Addiction

[sciatica123]

Hey board. I was an Anesthesia resident that ran into some trouble in life and turned to drugs instead of handling my issues in a healthy responsible way. I was nearly finished with residency when I was caught, went to rehab and have been sober for a little over three years now. Have tried very hard to get back into residency, any residency, any specialty, with very little luck. Hundreds of applications, a few interviews and no success. I would love to finish an Anesthesia residency but I understand that is a very high mountain to climb. Any advice on how to get back into residency and any anesthesia programs that might be open to a recovering addict would be greatly appreciated. Feel free to inbox me as well.

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[Noyac]

I hope you can get a residency. I wouldn't hold your past against you. But I would caution you against applying for an anesthesia residency. It's just no ideal. Do you like psych? Or Ped's? Just a couple examples. I wish you luck.

 

[eosinophilic]

[Q

 

[Man o War]

I applaud you for getting clean, not an easy road.
If I can speak frankly....I think anesthesia is a bad idea for you. I've seen several colleagues get clean and relapse after coming back to the OR. The temptation is just too strong. I wish you the best of luck, sincerely.

 

[anbuitachi]

what are your step scores?

 

[deleted171991]

Respectfully, you have zero chances of getting back into anesthesiology, or any other job that involves addictive substances. Nobody will take that liability. You yourself shouldn't wish for it either; a recovering alcoholic shouldn't take a job in a bar.

 

[anbuitachi]

Respectfully, you have zero chances of getting back into anesthesiology, or any other job that involves addictive substances. Nobody will take that liability. You yourself shouldn't wish for it either; a recovering alcoholic shouldn't take a job in a bar.

Well this is not true. there were a few recovering addicts retraining in anesthesiology when i trained

 

[B-Bone]

there is a formerly very prolific contributor to these forums with a very similar story. He shared his story at our grand rounds when I was a resident, and it was a scary and sobering tale. He found a way past it and has been successful in another field of medicine. His perspective was that anesthesia was not an option, and that this was an actual life-or-death issue. N=1, but I tend to agree.

 

[Pooh & Annie]

Hey board. I was an Anesthesia resident that ran into some trouble in life and turned to drugs instead of handling my issues in a healthy responsible way. I was nearly finished with residency when I was caught, went to rehab and have been sober for a little over three years now. Have tried very hard to get back into residency, any residency, any specialty, with very little luck. Hundreds of applications, a few interviews and no success. I would love to finish an Anesthesia residency but I understand that is a very high mountain to climb. Any advice on how to get back into residency and any anesthesia programs that might be open to a recovering addict would be greatly appreciated. Feel free to inbox me as well.

You can definitely get a residency, and maybe in anesthesiology (although whether that's healthy/safe for you is a decision you really need to evaluate).

A state physician monitoring board will be your best friend in this situation. If your state doesn't have one, you may need to go somewhere that does. They provide the residencies a safety net that makes them FAR more comfortable in hiring you, and to some degree, makes you a MORE desireable candidate.

 

[deleted171991]

Well this is not true. there were a few recovering addicts retraining in anesthesiology when i trained

OP did not ask for help. S/he was caught. Completely different story. That's the kind of addict fewer people trust. But maybe I am wrong.

 

[anbuitachi]

But dont forget the last study done showed mortality of 13% for recovered addicts reentering residency

 

[Pharmado]

Anesthesia is a high stress field with bountiful access to addictive substances. This is not a recipe for staying clean. Your life is more important than your medical career. Be an example to others in your position by persevering and staying alive. Succeed in any discipline of medicine you'd like, but stay away from anesthesia. Figure out what you like most about medicine and pick a specialty that utilizes those traits. Make your #1 consideration that you have no daily exposure to narcotics. You are likely in a position where you need to take what options are open to you, but PLEASE realize that anesthesia is a poor choice for you. Our program had a CA-3 Chief resident get caught stealing drugs. After he got clean he went into EM and has done very well for himself. You can continue in medicine, but choose a different path.

 

[Planktonmd]

I wonder how many drug abusers we work with everyday without the slightest suspicion!
It's really like everything in life, you can do whatever you want just don't get caught, because if you do, everyone will start judging you and projecting their personal prejudices over you.

 

[Pooh & Annie]

OP did not ask for help. S/he was caught. Completely different story. That's the kind of addict fewer people trust. But maybe I am wrong.

Doctors rarely ask for help. Someone is in bad shape if they're risking their career by asking for help. And I don't know, but I think that once someone has gone to treatment and has some recovery time, the risk of relapse is the same whether they got help voluntarily or not.

