Substance use disorder among anesthesiology residents, 1975-2009

David Oman Warner, Keith Berge, Huaping Sun, Ann Harman, Andrew Hanson, Darrell R. Schroeder

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

IMPORTANCE: Substance use disorder (SUD) among anesthesiologists and other physicians poses serious risks to both physicians and patients. Formulation of policy and individual treatment plans is hampered by lack of data regarding the epidemiology and outcomes of physician SUD. OBJECTIVE: To describe the incidence and outcomes of SUD among anesthesiology residents. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of physicians who began training in United States anesthesiology residency programs from July 1, 1975, to July 1, 2009, including 44 612 residents contributing 177 848 resident-years to analysis. Follow-up for incidence and relapse was to the end of training and December 31, 2010, respectively. MAIN OUTCOMES AND MEASURES Cases of SUD (including initial SUD episode and any relapse, vital status and cause of death, and professional consequences of SUD) ascertained through training records of the American Board of Anesthesiology, including information from the Disciplinary Action Notification Service of the Federation of State Medical Boards and cause of death information from the National Death Index. RESULTS: Of the residents, 384 had evidence of SUD during training, with an overall incidence of 2.16 (95% CI, 1.95-2.39) per 1000 resident-years (2.68 [95% CI, 2.41-2.98] men and 0.65 [95% CI, 0.44-0.93] women per 1000 resident-years). During the study period, an initial rate increase was followed by a period of lower rates in 1996-2002, but the highest incidence has occurred since 2003 (2.87 [95% CI, 2.42-3.39] per 1000 resident-years). The most common substance category was intravenous opioids, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. Twenty-eight individuals (7.3%; 95% CI, 4.9%-10.4%) died during the training period; all deaths were related to SUD. The Kaplan-Meier estimate of the cumulative proportion of survivors experiencing at least 1 relapse by 30 years after the initial episode (based on a median follow-up of 8.9 years [interquartile range, 5.0-18.8 years]) was 43% (95% CI, 34%-51%). Rates of relapse and death did not depend on the category of substance used. Relapse rates did not change over the study period. CONCLUSIONS AND RELEVANCE: Among anesthesiology residents entering primary training from 1975 to 2009, 0.86% had evidence of SUD during training. Risk of relapse over the follow-up period was high, indicating persistence of risk after training.

Original languageEnglish (US)
Pages (from-to)2289-2296
Number of pages8
JournalJAMA - Journal of the American Medical Association
Volume310
Issue number21
DOIs
StatePublished - 2013

Fingerprint

Anesthesiology
Substance-Related Disorders
Recurrence
Physicians
Incidence
Opioid Analgesics
Cause of Death
Kaplan-Meier Estimate
Cannabis
Internship and Residency
Hypnotics and Sedatives
Cocaine
Survivors
Anesthetics
Epidemiology
Cohort Studies
Retrospective Studies
Alcohols
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Substance use disorder among anesthesiology residents, 1975-2009. / Warner, David Oman; Berge, Keith; Sun, Huaping; Harman, Ann; Hanson, Andrew; Schroeder, Darrell R.

In: JAMA - Journal of the American Medical Association, Vol. 310, No. 21, 2013, p. 2289-2296.

Research output: Contribution to journalArticle

Warner, David Oman ; Berge, Keith ; Sun, Huaping ; Harman, Ann ; Hanson, Andrew ; Schroeder, Darrell R. / Substance use disorder among anesthesiology residents, 1975-2009. In: JAMA - Journal of the American Medical Association. 2013 ; Vol. 310, No. 21. pp. 2289-2296.
@article{7f6b3c2a11314b1ebc82b1c3bb24b0a1,
title = "Substance use disorder among anesthesiology residents, 1975-2009",
abstract = "IMPORTANCE: Substance use disorder (SUD) among anesthesiologists and other physicians poses serious risks to both physicians and patients. Formulation of policy and individual treatment plans is hampered by lack of data regarding the epidemiology and outcomes of physician SUD. OBJECTIVE: To describe the incidence and outcomes of SUD among anesthesiology residents. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of physicians who began training in United States anesthesiology residency programs from July 1, 1975, to July 1, 2009, including 44 612 residents contributing 177 848 resident-years to analysis. Follow-up for incidence and relapse was to the end of training and December 31, 2010, respectively. MAIN OUTCOMES AND MEASURES Cases of SUD (including initial SUD episode and any relapse, vital status and cause of death, and professional consequences of SUD) ascertained through training records of the American Board of Anesthesiology, including information from the Disciplinary Action Notification Service of the Federation of State Medical Boards and cause of death information from the National Death Index. RESULTS: Of the residents, 384 had evidence of SUD during training, with an overall incidence of 2.16 (95{\%} CI, 1.95-2.39) per 1000 resident-years (2.68 [95{\%} CI, 2.41-2.98] men and 0.65 [95{\%} CI, 0.44-0.93] women per 1000 resident-years). During the study period, an initial rate increase was followed by a period of lower rates in 1996-2002, but the highest incidence has occurred since 2003 (2.87 [95{\%} CI, 2.42-3.39] per 1000 resident-years). The most common substance category was intravenous opioids, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. Twenty-eight individuals (7.3{\%}; 95{\%} CI, 4.9{\%}-10.4{\%}) died during the training period; all deaths were related to SUD. The Kaplan-Meier estimate of the cumulative proportion of survivors experiencing at least 1 relapse by 30 years after the initial episode (based on a median follow-up of 8.9 years [interquartile range, 5.0-18.8 years]) was 43{\%} (95{\%} CI, 34{\%}-51{\%}). Rates of relapse and death did not depend on the category of substance used. Relapse rates did not change over the study period. CONCLUSIONS AND RELEVANCE: Among anesthesiology residents entering primary training from 1975 to 2009, 0.86{\%} had evidence of SUD during training. Risk of relapse over the follow-up period was high, indicating persistence of risk after training.",
author = "Warner, {David Oman} and Keith Berge and Huaping Sun and Ann Harman and Andrew Hanson and Schroeder, {Darrell R.}",
year = "2013",
doi = "10.1001/jama.2013.281954",
language = "English (US)",
volume = "310",
pages = "2289--2296",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "21",

