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Lal A, Tharyan A, Tharyan P. The prevalence, determinants and the role of empathy and religious or spiritual beliefs on job stress, job satisfaction, coping, burnout, and mental health in medical and surgical faculty of a teaching hospital: A cross-sectional survey. Rev Med Interne 2020; 41:232-240. [PMID: 31924391 DOI: 10.1016/j.revmed.2019.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/26/2019] [Accepted: 12/08/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Systematically ascertained data on job stress and burnout and their antecedents and mediators in health professionals from low- and middle-income countries are scant. METHODS This cross sectional survey, conducted from July 2007 to August 2008, of consenting medical and surgical faculty of a large, charitable, teaching hospital aimed to evaluate: 1) the prevalence and sources of job stress and job satisfaction, and the ways used to cope with stress; 2) the prevalence of burnout and mental distress; and 3) the influence of age, gender, empathy and religious or spiritual beliefs on job stress, satisfaction, mental health and burnout. RESULTS Of 345 respondents, high job stress on the Physician Stress and Satisfaction questionnaire were reported by 23%. However, 98% of faculty reported high levels of job satisfaction with deriving intellectual stimulation from teaching and a high level of responsibility identified as important contributory sources. Significantly more respondents aged<45 years compared to older faculty achieved moderate or high scores on Emotional Exhaustion and Depersonalization. General Health Questionnaire-12 scores suggested psychiatric morbidity in 21%, particularly in younger faculty. High job stress was associated with high scores for Emotional Exhaustion and Depersonalization. High scores on the Jefferson Scale of Physician Empathy correlated with high scores of Emotional Exhaustion. Religious or spiritual beliefs strongly influencing attitudes to work were significantly associated with high levels of Personal Accomplishment. CONCLUSIONS This study provides data that will inform the design and implementation of interventions to reduce job stress and burnout and improve retention of faculty.
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Affiliation(s)
- A Lal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 55902 Rochester, MN, USA.
| | - A Tharyan
- Department of Psychiatry, Christian Medical College, 632002 Vellore, Tamil Nadu, India
| | - P Tharyan
- Department of Psychiatry, Christian Medical College, 632002 Vellore, Tamil Nadu, India
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Levy S, Seale JP, Alford DP. Medicine, with a focus on physicians: Addressing substance use in the 21st century. Subst Abus 2019; 40:396-404. [DOI: 10.1080/08897077.2019.1691130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sharon Levy
- Director, Adolescent Substance Use and Addiction Program, Boston Children’s Hospital, Boston, Masachussetts, USA
| | - J. Paul Seale
- School of Medicine, Navicent Health and Mercer University School of Medicine, Macon, Georgia, USA
| | - Daniel P. Alford
- Boston University School of Medicine, Boston Medical Center, Boston, Masachussetts, USA
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Angres DH, John A, Bettinardi-Angres K, Agarwal G. The Forensic Evaluation and Rehabilitation of the Impaired Physician. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20191009-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Earley PH, Zummo J, Memisoglu A, Silverman BL, Gastfriend DR. Open-label Study of Injectable Extended-release Naltrexone (XR-NTX) in Healthcare Professionals With Opioid Dependence. J Addict Med 2018; 11:224-230. [PMID: 28358754 PMCID: PMC5457834 DOI: 10.1097/adm.0000000000000302] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Healthcare professionals (HCPs) with opioid dependence are at risk for relapse and death, particularly in the first year of recovery; however, maintenance treatment with opioid agonists is controversial in this safety-sensitive group. We evaluated long-term safety, tolerability, and treatment outcomes of injectable, intramuscular, extended-release naltrexone (XR-NTX) in opioid-dependent HCPs. METHODS This single-arm, multisite, open-label study was conducted in opioid-dependent HCPs who had been detoxified from opioids for at least 2 weeks. Subjects received monthly XR-NTX injections for up to 24 months, combined with counseling via intensive outpatient substance abuse treatment programs. Assessments included monthly urine opioid drug tests and routine safety assessments, along with a trimonthly short form (36) Health Survey, opioid craving questionnaire, and Treatment Satisfaction Questionnaire for Medication. RESULTS Of 49 opioid-dependent HCPs screened, 38 enrolled and received at least 1 XR-NTX injection. Most were female (n = 31) and nurses or nursing assistants (n = 30). More than half (n = 21; 55.3%) received at least 12 injections. Seven discontinued due to adverse events (3 anxiety, 2 headache, 1 injection-site mass, 1 derealization). None experienced relapses to opioid dependence necessitating detoxification, overdose, or death during treatment. At 24 months, mean opioid craving fell by 45.2%, and short form (36) mental component scores improved by 31.1% from baseline and approached normal levels. Of 22 unemployed subjects at baseline, 45.5% improved employment status at 24 months. CONCLUSIONS Long-term (2 years) XR-NTX was associated with no new safety concerns, and, compared with shorter-term studies in the general population, similar or better rates of retention, opioid-negative urines, opioid craving reduction, mental health functional quality of life improvement, and re-employment.