 

[BLADEMDA]

Anesthesiologists Recovering From Chemical Dependency: Can They Safely Return to the Operating Room?

Anesthesiologists Recovering From Chemical Dependency: Can They Safely Return to the Operating Room?

 

[BLADEMDA]

In contrast, according to Dr. Skipper’s research, which is the first long-term outcome study based on actual data from records of anesthesiologists, most anesthesiologists can safely return to practice if certain safeguards are in place. In his study, anesthesiologists who were treated and monitored for substance use disorders under the supervision of PHPs had excellent outcomes similar to other physicians. At the end of the five-year follow-up period, 71 percent of anesthesiologists and 64 percent of nonanesthesiologists had completed their contracts and were no longer required to be monitored.

Although they face greater stigma, the research shows that anesthesiologists:

• Were less likely to fail a drug test during monitoring
• Were as likely to complete treatment and return to practice
• Experienced suicide risks, relapse rates and disciplinary rates that were no higher than other physicians
• Did not put their patients at risk of significant harm from relapse

Addiction Treatment for Addicted Anesthesiologists

Treatment for addicted anesthesiologists typically involves specialized drug rehabilitation programs that provide comprehensive assessments, intensive individual and group therapy for professionals, 12-Step support, and extensive aftercare and relapse prevention planning. Certain long-term monitoring measures have proven particularly effective in deterring substance abuse among anesthesiologists:

1. Long-acting natlrexone administration
2. Regular periodic hair testing (which is more accurate, particularly in detecting opioid abuse, than urine testing)
3. Enhanced security measures in and around the operating room (e.g., using witnesses for drug access and disposal, automated distribution devices, monitoring cameras, and spectrometric scanning of waste)

There is a growing body of evidence that the stigma against anesthesiologists returning to work is unwarranted. Although any incidence of overdose, suicide or patient harm is unacceptable, and re-entry must be handled on a case-by-case basis, studies show that addicted anesthesiologists who receive substance abuse treatment and are managed by PHPs have good long-term outcomes, on par with other physicians.

There is still hope.
Our licensed addiction experts can help. Call us today for a confidential assessment.

888-651-7238
Published on January 9, 2012

 

[deleted162650]

I know somebody who had issues as a resident. Went through the whole process to return to work at the same program, and then went on to be staff there where he was a very well liked/hard working clinician. In this past year (7-8 years out of residency), he was found unconscious in the bathroom at work. Lucky for him (and his new wife and baby at home), he was still alive. Once those floodgates have been opened, I don't think it's wise to return to work as an anesthesiologist. Access is just too easy, and you never what or when some particular life stressor is gonna trigger the desire to use again. I do think a recovering addict can go on to have a safe, productive career in just about any other field of medicine.

 

[aneftp]

Yeah. I know quite a few people who have drug addictions. Too much access. I would recommend especially since OP has not finished anesthesia residency to apply for an speciality.

Guy who was mainly pain did some anesthesia (set up pain practice for group). Group didn't make him partner. I don't know if it had to do anything. But 1 week before xmas. He checked into hotel on a Friday and overdose (or purposely killed himself). Shame. Young guy with 2 young kids and a wife.

 

[Pharmado]

This is an issue that many people have strong feelings about. The truth is, we don't know if you can A) get back into an anesthesia program and B) stay clean. Honestly, A is probably much easier than B. From the study that Blaze quoted, 71% of anesthesiologists under the very best monitoring possible, were able to return and complete their contract. 71% sounds pretty enticing for a group of people who have always been near the top of everything. Consider it this way, you have a 29% chance of failure under the best of circumstances. Unlike the 36% from other disciplines, this 29% had abundant access to extremely potent narcotics. The odds that those who didn't stay clean ended up dying are far greater.

To the OP, this is your life. If you KNOW that you can do this and anesthesia is the ONLY specialty that appeals to you then I wish you the best. Just know that the consequences for slipping up may be your life. I recommend, and I think most of us would likely agree, to strongly consider another field. This isn't because you can't do anesthesia, it is because your life is more important and shouldn't be put at risk.

 

[IlDestriero]

I knew one person that electively sought help after being resuscitated at home by his wife. He went to rehab, left anesthesia and was successfully retrained in psych and addiction medicine. He was clean last I knew. One reason is limited access. Drugs are just to available to us, too easy to divert. I would consider psych and not look at anesthesia again.


--
Il Destriero

 

[Noyac]

I've lost a close friend to this.
I was on the addiction committee in residency and I've remained abreast of this topic ever sense.
Anesthesia is too risky.
There are too many other fields.
Just because you took chances in the past doesn't mean that you need to continue this behavior.
Again, this country needs good psychiatric doctors.

