Prevalence

Numerous studies have attempted to estimate the prevalence of substance abuse among physicians,^{[152] [153]} interns and residents,^{[154] [155] [156]} and medical students.^[157] A national survey published in 1992 reported a 2.1% annual and a 7.9% lifetime prevalence of substance abuse among physicians. This rate was substantially lower than the corresponding rate of 16% reported for the general population and thus disproved the myth that physicians are more likely to become substance addicted than the population in general.^[155] Although physicians are less likely to use cigarettes and illicit substances such as marijuana, cocaine, and heroin, they are five times as likely to take sedatives and minor tranquilizers without medical supervision.^{[155] [158]} This tendency to self-prescribe begins in medical school with tranquilizers and continues in residency with benzodiazepines and prescription opioids. Alcohol abuse is of particular concern in physicians. In 1991, over 87% of medical students reported alcohol use within "the last month" versus 83% of matched controls.^[157] Although heavy alcohol use is less in young physicians than in matched controls, the incidence increases with age in the physician population and decreases with age in the general population. By the mid-50s, heavy use of alcohol in physicians surpasses that of the general population.^[159]

Three retrospective surveys suggest that the prevalence of drug abuse in anesthesiologists ranges from 1% to 2%.^{[160] [161] [162]} These published percentages rely on the recall of directors of U.S. anesthesiology programs and the honesty of individual anesthesiologists responding to questionnaires. Nevertheless, the estimates from these surveys are remarkably similar, and the prevalence is in line with published studies of anesthesia trainees in Australia and New Zealand. ^[163] In 1993 it was estimated that approximately 2% of U.S. anesthesia residents would become addicted to a substance during their residency.^[164]

When comparing the published incidence of substance abuse in physicians as a whole with that of anesthesiologists, it is apparent that the overall incidence of abuse is not consistently higher in the practice of anesthesia than in other specialties. ^[165] It is notable, however, that anesthesiologists are consistently over-represented in drug treatment centers.^[166] Although anesthesiologists account for 12% to 14% of physicians treated in three well-known treatment programs, they constitute only 4% of physicians in the United States.^{[167] [168] [169]} This 3:1 overrepresentation of anesthesiologists in drug treatment centers is relatively consistent across state lines and over time. For instance, in 1987, the Medical Association of Georgia's Impaired Physician Program reported that anesthesiologists represented 13% of physicians in treatment whereas they accounted for only 3% of physicians in practice.^[166] Data from the California Physicians Diversion program in 1989 were similar, with anesthesiologists accounting for 17% of physicians in treatment and 5% of physicians in practice.^[170] Although these data imply that the incidence of chemical dependence is significantly greater among anesthesiologists, they may reflect the potency of the drugs abused, the ability of anesthesiologists to recognize the disease in their colleagues, and the diligence within the specialty to refer colleagues for treatment. The referral pattern mandated by the individual state medical boards and their associated legal ramifications may influence the percentages of impaired physician enrolled in treatment. The experience in Oregon documented a lower percentage of anesthesiologists in treatment. This was the only

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The time until detection of abuse is proportional to the potency of the drug abused. Much of the overrepresentation of anesthesiologists in treatment centers may reflect their preference for and access to potent narcotics. For instance, abuse of sufentanil and fentanyl is typically detected within 1 to 6 months and 6 to 12 months, respectively, whereas abuse of alcohol may not be detected for more than 20 years.^[172] In the initial reports published in the 1980s,^{[167] [168] [169] [171]} all of the anesthesiologists were chemically dependent, whereas 10% of the remaining physicians had other forms of impairment, such as depression. Of the anesthesiologists, nearly 50% were younger than 35 years, and a third were residents. Half the anesthesiologists used both drugs and alcohol, 40% used drugs alone, and a minority used only alcohol. Narcotics were more frequently preferred by younger anesthesiologists. Fentanyl was the most commonly abused narcotic, followed by sufentanil, meperidine, morphine, and oral drugs.

The ASA Task Force on Chemical Dependence^[173] has identified the following characteristics of addicted anesthesiologists. ^*

• 50% are younger than 35 years

• Residents are overrepresented

• Many are members of AOA

• 67% to 88% are male

• 75% to 96% are white

• 76% to 90% abuse opioids as their drug of choice

• 33% to 50% are polydrug abusers

• 33% have a family history of addictive disease

• 65% are associated with academic departments