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Affiliation(s)
- Paul H Earley
- Earley Consultancy, LLC, Atlanta, GA (PHE); Alkermes, Inc, Waltham, MA (JZ, AM, BLS); Treatment Research Institute, Philadelphia, PA (DRG)
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Mokaya AG, Mutiso V, Musau A, Tele A, Kombe Y, Ng’ang’a Z, Frank E, Ndetei DM, Clair V. Substance Use among a Sample of Healthcare Workers in Kenya: A Cross-Sectional Study. J Psychoactive Drugs 2016; 48:310-9. [PMID: 27485987 PMCID: PMC5020342 DOI: 10.1080/02791072.2016.1211352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/20/2016] [Accepted: 06/09/2016] [Indexed: 01/08/2023]
Abstract
This study describes reported substance use among Kenyan healthcare workers (HCWs), as it has implications for HCWs' health, productivity, and their ability and likelihood to intervene on substance use. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) was administered to a convenience sample of HCWs (n = 206) in 15 health facilities. Reported lifetime use was 35.8% for alcohol, 23.5% for tobacco, 9.3% for cannabis, 9.3% for sedatives, 8.8% for cocaine, 6.4% for amphetamine-like stimulants, 5.4% for hallucinogens, 3.4% for inhalants, and 3.9% for opioids. Tobacco and alcohol were also the two most commonly used substances in the previous three months. Male gender and other substance use were key predictors of both lifetime and previous three months' use rates. HCWs' substance use rates appear generally higher than those seen in the general population in Kenya, though lower than those reported among many HCWs globally. This pattern of use has implications for both HCWs and their clients.
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Affiliation(s)
- Aggrey G. Mokaya
- Master Student, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
- Master Student, Kenya Medical Research Institute, Centre for Public Health Research, Nairobi, Kenya
| | - Victoria Mutiso
- Director, Research Administration and Finance, Africa Mental Health Foundation, Nairobi, Kenya
| | - Abednego Musau
- Research Officer, Africa Mental Health Foundation, Nairobi, Kenya
| | - Albert Tele
- Statistician, Africa Mental Health Foundation, Nairobi, Kenya
| | - Yeri Kombe
- Chief Research Officer, Kenya Medical Research Institute, Centre for Public Health Research, Nairobi, Kenya
| | - Zipporah Ng’ang’a
- Deputy Vice Chancellor (Academic, Research and Student Affairs), South Eastern Kenya University, Kitui, Kenya
| | - Erica Frank
- Professor and Canada Research Chair, University of British Columbia, Vancouver, BC, Canada
- Founder and President, NextGenU.org, Clear Lake, WA, USA
| | - David M. Ndetei
- Founding Director, Africa Mental Health Foundation, Nairobi, Kenya
- Professor of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Veronic Clair
- Co-PI eDATA K NextGenU.org, Vancouver, BC, Canada and Senior Scientist, Africa Mental Health Foundation, Nairobi, Kenya
- Clinical Faculty, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Abernethy AP. A Balanced Approach to Physician Responsibilities: Oncologists' Duties toward Themselves. Am Soc Clin Oncol Educ Book 2016:e9-e14. [PMID: 24451840 DOI: 10.14694/edbook_am.2012.32.