The Junkie in the O.R.

[hoboken]

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This from the current Men's Health Magazine…..in a store near you and your patients…

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The Junkie in the O.R.(Some doctors are addicted to the very drugs they prescribe. Find out why going under the knife could be more dangerous than you think)

link;
http://www.menshealth.com/cda/artic...item=d7a4dfaa4d41e010VgnVCM20000012281eac____

Cole called attorney Richard Silver and was soon plunged into a dark side of medical care that he'd never dreamed existed. Silver began digging and learned that Sadie's anesthesiologist -- Dr. Jay Angeluzzi -- had behaved bizarrely during the procedure. First, he'd failed to recognize that Sadie had stopped breathing, even after the electronic monitor's alarms sounded. Then, instead of examining her, he'd turned off the alarms and left the room. It would be 9 critical minutes before anyone noticed Sadie was not responsive. By the time she was revived, her brain had been oxygen starved and ruined.

So why not just have docs step up to the cup, same as pilots and pro cyclists? One big problem: There's no test for fentanyl, the drug of choice for most addicted anesthesia providers. "We had Abbott Laboratories working on a fentanyl test for more than a year," says Dr. Arens, who had commissioned the project on behalf of the American Society of Anesthesiologists. "But they failed. Every variation showed false positives with antihistamines. So it's easy to call for randomized drug tests, but what do you do if you have no test?"

Writhing agony on the operating table is what finally trapped Dr. Frank Ruhl Peterson, a 45-year-old Pennsylvania anesthesiologist who was sentenced to 10 to 23 months in prison in 1997. "He had more than 200 patients in the couple of months he was there. When I asked him how many of his patients he shortchanged on the drugs, he said, 'Everybody,' " the investigating detective told the Associated Press. "Since the patients were under no anesthetic, they could actually feel the scalpel cutting them, and the operations had to be stopped."

Wait, he thought. What if the drugs are escaping from the patients' breath? The system for delivering drugs may be airtight, but how about the ventilation? Dr. Gold enlisted the University of Florida's nanotechnology group to use its mass spectronomy equipment to test for the presence of drugs above a patient's mouth. They scanned an O.R., and . . . jackpot! Sure enough, narcotics were detected not only in the air, but also on metal trays and tables -- exactly the way vaporized gas would settle. "Fentanyl is extremely potent and active in the air -- that's why the Russians used it to put everyone in the theater to sleep during the Chechen hostage crisis," Dr. Gold explains. "It's also easily absorbed through the skin."


Dr. Gold became aware of how many anesthesiologists were diverting drugs into their own veins while he was assessing 20 years' worth of confidential records at the Physicians Recovery Network, an intervention and rehabilitation organization. He was struck by how often "anesthesiology" turned up as an addicted doctor's specialty, so he began tabulating. Dr. Gold has been an addiction expert for more than 30 years, but even that didn't prepare him for the total: Anesthesiologists are overrepresented by a staggering 500 percent.

"I lost 12 top residents to addiction in 12 years, and I don't know how many others I've missed," concedes James Arens, M.D., chairman of the anesthesiology department at the University of Texas Health Science Center at Houston. "I never confronted a resident who didn't have narcotic addiction, which tells me I didn't confront enough." Translation: If he'd been wrong a few times, Dr. Arens would be more confident he was erring on the side of caution.

 

[VolatileAgent]

Dr. Gold became aware of how many anesthesiologists were diverting drugs into their own veins while he was assessing 20 years' worth of confidential records at the Physicians Recovery Network, an intervention and rehabilitation organization.

you see? this kind of sloppy, tattle-tale type journalism is exactly what is going to prevent addicted physicians from seeking help. isn't this some sort of hipaa violation? or, shouldn't it be? what's the next step? posting all their names?

 

[hoboken]

Wait, he thought. What if the drugs are escaping from the patients' breath? The system for delivering drugs may be airtight, but how about the ventilation? Dr. Gold enlisted the University of Florida's nanotechnology group to use its mass spectronomy equipment to test for the presence of drugs above a patient's mouth. They scanned an O.R., and . . . jackpot! Sure enough, narcotics were detected not only in the air, but also on metal trays and tables -- exactly the way vaporized gas would settle. "Fentanyl is extremely potent and active in the air -- that's why the Russians used it to put everyone in the theater to sleep during the Chechen hostage crisis," Dr. Gold explains. "It's also easily absorbed through the skin."


