Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942012000300010
Brazilian Journal of Anesthesiology
Review Article

Abuso de fármacos anestésicos pelos anestesiologistas

Anesthetic drug abuse by anesthesiologists

Flavia Serebrenic Jungerman; Hamer Nastasy Palhares Alves; Maria José Carvalho Carmona; Nancy Brisola Conti; André Malbergier

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Resumo

JUSTIFICATIVA E OBJETIVOS: O uso de substâncias psicoativas é um pouco mais alto na classe médica comparado à população geral. Dentre as especialidades médicas, a Anestesiologia é uma das mais atingidas, principalmente por excesso de trabalho e maior acesso aos fármacos. O objetivo deste artigo é revisar a literatura sobre o assunto. Para isso, realizou-se uma pesquisa com as palavras-chaves relacionadas ao assunto no MEDLINE, com artigos dos últimos 30 anos. CONTEÚDO: Apesar da droga de maior abuso entre os anestesiologistas ser o álcool, o abuso de agentes anestésicos é o mais preocupante, devido ao alto potencial de dependência, bem como às suas consequências, muitas vezes letais. Os mais usados são os opioides (fentanil e sufentanil), o propofol e os anestésicos inalatórios. Os profissionais mais jovens são os mais afetados. As consequências do uso vão desde afastamento do local de trabalho até morte. A volta à sala de cirurgia parece levar a alto risco de recaída. Programas de tratamento especializado para a classe médica são propostos nos EUA e na Europa, bem como medidas preventivas, como rigidez no controle de fármacos e identificação dos profissionais sob maior risco de abuso. No Brasil, os anestesiologistas são a segunda especialidade que mais consomem substâncias, porém o assunto é pouco estudado e há uma carência de programas especializados na área. CONCLUSÕES: O abuso de substâncias entre os anestesiologistas é um assunto que necessita maior atenção, principalmente devido às consequências graves que este consumo pode acarretar tanto para o profissional como para os pacientes.

Palavras-chave

analgésicos, opioides, anestesiologia, segurança, anestesiologistas, complicações, mortalidade

Abstract

BACKGROUND AND OBJECTIVES: Physicians has a slightly higher rate of psychoactive substance use when compared to the population in general. Anesthesiology is one of the most affected medicine specialties, especially due to overwork and easier access to drugs. This paper aims to carry out a literature review on the topic. Therefore, research was conducted by searching topic-related keywords on papers from the last 30 years available on MEDLINE. CONTENT: Despite the fact that alcohol abuse is the most common among anesthesiologists, the abuse of anesthetic agents causes more concern, due to its high dependence potential and consequences, which are often fatal. The most widely used drugs are opioids (fentanyl and sufentanil), propofol and inhalational anesthetics. Young professionals are the most affected. Among the consequences of drug abuse are workplace absence and even death. The return to operating rooms seems to increase the risk of relapse. In Europe and in the USA there are specialized treatment programs for the middle class, as well as preventive measures, such as strict control of drugs and identification of professionals at high risk of abuse. In Brazil, Anesthesiology is the second medicine specialty with most drug addicts, but the topic has not been much studied and there are few specialized programs in the field. CONCLUSIONS: Substance abuse by anesthesiologists is an issue that needs to be discussed further, especially due to the possibility of severe consequences for professionals and patients.

Keywords

absenteeism, anesthesiology, mortality, occupational diseases, opioid related disorders, physicians

References

Alves HN, Surjan JC, Nogueira-Martins LA, Marques AC, Ramos SP, Laranjeira RR. Clinical and demographical aspects of alcohol and drug dependent physicians. Rev Assoc Med Bras. 2005;51(3):139-143.

Robb N. University acknowledges special risks, introduces drug program for anesthetists. Cmaj. 1995;153(4):449-452.

Tetzalff J. Chemical dependency and anesthesiology. 2009.

McGlynn EA, Asch SM, Adams J. The quality of health care delivered to adults in the United States. New Eng J Med. 2003;348(26):2635-2645.

Farber NJ, Gilibert SG, Aboff BM, Collier VU, Weiner J, Boyer EG. Physicians willingness to report impaired colleagues. Soc Sci Med. 2005;61(8):1772-1775.

Berge KH, Seppala MD, Schipper AM. Chemical dependency and the physician. Mayo Clin Proc. 2009;84(7):625-631.

Talbott GD. The impaired physician and intervention: a key to recovery. J Fla Med Assoc. 1982;69(9):793-797.

