it is certainly not true - just assume they are not on your side, and you get your answer.

Originally Posted by droliver

You absolutely would not be allowed to practice surgery by any institution while on methadone, as by definition you would be considered impaired

Thank you sir. I was starting to get worried that everyone was talking about the DUI scenario, and the fact that the surgeon was using methadone and performing surgery wasn't being mentioned.