 

[leaverus]

i'm ambivalent about this. i know we're talking about scheduled substances here but obviously many of the regulars on this forum (including me) enjoy their drink if the "scotch" thread is any indication. not saying we are all alcoholics but there's likely to be a few among us, and really is alcohol in excess any less impairing? i've never had surgery, but if i ever were a pt i think i'd want my anesthesiologist to tell me if they've ever been addicted to booze/drugs and i'd likely request a different doctor.

 

[deleted171991]

i'm ambivalent about this. i know we're talking about scheduled substances here but obviously many of the regulars on this forum (including me) enjoy their drink if the "scotch" thread is any indication. not saying we are all alcoholics but there's likely to be a few among us, and really is alcohol in excess any less impairing? i've never had surgery, but if i ever were a pt i think i'd want my anesthesiologist to tell me if they've ever been addicted to booze/drugs and i'd likely request a different doctor.

I barely touch any alcohol, but one can't compare its addictive potential with fentanyl, for example. Also, there was no alcohol in the OR, last time I checked.

I honestly don't care what my doc does in his spare time, as long as he shows up unimpaired to work. I just don't think the best place for a (former) addict is one with easy access to the source of his addiction. I wouldn't recommend to any of the heavy scotch drinkers to work in a bar, the same way fat people shouldn't become cooks.

 

[Onefellswoop87]

i'm ambivalent about this. i know we're talking about scheduled substances here but obviously many of the regulars on this forum (including me) enjoy their drink if the "scotch" thread is any indication. not saying we are all alcoholics but there's likely to be a few among us, and really is alcohol in excess any less impairing? i've never had surgery, but if i ever were a pt i think i'd want my anesthesiologist to tell me if they've ever been addicted to booze/drugs and i'd likely request a different doctor.

So to make the analogy that you started - if a person had successfully gone through AA and is now clean, would you give them two thumbs up to being a bartender? I couldn't in good conscious. I'm starting CA-1 in about 2 weeks but from all I've heard and discussed with others, I agree with the above posters that a speciality change is probably best for the OP's health.

 

[Robotic Wis-Hipple]

i'm ambivalent about this. i know we're talking about scheduled substances here but obviously many of the regulars on this forum (including me) enjoy their drink if the "scotch" thread is any indication. not saying we are all alcoholics but there's likely to be a few among us, and really is alcohol in excess any less impairing? i've never had surgery, but if i ever were a pt i think i'd want my anesthesiologist to tell me if they've ever been addicted to booze/drugs and i'd likely request a different doctor.

I don't think this is relateable at all. Nobody is coming to work sloshed and allowed to go anesthetize someone. I've yet to hear about the Anesthesiologist swigging mini bar shots under his mask in the OR. Sure, lots of physicians, and certainly Anesthesiologists are alcoholics, but when they become a danger it's noticeable.

The same cannot be said with those that start dabbling in the litany of narcotics we have readily available. While I'm not discounting the possible patient harm in either case, with narcotics the most common presentation is being found down. The average user likely gets away with it for weeks to months before they just go to far.

I also think it's odd you're ambivalent about the return of a physician with history of abuse of opioids but at the same time would ask for a different Anesthesiologist that self reported to you they drink alcohol.

 

[Pooh & Annie]

i've never had surgery, but if i ever were a pt i think i'd want my anesthesiologist to tell me if they've ever been addicted to booze/drugs and i'd likely request a different doctor.

I get it, but I don't know if I agree. Is there reason to believe that they'd put you at risk? Should background info that poses a strictly theoretical risk be available to patients? What if your anesthesiologist graduated in the bottom third of a carribean school and failed the written boards twice? What if he/she had a remedial year in residency? What if they took meds for mental illness? What if they said they'd never been addicted to booze or drugs but had DUIs?

I don't know what's right here, but I think if there's no data to support that a doctor's history puts you at risk, then there's no reason for you to know their history.

If that's NOT the case, and there's some info suggesting the doctor may pose a risk, then I agree that a patient should absolutely know. Otherwise I think we/patients have to have some faith that the state licensing institutions and medical boards/specialty boards have the appropriate requirements in place to assure we're properly being cared for.

At the same time I don't think it's unreasonable to do a quick search on the google or state board sites to find out if there are any red flags. I don't think I would routinely do this, but I understand why someone might.

