Addicted Anaesthesiologists

[muchdutch]

Thought some people (especially those interested in anaesthesiology) would be interested in this article I found.

 

http://www.menshealth.com/cda/article.do?site=MensHealth&channel=health&category=doctors.hospitals&conitem=d7a4dfaa4d41e010VgnVCM20000012281eac____&page=1

[SarahZ]

interesting read, especially the part at the end about the airborne narcotics!!!

Side note, I had fent during childbirth and that is some heavy duty stuff, I told them to stop giving it to me because I felt too altered.

[Kiel]

Thought some people (especially those interested in anaesthesiology) would be interested in this article I found.

 

http://www.menshealth.com/cda/article.do?site=MensHealth&channel=health&category=doctors.hospitals&conitem=d7a4dfaa4d41e010VgnVCM20000012281eac____&page=1

WOW......

[LackingPhysics]

Wow, it's really sad that so many lives have been ruined by this (the doctor and the patients). Especially if the doctor was inhaling that stuff without even knowing and became addicted while just trying to do his job!

[Smurfette]

Interesting article. I've been told stories about anesthesiologists that get withdrawal symptoms when they go on holiday because they're out of the fumes of the OR. They promptly feel better when they get back to work. Talk about being addicted to your work, literally...a little scary actually.

 

I wonder whether they get addicted to other drugs too...not just narcotics, but any of the inhaled anesthetics too...sevoflurane, isoflurane, etc.

[Jixe]

Wow, it's really sad that so many lives have been ruined by this (the doctor and the patients). Especially if the doctor was inhaling that stuff without even knowing and became addicted while just trying to do his job!

 

That's no excuse, in my opinion. This sort of stuff should be anticipated before working in the OR and appropriate precaution should be taken.

[EMD]

I wonder whether they get addicted to other drugs too...not just narcotics, but any of the inhaled anesthetics too...sevoflurane, isoflurane, etc.

I think it is mostly the narcotics... as they hit the morphine receptors. Also, if I remember my pharmacology lectures right... the short half-life of many anesthetics (which makes 'em ideal anesthetics) also makes 'em pleasant drugs to abuse-- as one gets a 'rush', i.e. a fast onset of action. If you know your history of medicine... you know cocaine was once considered a great anesthetic. I'm surprised TimmyMax hasn't weighted in on this one... he is going to be a gas man.

[Smurfette]

I think it is mostly the narcotics... as they hit the morphine receptors. Also, if I remember my pharmacology lectures right... the short half-life of many anesthetics (which makes 'em ideal anesthetics) also makes 'em pleasant drugs to abuse-- as one gets a 'rush', i.e. a fast onset of action. If you know your history of medicine... you know cocaine was once considered a great anesthetic. I'm surprised TimmyMax hasn't weighted in on this one... he is going to be a gas man.

 

I think most of the inhaled anesthetics have short half-lives too - probably shorter than morphine. I don't know whether they're addictive though.

 

As for cocaine...isn't it still occasionally used as a local anesthetic? I might be wrong on this, so if someone knows, please correct me. But isn't cocaine still used as the local in some ENT procedures and occasionally in ophthalmology as well?

[Kuantum]

I read that article and that was crazy.

[peachy]

That's no excuse, in my opinion. This sort of stuff should be anticipated before working in the OR and appropriate precaution should be taken.

But as the article explains, they didn't necessarily know previously that anesthesiologists were being unwittingly exposed to enough drugs in the course of a surgery to trigger an addiction in individuals who were susceptible. You can't anticipate and take appropriate precauations if you don't know what the reason is for the increased rate of addictions.

[blinknoodle]

As for cocaine...isn't it still occasionally used as a local anesthetic? I might be wrong on this, so if someone knows, please correct me. But isn't cocaine still used as the local in some ENT procedures and occasionally in ophthalmology as well?

 

We used cocaine as a topical anesthetic while reducing a nasal fracture in the OR. Its vasoconstriction properties were probably equally as important and it helps to control initial bleeding as well. I wouldn't doubt ENT uses it.

