Question

Should a physician who has/had a substance abuse addiction be permitted to retain their license to practice medicine? What are the laws or ethics in your state on this subject?

Answer 1

WHAT IF PHYSICIAN ADDICTION IS SUSPECTED?

· The signs and symptoms of addictive addiction range from very subtle to painfully evident. While they can be as evident as job poisoning, with the stereotypic symptoms of ataxia and dysarthria, the results are much more subtle in general. The addicted physician may continue to work at a high level , especially with opioid addiction, and his or her colleagues have just a suggestion of a problem due to changes in behaviour. Because it is of paramount importance to ensure the health of our (and the addicted physician's) patients, the addicted physician who uses parenteral opioid has a very real risk of severe morbidity (e.g., anoxic brain injury from inadvertent overdose) and death.

· Thus, if physician addiction is suspected, prompt confirmation and intervention is necessary. Unfortunately, decisions also have to be made in the face of non-conclusive proof of physician abuse or drug diversion for self-use. Unless an assessment is postponed until evidence of physician abuse or drug misuse is "beyond reasonable doubt" obtained, the likelihood of a catastrophic outcome increases.

· Because any therapy involving a drug dependency assessment does not consist of accusing the person of a crime — reasonable suspicion of an addictive disorder is necessary. The laws governing these matters vary from State to State, Replacing a formal written policy for all health-care organizations is not sufficiently specific. When companies refuse to formalize their procedures in writing, they will then be at risk of harmful medical or legal consequences.

SHOULD THE ADDICTED PHYSICIAN RETURN TO PRACTICE?

Physicians have remarkable abstinence rates compared to the general population after completing an addiction / rehabilitation programme. Abstinence rates range from 74% to 90%, similar to another professional group with success rates higher than average, airline pilots.

Such high levels may be attributed to the incentive needed to retain licenses and to pursue medical practice, as well as the intensive care and long-term monitoring. Yet there's also a troubling rate of recurrence for addicted doctors.

Over a 10-year period, the Washington State PHP analyzed its interaction with health care workers and found that 25 per cent had at least 1 relapse and recognized possible contributing or conflicting factors. A family history of a drug use disorder and a coexisting mental condition (dual-diagnosis) raised the likelihood of relapse. Nevertheless, a coexisting psychiatric disorder or a strong family history of addiction has resulted in a substantially elevated risk of relapse in the environment of opioid addiction.

When combined into one individual, the 3 factors resulted in a 13-fold increase in the risk of relapse. It has been found that only 1 relapse can be devastating in the setting of addiction to potent opioids such as fentanyl, as 16 percent of residents with recurrent anesthesia were found dead before anybody suspected a relapse.

Thus, addiction treatment and monitoring programs must take these factors into account when developing treatment plans and when physicians are advised to return to practice. Society and the investment of the individual in physician training, as well as the high abstinence rates for addicted physicians who complete a suitable treatment program, support a rehabilitation model.

Through a good drug treatment plan and screening programs in place, a lot of doctors will successfully return to work. Every doctor returning to the profession will participate in the PHP of his or her state, and such involvement is mandatory in general.

Such services are typically led by physician practitioners, offering support for individual and group counseling, clinical treatment, meetings of mutual aid, body fluid screening for drugs of violence, and training and supervision in the work place.

Typically, PHPs require contracts with the practitioner that record the activities planned and require compliance with the activities, most likely to ensure abstinence and a positive return to practice. Failure to comply with the PHP system would result in referral to the medical licensing board of the State; At that point, disciplinary action will typically be taken with the possibility of public disclosure, penalties up to and including suspension of licences or, in extreme cases, revocation.

In general, the PHP must handle the logistics of acquiring and tracking necessary drug screens, both randomly and for reasons. These testing both encourages abstinence and maintains an abstinence record, although there are limitations to such testing which can lead to false-positive and false-negative test results.

Often, limitations on physician prescription are put in place to include opioids or other potentially addictive medicines. Anesthesiologists are a special case in which access to and use of highly addictive medicines is common in anesthesia.

Furthermore, anesthesiologists who are addicted to anesthetic agents or anesthetic supplements (eg, opioids, propofol, volatile anesthetic agents) have a uniquely high relapse rate associated with an unacceptable risk of morbidity and mortality.

LEGAL ASPECTS

The ethical implications of coping with physician addiction can be nuanced and thorny. Upon learning that a staff physician has an addiction, the first legal and ethical duty of a clinic or hospital is to protect patients by withdrawing the doctor from practice and advising the doctor to take leave of absence for care. State regulations differ about workplace substance monitoring.

Many states disallow drug and alcohol testing unless the company has a formal policy on drug and alcohol testing that meets the legal standards in place. Some state legislation limits random testing and limits testing grounds based on "reasonable suspicion."

State medical licensing boards usually allow physicians to register for themselves and register on other physicians who are unable to practice medicine safely because of drug or alcohol use. Many states have a workaround system that allows the state licensing board to forego a request, instead requiring a request to the state's PHP to satisfy the requirement.

Nevertheless, these bypass programs may have eligibility requirements which exclude the participation of certain physicians and require a report to the medical board. Typical exclusions are for doctors who are still under the supervision of the licensing board, others who have already been removed from a medical rehabilitation programme, Others that have diverted controlled drugs for reasons other than self-administration, or those whose continuing medical practice will create a significant risk of harm to the public.

So long as the identified practitioner complies with the recovery program's practice restrictions and continuing care criteria and complies with the PHP criteria, the licensing board may usually prevent formal, public reprimand or administrative action by the practitioner involved in a bypass system.

Federal legislation, such as the Americans with Disabilities Act, and state civil rights statutes typically protect doctors who are actively participating in recovery services for drug dependence as well as recovering abusers. These laws generally require "reasonable accommodation" for alcoholic and drug addicts recovering, Imagine a changed timetable for the job. (However, the Americans with Disabilities Act expressly prohibits 'psychoactive substance abuse problems arising from existing illegal drug use' as protected by the disability)

Additionally, federal and state laws require work security during a medical leave for alcohol treatment, usually up to 12 weeks away. Once a doctor returns to work following treatment for addiction, employers and hospitals will usually enforce job limits, as stated in the previous section.

Clinics and hospitals should spell out the consequences of a relapse or failure to fulfill any of the return-to - work conditions for the returning physician. Addictive disease is relatively common in both the general population and the physician population. Addictive disorder cause identification in a doctor is challenging and yet important as delay may lead to morbidity or mortality not only in the addicted doctor but also in his or her patients.

It is important that written policies and protocols are in place to help with these particularly emotionally burdened cases, as they can facilitate a clear and efficient approach to facilitating early identification of a substance abuse epidemic, successful intervention, and effective treatment and aftercare.

These measures will help protect the affected physician, his or her colleagues or employer and the patients of the physician from experiencing catastrophic medical and legal consequences. PHP of each state will serve as a reliable source of knowledge and assistance and should be contacted when there is no definite acceptable course of action.

Most doctors can achieve long-term recovery and sobriety with appropriate medication, aftercare and supervision, but certain specialties, such as anesthesiology, pose specific challenges and concerns. Considering the possible damage that both the addicted physician and patients that experience, it is important that family , friends, colleagues and employers should not "turn a blind eye" to a physician who is suspected of having addiction.