Substance Use Disorder (SUD) and Physician Impairment

This month JC will be expanding on our wellness topics by discussing substance use disorders (SUD’s) among healthcare professionals. The earliest American essay on alcoholism Mighty Destroyer Displayed dates back to 1774 and was written by Anthony Benezet. One of America’s founding fathers, also considered a father of psychiatry, Dr. Benjamin Rush in 1784, wrote Inquiry into the Effects of Ardent Spirits on the Human Mind and Body where he catalogues the consequence of chronic drunkenness and argues that this condition is a “disease” that physicians should be treating. Fast forward 233 years and we find ourselves confronted with an “epidemic of substance abuse” as outlined in a recent  Presidential Commission report.  The report cites industry marketing, the mandating of pain scales as a “fifth vital sign”, unrestrained distributors, rogue pharmacies, unethical physicians, and patients whose opioid medications were diverted as contributing factors. Physicians are particularly vulnerable to SUD’s because of historically easy access to drugs of abuse, a clinical acumen that provides them with a skill set for evasion and a professional culture that applies a deep social stigma to addiction. Early intervention is generally the exception in physicians with substance use disorders. We are fortunate to have a few of our Addiction Psychiatry colleagues joining us and have extended invitations to physicians who have had personal experiences with addiction and recovery. I am looking forward to an incredibly informative and meaningful JC and hope we will be able to advance our understanding, empathy and openness about this particularly indolent disease. 

Samuelson ST et al, The impaired anesthesiologist: what you should know about substance abuse. Can J Anaesth. 2017 Feb;64(2):219-235 | 

MacNicol B, The biology of addiction. Can J Anaesth. 2017 Feb;64(2):141-148. 

McLellan AT et al, Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ. 2008 Nov 4 | 

Pham JC, Pronovost PJ, Identification of physician impairment. JAMA. 2013 May 22;309(20):2101-2.