Addicted health care professionals: missing the wood for the trees?

Drug-caused deaths in Australian medical practitioners and health-care professionals

BACKGROUND AND AIMS

There are numerous factors putting health-care professionals (HCP) at a higher risk of substance abuse and premature death, including high-stress jobs, access to controlled substances, long hours of practice and constant contact with the critically ill. This study aimed to examine fatal drug toxicity in this high-risk cohort, in order to: (1) estimate the rate of drug-caused deaths of Australian HCPs; (2) describe the key characteristics of the cohort; and (3) examine the relationship between HCP occupation and drug type, or intent.

DESIGN

Retrospective cohort study.

SETTING

The National Coronial Information System (NCIS), a database of cases reported to an Australian coroner.

PARTICIPANTS

A total of 404 drug-caused deaths reported to an Australian coroner between 2003 and 2013 involving HCPs (including medical practitioners, paramedics, nurses, dentists, psychologists, pharmacists and veterinarians).

MEASURES

χ² tests and descriptive statistics were used to examine relationships. The primary outcome measures were drug type and intent. Covariates included occupation type, mental illness and self-harm.

FINDINGS

Females comprised nearly two-thirds of the cohort. The highest number of cases involved nurses (62.87%) and medical practitioners (18.07%). The mortality rate was highest among the veterinary group [confidence interval (CI) = 42.21-58.79]. Most were intentional self-harm deaths (50.25%), followed by unintentional deaths (37.62%) (CI = 92.15-109.85). Mental illness was common, diagnosed in almost half of cases (46.04%), with the majority involving depression (CI = 33.48-44.12). Specific drugs were associated significantly with certain professions, such as intravenous barbiturates among veterinarians (χ²₍₇₎  = 237.391). A number of cases reported additional stressors, such as relationship, work-place or financial issues, and drugs were diverted from the work-place in nearly a fifth of cases.

CONCLUSIONS

Between 2003 and 2013, Australian health-care professionals averaged 37 deaths per year attributed to drug toxicity, with a mortality rate of nearly five deaths per 1000 employed HCPs. Drug-caused deaths among HCPs in Australia commonly involve females in their mid-40s, with a diagnosis of mental illness, personal and professional stress and the intent to self-harm.