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although critical to the provision of best patient care, physician self-care is an underattended aspect of responsibility in the medical professions, including oncology. Neglecting self-care bears negative consequences for the individual oncologist, ranging from burnout and fatigue to interpersonal and relationship stress, addiction, and disruptive behavior. It may also contribute to medical errors, disinterest in or depersonalization of patient care, and lower quality of care. Because of its effect on physicians, patients, and the health care environment, physician self-care is increasingly recognized as an important professional responsibility. Nonetheless, professional obligations, competing demands on time, and personal priorities conspire to prevent a large proportion of oncologists from adequately attending to self-care in even simple ways, such as getting sufficient exercise and sleep. This chapter discusses the need for physician self-care and the repercussions of not meeting this fundamental responsibility. Self-care is described in the context of three life domains: professional, personal (physical, psychological, mental, and spiritual), and interpersonal (relationships, family, social, and community). Strategies are provided for caring for the self in each domain.
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Affiliation(s)
- Amy P Abernethy
- From the Division of Medical Oncology, Department of Medicine, and the Duke Cancer Institute, Duke University Medical Center, Durham, NC
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Telusca N, Ganguly K, Jeter C, Newmark JL. Substance Abuse Among Healthcare Professionals. Subst Abus 2015. [DOI: 10.1007/978-1-4939-1951-2_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chiou SJ, Kung PT, Naessens JM, Huang KH, Chang YC, Wang YH, Tsai WC. Do physicians with diabetes have differences in dialysis use and survival than other patients with diabetes. Diabetes Res Clin Pract 2014; 105:382-90. [PMID: 25088403 DOI: 10.1016/j.diabres.2014.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/10/2014] [Accepted: 07/05/2014] [Indexed: 11/24/2022]
Abstract
AIMS To assess whether the increased knowledge and resources available to physicians led to differences in dialysis and survival rates between physicians and non-physician patients with diabetes. METHODS All newly diagnosed (1997-2009) type 2 diabetes patients aged ≥35 years from the National Health Insurance Program of Taiwan database were included. After propensity score matching (1:10), we estimated the relative risk of dialysis and death using Cox proportional hazards model adjusted for demographic characteristics and comorbidities. RESULTS Physicians with diabetes were more likely to start dialysis than general patients, with a 48% increased hazard risk (HR) (P=0.006). Physicians with diabetes had significantly lower risk of death (HR: 0.88; P=0.025). However, those requiring dialysis had a non-significant increased risk of death (HR: 1.19). There was an increased HR for death in older physicians (HR: 1.81; P<0.001) and those with cancer or catastrophic illness. The HR of dialysis (7.89; P<0.0001) increased dramatically with increasing Charlson Comorbidity Index scores. CONCLUSIONS Physicians with DM survived longer than other patients with diabetes, likely benefiting from their professional resources in disease control and prevention. Nonetheless, they displayed no advantage from their medical backgrounds compared with the general patients if they developed end stage renal disease.
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Affiliation(s)
- Shang-Jyh Chiou
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, No. 89, Nei-Chiang Street, Taipei 10845, Taiwan, ROC; Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan, ROC
| | - James M Naessens
- Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC
| | - Yu-Chia Chang
- Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan, ROC
| | - Yueh-Hsin Wang
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC.
