Winter 2014 – Substance Use Among Physicians and Medical Students
Substance Use Among Physicians and Medical Students.
Catalina I. Dumitrascu1*, Philip Z. Mannes2, Lena J. Gamble3, Jeffrey A. Selzer4
1Creighton University School of Medicine, Omaha, NE, USA.
2Dartmouth College, Hanover, NH, USA.
3National Institutes of Health, Department of Perioperative Medicine, Bethesda, MD, USA.
4Committee for Physician Health, Albany, NY, USA.
Full Text Article PDF
Corresponding author: Catalina I. Dumitrascu, BS, MS; catalinadumitrascu[at]creighton.edu
Key Words: Substance-related disorders; Alcohol abuse; Physician Health Programs.
Background: Physicians and medical students whose substance use causes impairment pose a risk to both themselves and their patients. Drug abuse is a documented problem in physicians, however few studies have investigated the rates of drug abuse in medical students. While treatment plans may be tailored for both students and attending physicians, there is often a reluctance to refer one’s self or a colleague due to a variety of reasons related to fear of repercussions, belief the problem has already been addressed, failure to recognize, or ignorance. This review provides a brief background on common signs and symptoms of potential abuse and resources available to doctors in training at various stages of their career, along with providing a clear picture of the literature as it pertains to physician and medical student substance abuse.
Methods: Extensive search of the literature utilized physical and electronic resources available at the National Institutes of Health Library and the National Library of Medicine with search results limited to the topics of physician or medical student substance use, substance abuse, impairment, and treatment.
Results: Sparse recent data regarding physician and medical student substance abuse are available. Studies completed two decades ago demonstrate that drug abuse was a significant problem for doctors and medical students at that time.
Conclusion: Due to outdated, and/or incomplete data on substance abuse in physicians and especially medical students, it is difficult to report the current extent of substance abuse in these groups. Nonetheless, it is important to recognize substance abuse in these populations and promote referral to substance abuse programs. Early rehabilitation and treatment improves both career and patient outcomes. This study highly suggests the need for up to date information regarding substance abuse in the medical community so that appropriate resources can be developed and effectively utilized.
Published: January 1, 2014
Senior Editor: Kevin C. Patterson
Junior Editor: Caela Hesano
Dumitrascu CI, Mannes PZ, Gamble LJ, Selzer JA. Substance Use Among Physicians and Medical Students. Medical Student Research Journal. 2014;3(Winter):26-35.
1. Hasin DS, O’Brien CP, Auriacombe M, et al. DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry. Aug 2013;170(8):834-851. http://dx.doi.org/10.1176/appi.ajp.2013.12060782.
2. Federation of State Medical Boards Policy on Physician Impairment. Euless, TX: House of Delegates of the Federation of State Medical Boards of the United States;2011.
3. World Drug Report 2013. United Nations Office on Drugs and Crime;2013. Sales No. E.13.XI.6.
4. Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration;2012. HHS Publication No. (SMA) 12-4713.
5. CDC. Policy impact: prescription painkiller overdoses. Atlanta, GA, USA: US Department of Health and Human Services, CDC; 2011.
6. The sick physician. Impairment by psychiatric disorders, including alcoholism and drug dependence. JAMA. Feb 1973;223(6):684-687. http://dx.doi.org/10.1001/jama.1973.03220060058020.
7. Shaw MF, McGovern MP, Angres DH, Rawal P. Physicians and nurses with substance use disorders. Journal of advanced nursing. Sep 2004;47(5):561-571. http://dx.doi.org/10.1111/j.1365-2648.2004.03133.x.
8. Oreskovich MR, Kaups KL, Balch CM, et al. Prevalence of alcohol use disorders among American surgeons. Arch Surg. Feb 2012;147(2):168-174. http://dx.doi.org/10.1001/archsurg.2011.1481.
9. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. Sep 2008;149(5):334-341. http://dx.doi.org/10.7326/0003-4819-149-5-200809020-00008.
10. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. Oct 2012;172(18):1377-1385. http://dx.doi.org/10.1001/archinternmed.2012.3199.
11. Cicala RS. Substance Abuse Among Physicians: What you need to know. Hospital Physician. 2003;39(7)
12. DesRoches CM, Rao SR, Fromson JA, et al. Physicians’ perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues. JAMA : the journal of the American Medical Association. Jul 14 2010;304(2):187-193. http://dx.doi.org/10.1001/jama.2010.921.
13. Hughes PH, Brandenburg N, Baldwin DC, et al. Prevalence of substance use among US physicians. JAMA : the journal of the American Medical Association. May 1992;267(17):2333-2339. http://dx.doi.org/10.1001/jama.1992.03480170059029.