This article also implies that ever anesthesiologist is a junkie because we are inhaling fentanyl all day long.

 

[Gern Blansten]

carfentanil is not fentanyl. That is really sloppy journalism that somehow made it to print. Very sad. The purpose of the guys research in Florida had nothing to do with how this guy is presenting it. I read his article a while back and if I recall correctly, the researcher was trying to show that our profession is exposed to VERY small amounts of fentanyl through on the job exposure as fentanyl is found in small amountsin the air. His point was that perhaps anesthesiologists are sensitized to it such that if they are exposed to subsequent intravenous doses, they are instantly addicted.

 

[The_Sensei]

There was such a plethora of misinformation in this article, that it actually caused me physical pain when I read it. The author should be sued for slander; then again, this is from Men's Journal, which isn't necessarily the NEJM😳

 

[supahfresh]

Dr. Gold was doubtful. Yes, anesthesiologists are under terrible pressure, and sure, bliss is just a needle prick away, but that's just as true for other medical professionals. Oncologists trying to save dying patients are far more stressed and carry painkillers in their pockets all day, but don't have nearly the addiction rate. Nor does stress account for anesthesiologists' terrible relapse rate."Even after successful treatment, they have the highest relapse rate among all doctors," says Dr. Gold.

I appreciate the stress oncologists go through but I think taking care of a healthy kid who is in laryngospasm trying to die on me in the next 2 minutes is far more stressful than caring for the kid dying from cancer over a longer timeframe.

also, aren't anesthesiologists addiction rates only slighter higher than other specialties? they make it sound like nobody else in medicine gets addicted to narcs.

 

[VolatileAgent]

oncologists do not "carry painkillers in their pockets all day". what a load of horsesh*t.

 

[lobelsteve]

Fentanyl is tested in our clinics routine UDS.

The article was written by a third grader.

Both Ameritox and AIT Labs do GC/MS urine screens and can differentiate between any and all opioids via GC/MS and metabolites are generally sorted based on relative levels.

 

[SexPanther]

So should we all write to Men's Health to let them know that the vast majority of anesthesiologists do not abuse the medications they utilize daily?

The American public is not smart enough to realize that most of the information contained in the article is junk.

 

[VolatileAgent]

asa notified. at the very least, this should get a written response from them. (just like the response to the grey's anatomy crap-fest that the unindoctrinated public has to endure and, perhaps, even mistakenly believe remotely approximates what goes on in the hospital.)

 

[TheSandMan]

asa notified. at the very least, this should get a written response from them. (just like the response to the grey's anatomy crap-fest that the unindoctrinated public has to endure and, perhaps, even mistakenly believe remotely approximates what goes on in the hospital.)

nice link volatile. good to see asa is on top of things, because as they state in their letter, not only are they doing our profesion a disservice, but more importantly the public through providing misinformation that could adversely effect their decisions and thoughts (eg. a mother blaming herself for needing an emergent c-section after requesting an epidural)

 

[VolatileAgent]

i already received a response from the asa. they have contacted the magazine's editor and have indicated that they will be responding formally to what they describe as a "despicable" article.

i encourage each of you who was offended by this juvenile piece of 'journalism' to write in and/or cancel your subscriptions (for those of you who actually pay for this piece of garbage that calls itself a magazine).

 

[supahfresh]

i already received a response from the asa. they have contacted the magazine's editor and have indicated that they will be responding formally to what they describe as a "despicable" article.

i encourage each of you who was offended by this juvenile piece of 'journalism' to write in and/or cancel your subscriptions (for those of you who actually pay for this piece of garbage that calls itself a magazine).

cancel my subscription? but who is going to teach me how to get ripped abs and best sex of my life week after week?