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Pretorius D, Basson WJ, Ogunbanjo GA. Personality profile and coping resources of family medicine vocational trainees at the University of Limpopo, South Africa. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2010.10874023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Braquehais MD, Lusilla P, Bel MJ, Navarro MC, Nasillo V, Díaz A, Valero S, Padrós J, Bruguera E, Casas M. Dual diagnosis among physicians: a clinical perspective. J Dual Diagn 2014; 10:148-55. [PMID: 25392289 DOI: 10.1080/15504263.2014.929331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Co-occurrence of mental disorders and substance use disorders (dual diagnosis) among doctors is a cause of serious concern due to its negative personal, professional, and social consequences. This work provides an overview of the prevalence of dual diagnosis among physicians, suggests a clinical etiological model to explain the development of dual diagnosis in doctors, and recommends some treatment strategies specifically for doctors. The most common presentation of dual diagnosis among doctors is the combination of alcohol use disorders and affective disorders. There are also high rates of self-medication with benzodiazepines, legal opiates, and amphetamines compared to the general population, and cannabis use disorders are increasing, mainly in young doctors. The prevalence of nicotine dependence varies from one country to another depending on the nature of public health policies. Emergency medicine physicians, psychiatrists, and anaesthesiologists are at higher risk for developing a substance use disorder compared with other doctors, perhaps because of their knowledge of and access to certain legal drugs. Two main pathways may lead doctors toward dual diagnosis: (a) the use of substances (often alcohol or self-prescribed drugs) as an unhealthy strategy to cope with their emotional or mental distress and (b) the use of substances for recreational or other purposes. In both cases, doctors tend to delay seeking help once a problem has been established, often for many years. Denial, minimization, and rationalization are common defense mechanisms, maybe because of the social stigma associated with mental or substance use disorders, the risk of losing employment/medical license, and a professional culture of perfectionism and denial of emotional needs or failures. Personal vulnerability interacts with these factors to increase the risk of a dual diagnosis developing in some individuals. When doctors with substance use disorders accept treatment in programs specifically designed for them (Physicians' Health Programs), they show better outcomes than the general population. However, physicians with dual diagnosis have more psychological distress and worse clinical prognosis than those with substance use disorders only. Future studies should contribute to a better comprehension of the risk and protective factors and the evidence-based treatment strategies for doctors with dual diagnosis.
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Affiliation(s)
- María Dolores Braquehais
- a Integral Care Program for Sick Doctors, Galatea Clinic, Galatea Foundation , Col·legi Oficial de Metges de Barcelona , Barcelona , Spain
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Extended-release intramuscular naltrexone (VIVITROL®): a review of its use in the prevention of relapse to opioid dependence in detoxified patients. CNS Drugs 2013; 27:851-61. [PMID: 24018540 DOI: 10.1007/s40263-013-0110-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Naltrexone is a μ-opioid receptor antagonist that blocks the euphoric effects of heroin and prescription opioids. In order to improve treatment adherence, a once-monthly, intramuscular, extended-release formulation of naltrexone (XR-NTX) [VIVITROL(®)] has been developed, and approved in the USA and Russia for the prevention of relapse to opioid dependence, after opioid detoxification. The clinical efficacy of this formulation in patients with opioid dependence was demonstrated in a 24-week, randomized, double-blind, placebo-controlled, multicentre, phase III trial (ALK21-013; n = 250). In this trial, opioid-detoxified patients receiving XR-NTX 380 mg once every 4 weeks, in combination with psychosocial support, had a significantly higher median proportion of weeks of confirmed opioid abstinence during weeks 5-24, compared with those receiving placebo (primary endpoint). A significantly higher proportion of patients receiving XR-NTX achieved total confirmed abstinence during this period than those receiving placebo. XR-NTX was also associated with a significantly greater reduction in opioid craving and a significantly longer treatment retention period than placebo. XR-NTX was generally well tolerated in the phase III trial. The most common (incidence ≥5 %) treatment-emergent adverse events that also occurred more frequently with XR-NTX than with placebo were hepatic enzyme abnormalities, nasopharyngitis, insomnia, hypertension, influenza and injection-site pain. Thus, XR-NTX is a useful treatment option for the prevention of relapse to opioid dependence, following opioid detoxification.