}

TY - JOUR

T1 - Substance use disorder among anesthesiology residents, 1975-2009

AU - Warner, David Oman

AU - Berge, Keith

AU - Sun, Huaping

AU - Harman, Ann

AU - Hanson, Andrew

AU - Schroeder, Darrell R.

PY - 2013

Y1 - 2013

N2 - IMPORTANCE: Substance use disorder (SUD) among anesthesiologists and other physicians poses serious risks to both physicians and patients. Formulation of policy and individual treatment plans is hampered by lack of data regarding the epidemiology and outcomes of physician SUD. OBJECTIVE: To describe the incidence and outcomes of SUD among anesthesiology residents. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of physicians who began training in United States anesthesiology residency programs from July 1, 1975, to July 1, 2009, including 44 612 residents contributing 177 848 resident-years to analysis. Follow-up for incidence and relapse was to the end of training and December 31, 2010, respectively. MAIN OUTCOMES AND MEASURES Cases of SUD (including initial SUD episode and any relapse, vital status and cause of death, and professional consequences of SUD) ascertained through training records of the American Board of Anesthesiology, including information from the Disciplinary Action Notification Service of the Federation of State Medical Boards and cause of death information from the National Death Index. RESULTS: Of the residents, 384 had evidence of SUD during training, with an overall incidence of 2.16 (95% CI, 1.95-2.39) per 1000 resident-years (2.68 [95% CI, 2.41-2.98] men and 0.65 [95% CI, 0.44-0.93] women per 1000 resident-years). During the study period, an initial rate increase was followed by a period of lower rates in 1996-2002, but the highest incidence has occurred since 2003 (2.87 [95% CI, 2.42-3.39] per 1000 resident-years). The most common substance category was intravenous opioids, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. Twenty-eight individuals (7.3%; 95% CI, 4.9%-10.4%) died during the training period; all deaths were related to SUD. The Kaplan-Meier estimate of the cumulative proportion of survivors experiencing at least 1 relapse by 30 years after the initial episode (based on a median follow-up of 8.9 years [interquartile range, 5.0-18.8 years]) was 43% (95% CI, 34%-51%). Rates of relapse and death did not depend on the category of substance used. Relapse rates did not change over the study period. CONCLUSIONS AND RELEVANCE: Among anesthesiology residents entering primary training from 1975 to 2009, 0.86% had evidence of SUD during training. Risk of relapse over the follow-up period was high, indicating persistence of risk after training.

AB - IMPORTANCE: Substance use disorder (SUD) among anesthesiologists and other physicians poses serious risks to both physicians and patients. Formulation of policy and individual treatment plans is hampered by lack of data regarding the epidemiology and outcomes of physician SUD. OBJECTIVE: To describe the incidence and outcomes of SUD among anesthesiology residents. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of physicians who began training in United States anesthesiology residency programs from July 1, 1975, to July 1, 2009, including 44 612 residents contributing 177 848 resident-years to analysis. Follow-up for incidence and relapse was to the end of training and December 31, 2010, respectively. MAIN OUTCOMES AND MEASURES Cases of SUD (including initial SUD episode and any relapse, vital status and cause of death, and professional consequences of SUD) ascertained through training records of the American Board of Anesthesiology, including information from the Disciplinary Action Notification Service of the Federation of State Medical Boards and cause of death information from the National Death Index. RESULTS: Of the residents, 384 had evidence of SUD during training, with an overall incidence of 2.16 (95% CI, 1.95-2.39) per 1000 resident-years (2.68 [95% CI, 2.41-2.98] men and 0.65 [95% CI, 0.44-0.93] women per 1000 resident-years). During the study period, an initial rate increase was followed by a period of lower rates in 1996-2002, but the highest incidence has occurred since 2003 (2.87 [95% CI, 2.42-3.39] per 1000 resident-years). The most common substance category was intravenous opioids, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. Twenty-eight individuals (7.3%; 95% CI, 4.9%-10.4%) died during the training period; all deaths were related to SUD. The Kaplan-Meier estimate of the cumulative proportion of survivors experiencing at least 1 relapse by 30 years after the initial episode (based on a median follow-up of 8.9 years [interquartile range, 5.0-18.8 years]) was 43% (95% CI, 34%-51%). Rates of relapse and death did not depend on the category of substance used. Relapse rates did not change over the study period. CONCLUSIONS AND RELEVANCE: Among anesthesiology residents entering primary training from 1975 to 2009, 0.86% had evidence of SUD during training. Risk of relapse over the follow-up period was high, indicating persistence of risk after training.

UR - http://www.scopus.com/inward/record.url?scp=84889068947&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84889068947&partnerID=8YFLogxK

U2 - 10.1001/jama.2013.281954

DO - 10.1001/jama.2013.281954

M3 - Article

VL - 310

SP - 2289

EP - 2296

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 21

ER -