14. Lutsky I, Hopwood M, Abram SE, Cerletty JM, Hoffman RG, Kampine JP. Use of psychoactive substances in three medical specialties: anaesthesia, medicine and surgery. Can J Anaesth. Jul 1994;41(7):561-567. http://dx.doi.org/10.1007/BF03009992.
15. Berge KH, Seppala MD, Schipper AM. Chemical dependency and the physician. Mayo Clin Proc. Jul 2009;84(7):625-631. http://dx.doi.org/10.1016/S0025-6196(11)60751-9.
16. Wright EL, McGuiness T, Moneyham LD, Schumacher JE, Zwerling A, Stullenbarger NE. Opioid abuse among nurse anesthetists and anesthesiologists. AANA J. Apr 2012;80(2):120-128.
17. Hughes PH, Storr CL, Brandenburg NA, Baldwin DC, Jr., Anthony JC, Sheehan DV. Physician substance use by medical specialty. Journal of addictive diseases. 1999;18(2):23-37. http://dx.doi.org/10.1300/J069v18n02_03.
18. About the FSPHP: History. [Web]. http://www.fsphp.org/History.html. Accessed 9/7/2013.
19. DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs. J Subst Abuse Treat. Mar 2009;36(2):159-171. http://dx.doi.org/10.1016/j.jsat.2008.01.004.
20. Gastfriend DR. Physician substance abuse and recovery: what does it mean for physicians–and everyone else? JAMA. Mar 2005;293(12):1513-1515. http://dx.doi.org/10.1001/jama.293.12.1513.
21. Arizona. State Programs [Web]. http://www.fsphp.org/arizona.html, 2013.
22. North Carolina. [Web]. http://www.fsphp.org/northcarolina.html, 2013.
23. Illinois. [Web]. http://www.fsphp.org/illinois.html, 2013.
24. Baldwin DC, Hughes PH, Conard SE, Storr CL, Sheehan DV. Substance use among senior medical students. JAMA. 1991;265(16). http://dx.doi.org/10.1001/jama.1991.03460160052028.
25. Bucher JT, Vu DM, Hojat M. Psychostimulant drug abuse and personality factors in medical students. Med Teach. 2013;35(1):53-57. http://dx.doi.org/10.3109/0142159X.2012.731099.
26. Conard S, Hughes P, Baldwin DC, Achenbach KE, Sheehan DV. Substance use by fourth-year students at 13 U.S. medical schools. J Med Educ. Oct 1988;63(10):747-758.
27. Da Silveira DX, Rosa-Oliveira L, Di Pietro M, Niel M, Doering-Silveira E, Jorge MR. Evolutional pattern of drug use by medical students. Addict Behav. Mar 2008;33(3):490-495. http://dx.doi.org/10.1016/j.addbeh.2007.10.005.
28. Grafton WD, Bairnsfather LE. Use of psychoactive substances by medical students: a survey. J La State Med Soc. Jun 1991;143(6):27-29.
29. Herzog DB, Borus JF, Hamburg P, Ott IL, Concus A. Substance use, eating behaviors, and social impairment of medical students. J Med Educ. Aug 1987;62(8):651-657.
30. Kory WP, Crandall LA. Nonmedical drug use patterns among medical students. Int J Addict. Dec 1984;19(8):871-884.
31. Maddux JF, Hoppe SK, Costello RM. Psychoactive substance use among medical students. Am J Psychiatry. Feb 1986;143(2):187-191.
32. McAuliffe WE, Rohman M, Santangelo S, et al. Psychoactive drug use among practicing physicians and medical students. N Engl J Med. Sep 1986;315(13):805-810. http://dx.doi.org/10.1056/NEJM198609253151305.
33. Roberts LW, Warner TD, Rogers M, Horwitz R, Redgrave G, Care CRGoMSH. Medical student illness and impairment: a vignette-based survey study involving 955 students at 9 medical schools. Compr Psychiatry. 2005 May-Jun 2005;46(3):229-237. http://dx.doi.org/10.1016/j.comppsych.2004.08.008.
34. Frank E, Elon L, Naimi T, Brewer R. Alcohol consumption and alcohol counselling behaviour among US medical students: cohort study. BMJ. 2008;337:a2155. http://dx.doi.org/10.1136/bmj.a2155.
35. Tuttle JP, Scheurich NE, Ranseen J. Prevalence of ADHD diagnosis and nonmedical prescription stimulant use in medical students. Acad Psychiatry. 2010 May-Jun 2010;34(3):220-223. http://dx.doi.org/10.1176/appi.ap.34.3.220.
36. Baldisseri MR. Impaired healthcare professional. Crit Care Med. Feb 2007;35(2 Suppl):S106-116. http://dx.doi.org/10.1097/01.CCM.0000252918.87746.96.
