In the Showtime hit "Nurse Jackie," an emergency room nurse, played by Edie Falco, abuses a wide array of prescription drugs, somehow managing to carry out her professional responsibilities despite the effort involved in obtaining drugs and concealing her habit.
Can a medical professional balance all those demands? Should you be worried that a doctor or nurse who treats you is abusing drugs? I asked Lisa J. Merlo, an assistant professor of psychiatry at the University of Florida who has studied the prevalence of impact of drug abuse among medical professionals.
How prevalent is abuse of prescription drugs by physicians? Should I be concerned that my health-care provider’s judgment or skill are impaired by overuse of these drugs?
Previous research by other scientists has estimated that lifetime rates of substance use disorders range from 10 to 15 percent among physicians. This does not mean that 10 to 15 percent of physicians are impaired at any one time. Some recover through treatment or on their own; others leave medicine. Plus, not all physicians who abuse substances do so while they are at work. The number of physicians who are impaired by substance use on the job is likely quite low.
Do these doctors fall into any particular categories? For example, do they tend to be surgeons or psychiatrists or internists, or are they distributed across the medical profession? Where and how do they get the drugs? Do they favor a particular kind?
Substance use disorders can affect anyone. A person’s education, wealth, personality, social standing or career cannot protect him or her. One of the best predictors that an individual will develop a substance use disorder is a family history of substance use disorders.
That being said, certain medical specialties do have higher rates of substance abuse problems. Anesthesiologists, psychiatrists, primary care providers, ER doctors and surgeons seem to be at higher risk. Alcohol and prescription drugs (especially opiates and benzodiazepines) are the most likely drugs of choice among physicians, and access likely plays a role. Some physicians who develop addiction to prescription drugs admit to diverting from work. Others may self-prescribe or find a colleague to write prescriptions for them.
In “Nurse Jackie,” the main character is a drug-addicted nurse who remains largely clear-headed at work as long as she can get her drugs when she needs them. Is that a realistic portrayal? Can health care providers function well at work but truly be dependent on, or addicted to, drugs?
In most cases, work performance is the last thing to go. Many health-care professionals with addiction function very well at work, often avoiding substance use while on the job, even if they are using significant amounts in their “off time.” Once work performance is impaired, it is likely that the addiction is quite severe.
Some addicted health-care professionals admit to using substances to stave off withdrawal during the workday. The level of impairment they experience would depend on the substance being used, the dose they are using, their level of tolerance and the complexity of the work they are performing.
Is there anything distinctive about physicians who abuse drugs as opposed to drug addicts in the general population? Clearly they have more money with which to acquire drugs; does that make any difference? What reasons do they give for turning to drugs that might differ from those given by other folks?
Our research has demonstrated a lot of similarities between addicted physicians and addicts in the general population. Both groups report early experimentation and use of “gateway drugs” such as tobacco, alcohol, and marijuana. Physicians have traditionally had greater access to prescription drugs, putting them at higher risk for abuse of these substances. However, the proliferation of “pill mills” and the prescription drug abuse epidemic have narrowed the access gap.
In focus groups, physicians addicted to prescription drugs reported using them primarily for pain management, psychiatric distress, stress relief and recreational purposes.
The primary difference between physicians with addiction and individuals from the general population with addiction is the quantity and quality of treatment they receive. Physicians are typically mandated to 90 days of residential treatment, followed by five years of monitoring with random drug tests. As a result, rates of recovery exceed 80 percent, even five years after treatment.
By contrast, individuals in the general population are frequently unable to obtain residential treatment until they “fail” lower levels of care by relapsing. Even if they participate in treatment, they typically have no follow-up monitoring. As a result, rates of recovery in the general population are closer to 20-50 percent at one year after treatment.