Substance abuse among medical practitioners

Psychiatrically impaired medical practitioners: an overview with special reference to impaired psychiatrists

OBJECTIVE

This paper will define and describe impairment in medical practitioners due to mental illness, with special reference to the specialty of psychiatry, and then review the prevalence and identification of impaired practitioners.

METHODS

The quantitative and qualitative evidence regarding the incidence and impact of medical practitioner impairment due to mental illness (and, to some extent, substance use), with special reference to impaired psychiatrists, is reviewed.

RESULTS

Medical practitioner impairment due to mental illness has a severe impact on their lives and their families due to both the effects of the disorder and the experience of communal, professional and self stigma.

CONCLUSIONS

The consequences of impairment among medical practitioners and specialist psychiatrists as well as the under-reporting of impaired practitioners is a significant problem.

Impaired practitioners notified to the Medical Practitioners Board of Victoria from 1983 to 1997

OBJECTIVE

To describe the characteristics of and outcome for impaired medical practitioners notified to the Medical Practitioners Board of Victoria.

DESIGN

Retrospective review of records for all impaired practitioners notified to the Board for the first time from January 1983 to December 1997.

OUTCOME MEASURES

Number of notifications per year; characteristics of impaired practitioners; source of notification; diagnosis and diagnostic categories; actions by the Board; and outcomes for impaired practitioners.

RESULTS

In 15 years, 170 impaired practitioners were notified to the Board for the first time, 86 in the last four years. Significantly more men than women were notified to the Board (ratio, 4.2:1; P < 0.001). Reporting by patients was uncommon, but 46 impaired practitioners reported themselves. One hundred and five impaired practitioners had a psychiatric disorder, 73 had a drug use disorder, 35 had an alcohol use disorder, and 13 had a physical disorder (not exclusive categories). The Board suspended 73 practitioners and imposed conditional registration on 76. Subsequently, 88 practitioners were able to improve their registration status. Fifty-nine practitioners were renotified to the Board or tested positive to a urinary drug screen. Eleven practitioners died, four before the age of 55 years.

CONCLUSIONS

Increasing numbers of notifications in recent years coincided with changes in the legislative framework, making notification compulsory but also giving the Board more flexibility in dealing with impaired practitioners. Nonetheless, comparison with population data suggests that impaired practitioners (particularly those with substance use disorders) may be under-reported.

Doctors detected self-administering opioids in New South Wales, 1985-1994: characteristics and outcomes

OBJECTIVE

To describe the characteristics and outcomes of doctors whose drug authorities were withdrawn as a result of self-administering opioids for non-medical purposes.

DESIGN

Retrospective review of New South Wales Health Department information relating to all doctors whose authorities to possess, supply, prescribe or administer drugs of addiction had been withdrawn in the period 1985 to 1994 as a result of confirmed self-administration of opioids.

OUTCOME MEASURES

Age, sex, geographical location and practice category at the time of intervention; drugs used; period of opioid use before authority withdrawal; means of detection; and registration status as at August 1995.

RESULTS

From 1985 to 1994, 79 doctors had their drug authorities withdrawn (0.4% of the NSW medical profession in 1994). The groups significantly over-represented were general practitioners and those aged 30-39 years. Pethidine was the main drug used (66 doctors; 84%). Drug use for more than two years before detection was reported by 34 (43%) doctors. Community pharmacists were the source of reports leading to detection of 28 (35%) doctors. As at August 1995, 27 (34%) of the study group were not practising; 10 (13%) had died.

CONCLUSION

Outcomes for these doctors were poor. There was substantial attrition from practice and a high mortality rate.

Chemical dependence in anaesthetic registrars in Australia and New Zealand

The Supervisors of Anaesthetic Training in Australia and New Zealand were surveyed and asked to report any cases of chemical dependence from anaesthetic registrars at their hospital from 1981 to 1991. From 83 questionnaires there were 65 (78%) returned. There were 14 departments (22%) with experience of one or more cases during this interval. Only five (7%) reported conducting a lecture or tutorial on the problem. The departmental reports covered 4425 registrar years of training and there were 17 cases reported. Of these, 13 were complete and are considered in detail. It is estimated that 1.3% of those who entered anaesthetic training during the interval were recognised to become chemically dependent during their training. Follow-up was available on only six of the 13 registrars and only one was reported to have completed training. The results of this survey indicate that chemical dependence is already a major health problem amongst anaesthetic registrars in Australia and New Zealand.