De Oliveira GS Jr, Ahmad S, Stock MC. High incidence of burnout in academic chairpersons of anesthesiology: should we be taking better care of our leaders?. Anesthesiology. 2011;114(1):181-193.

Collins GB, McAllister MS, Jensen M, Gooden TA. Chemical dependency treatment outcomes of residents in anesthesiology: results of a survey. Anesth Analg. 2005;101(5):1457-1462.

Hughes P. Can we improve on how we select medical students?. J R Soc Med. 2002;95(1):18-22.

McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ Clinical research ed. 2008;337:a2038.

Alexander BH, Checkoway H, Nagahama SI, Domino KB. Cause-specific mortality risks of anesthesiologists. Anesthesiology. 2000;93(4):922-930.

Brewster JM. Prevalence of alcohol and other drug problems among physicians. JAMA. 1986;255(14):1913-1920.

Krizek TJ. The impaired surgical resident. Surg Clin North Am. 2004;84(6):1587-1604.

Ward CF, Ward GC, Saidman LJ. Drug abuse in anesthesia training programs: A survey: 1970 through 1980. JAMA. 1983;250(7):922-925.

Gravenstein JS, Kory WP, Marks RG. Drug abuse by anesthesia personnel. Anesth Analg. 1983;62(5):467-472.

Talbott GD, Wright C. Chemical dependency in health care professionals. Occup Med. 1987;2(3):581-591.

Booth JV, Grossman D, Moore J. Substance abuse among physicians: a survey of academic anesthesiology programs. Anesth Analg. 2002;95(4):1024-1030.

Levine MR, Rennie WP. Pre-employment urine drug testing of hospital employees: future questions and review of current literature. Occup Environ Med. 2004;61(4):318-324.

Collins GB, McAllister MS, Jensen M, Gooden TA. Chemical dependency treatment outcomes of residents in anesthesiology: results of a survey. Anesth Analg. 2005;101(5):1457-1462.

Spiegelman WG, Saunders L, Mazze RI. Addiction and anesthesiology. Anesthesiology. 1984;60(4):335-341.

Berry CB, Crome IB, Plant M, Plant M. Substance misuse amongst anaesthetists in the United Kingdom and Ireland: The results of a study commissioned by the Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2000;55(10):946-952.

Weeks AM, Buckland MR, Morgan EB, Myles PS. Chemical dependence in anaesthetic registrars in Australia and New Zealand. Anaesth Int Care. 1993;21(2):151-155.

Bell DM, McDonough JP, Ellison JS, Fitzhugh EC. Controlled drug misuse by Certified Registered Nurse Anesthetists. AANA Journal. 1999;67(2):133-140.

DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians Health Programs. J Subst Abuse Treat. 2009;36(2):159-171.

Bryson EO, Levine A. One approach to the return to residency for anesthesia residents recovering from opioid addiction. J Clin Anesth. 2008;20(5):397-400.

Wischmeyer PE, Johnson BR, Wilson JE. A survey of propofol abuse in academic anesthesia programs. Anesth Analg. 2007;105(4):1066-1071.

Wilson JE, Kiselanova N, Stevens Q. A survey of inhalational anaesthetic abuse in anaesthesia training programmes. Anaesthesia. 2008;63(6):616-620.

Pain L, Gobaille S, Schleef C, Aunis D, Oberling P. In vivo dopamine measurements in the nucleus accumbens after nonanesthetic and anesthetic doses of propofol in rats. Anesth Analg. 2002;95(4):915-919.

McAuliffe PF, Gold MS, Bajpai L. Second-hand exposure to aerosolized intravenous anesthetics propofol and fentanyl may cause sensitization and subsequent opiate addiction among anesthesiologists and surgeons. Med Hypoth. 2006;66(5):874-882.

Zacny JP, Lichtor JL, Coalson DW. Subjective and psychomotor effects of subanesthetic doses of propofol in healthy volunteers. Anesthesiology. 1992;76(5):696-702.

Bryson EO, Silverstein JH. Addiction and substance abuse in anesthesiology. Anesthesiology. 2008;109(5):905-917.

Nace EP, Davis CW, Gaspari JP. Axis II comorbidity in substance abusers. Am J Psych. 1991;148(1):118-120.

Skipper GE, Campbell MD, Dupont RL. Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs. Anesth Analg. 2009;109(3):891-896.

