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LETTER TO THE EDITOR

Chemical Dependency Treatment Outcomes of Residents

Alcohol and Drug Recovery Center; Department of Psychiatry and Psychology; Cleveland Clinic Foundation; Cleveland, OH; colling{at}ccf.org

In Response:

The comments of Fry are well-taken; they reflect what appears to be a global problem, not one limited to anesthesiology programs in the United States. Unlike the survey results reported by Fry (1), our survey results (2) do not contain mortality data on those residents who changed specialties after treatment; they contain mortality data only on those who continued in anesthesiology. We did ascertain, however, that approximately half of all treated residents were apparently functioning well in some specialty of medicine at the time of survey completion, although 7% were lost to follow-up.

Our interpretation of Fry’s data on anesthesia trainees reveals only three deaths presumably related to substance abuse (suicide), with one death being unclassified. Only one of the seven residents returning to anesthesiology training died as a result of substance abuse (again via suicide), although a majority relapsed. This mortality rate (14%) is comparable to the mortality rate observed in our survey (9%).

Regardless, it is worrisome that only two of the 16 abusing residents in Fry’s data ultimately completed their training in anesthesiology. The completion rate highlights abusing residents’ low success rate, regardless of their motivation, the intensity of outside monitoring, drug accounting practices, etc. Clearly, we need a new approach. The demonstrated safety and tolerability of depot naltrexone (3) may offer a new tool for programs that choose to take back recovering residents. Although untested in opioid-abusing physicians thus far, it may offer a new horizon in compliance assurance.

REFERENCES

1. Fry RA. Substance abuse by anaesthetists in Australia and New Zealand. Anaesth Intensive Care 2005;33:248–55.[Web of Science][Medline]
2. 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]
3. Johnson BA, Ait-Daoud N, Aubin HJ, et al. A pilot evaluation of the safety and tolerability of repeat dose administration of long-acting injectable naltrexone (Vivitrex) in patients with alcohol dependence. Alcohol Clin Exp Res. 2004;28:1356–61.[Web of Science][Medline]

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