The recent article, “Going Under,” in The New Republic eloquently describes what has fortunately become a rare fatal outcome for physicians treated by state Physician Health Programs (PHPs). Failure to put this into perspective leaves readers with the mistaken impression that addiction is commonly or inevitably fatal. This article underscores that fact that there are two common errors in dealing with addiction: the first and most common is to underestimate its power. The second is to underestimate the potential for recovery in even the most desperate cases of addiction.
The article fails to describe the emergent role of PHPs and their documented achievements in early detection and treatment of addicted doctors. PHPs are quite literally setting new standards for recovery and numerous articles document their successes. Pelton and Ikeda reported a ten year follow-up of 255 physicians (including 35 anesthesiologists) successfully completing the California Diversion Program with excellent outcomes. Paris and Canavan from New Jersey reported a case control study comparing relapse rates between addicted anesthesiologists and other physicians showing no significant difference. Domino, et al reported an eleven-year follow-up of 262 physicians (including 33 anesthesiologists) with excellent outcomes with not a single anesthesiologist overdose death. Finally, McLellan, et al recently reported outcomes of 904 physicians from 16 PHPs followed for five or more years, including 102 anesthesiologists, with excellent outcomes.
We are convinced by the still growing mountain of evidence of the high rates of success for PHPs that there should be a greater focus on early referral prior to overt impairment or overdose, aided by workplace drug testing of physicians (something that is only beginning to occur). And when problems are identified, we think they should be immediately referred to PHPs so they can be properly managed to assure patient safety and good outcomes.
Even with the best of care management and the best of treatments, tragic failures continue to occur, as was the case in this story in The New Republic. This is true today for most potentially fatal diseases, but for addictions there is real new hope using this new model.
Robert L. Dupont, MD is President and CEO of the Institute for Behavior and Health, and Gregory E. Skipper is a fellow at the American Society of Addiction Medicine.
By Robert L. Dupont and Gregory E. Skipper