Anesthesia on drugs

[waterbottle10]

Has anyone had experience with working while on controlled substances for medical reasons (opioids, benzos, marijuana, etc)? Are we allowed to practice with low dose medications? I remember having to report all my medications when I first signed my papers but do we have to tell the world every time we change meds/start controlled meds?

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[DM27]

Having your cake and eating it too is always the dream.

 

[IMGASMD]

If you should not be driving, you shouldn’t be giving anesthesia.
Or
The grandma test. If your grandma were under on the table, are you capable of taking care of her?
I am sure there are plenty of people giving anesthesia while on medication, legally or even illegally. Common sense has to come in play, let’s say if you gave a Percocet to a patient to take home, if he drove and got into an accident..... I hope you see where this is going.... I wouldn’t think your doctor want that kind of liability on his/her record.

 

[okayplayer]

Odd and somewhat concerning question.

 

[IMGASMD]

Odd and somewhat concerning question.

I don’t see anything wrong with his/her question...... nothing, nada. Sounds like a logical question.

but in all seriousness, what if op is depressed and on a SSRI? The first few weeks can be rough. Having anxiety, and was started on a benzo?
But I agree the way op asked the question without any background is, a little... odd.

A co-resident, got hooked, finally got clean, kicked out. But for those few months, no one suspected a thing. Only afterward, we saw the signs.

 

[jwk]

I don’t see anything wrong with his/her question...... nothing, nada. Sounds like a logical question.

but in all seriousness, what if op is depressed and on a SSRI? The first few weeks can be rough. Having anxiety, and was started on a benzo?
But I agree the way op asked the question without any background is, a little... odd.

A co-resident, got hooked, finally got clean, kicked out. But for those few months, no one suspected a thing. Only afterward, we saw the signs.

I think it was a reasonable question until marijuana was on the list.

 

[DM27]

Marijuana could be relevant if OP is in a state where medical and even recreation use is legal and while he/she may not be intoxicated at work he/she would test positive for it on a screen and whether due to this it should be disclosed.

However, I also inferred from the original post that this substance will be actively working while he/she is at work.

 

[studentofsdn]

I don’t see anything wrong with his/her question...... nothing, nada. Sounds like a logical question.

but in all seriousness, what if op is depressed and on a SSRI? The first few weeks can be rough. Having anxiety, and was started on a benzo?
But I agree the way op asked the question without any background is, a little... odd.

A co-resident, got hooked, finally got clean, kicked out. But for those few months, no one suspected a thing. Only afterward, we saw the signs.

what were the signs?

 

[studentofsdn]

I think this is a big nono in any procedural specialty like anesthesia since less than optimal vigilance, reaction time, or hand-eye coordination can be catastrophic. I think if you're a medicine hospitalist and had low dose benzos or opiates rx'd for a legit reason, its probably fine. Granted, I would hope the latter person wouldn't be driving home afterwards during the peak effects.

 

[waterbottle10]

I think this is a big nono in any procedural specialty like anesthesia since less than optimal vigilance, reaction time, or hand-eye coordination can be catastrophic. I think if you're a medicine hospitalist and had low dose benzos or opiates rx'd for a legit reason, its probably fine. Granted, I would hope the latter person wouldn't be driving home afterwards during the peak effects.

I was referring to using them in clinically relevant settings. If I have severe pain, and I take a percocet a day, I would say the percocet helps me instead of hurts me. Is it better to work while in severe pain or be on a percocet? The same thing with anxiety. If you take a benzo a day before you go to bed for your chronic anxiety, it should help not hurt during work. I'm not referring to using them illegally.

I'm surprised not more anesthesiologists have had to go through with this stuff. A lot of people have anxiety, and I see benzos on medication lists all the type for my patients.

 

[Psai]

If you're on benzos for anxiety you should probably see about a new doctor

 

[deleted162650]

Anesthesia is not a great specialty choice for someone with anxiety.

 

[waterbottle10]

If you're on benzos for anxiety you should probably see about a new doctor

What do you recommend? SSRI? If you look any of the studies, SSRI is not very effective for anxiety at all. EtOH? Not the best for the liver.

Anesthesia is not a great specialty choice for someone with anxiety.

