Diapositiva 1

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Doctors Health Matters Finding The Balance BMA
House, London
Addiction to opiates among impaired
physicians treated in a Spanish Physicians
program (PAIMM)a descriptive study Pilar
Lusilla, Carlos Roncero, Francisco Collazos,
Miquel Casas. 17th November 2008
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Who...me?
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Vicodin Generic Name acetaminophen and
hydrocodone
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Index

• Some topics on the Opiate Use by Physicians
• Descriptive study of OAD (Opiate Abuse and
  Dependence) Physicians
• Outcome Treatment data of OAD Physicians
• Comparison of OAD Physicians versus other
  inpatient Physicians

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Introduction

• OAD (opiate abuse and dependence) is a cause of
  concern among physicians.
• It is often associated to denial of the illness,
  polydrug abuse and a higher mortality rate by
  overdose and suicide. (Farley, 1983 Gallegos et
  al. 1988 Roth et al, 1997)
• Anaesthesiologists are usually overrepresented.
  (Ward et al. 1983 Cadman Bell, 1998)
• There is a high risk of malpractice among OAD
  physicians. (Ginzburg Glass, 1984)
• Long term recovery programs with stricter
  follow-up and monitoring are recognized useful
  (Sanders, 2006)
• There is a lack of data about outcome an return
  to work among this patients

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Aims

• To describe the characteristics of opiate abuse
  and dependence (OAD) among physicians treated in
  a Spanish Physicians Program.
• To evaluate the results and the efficacy of
  treatment in OAD physicians
• To compare clinical data with the rest of
  physicians.

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Methods

• Retrospective review of clinical and demographic
  data of physicians with OAD treated in the PAIMM
  from November 1998 to December 2007.
• Phone Interview to all OAD physicians to evaluate
  the results of treatment and their current status
  (September 2008).

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Flow Chart (1)
1292 Patients admitted to the Program 1999-2007
801 Outpatiens
491 Inpatient Treatment
88 Nurses
403 Physicians
8 outpatient OAD (16)
42 inpatient OAD (84)
46 Dependence (92)
50 OAD
4 Abuse (8)
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Flow Chart (2)
50 OAD
7 Not Found
8 UNKNOWN OUTCOME
1 Refuse to Answer
28 Sustained Full Remission
7 Dead (14)
32 GOOD OUTCOME (76,2)
35 Located and agree to answer
4 Sustained Partial Remission
10 BAD OUTCOME 23,8
3 Currently manifesting a pattern of dependence
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Characteristics of OAD physicians

• 1. Demographical Data

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Where do the OAD patients come from?
19 patients 38
31 patients 62
PAIMM
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Gender
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Age of the sample
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Marital Status
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Professional background
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Pathways to evaluation
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Characteristics of OAD physicians

• 1. Clinical Data

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Family Antecedents
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Abused Drugs
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Route of Administration of drug of choice
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Pattern of use of drug of choice
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Length of addiction
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Other Drugs currently used by OAD physicians
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Drugs Abused in the past among OAD Physicians
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Number of Drugs Abused ()
() Excluding nicotine
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Dual Diagnosis
23 (46)
27 (54)
YES
NO
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Other Clinical Data

• 88 recognized self-prescription.
• 16 had previous suicidal attempts prior to
  admission in the PAIMM.
• 72 had undergone treatment for psychiatric and
  or addictive behaviour prior to admission.
• The average delay for seeking help was 7.5 years
  (SD5.7, range1-19 years)

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Characteristics of OAD physicians

• 3. Data on evolution outcome

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Flow Chart (2)
50 OAD
7 Not Found
8 UNKNOWN OUTCOME
1 Refuse to Answer
28 Sustained Full Remission
7 Dead
32 GOOD OUTCOME (76.2)
35 Located and agree to answer
4 Sustained Partial Remission
10 BAD OUTCOME 23.8
3 Currently manifesting a pattern of dependence
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Summary of Outcome

• 84 needed inpatient treatment for detoxification
• 3 patients (6) were voluntary discharged against
  medical indication
• 76.2 good outcome
• 14 dead (overdoses)
• 96 used other drugs (76 met dependence criteria
  and 68 were polydrug users).

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Demographic variables Outcome

• Outcome is not related to
• Gender,
• Age,
• Marital Status,

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Outcome and Speciality
ns
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Outcome and Clinical variables (n50)
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Route of administration
ns
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Length of addiction Outcome
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Outcome and Inpatient variables (n42)
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Outcome and Follow-up process (n50)
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Compliance of Treatment
Plt0.001
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Length of Follow-up
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Outcome and return to work

• 87.5 of OAD recovered physicians are currently
  working.
• 12.5 are retired.

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Characteristics of OAD physicians

• 4. Comparison with the rest of physicians

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Number Inpatiens
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Sex and Age
Plt0.02

• OAD physicians are 4 years younger than other
  inpatiens physicians
• (plt0.009)

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OAD Behaviour and pathway to the PAIMM
Plt0.02
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OAD Behaviour and Therapeutic Contract
Plt0.000
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OAD Physician Profile

• Man around 40 years old
• Specialist and specially Anaesthesiologist
• Self-prescribing.
• Polydrug dependence and one out of two with dual
  diagnosis.
• Usually he has delayed asking for help during
  seven years and a half
• He often comes to treatment after problems at
  work or legal claims have shown up

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Conclusions

• OAD Physicians are a cause of concern since they
  are reluctant to seek treatment and the risk of
  complaints is high.
• In spite of the severity of the addictive
  behaviours it is worth to make effort for
  improving compliance because many of these
  patients could be recovered.
• In addition to the standard treatment, these
  patients need more strict management and longer
  follow up in order to detect relapses early.
• A program based upon confidentiality and
  supported by the medical regulatory body leads to
  sick physicians being confident and ask for help

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Thank you!
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