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LETTER TO THE EDITOR

Chemical Dependency Treatment Outcomes of Residents

Department of Anaesthesiology; Auckland City Hospital; Auckland, New Zealand; RobF{at}adhb.govt.nz

To the Editor:

Collins et al. (1) recently reported the outcome of chemical dependency treatment in anesthesiology residents. I (2) recently published the results of a similar survey of all anesthesiologists in Australia and New Zealand over a 10 yr period. The article by Collins et al. prompted me to re-examine those results from my survey related purely to registrars (residents). Although the numbers were small, the results were similar to those published by Collins et al.

Of the 44 cases of substance abuse reported, 16 were registrars, 14 of whom abused opioids. One registrar only abused propofol and one only abused alcohol. Both were subsequently dismissed. Eleven registrars (69%) returned to work, equivalent to the study of Collins et al. (72%). Of the 14 registrars abusing opioids, three did not return to work and two of these registrars subsequently committed suicide, the other being lost to follow-up. Of the 11 returning to the workplace, seven re-entered anesthesia and four entered other medical specialties. Of the seven returning to anesthesia five relapsed, one of whom then attempted another career but was eventually dismissed, and one committed suicide. This is consistent with prior reports suggesting a poor likelihood of success for anesthesiologists with opioid dependency returning to clinical anesthesia practice (3). Of the four selecting an alternate medical career, two were classified as totally recovered, one relapsed then resigned, and one died an unclassified death.

Ultimately five of the 16 registrars died (31%), which compares very poorly with a 9% mortality in the United States. Overall, only 19% of all abusers were successful in some specialty of medicine as opposed to 39% of those in the survey by Collins et al. Of those re-entering anesthesia, only 15% were successful compared with 60% in the American survey.

Substance abuse in anesthesiologists remains a significant and poorly managed problem in Australasia. This small sample highlights the problem among trainees. In the previous study by Weeks et al. (4), only one registrar of 17 abusing substances completed anesthesia training, essentially unchanged during the second epoch (4). The incidence of abuse in registrars appears to have decreased by 50%, considering the increase in trainee numbers in the most recent survey. New developments in rehabilitation plus results from South Australia indicate outcomes for substance abusers may be improving (5,6).

REFERENCES

1. Collins GB, McAllister MS, Jensen M, Gooden TA. Chemical dependency treatment outcomes of residents in anesthesiology: results of a survey. Anesth Analg 2005;101:1457–62.[Abstract/Free Full Text]
2. Fry RA. Substance abuse in anaesthetists in Australia and New Zealand. Anaesth Intensive Care 2005;33:248–55.[Web of Science][Medline]
3. Menk EJ, Baumgarten RK, Kingsley CP. Success of reentry into anaesthesiology training programs by residents with a history of substance abuse. JAMA 1990; 263:3060–2.[Abstract/Free Full Text]
4. Weeks A, Buckland M, Morgan E, Myles P. Chemical dependence in anaesthetic registrars in Australia and New Zealand. Anaesth Intensive Care 1993;21:151–5.[Web of Science][Medline]
5. Paull J, Warhaft N. Back to work? Returning anaesthetists to the workplace after treatment for substance abuse. In: Keneally J, ed. Australian Anaesthesia. Bridge Printery: Alexandria, Australia, 2001:13–18.
6. Warhaft N. The Victorian doctors health program: the first 3 years. Med J Aust 2004;181:376–9.[Web of Science][Medline]

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