Opinion : Physician addicts

Submitted for a grade as part of my medical ethics class:

Drug addiction is a serious problem in all parts of society, and medicine is no exception. Despite the image of a noble and beneficial profession, physicians frequently become addicts. These addictions are fueled by stressful jobs, easy access to narcotics, and often an irrational sense that their use is not a problem. Considering these factors, more needs to be done to eliminate this problem so that both patients and physicians are protected from the horrible struggle that characterizes addiction.

To understand why a successful, benevolent person would turn to drugs, we must consider the risk factors that are inherent in medical practice. First of all, there is the stress and negative emotional toll that comes with the job. Everyone responds to stress differently, and some people will respond by self-medicating. Stress is a problem with almost any job, yet the impulse towards self-medication is particularly a problem in physicians because they have easy access to powerful narcotics. If a lawyer or pilot was stressed for instance, they may have a drink after work or take too many aspirin, but it is unlikely that they would have Vicadin or codeine readily available at their workplace. This access lowers the opportunity barrier to addictions for physicians and often starts them along a downward spiral.

Once they are addicted to drugs, being a physician can also hinder the ability for others to help. Physicians are generally respected and trusted in the community so outsiders are often reluctant to step in. Physicians can be insulated from the consequences of their actions by the work of their colleagues (to fix mistakes) or their licensure (to mitigate legal consequences). There is often a culture of acceptance among colleagues who want to help, but not hurt, their friends. The stereotypes surrounding drug addicts will also help to defer suspicion and give the impression that the drug habit is not a problem. A physician who is addicted may feel that as long as they can pay their bills and do their job, there is no problem. Addiction is ultimately a downward spiral, however, and the earlier the intervention, the better it is for everyone involved.

Everyone will agree that this drug problem needs to be wiped out, but there is little agreement or action on the subject. One reason for the inaction is that outing large numbers of physician addicts would damage reputations, and no one from hospitals to medical schools to the AMA wants to do that. To solve the problem, however, reputations will need to be damaged. Patient safety is simply more important than reputation, and any short-term damage will be outweighed by the long-term benefits of deterrence and breaking the culture of acceptance. First there needs to be a system of random drug tests to catch physicians in the act. Second, hospitals or other employers must be required to report the results of these tests (unlike baseball) and the hospitals must be held accountable for their employees. Finally, a system of amnesty must be in place to encourage physicians to seek rehab treatments. Physicians should be allowed to resume practice as long as they can stay clean. In addition, the systems to track and distribute medicines in a hospital should be revised so that the pharmacy can keep tighter control on supplies and drugs can be tracked more readily. Electronic prescription dispensing should help reduce the opportunity that physicians have to take the first fateful hit, and also catch the problem sooner.

Addicted physicians are a serious problem, but a solvable one. If the medical establishment puts aside its ego and reputation and implements specific and strict policies, this problem can be greatly reduced, and many lives will be saved.