 

[The_Sensei]

i already received a response from the asa. they have contacted the magazine's editor and have indicated that they will be responding formally to what they describe as a "despicable" article.

i encourage each of you who was offended by this juvenile piece of 'journalism' to write in and/or cancel your subscriptions (for those of you who actually pay for this piece of garbage that calls itself a magazine).

Nice work!👍

 

[bigdan]

I just whipped off a letter to the editor at Men's Health....I'll let you know if they reply.

Thanks for sending to ASA, Volatile.

dc

 

[EV-Stentor]

i already received a response from the asa. they have contacted the magazine's editor and have indicated that they will be responding formally to what they describe as a "despicable" article.

i encourage each of you who was offended by this juvenile piece of 'journalism' to write in and/or cancel your subscriptions (for those of you who actually pay for this piece of garbage that calls itself a magazine).

Thanks Vol. for your strong activism...this article is a sorry excuse for journalism!

 

[VolatileAgent]

Thanks Vol. for your strong activism...this article is a sorry excuse for journalism!

thank you for seeing my comments as activism and not "hubris", like certain other posters. i care about this career i've chosen and i'm not willing to see it run into the ground, either by general apathy, inadequate training, or more-comfy-than-they-should-be private practitioners.

you should also let the asa know you're out there, aware of what's going on in our field, and that you support their efforts. they appreciate it. i'm likewise quite pleasantly reassured that they are listening and care, as evidenced by the quick response i got.

and, more importantly, thanks hoboken for bringing this article to our attention. this is evidence of the kind of good this open forum can do, by bringing such things to wider attention and to those of us who care to respond and try to actually do something about it.

 

[Noyac]

I appreciate the stress oncologists go through but I think taking care of a healthy kid who is in laryngospasm trying to die on me in the next 2 minutes is far more stressful than caring for the kid dying from cancer over a longer timeframe.

also, aren't anesthesiologists addiction rates only slighter higher than other specialties? they make it sound like nobody else in medicine gets addicted to narcs.

I have to disagree (respectfully of course). I think the stress we experience is instantaneous and short lived. The stress on a pediatric oncologist is long lasting. They form bonds with their pts and families that we don't get to experience. I say this b/c i just returned from Denver visiting my best friend who's 4 yr old son has been fighting an undiagnosed brain tumor that has everyone baffled. He has been through radiation, high dose chemo. 4 brian surgeries multiple port insertions and now with renal insuff, hearing loss, and C. diff. He can't run b/c the tumor was in the cerebellum and his coordination is shot. Its never ending with these kids. I couldn't do that without some medication, drugs, alcohol, whatever.

And I was told during residency that anesthesiologists make up less than 10% of the physicians out there but occupy 30% of the physicians in rehab. I haven't checked lately but I can't imagine things have changed much in 5 yrs.

 

[ketamine]

I couldn't do that without some medication, drugs, alcohol, whatever.

And I was told during residency that anesthesiologists make up less than 10% of the physicians out there but occupy 30% of the physicians in rehab. I haven't checked lately but I can't imagine things have changed much in 5 yrs.

aaa

 

[bigdan]

I had beef with the way the topic presented, not the issue that was presented.

There is undoubtedly a problem that needs to be addressed within the profession - in fact, I think it is being addressed to a degree. But why use examples like "oncologists carry pain killers in their pockets" and "fentanyl is inhaled all day...that's why it was used in Chechen terror" to sell the story? Who has a port installed in their ankle?

dc

 

[Gern Blansten]

Who has a port installed in their ankle?

dc

I am sure he simply meant an IV. Unfortunately, it happens. I agree with you about all of the misplaced facts.

 

[bigdan]

Gern-

...and that's my gripe - we look at this article through glasses colored with know-how. So we may interpret "IV", but the average Men's Health reader might think "Wow - they even get ports installed to steal this stuff". We (well not me yet) look like high priced crack ******.

dc

 

[VolatileAgent]

Gern-

...and that's my gripe - we look at this article through glasses colored with know-how. So we may interpret "IV", but the average Men's Health reader might think "Wow - they even get ports installed to steal this stuff". We (well not me yet) look like high priced crack ******.

dc

when you attack an entire profession, you better have your facts air tight. i imagine that, if they have the guts to print my letter without editing it, the guy who wrote is going to look quite stupid.