 

[ScarfTheVerb]

Ironically I think a pain fellowship would probably be a good move for someone in anesthesia fighting addiction issues in residency or after. No more access to drugs than any other specialty, and only one extra year of training.

 

[IlDestriero]

There are a lot of crappy anesthesiologists out there practicing below the standard of care. I'd worry about ending up with one of them before I worried about someone being a former alcoholic.


--
Il Destriero

 

[Aether2000]

I would rec anything but anesthesia. Several addicted to fentanyl in programs where i did residency and another where i taught. It is not worth the risk

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[Planktonmd]

i'm ambivalent about this. i know we're talking about scheduled substances here but obviously many of the regulars on this forum (including me) enjoy their drink if the "scotch" thread is any indication. not saying we are all alcoholics but there's likely to be a few among us, and really is alcohol in excess any less impairing? i've never had surgery, but if i ever were a pt i think i'd want my anesthesiologist to tell me if they've ever been addicted to booze/drugs and i'd likely request a different doctor.

And what are the odds that your doctor is going to tell you: "Oh, by the way, I am an alcoholic, and I do some Fentanyl in my spare time"?

 

[teacher2md]

Do residents who divert usually have a prior history of using narcotics before residency? Or do they typically begin once they have access in the OR?

I have a hard time imagining someone with no history of hard drug usage jumping straight in to IV narcotics. Usually IV users are people who have become addicted on pills, and then escalate from there.

to the OP: had you used narcs in the past?

 

[WholeLottaGame7]

Do residents who divert usually have a prior history of using narcotics before residency? Or do they typically begin once they have access in the OR?

I have a hard time imagining someone with no history of hard drug usage jumping straight in to IV narcotics. Usually IV users are people who have become addicted on pills, and then escalate from there.

to the OP: had you used narcs in the past?

Why is it so hard to imagine? You're combining what is probably the most stressful time of someone's life and adding the easiest access to controlled substances of someone's life. Bad things can and do happen.

 

[Chip N Sawbones]

Do residents who divert usually have a prior history of using narcotics before residency? Or do they typically begin once they have access in the OR?

I have a hard time imagining someone with no history of hard drug usage jumping straight in to IV narcotics. Usually IV users are people who have become addicted on pills, and then escalate from there.

to the OP: had you used narcs in the past?

When you give patients IV narcotics a dozen times a day they lose a lot of their scariness. Even as a med student I've given (under careful supervision) more fentanyl to patients then I have aspirin. When you handle the stuff every day you start to wonder what it's like to try it. From that point on there's varying degrees of temptation to try using it, and fentanyl has so much addictive potential that one use can pretty easily lead to a raging drug habit and being found down in a bathroom after an overdose.

 

[pgg]

I have a hard time imagining someone with no history of hard drug usage jumping straight in to IV narcotics. Usually IV users are people who have become addicted on pills, and then escalate from there.

They have a hard time imagining they'll lose control of their use, too. Which is why they start.

What you describe may be the path of the typical layperson street user, but not for our profession.

The common thread in almost every anesthesiologist or CRNA who starts diverting opiates (or propofol, or volatiles, or anything else) is that they believe they have special knowledge or ability and can control it. They know how he drugs work, and are intimately familiar with them. They're smart. They can control it. Usually they're extremely high functioning up until the instant they get caught or drop dead. They know they can control it, and they do. Until they can't.

It's a mix of lack of respect for the drugs, and ego, and all the other factors that contribute to addictions.

I know (knew) four people who diverted opiates. They were all very different people. You'd never pick them out of a lineup as the ones most likely to divert.

All four were caught. All four thought they were still in control until they got caught. One even thought he was still in control after a month of inpatient rehab ... somehow he secretly found himself a locums job on the side where he could practice anesthesia while his court case was underway.

It's a mistake to think of the synthetic opiates we use as if they're ordinary drugs of abuse, and it's a mistake to think of anesthesiologists and CRNAs who divert as ordinary addicts.

 

[sigrhoillusion]

"somehow he secretly found himself a locums job on the side where he could practice anesthesia while his court case was underway"

How the F did that occur!? I guess if you check the "No" box they don't check? Does it not go into your registry until after the case is settled? Assuming he'd get references at places where they didn't know about the case.

 

[pgg]

How the F did that occur!? I guess if you check the "No" box they don't check? Does it not go into your registry until after the case is settled? Assuming he'd get references at places where they didn't know about the case.

It was a job he had lined up prior to getting caught.

This was a number of years ago. To my knowledge he's now practicing anesthesia - drug free and doing well, last I heard. I didn't think he'd be able to safely return to practice. He had all of the risk factors for relapse. Glad to be wrong (so far).

