POLITICS JANUARY 8, 2009
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Gregory Skipper and Robert DuPont are right to note the important role Physician Health Programs (PHPs) play in treating drug-addicted M.D.'s. In Brent Cambron's case, it's difficult to know much about that role (which is why I didn't address it in my article). According to some people who were close to him, Cambron felt that the PHP that monitored his recovery was more of a hindrance than a help, questioning his commitment to recovery in such a way that he himself began to doubt it. Unfortunately, due to the confidential nature of the program, the director of the PHP in Massachusetts Physicians Health Services was unable to tell me his program's side of the story; indeed, the director couldn't even confirm for me that the PHP had helped Cambron in his recovery efforts.But there's no denying the growing body of literature Skipper and DuPont cite documenting PHPs achievements. One important question about PHPs that remains open--and that I did try to briefly address in my article--is whether they should redirect drug-addicted anesthesiologists in recovery toward other, lower-risk medical specialties or whether they should facilitate their returns to anesthesia. Keith Berge, an anesthesiologist at the Mayo Clinic, recently argued in Anesthesiology in favor of a "one strike, you're out" policy for drug-addicted anesthesiologists under which, even after they've emerged from a treatment program, they're prohibited from returning to the practice of anesthesia. Berge believes the risk of relapse is simply too great. Of course, one of several arguments against a "one strike" policy is that, without the hope of eventually returning to their specialty, drug-addicted anesthesiologists might resist seeking treatment before overt impairment or overdose. But I do think it's an important question--and one that deserves more debate and research.
Jason Zengerle is a senior editor at The New Republic.
Click here to read Dupont and Skipper's response to Zengerle's original article.
2 comments
It is not rare for sober alcoholics to continue to work as bartenders or waiters. While none of my acquaintance has been thrilled to do so, alcohol is so easily accessible that 'avoiding temptation' is not a practical plan. Keeping anesthesiologists away from their former workplace may be an excellent temporary policy, but one cannot expect such measures to guarantee success in the long term. All addicted physicians have to deal with the fact that enhanced access to drugs is an ongoing risk.
- John the Drunkard
January 8, 2009 at 4:17pm
Anesthesiologists are at a high risk of relapse when they return to work from residential treatment (Pavlovian Conditioning is a strong factor in relapse). The opioid antagonist naltrexone is ideally suited to protect patients from relapsing. The availability of the depot injectable preparation of naltrexone which lasts for a month improves compliance. We have treated dozens of pharmacists, physicians and nurses addicted to opioids through a combination of naltrexone, individual and group counseling and random urine tests and the outcomes are impressive. Few physician health programs incorporate anticraving medications in the recovery programs for physicians. We have to put aside the long-held bias against medications to treat addictions.
- Percy Menzies
January 20, 2009 at 5:58pm