This probably depends on the type of anxiety, but either way, I'm not about to quit after spending so many years in anesthesia. I kind of like my job

 

[San Marzano]

What do you recommend? SSRI? If you look any of the studies, SSRI is not very effective for anxiety at all. EtOH? Not the best for the liver.



This probably depends on the type of anxiety, but either way, I'm not about to quit after spending so many years in anesthesia. I kind of like my job

If you want to take benzos and practice anesthesia then you absolutely need to discuss that with your psychiatrist and get evaluated by your state’s physician monitoring program. These kind of things are way easier to deal with when you preemptively get out in front of them. If heaven forbid something were to happen and you get reported to the board then your career all the sudden takes a very rocky left turn.

 

[waterbottle10]

If you want to take benzos and practice anesthesia then you absolutely need to discuss that with your psychiatrist and get evaluated by your state’s physician monitoring program. These kind of things are way easier to deal with when you preemptively get out in front of them. If heaven forbid something were to happen and you get reported to the board then your career all the sudden takes a very rocky left turn.

I discussed it with my physician, however he doesn't know of the policies or what I need to do. He thinks it should be fine if it's for a clinically appropriate reason. But I will have to look into this. Sounds like a ton of work having to disclose it to state and employer. Insane

 

[anbuitachi]

this came up in a discussion sometime ago? but i dont think there was a good answer. though i still find it pretty ridiculous theres no guideline for doctors for these types of issues since docs suffer from some of the highest mental issues (hence high suicide rate and stuff), esp in anesthesiology and everyone keeps on saying get help and treatment, but they dont tell you what to do after that.. quit your job if on meds? you'd think there'd be a website or something that guides you on what you have to do, but of course not (or idk about it). theres like zero support for mental health in this profession

i imagine a lot of docs are probably just taking a risk and not reporting it to anyone. i think there were studies showing a significant percentage of med students/residents are or at some point were on stimulants or psychiatric meds

 

[WholeLottaGame7]

I was referring to using them in clinically relevant settings. If I have severe pain, and I take a percocet a day, I would say the percocet helps me instead of hurts me. Is it better to work while in severe pain or be on a percocet? The same thing with anxiety. If you take a benzo a day before you go to bed for your chronic anxiety, it should help not hurt during work. I'm not referring to using them illegally.

I'm surprised not more anesthesiologists have had to go through with this stuff. A lot of people have anxiety, and I see benzos on medication lists all the type for my patients.

If your options are to A) come to work in severe pain that will distract you from doing your job, or B) come to work on narcotics, you should seriously look into going out on disability until you get the situation addressed.

If you have a bad outcome and it comes out that you took some oxycodone in the AM before coming to work, you will get slaughtered in the court room, if it even gets that far.

 

[vector2]

I discussed it with my physician, however he doesn't know of the policies or what I need to do. He thinks it should be fine if it's for a clinically appropriate reason. But I will have to look into this. Sounds like a ton of work having to disclose it to state and employer. Insane

In the case of hypothetical anxiety, god forbid he ever tries to wean it off cause I don't know what I would do if I was taking a couple xanax a day for 10 years, suddenly lost my scipt, and then continued to go to work and be surrounded by hundreds of vials of versed all day long.

 

[deleted171991]

Sounds like OP needs a new specialty.

Opiate, benzo. Can't imagine many things dumber than mixing those two and practicing anesthesia. Dude, get out while you're still alive and have a career.

The first time anything happens and they ask you in court whether you were on any medications, and you say benzos for anxiety... Yeah, I can see the face of the jury,

I hope you don't plan on going into cardiac or similar. If you're anxious now, when you're just a resident, wait till you become an attending and the buck stops with you. There are four letters burned on your forehead: P-A-I-N.

 

[IMGASMD]

I discussed it with my physician, however he doesn't know of the policies or what I need to do. He thinks it should be fine if it's for a clinically appropriate reason. But I will have to look into this. Sounds like a ton of work having to disclose it to state and employer. Insane

Is this person a psychiatrist? I think there was a discussion recently whether to disclose or not. Or even what’s the psychiatrists responsibility, to keep notes and/or pay cash for treatments. You may need to find someone who has experience treating physicians? Try a different combo of meds? SNRI? Behavioral therapy? Get a good disability insurance while you can? Get a less stressful gig?