 

[nimbus]

Too bad they sensationalize it but the specialty does have a disproportionate problem with opioid abuse. I personally know 3 anesthesia providers who have faced this issue and one of them is dead because of it. Two others continue to practice with moniters.

 

[Gimlet]

when you attack an entire profession, you better have your facts air tight. i imagine that, if they have the guts to print my letter without editing it, the guy who wrote is going to look quite stupid.

Keep us updated if they do! I don't make it a habit to pick up Men's Health.

 

[blocks]

when you attack an entire profession, you better have your facts air tight. i imagine that, if they have the guts to print my letter without editing it, the guy who wrote is going to look quite stupid.

Strong work, why not post it here as well.👍

 

[VolatileAgent]

follow-up, and for what it's worth:

http://www.asahq.org/news/lemaletter110606.htm

let's see if they have the guts to publish this letter (and mine) in their next installment.

i'd suggest you show your support by thanking the ASA directly. you can contact gina steiner via email. this is who i corresponded with.

 

[bigdan]

V-

Nice. Thanks for the link.

Did you ever hear back from MH after your submission? I sent my letter a few weeks ago and have heard nothing - not even a "Thanks - we got it".

dc

 

[VolatileAgent]

Did you ever hear back from MH after your submission?

me neither. i sent my comments through this link (including my professional credentials and a place i could be contacted for any questions or follow-up):

http://www.menshealth.com/cda/custom.do?incFile=lettersToEditor.jsp&pageTitle=Letters+To+The+Editor

 

[Orthonut]

*sigh* just thought you guys might want to know the pre-meds discovered this article, which is now posted on MSN for *free* (yay! <insert sarcasm>)
While we use many of the same drugs, veterinary anesthesia is completely different from human anesthesia and I feel woefully inadequate to whomp them upside the head as some so richly deserve. Please. Someone, go give the Come To Jesus Meeting.
http://forums.studentdoctor.net/showthread.php?t=341550

 

[the junkie]

I am the guy featured in the article. I last 'passed gas' in 2001, then went to 13 weeks of residential treatment... took a couple years off... then did a psychiatry residency. I'm now in my own solo, independent psychiatry practice, and Assistant Clinical Prof of Psychiatry at the Medical College of Wisconsin.

I don't know how the magazine happened to zero in on me, but they contacted me 6 months ago out of the blue. The reporter said that they were doing an article about 'professionals and successful people who perservere (sp?) through addictions. He 'assured' me a number of times that it was not a 'gotcha' story, and I really thought it would be about my perceptions about the personality factors that predispose one to addiction. I had never read Mens Health-- I genuinely thought it was a 'health magazine'. It is generally accurate...

When he told me about the aerosolized fentanyl study, I told him that I considered it to be no factor in my case, and I considered the idea of the inhaled narcotic as a risk factor to be a stretch.

The main things that I wish had come out: first, it is impressive how fast a doc can become disposable. I was chief of our 8-person department, elected, for 8 of my 10 years; I was the guy who the surgeons requested for the complicated cases, I was friends with everyone, sitting on the executive committee, friends (I thought) with the CEO... and yes, I understand the horrible risks that put patients through... but the weekly dinner party invitations ended, never to return... no spouses contacted my wife, who struggled alone with our three kids while was gone to treatment for 13 weeks... my partners fired me by driving by the house and placing a letter in my mailbox... the most painful part of the whole thing was that my partners in our independent, single specialty group, who I had joined at Christmas parties, dinners, family get-togethers, all just disappeared. I will still see them around town, and they walk the other way, I assume to avoid having to deal with the feelings one has when they act the way they acted...

As an 'aa' guy, I'm not bitter, but the experience did change my perception of the nature of friendship. I lost a bit of my idealism. Which maybe is good, because I consider my idealism to be one of the many personality traits that allowed me to do the stupid things that I did.