37. Carinci AJ, Christo PJ. Physician impairment: is recovery feasible? Pain physician. May-Jun 2009;12(3):487-491.
38. Lipp MR, Benson SG, Taintor Z. Marijuana use by medical students. Am J Psychiatry. Aug 1971;128(2):207-212.
39. Solursh LP, Weinstock SJ, Saunders CS, Ungerleider JT. Attitudes of medical students toward cannabis. JAMA. Sep 1971;217(10):1371-1372. http://dx.doi.org/10.1001/jama.1971.03190100055011.
40. Mechanick P, Mintz J, Gallagher J, Lapid G, Rubin R, Good J. Nonmedical drug use among medical students. Arch Gen Psychiatry. Jul 1973;29(1):48-50. http://dx.doi.org/10.1001/archpsyc.1973.04200010029005.
41. Rochford J, Grant I, LaVigne G. Medical students and drugs: further neuropsychological and use pattern considerations. Int J Addict. Dec 1977;12(8):1057-1065. http://dx.doi.org/10.3109/10826087709027270.
42. Horowitz A, Galanter M, Dermatis H, Franklin J. Use of and attitudes toward club drugs by medical students. J Addict Dis. 2008;27(4):35-42. http://dx.doi.org/10.1080/10550880802324705.
43. Choi D, Tolova V, Socha E, Samenow CP. Substance use and attitudes on professional conduct among medical students: a single-institution study. Acad Psychiatry. May 2013;37(3):191-195. http://dx.doi.org/10.1176/appi.ap.12060126.
44. Webb JR, Valasek MA, North CS. Prevalence of stimulant use in a sample of US medical students. Ann Clin Psychiatry. Feb 2013;25(1):27-32.
45. Procedures, Policies, and Essential Information for the MD Training Program. Palo Alto, CA: Stanford University School of Medicine;2004.
46. MD Program Handbook: Policies and Procedures. Palo Alto, CA: Stanford University School of Medicine;2012.
47. Assistance for the Impaired Medical Student Aims. Valhalla, NY: New York Medical College; June 2013.
48. AIMS: Aid for the Impaired Medical Student. Memphis, TN: The University of Tennessee College of Medicine.
49. Student Handbook: Impaired Student Program. Indianapolis, IN: Indiana University;2013.
50. Student Handbook: Impaired Student Policy. Lexington, KY: University of Kentucky College of Medicine;2013.
51. Student Needs and Assistance Program. Hanover, NH: Geisel School of Medicine;2001.
52. Student Handbook. Omaha, NE: Creighton University School of Medicine;2013.
53. Student Handbook. Jackson, MS: The University of Mississippi Medical Center School of Health Related Professionals;2012.
54. Student Handbook. Omaha, NE: University of Nebraska Medical Center;2013.
55. Medical Student Handbook. Columbus, OH: Ohio State University College of Medicine;2013.
56. Medical Student Handbook. Portland, OR: Oregon Health and Science University School of Medicine;2011.
57. Student Handbook. Salt Lake City, UT: University of Utah School of Medicine;2013.
58. Student Handbook. Seattle, WA: University of Washington School of Medicine;2013.
59. Student Handbook. Roanoke, VA: Virginia Tech Carilion School of Medicine;2013.
60. Substance Abuse and Impairment. Reno, NV: University of Nevada School of Medicine;2013.
61. Substance Abuse Policy. Los Angeles, CA: David Geffen School of Medicine.
62. Student Handbook for College of Medicine Students. Bryan, TX: Texas A&M Health Science Center College of Medicine;2010.
63. M.D. Program Student Handbook. Orlando, FL: University of Central Florida College of Medicine;2011.
64. Student Handbook. North Chicago, IL: Rosalind Franklin University of Medicine and Science;2013.
65. Student Handbook: Policy Regarding Drugs and Alcohol. Boston, MA: Harvard Medical School.
66. Henderson HW. Addicted Doctors: Responding to their Needs. Can Fam Physician. Sep 1983;29:1691-1699.
67. O’connor PG, Spickard A. Physician impairment by substance abuse. Med Clin North Am 1997;81(4). http://dx.doi.org/10.1016/S0025-7125(05)70562-9.
68. Bryson EO, Silverstein JH. Addiction and substance abuse in anesthesiology. Anesthesiology. Nov 2008;109(5):905-917. http://dx.doi.org/10.1097/ALN.0b013e3181895bc1.
69. Bryson EO, Hamza H. The drug seeking anesthesia care provider. Int Anesthesiol Clin. 2011;49(1):157-171. http://dx.doi.org/10.1097/AIA.0b013e3181e72553.
70. Cost Benefits of Investing Early In Substance Abuse Treatment. Washington, DC, USA: Office of National Drug Control Policy; 2012.
71. McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. Oct 2000;284(13):1689-1695. http://dx.doi.org/10.1001/jama.284.13.1689.
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