Like everyone else has said already. Anxiety and anesthesia don’t play well together. Benzo and/or any opioids have tendency to cause trouble, for you or even prescribing physician. And no one had taken up my suggestion of the grandmas test. Do you feel comfortable of someone on Benzo or oxy taking care of your grandma?

It is not fair. But these are the rules of the game.

Good luck, OP.

 

[GravelRider]

Consider using your disability insurance. I wouldn’t practice anesthesia under any sort of mind altering substance. You would be a malpractice attorney’s wet dream.

 

[narcusprince]

What do you recommend? SSRI? If you look any of the studies, SSRI is not very effective for anxiety at all. EtOH? Not the best for the liver.



This probably depends on the type of anxiety, but either way, I'm not about to quit after spending so many years in anesthesia. I kind of like my job

I probably at some point in my life have had anxiety. Meditation helped. I started using mindbliss app. It certainly helped cutoff potentially negative emotions. I used to have certain people that would trigger my anxiety. With meditation it helped me gain dominion over negative thought. Honestly different environment helps too!

 

[waterbottle10]

Is this person a psychiatrist? I think there was a discussion recently whether to disclose or not. Or even what’s the psychiatrists responsibility, to keep notes and/or pay cash for treatments. You may need to find someone who has experience treating physicians? Try a different combo of meds? SNRI? Behavioral therapy? Get a good disability insurance while you can? Get a less stressful gig?

Like everyone else has said already. Anxiety and anesthesia don’t play well together. Benzo and/or any opioids have tendency to cause trouble, for you or even prescribing physician. And no one had taken up my suggestion of the grandmas test. Do you feel comfortable of someone on Benzo or oxy taking care of your grandma?

It is not fair. But these are the rules of the game.

Good luck, OP.

I mean for a thread of doctors there seems to be a lot of ignorance of the subject. I get it if it's a group of lawyers or patients but its a board of doctors. Addiction/substance abuse is not the same thing as taking a needed medication for a clinical diagnosis. Yes latter can lead to former but it's not that common. Maybe that's why benzo is schedule 4 right in front of cough medications.

Anyway, SSRI failed miserably, didn't do anything (the problem with being a doctor is we know where to find information. Seeing how badly SSRIs do for anxiety in studies kind of kills your placebo affect). Behavior therapy didn't do anything. Though I think this is difficult since it takes a lot of time and a lot of psychiatrists are really bad at it!

Anyway anxiety isn't even related to work but I guess I'll have to read into my hospitals policies
And disability insurance excluded mental disorders

 

[IMGASMD]

what were the signs?

The usual which you will learn or learned in residency. Taking other people’s calls. Volunteer giving people breaks. More obvious ones including taking dilaudid out for all cases, asking for breaks right after cases start, asking for frequent breaks. The one I find the most troubling afterwards was the fact they always wore long sleeve shirt no matter what the weather is like. This one really made me think, since I am always cold in OR and would have never expected this......

Don’t do drugs.

 

[WholeLottaGame7]

I mean for a thread of doctors there seems to be a lot of ignorance of the subject. I get it if it's a group of lawyers or patients but its a board of doctors. Addiction/substance abuse is not the same thing as taking a needed medication for a clinical diagnosis. Yes latter can lead to former but it's not that common. Maybe that's why benzo is schedule 4 right in front of cough medications.

Anyway, SSRI failed miserably, didn't do anything (the problem with being a doctor is we know where to find information. Seeing how badly SSRIs do for anxiety in studies kind of kills your placebo affect). Behavior therapy didn't do anything. Though I think this is difficult since it takes a lot of time and a lot of psychiatrists are really bad at it!

Anyway anxiety isn't even related to work but I guess I'll have to read into my hospitals policies
And disability insurance excluded mental disorders

What exactly is your role/experience again?

You asked a board of physicians who administer and see the effects of opioids and benzodiazepines on a daily basis. I'm sorry you don't like the replies.

Just do whatever you were going to do anyway.