I also wanted to encourage addicted docs to seek help early, before they lose everything or kill themselves. I wanted to get across how things have worked out OK, after once fearing that I had lost everything. Yes, I do miss anesthesia-- I was good at it, I truly enjoyed it, I made tons of money-- I considered myself to be the luckiest guy in the world, to have such a career. But I also enjoy the new things I do... teaching med students once a week, running a private practice, writing a quarterly column for Psychiatry Times, marketing my practice...

I would gladly share my experiences and discoveries with anybody out there who fears they have a problem. I now know of so many options out there for treatment, including ways to keep things confidential. I would never disclose anything that anyone decide to share with me (unless someone tells me about a concrete plan to do harm to others, or concrete plans to commit suicide).

One more thing, speaking of confidentiality... in 13 weeks of treatment, I went through tons of individual and group psychotherapy. The State Medical Board demanded my treatment records in order to try to get my license back, and the local hospital demanded all of my records to consider keeping me on staff. The medical board posts all of their decisions on the internet, including some details of my history from my treatment records. So essentially I sign a release of very sensitive material to the Board, and then they do whatever they want with it as part of the public record. The hospital shared my records with the executive committee--basically all of my peers in my small town--and then cut my privileges. And when I came back 5 years later to apply for psychiatry privileges, discussions with administrators included references to particulars that were known only from my treatment records. I still have no idea how many people have read through some very personal stuff.

Anyway... comments welcome. Please contact me if you are in trouble. And sorry about the black eye to the profession. I still tell med students to go into anesthesiology... but to never consider themselves smart enough, or good enough, to ignore the rules.

 

[DianeCRNA]

Dr. Junig, thank you for your reply. I am happy that you have been given the opportunity to tell your side of the story. As usual, the truth is more complicated and less sensationalized than what is printed by our media. And I should know - I am the wife and caretaker of another physician mentioned in the article - Dr. Jay Angeluzzi.

We were never contacted by Christopher McDougall, the author of "The Junkie in the O.R." If we had been, he would have discovered that the very lurid picture of substance abuse and bizarre behaviour reported by Mr. Cole was pure allegation. My husband has never been a substance abuser or addict. He has been hospitalized for situational depression (never once putting a patient at risk) in the past. And he now suffers from early-onset Alzheimer's disease - tragically discovered because of his slow response to an emergency in the O.R. It's telling that when MSN.COM put the Men's Health article on its website, all reference to my husband was removed. I guess the research department at MSN knows how to differentiate between perverted allegations and facts.

I wasn't naive when I met my husband but even I was astounded by the bias in the media, the allegations taken as truth, and the response by the medical community. If you control the media (and we don't as doctors and medical professionals) then you control what gets reported. I understand that. It's the gossip spreading and alienation by my husband's partners that was disheartening. One distressing aspect of human nature is our apparent desire to believe the worst of others - it makes us feel better about ourselves. And for that reason, I don't see these types of articles as ever disappearing.

I hope none of the members of this forum ever experience this type of treatment in the media. Thank you for letting me speak for my husband.

 

[UTSouthwestern]

Dr. Junig, thank you for your reply. I am happy that you have been given the opportunity to tell your side of the story. As usual, the truth is more complicated and less sensationalized than what is printed by our media. And I should know - I am the wife and caretaker of another physician mentioned in the article - Dr. Jay Angeluzzi.

We were never contacted by Christopher McDougall, the author of "The Junkie in the O.R." If we had been, he would have discovered that the very lurid picture of substance abuse and bizarre behaviour reported by Mr. Cole was pure allegation. My husband has never been a substance abuser or addict. He has been hospitalized for situational depression (never once putting a patient at risk) in the past. And he now suffers from early-onset Alzheimer's disease - tragically discovered because of his slow response to an emergency in the O.R. It's telling that when MSN.COM put the Men's Health article on its website, all reference to my husband was removed. I guess the research department at MSN knows how to differentiate between perverted allegations and facts.

I wasn't naive when I met my husband but even I was astounded by the bias in the media, the allegations taken as truth, and the response by the medical community. If you control the media (and we don't as doctors and medical professionals) then you control what gets reported. I understand that. It's the gossip spreading and alienation by my husband's partners that was disheartening. One distressing aspect of human nature is our apparent desire to believe the worst of others - it makes us feel better about ourselves. And for that reason, I don't see these types of articles as ever disappearing.

