Quoted: Chemical dependency / suboxone as a medical student

[NotAProgDirector]

I am a 2nd year medical student and, to be frank, am chemically dependent. I am considering trying out methadone maintenance or suboxone, but am afraid of what implications it might have later down the road when it comes to licensing (surprise: I am hoping to go into anesthesia or EM). I'm also afraid of what my school administration might do if they found out.

For context, I am functional in day-to-day activities, an average student in my class, and look nothing like a "drug user."

First, I want to reinforce that addressing this problem immediately is in your best interest, both from a personal health and career standpoint. Admitting that you have a problem is a huge and difficult first step, and I commend you for that. Also, drug testing is now a part of most hiring processes, so you'll be found out at some point.

This is going to be a very difficult issue to address. There are several facets: legal, ethical, and educational.

Legal -- Whether or not you have to report your drug problem to anyone will depend upon your state's laws, and upon the rules at your school. In general, drug use is not covered by the ADA. Your school would probably be required to give you a medical LOA for rehab if you asked (and you could simply ask for a medical LOA from a physician without details, unclear if this would be acceptable). If you're caught using illegal drugs, you might be terminated on the spot (since you're breaking the law). Your school's policy might include rules about what to do in this situation -- you should check. Of note, physicians who are impaired can always self report to the Board of Medicine -- most state boards have a system by which you self report and they promise not to take your license away (assuming you get treatment). As a medical student, I don't know if this avenue is open to you.

Ethical -- chances are that your school includes some patient contact in the early years. Whether seeing patients while you're impaired on drugs is ethically OK is a choice you'll need to address.

Educational -- I would assume that any level of drug use would impair your ability to do your best educational work. You mention that you're average -- maybe you'd be above average if you were not addicted to drugs?

Of note, Anesthesia should be off the table IMHO. In the same way that alcoholics should not be bartenders, anyone with a drug problem should very carefully consider the choice of anesthesia. In that field, you will routinely be handling syringes full of narcotics and other drugs. Your drug problem never goes away -- it will hopefully go into remission, but the temptation that will be created in anesthesia must be avoided. You are just asking for trouble, and could easily undo all of your hard work. ED would be much more reasonable.

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[nitemagi]

Great comments from APD. I would affirm that Anesthesia and frankly anything with direct access to narcotics (EM) should be taken off the table. Especially since you are not at this point clean and sober. You've yet to even get clean, so the factors to stay clean for you are unclear. Furthermore residencies are going to be very cautious before they even consider taking you into those specialties. I'd also think carefully about withholding information from the medical board down the road. If you withhold your history and anyone blows the whistle on you (which will inevitably happen), then medical board finds out not only that you're drug dependent but that you LIED about it on your application, that may very well be game over. License Revoked. Look at your state medical board newsletter for countless examples of this (I see this all the time in California). Your best option is to get clean NOW, plan for responsible decisions including residency choices, and accept that the consequences as they will be coming for a long time.

You may also want to consult with an attorney and an advisor (who can guarantee confidentiality at least initially).

All that being said I've known medical students who were abusing stimulants or other drugs during medical school, got clean and disclosed this in their application essays. It's a red flag, but the fact that they took measures to address it and keep it under control led to them matching just fine. Not at their top pick, mind you, but well enough.

 

[Apollyon]

Great comments from APD. I would affirm that Anesthesia and frankly anything with direct access to narcotics (EM) should be taken off the table.

EM docs don't have direct access to narcs. Anesthesia docs do, as do dentists. Likewise, ENT has "good" stuff in the office (among others). But, for EM, it's nurses that access the Pyxis. Diversion is very difficult for EM docs (unless there is a confederate - three people can keep a secret if 2 of them are dead).