I wish our field had some sort of accepted guidance or framework for how to identify this situation early and help these people. In three years of residency we lost two residents to overdoses, one of them in the actual OR. We got an email saying there were counselors available if we wanted to talk, but otherwise the day would continue normally.
It’s hard to identify when you have super smart people whose main goal is NOT to be discovered. Sometimes their spouse is even aware but they become “in cahoots” because their entire lives are on the line and the spouse doesn’t understand that death is a very high risk if the behavior persists. The offender will often convince the spouse that they have quit after the spouse’s discovery of the problem occurs. It is very tempting for the spouse to believe them because they can see the finish line ahead (end of residency) and the beginning of a much better and more prosperous life as payoff for all of the years of sacrifice on both of their parts. It can become that family’s dirty little secret and the spouse is convinced that they are okay and can beat the problem.
Because their source is the hospital, they appear to be the model employee. The person who always arrives early and stays late. The person willing to do the big cases (where more opioid can be justified). The person willing to give breaks for dinner. The person who will take the calls you need covered. Initially, the charting is meticulous in order to make sure all opioids are accounted for. It is not until the very advanced stages that the addict loses the ability to hide the problem from their colleagues at work.
In my experience, it is often a complete shock because the addict has been a stellar resident and has a reputation as a super hard worker (although I have also seen it in a resident that was a constant behavioral problem as well).
It is most often best detected by fellow residents and family members who can better notice the subtle changes earlier.
The best deterrent, in my opinion, is frequent discussions of the issue with the resident group, to include the spouses. In addition, I feel like the threat of random drug screens, even if infrequent, is a very good deterrent.
I also feel strongly that intravenous abuse of opioids should be a disqualifier for a return to the field of anesthesiology. Death being the first sign of relapse has been reported to be 20%. I feel like the risk is too high for our patients and for the individuals. I have also found that treatment centers will almost always recommend that the program accept them back into residency. I don’t trust their advice or their motivations.
komonews.com
www.seattlechildrens.org
cbs12.com