I hope none of the members of this forum ever experience this type of treatment in the media. Thank you for letting me speak for my husband.

I think it's time that internet news blogs start to refute the drivel from the mainstream media.

 

[s204367]

I am a subscriber to Men's Health, and certainly the last few paragraphs will result in a letter from me....However, I was at Columbia University. During my three years there, we had two residents and an attending released because of fentanyl addiction...In addition, another former resident who i trained with was arrested in his apartment in CHicago with a butload of Crystal Meth and a few handguns on him.....Something about the field that attracts some unstable medical students.......Sad thing about our attending is that he was originally diagnosed with Hep C, which I would imagine he contraced from the vials of left over fentanyl....there's a good .25 -.5 cc in some of the vial tops of a 1000mg vial...........
I am a very firm believer in help programs...but one strike and you are out in this field.

 

[salmonella]

I am a subscriber to Men's Health, and certainly the last few paragraphs will result in a letter from me....However, I was at Columbia University. During my three years there, we had two residents and an attending released because of fentanyl addiction...In addition, another former resident who i trained with was arrested in his apartment in CHicago with a butload of Crystal Meth and a few handguns on him.....Something about the field that attracts some unstable medical students.......Sad thing about our attending is that he was originally diagnosed with Hep C, which I would imagine he contraced from the vials of left over fentanyl....there's a good .25 -.5 cc in some of the vial tops of a 1000mg vial...........
I am a very firm believer in help programs...but one strike and you are out in this field.

Does anyone know the addiction rate for CRNAs? I would imagine that would be similar to their MDA counterpart. Otherwise, I bet the CRNAs are laughing their guts out because MDAs are getting such bad public perception, which may fuel the CRNAs movement to gain practice independence.

 

[dogbone65]

Does anyone know the addiction rate for CRNAs? I would imagine that would be similar to their MDA counterpart. Otherwise, I bet the CRNAs are laughing their guts out because MDAs are getting such bad public perception, which may fuel the CRNAs movement to gain practice independence.

Don't know the rate, but do know it's petty and small-minded to make such an assertion. Guys wife is a crna, and everyone I know has been very sympathetic. This sucks no matter who you are. Besides, with you guys, you do a good enough job screwing up your "image" on your own. Grow up, get real and get a clue.

 

[Conflicted]

Hey

Noone would be happy about this.

Does anyone know the addiction rate for CRNAs? I would imagine that would be similar to their MDA counterpart. Otherwise, I bet the CRNAs are laughing their guts out because MDAs are getting such bad public perception, which may fuel the CRNAs movement to gain practice independence.

 

[mick2003]

[

 

[DianeCRNA]

As far as CRNA addiction rates, I have always assumed it to be the same as MDs. I have had coworkers and former students who have since left practice because of addiction. No CRNAs that I know have ever used the idea of MDs having a higher number of addicts than CRNAs to "fuel the CRNAs movement to gain practice independence." Being married to an anesthesiologist, I assure you that some of us are very supportive of both MDs and CRNAs, being most comfortable in a team practice setting. I personally think having a mix of MDs and CRNAs is best for patients and might make addiction more difficult to hide. Just my opinion.

 

[VolatileAgent]

As far as CRNA addiction rates, I have always assumed it to be the same as MDs. I have had coworkers and former students who have since left practice because of addiction. No CRNAs that I know have ever used the idea of MDs having a higher number of addicts than CRNAs to "fuel the CRNAs movement to gain practice independence." Being married to an anesthesiologist, I assure you that some of us are very supportive of both MDs and CRNAs, being most comfortable in a team practice setting. I personally think having a mix of MDs and CRNAs is best for patients and might make addiction more difficult to hide. Just my opinion.

i can only hope the majority of crnas/srnas continue to feel as you do, or eventually mature to your viewpoint (as the case may be). your frankness, candor, and honesty are an asset to your profession.

 

[Conflicted]

Volatile

She is simply stating the truth. The research available proves that patients have better outcomes in ACT practice. Better, actually than MD only or CRNA only.

Glad your seeing the light.