 

[chocomorsel]

I mean for a thread of doctors there seems to be a lot of ignorance of the subject. I get it if it's a group of lawyers or patients but its a board of doctors. Addiction/substance abuse is not the same thing as taking a needed medication for a clinical diagnosis. Yes latter can lead to former but it's not that common. Maybe that's why benzo is schedule 4 right in front of cough medications.

Anyway, SSRI failed miserably, didn't do anything (the problem with being a doctor is we know where to find information. Seeing how badly SSRIs do for anxiety in studies kind of kills your placebo affect). Behavior therapy didn't do anything. Though I think this is difficult since it takes a lot of time and a lot of psychiatrists are really bad at it!

Anyway anxiety isn't even related to work but I guess I'll have to read into my hospitals policies
And disability insurance excluded mental disorders

I had pretty bad anxiety in residency. Started on prozac. Thought it was the best thing since sliced bread. I had no idea that I had had anxiety for a large number of years till it all culminated as a CA2/CA3.
SSRI's are pretty effective for anxiety for a large number of patients. It's the side effects that can suck. Too bad that didn't work for you. Can't imagine being on benzos on a daily. Hopefully its only at night.

 

[waterbottle10]

I had pretty bad anxiety in residency. Started on prozac. Thought it was the best thing since sliced bread. I had no idea that I had had anxiety for a large number of years till it all culminated as a CA2/CA3.
SSRI's are pretty effective for anxiety for a large number of patients. It's the side effects that can suck. Too bad that didn't work for you. Can't imagine being on benzos on a daily. Hopefully its only at night.

Glad it worked for you! Recent studies show the effectiveness is not very significant clinically, and some people say side effects outweigh the benefits but of course it varies per patient. A lot of the older studies had anxiety as a secondary outcome (basically patients who had another disorder like depression or bipolar, and anxiety, idea being the SSRI actually helped the 1st disorder and therefore anxiety improved). The doses for anxiety is pretty small , 0.25 Klonopin /day, which is about 1mg of Versed.

 

[DM27]

I don't know the policy of where you work, but you will likely need to disclose all of these things if they have a drug testing policy. Especially in anesthesia where if you are drug screened it's to test almost exclusively for benzos and/or opiates.

 

[Twiggidy]

I was referring to using them in clinically relevant settings. If I have severe pain, and I take a percocet a day, I would say the percocet helps me instead of hurts me. Is it better to work while in severe pain or be on a percocet? The same thing with anxiety. If you take a benzo a day before you go to bed for your chronic anxiety, it should help not hurt during work. I'm not referring to using them illegally.

I'm surprised not more anesthesiologists have had to go through with this stuff. A lot of people have anxiety, and I see benzos on medication lists all the type for my patients.

The problem here is your logic is flawed. Yes a lot of people have anxiety and take medicines for said anxiety but NOT a lot of people have other people's lives in their hands. I hate to use the way overused pilot reference but even they can't use prescription opioids (they have to wait 72 hrs after last dose before they can fly).

As said above, if it's that bad then you need to have good disability or even consider and career change (which is the extreme). As someone else said, the liability of having someone "under the influence" while working is way too high. It sounds unfair, but that's life. I literally know of a surgeon who died from liver failure due to taking too much tylenol because non-opioid medications were his only option if he wanted to keep working. One could argue that if someone is in pain and refuses to treat it if they should have the ability to work.

Edit: Pilots also can't use anxiety drugs. So basically, if a pilot can't take it, an anesthesiologist probably can't take it. I'm not sure if it applies to less "procedure based" fields. Interesting enough my reference for pilots say things like SSRI require "special issuance" so you would probably have to disclose and discuss with someone if you're on one of those.

 

[deleted171991]

Benzodiazepine addiction is real. This physician shares his story.

 

[MoMoGesiologist]

Whatever you do, do not let the hospital or your coworkers know you take medications or have an issue. The only person looking out for you, is you

 

[anbuitachi]

Whatever you do, do not let the hospital or your coworkers know you take medications or have an issue. The only person looking out for you, is you

the problem with that is if you get drug screened which some jobs do, you are screwed! lol. better call out sick for a month and then drug test after its out of your system hahah

though i do think there are a lot of doctors in this category. i guess for some ppl taking a risk like that is better than dealing with whatever problems they have untreated