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Jungerman FS, Palhares Alves HN, Carmona MJC, Conti NB, Malbergier A. Anesthetic Drug Abuse by Anesthesiologists. Braz J Anesthesiol 2012; 62:375-86. [DOI: 10.1016/s0034-7094(12)70138-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 08/29/2011] [Indexed: 10/26/2022] Open
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Brooks E, Early SR, Gundersen DC, Shore JH, Gendel MH. Comparing substance use monitoring and treatment variations among physician health programs. Am J Addict 2012; 21:327-34. [PMID: 22691011 DOI: 10.1111/j.1521-0391.2012.00239.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is growing evidence that physician health programs (PHPs) are an important component in physicians' recovery from substance disorders, although we do not know how variations in treatment and monitoring affect physician recovery. This study was designed to understand how programmatic differences impact clients' overall program completion. This study was part of a larger investigation, the Blueprint Project, which evaluated outcomes for clients enrolled in PHPs nationally. Here we compared physicians presenting to a Colorado-based PHP for substance use to a nationally based referent, contrasting treatment, monitoring, and outcomes (Colorado n = 72, National n = 730). The samples were similar demographically although more Colorado physicians were polysubstance users. We found variations in treatment and monitoring patterns with Colorado physicians participating in more types of primary treatment and monitoring services and were allowed to work more at some point during monitoring. There was greater relapse among Colorado physicians, but these differences disappeared when we controlled for prior treatment. The great majority of clients in both samples showed successful recovery. This data provides a foundation on which to understand population characteristics, contractual differences, and outcome variations among PHPs and serves to inform internal PHP programmatic structures and regulatory agencies.
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Affiliation(s)
- Elizabeth Brooks
- Department of Community and Behavioral Health, School of Public Health, University of Colorado-Denver, Aurora, CO 80045, USA.
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Abstract
Alcohol dependency (alcoholism) has existed throughout recorded history. It remains a highly stigmatized illness, looked down on by society, the patients themselves, and the medical establishment. Science defines alcoholism as a primary progressive illness with a powerful genetic predisposition, highly amenable to intervention, evaluation, and treatment, and responsive to continuing care like other chronic illnesses. Society, led by an educated medical community, needs to revisit the disease of alcoholism, challenge its outdated assumptions and prejudices, and embark on a new course with the goals of positively affecting these patients, their families, and communities and improving the nation's health.
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Abstract
Extended-release naltrexone (XR-NTX; Vivitrol), developed to address poor adherence in addictive disorders, is approved for use in alcohol and opioid-dependence disorders. In alcohol-dependent adults with ≥ 4-day initial abstinence, XR-NTX increased initial and 6-month abstinence. An fMRI study found that XR-NTX attenuated the salience of alcohol visual and olfactory cues in the absence of alcohol, and post hoc analyses demonstrated efficacy even during high cue-exposure holiday periods. Safety and tolerability have generally been good, without adverse hepatic impact or intractable acute pain management. XR-NTX use appears feasible in primary care and public systems, and retrospective claims analyses have found cost savings and decreased intensive service utilization relative to oral agents. In opioid dependence, following detoxification, XR-NTX shows efficacy for maintaining abstinence, improving retention, decreasing craving, and preventing relapse. Trials are also exploring its use for the treatment of stimulant dependence. XR-NTX appears compatible with counseling and self-help attendance. While more research is needed, current findings suggest that a formulation of naltrexone that was sought beginning over three decades ago is fulfilling its promise as an extended-release pharmacotherapeutic.