[TimmyMax]

Hey,

 

Cocaine is routinely used (mostly in the ER) as a topical anaesthestic for ENT-type procedures, such as fractures, really bad nosebleeds and other stuff.

Of course, the doses used are much less than the doses that addicts and junkies regularly use, so there's not much worry about getting your patients hooked on it or anything along those lines.

[muchdutch]

Timmymax,

 

Since you're in the field, has this issue been addressed so far in your career (in med school or in residency so far)? Or is it the white elephant in the room? Is there merit to these findings of trace amounts of anaesthesia hooking docs, or is it not really an issue?

[TimmyMax]

Hey,

 

I'm not too sure how true the idea about the 'trace' amounts of anaesthesia above the gas circuits hooking docs is, because, as any anaesthesia resident will tell you, none of the consultants really stick around in the room once the patient is asleep and of the ones that do, they're certainly not hunched right over the patient's head, trying to catch a buzz on what little gas does manage to escape from their circuit.

As for whether or not this issue has been addressed so far in my residency, I could make a few wisecracks here, but I will take the high (no pun intended!) road and say that it has on multiple occasions. Still, there seem to be a number that fall through the cracks, regardless of how much support and information you give them- I guess that some people just can't keep their hands out of the cookie jar, kind of like docs that sleep with their patients.

In my case, I'm not too worried because I'm deathly afraid of needles (but not of dishing them out) and couldn't imagine sticking myself with one for any reason (including to deliver insulin, a flu shot or anything else I may require). Fortunately, the really bad drugs don't come in a po form!

[kosmo14]

It is something that has been addressed in our residency program a few times already. We have had academic day seminars on addiction in anesthesia as well, our department has a night for the spouses to go to so that they can spot the signs and know where to look for help. It is a problem. Our anesthesia program has had at least 2 residents in the past that had to discontinue due to addiction issues. There are certainly attendings that will openly admit to having addiction problems in the past in the hopes of avoiding someone else going through that. I actually worked with one while on elective in Ontario that discussed thier past addiction with me quite openly.

 

As far as the aerosolized narcotics being the culprit, as Timmy said it seems rather far fetched. Anyone who has been in an OR knows that the anesthesiologist is rarely hunched over the patient (that usually only happens when sh*t hits the fan). For the most part the surgeons or scrub nurse are just as close to the patient and the vent. equipment as the anesthesiologist is. I think personality and access would be a better bet.

 

I for one think I will pass on using anything remotely addictive for pain relief if I ever need it as it seems that is frequently the beginning of the slope.

[Smurfette]

I think personality and access would be a better bet.

 

I understand the "access" part. But I'm curious what you mean by "personality."

[avenir001]

I'm not sure if this is what Kosmo meant, but personality traits such as sensation seeking and impulsivity have been found to be correlated with addictive behaviors.

[muchdutch]

Yeah, sure. Don't you know someone who has an addictive personality? Not that they necessarily have an addiction, but they go for things all the way. I'm sure there's a few women (and I'd like to think men too though I'm not as certain) out there on this board who, upon buying a bag of cookies (or whatever your vice is) have eaten them all in one sitting. That kind of thing.

[Smurfette]

Sure - there's people that are more prone to addictive behaviours, but why would anesthesiologists be more prone to addiction than other doctors?

[Kuantum]

I think they offer a possible explanation in the article.

[TimmyMax]

Hey,

 

why would anesthesiologists be more prone to addiction than other doctors?

The answer probably has to do more with proximity and accessibility than anything else. Anaesthesia is probably the only field where you actually physically obtain and administer potent narcotics (that are extremely addictive in themselves when used for the wrong purpose, specifically abuse) on a regular basis. No other field has this same accessibilty to relatively large amounts of narcotics (and nor should they).

Just as psychiatrists and GPs have proximity and accessibility to emotionally damaged/vulnerable patients which they can use for their own dark purposes, the same is true with anaesthesiologists and narcotics. You rarely hear of anaesthesiologists having inappropriate sexual contact with their patients, just as you rarely hear of GPs and psychiatrists becoming addicted to narcotics. This isn't to say that this doesn't happen- I'm sure it does, but I'm just saying that it's the proximity to the commodity of abuse that enables this kind of behaviour.