Hughes PH, Brandenburg N, Baldwin DC Jr. Prevalence of substance use among US physicians. JAMA. 1992;267(17):2333-2239.

Berge KH, Seppala MD, Lanier WL. The anesthesiology communitys approach to opioid- and anesthetic-abusing personnel: time to change course. Anesthesiology. 2008;109(5):762-764.

Fitzsimons MG, Baker KH, Lowenstein E, Zapol WM. Random drug testing to reduce the incidence of addiction in anesthesia residents: preliminary results from one program. Anesth Analg. 2008;107(2):630-635.

Gold MS, Byars JA, Frost-Pineda K. Occupational exposure and addictions for physicians: case studies and theoretical implications. Psychiatr Clin North Am. 2004;27(4):745-753.

Gold MS, Frost-Pineda K, Melker RJ. Physician suicide and drug abuse. The American journal of psychiatry. 2005;162(7):1390.

Gold MS, Melker RJ, Dennis DM. Fentanyl abuse and dependence: further evidence for second hand exposure hypothesis. J Add Dis. 2006;25(1):15-21.

Marienau ME and KHB. Personal verbal communication. Octo.

Oreskovich MR, Caldeiro RM. Anesthesiologists recovering from chemical dependency: can they safely return to the operating room?. Mayo Clinic Proceedings. 2009;84(7):576-580.

Domino KB, Hornbein TF, Polissar NL. Risk factors for relapse in health care professionals with substance use disorders. JAMA. 2005;293(12):1453-1460.

Silverstein JH, Silva DA, Iberti TJ. Opioid addiction in anesthesiology. Anesthesiology. 1993;79(2):354-375.

Hankes L, Bissel L. Health professionals. SUbstance abuse: a comprehensive textbook. 1992:897-908.

Rounsaville BJ, Carroll KM. Individual psychotherapy for drug abusers. Substance abuse: a Comprehensive textbook. 1992:496-508.

Gastfriend DR. Physician substance abuse and recovery: what does it mean for physicians and everyone else?. JAMA. 2005;293(12):1513-1515.

Smith PC, Smith JD. Treatment outcomes of impaired physicians in Oklahoma. J Okla State Med Assoc. 1991;84(12):599-603.

Kintz P, Villain M, Dumestre V. Cirimele V: Evidence of addiction by anesthesiologists as documented by hair analysis. Forensic Sci Int. 2005;153(1):81-84.

Gallegos KV, Norton M. Characterization of Georgias Impaired Physicians Program treatment population: data and statistics. J Med Assoc Ga. 1984;73(11):755-758.

Kliner DJ, Spicer J, Barnett P. Treatment outcome of alcoholic physicians. J Stud Alcohol. 1980;41(11):1217-1220.

Skutar C. Physicians Recovery Network targets attitudes about impairment. Mich Med. 1990;89(12):30-32.

Gladstone W, Webster IW, Rotem A. An initiative for teaching about alcohol and other drugs in Australian medical schools. Med J Aust. 1987;147(7):339-341.

Palhares-Alves HN, Laranjeira R, Nogueira-Martins LA. A pioneering experience in Brazil: the creation of a support network for alcohol and drug dependent physicians. A preliminary report. Rev Bras Psiquiatr. 2007;29(3):258-261.

Marcolino JA, Vieira JE, Piccinini Filho L, Mathias LA. Mentoring during residency in anesthesiology: the Irmandade da Santa Casa de Misericordia, São Paulo Program. Rev Bras Anestesiol. 2004;54(3):438-447.

Fagnani Neto R, Obara CS, Macedo PC, Citero VA, Nogueira-Martins LA. Clinical and demographic profile of users of a mental health system for medical residents and other health professionals undergoing training at the Universidade Federal de São Paulo. São Paulo Med J. 2004;122(4):152-157.

Kerr-Correa FGA, Bassit AZ, Boccutto NMVF. Uso de alcool e drogas por estudantes de medicina da Unesp. Rev Bras Psiquiatr. 1999;21(2):95-100.

Newbury-Birch D, Walshaw D, Kamali F. Drink and drugs: from medical students to doctors. Drug Alcohol Depende. 2001;64(3):265-270.

Baldisseri MR. Impaired healthcare professional. Crit Care Med. 2007;35(2^sSuppl):S106-S116.

Sanz Yaguez F, Lopez Corbalan JC. Abuse of psychoactive drugs among health professionals. Rev Esp Anestesiol Reanim. 1999;46(8):354-358.

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