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Wile C, Frei M, Jenkins K. Doctors and medical students case managed by an Australian Doctors Health Program: characteristics and outcomes. Australas Psychiatry 2011; 19:202-5. [PMID: 21682615 DOI: 10.3109/10398562.2011.561846] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this paper is to describe the characteristics and outcomes of participants with an Australian physician health program, the Victorian Doctors Health Program (VDHP), for case management of substance use disorder (SUD) and/or significant mental illness. METHOD As part of quality assurance, processes data, including demographic information, care plan components and outcomes, were analysed. RESULTS Between 2001 and 2008, 115 participants undertook case management plans with the VDHP. The majority (n = 71, 62%) had some involvement with the Medical Practitioners Board of Victoria (MPBV). Case management included facilitating referrals to addiction specialists, psychiatrists, counsellors and peer-based support. Ninety (78%) participants reported SUD, the remainder having mental illness (n = 25, 22%). Alcohol was the main drug reported by the SUD group (n = 44, 49%). Most of the SUD participants undertook biochemical monitoring. On commencement with the VDHP, 39 (34%) participants were on leave due to illness. The majority of participants case managed for 5 years were in medical work (n = 31, 84%). CONCLUSIONS Case management by an independent physician health program may protect the health of the doctor and the community, and could be considered in other jurisdictions.
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Affiliation(s)
- Cheryl Wile
- Victorian Doctors Health Program, Fitzroy, VIC, Australia.
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White WL. Wounded Healers in Recovery. ALCOHOLISM TREATMENT QUARTERLY 2011. [DOI: 10.1080/07347324.2011.538321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Although the nature and scope of addictive disease are commonly reported in the lay press, the problem of physician addiction has largely escaped the public's attention. This is not due to physician immunity from the problem, because physicians have been shown to have addiction at a rate similar to or higher than that of the general population. Additionally, physicians' addictive disease (when compared with the general public) is typically advanced before identification and intervention. This delay in diagnosis relates to physicians' tendency to protect their workplace performance and image well beyond the time when their life outside of work has deteriorated and become chaotic. We provide an overview of the scope and risks of physician addiction, the challenges of recognition and intervention, the treatment of the addicted physician, the ethical and legal implications of an addicted physician returning to the workplace, and their monitored aftercare. It is critical that written policies for dealing with workplace addiction are in place at every employment venue and that they are followed to minimize risk of an adverse medical or legal outcome and to provide appropriate care to the addicted physician.
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Affiliation(s)
- Keith H Berge
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
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DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians' Health Programs. J Subst Abuse Treat 2009; 36:159-71. [DOI: 10.1016/j.jsat.2008.01.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 01/04/2008] [Accepted: 01/08/2008] [Indexed: 10/21/2022]
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Lusilla P, Gual A, Roncero C, Bruguera E, Marcos V, Valero S, Casas M. Dual diagnosis in inpatient physicians: prevalence and clinical characteristics. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/17523280701724189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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McBeth BD, Ankel FK, Ling LJ, Asplin BR, Mason EJ, Flottemesch TJ, McNamara RM. Substance use in emergency medicine training programs. Acad Emerg Med 2008; 15:45-53. [PMID: 18211313 DOI: 10.1111/j.1553-2712.2007.00008.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To explore the prevalence of substance use among emergency medicine (EM) residents and compare to a prior study conducted in 1992. METHODS A voluntary, anonymous survey was distributed in February 2006 to EM residents nationally in the context of the national in-service examination. Data regarding 13 substances, demographics, and perceptions of personal patterns of substance use were collected. RESULTS A total of 133 of 134 residencies distributed the surveys (99%). The response rate was 56% of the total EM residents who took the in-service examination (2,397/4,281). The reported prevalence of most illicit drug use, including cocaine, heroin, amphetamines, and other opioids, among EM residents are low. Although residents reporting past marijuana use has declined (52.3% in 1992 to 45.0% in 2006; p < 0.001), past-year use (8.8%-11.8%; p < 0.001) and past-month use (2.5%-4.0%; p < 0.001) have increased. Alcohol use appears to be increasing, including an increase in reported daily drinkers from 3.3% to 4.9% (p < 0.001) and an increase in number of residents who indicate that their consumption of alcohol has increased during residency (from 4% to 12.6%; p < 0.001). CONCLUSIONS Self-reported use of most street drugs remains uncommon among EM residents. Marijuana and alcohol use, however, do appear to be increasing. Educators should be aware of these trends, and this may allow them to target resources for impaired and at-risk residents.
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Affiliation(s)
- Brian D McBeth
- Department of Emergency Medicine, San Francisco General Hospital/University of California, San Francisco, CA, USA.
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Katz NP, Adams EH, Chilcoat H, Colucci RD, Comer SD, Goliber P, Grudzinskas C, Jasinski D, Lande SD, Passik SD, Schnoll SH, Sellers E, Travers D, Weiss R. Challenges in the development of prescription opioid abuse-deterrent formulations. Clin J Pain 2007; 23:648-60. [PMID: 17885342 DOI: 10.1097/ajp.0b013e318125c5e8] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Opioid analgesics remain the cornerstone of effective management for moderate-to-severe pain. In the face of persistent lack of access to opioids by patients with legitimate pain problems, the rate of prescription opioid abuse in the United States has escalated over the past 15 years. Abuse-deterrent opioid products can play a central role in optimizing the risk-benefit ratio of opioid analgesics--if these products can be developed cost-effectively without compromising efficacy or creating new safety issues for the target treatment population. The development of scientific methods for assessing prescription opioid abuse potential remains a critical and challenging step in determining whether a claim of abuse deterrence for a new opioid product is indeed valid and will thus be accepted by the medical, regulatory, and reimbursement communities. To explore this and other potential impediments to the development of prescription opioid abuse-deterrent formulations, a panel of experts on opioid abuse and diversion from academia, industry, and governmental agencies participated in a Tufts Health Care Institute-supported symposium held on October 27 and 28, 2005, in Boston, MA. This manuscript captures the main consensus opinions of those experts, and also information gleaned from a review of the relevant published literature, to identify major impediments to the development of opioid abuse-deterrent formulations and offer strategies that may accelerate their commercialization.
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Katz NP, Adams EH, Benneyan JC, Birnbaum HG, Budman SH, Buzzeo RW, Carr DB, Cicero TJ, Gourlay D, Inciardi JA, Joranson DE, Kesslick J, Lande SD. Foundations of opioid risk management. Clin J Pain 2007; 23:103-18. [PMID: 17237659 DOI: 10.1097/01.ajp.0000210953.86255.8f] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increased abuse and diversion of prescription opioids has been a consequence of the increased availability of opioids to address the widespread problem of undertreated pain. Opioid risk management refers to the effort to minimize harms associated with opioid therapy while maintaining appropriate access to therapy. Management of these linked public health issues requires a coordinated and balanced effort among a disparate group of stakeholders at the federal, state, industry, practitioner, and patient levels. This paper reviews the principles of opioid risk management by examining the epidemiology of prescription opioid abuse in the United States; identifying key stakeholders involved in opioid risk management and their responsibilities for managing or monitoring opioid abuse and diversion; and summarizing the mechanisms currently used to monitor and address prescription opioid abuse. Limitations of current approaches, and emerging directions in opioid risk management, are also presented.
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Beletsky L, Ruthazer R, Macalino GE, Rich JD, Tan L, Burris S. Physicians' knowledge of and willingness to prescribe naloxone to reverse accidental opiate overdose: challenges and opportunities. J Urban Health 2007; 84:126-36. [PMID: 17146712 PMCID: PMC2078257 DOI: 10.1007/s11524-006-9120-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a "take-home" dose of naloxone. Under current Food and Drug Administration (FDA) regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs. Our data suggest that steps to promote naloxone distribution programs should include physician education about evidence-based harm minimization schemes, broader support for such initiatives by professional organizations, and policy reform to alleviate medicolegal concerns associated with naloxone prescription. FDA re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be explored.
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Affiliation(s)
- Leo Beletsky
- Temple University Beasley School of Law, Philadelphia, PA 19122, USA.
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