Sad and painful subject.

 

[sevoflurane]

Don't have much to add to this discussion besides the fact that anesthesiologists can and do enter rehab with a long monitoring program. They then successfully come back to be functional anesthesiologists for the duration.

We have such an individual in our group. He is a rock star. Been sober for over 20 years. Glad our group let him return and gave him the chance to come back to the work he loves. He is an asset to our group. Everyone deserves a second chance IMO.

 

[CriticallyCarED4]

For those practicing without any hx of abuse, what have you done to prevent it from happening?

Edit: I mean aside from the smart ass "don't use fentanyl" kind of answers.

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[nimbus]

For those practicing without any hx of abuse, what have you done to prevent it from happening?

Edit: I mean aside from the smart ass "don't use fentanyl" kind of answers.

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Don't use fentanyl. Honestly it's never even crossed my mind.

 

[pgg]

For those practicing without any hx of abuse, what have you done to prevent it from happening?

Edit: I mean aside from the smart ass "don't use fentanyl" kind of answers.

On the surface, this is an odd question with an obvious and simple answer: we just choose not to use drugs because of the health risk, legal risk, professional risk, and risk to patients. It's a hard line we don't cross. Seeing friends and colleagues go off the rails and/or die has some deterrent effect too.


But I know that's not the answer you're looking for. In this, as in most things, prevention of bad behavior or self-destructive behavior hinges on education. IIRC, the ACGME requires (or just encourages?) all anesthesiology residency programs to have annual didactics or discussion on the risk of substance abuse. The ASA has a formal curriculum and some educational materials.

"Wearing Masks" is an educational video that most of us have seen a couple times during residency. I just read that this video was actually made by the AANA ... I guess now I can't say they've never done anything useful any more.

 

[OB1🤙]

I throw my lot in with the "never again" crowd. Addiction is simply too powerful and the risk too great. Yes, it's possible to come back and be clean forever. And it's also very possible to succumb to that demon again and get found dead somewhere. Such stories are absolutely everywhere.

Addiction medicine makes a great second career for these folks. I have known a few such individuals over the years.

 

[dhb]

We have such an individual in our group. He is a rock star. Been sober for over 20 years. Glad our group let him return and gave him the chance to come back to the work he loves. He is an asset to our group. Everyone deserves a second chance IMO.

How do you greet him in the morning?
What's uf man?

 

[Onefellswoop87]

How do you greet him in the morning?
What's uf man?

Why would you treat him unlike anyone else? How do greet any other coworker in the morning?

 

[sciatica123]

I understand the risks and have made efforts to secure a residency in a different field. I have had about as much success in getting responses from anesthesia programs as other specialities. I am an American Grade (50th percentile of class) with decent board scores and very good ITE and AKT scores. I plan on trying for psych this year.

On a side note I had smoked weed before residency and drank regularly on weekends but not much else. I just thought I would try it and thats it. Very easy to slip and lose sight of everything. Thanks for the tidbits and PMs.

 

[deleted171991]

For those practicing without any hx of abuse, what have you done to prevent it from happening?

Edit: I mean aside from the smart ass "don't use fentanyl" kind of answers.

Sent from my iPhone using SDN mobile

The way I stay away from trouble is by avoiding any situation that could get me into it. Why? Because my job and the future of my family are highly-dependent on it, and neither is worth even a moment of stupidity. Those who don't play with fire won't get burned. Curiosity killed the cat.

So I won't take opiates, unless there is no way around it (hasn't happened yet). Not only don't I get drunk (ever), but I never drive if my alcohol level is above zero, regardless what the law allows (that's also because I don't believe in "safe" alcohol limits for driving). I never take controlled substances without a prescription written specifically for me (and generally try to stay away from anything potentially addictive - e.g. benzos). I will not touch marijuana, even in a state where it's legal, because it's still a federal offense. Generally, you could test me anytime I am on duty or in public and I will be clean.

I do realize that I work in a very trust-dependent position, so I cannot compromise my integrity in any way. I am anal about my drug waste reports, and I will follow up even the tiniest pharmacy problem with them. I consider my controlled substance license the equivalent of a firearm license (as importance), including the responsibilities that come with it.

 

[deleted171991]

I understand the risks and have made efforts to secure a residency in a different field. I have had about as much success in getting responses from anesthesia programs as other specialities. I am an American Grade (50th percentile of class) with decent board scores and very good ITE and AKT scores. I plan on trying for psych this year.

On a side note I had smoked weed before residency and drank regularly on weekends but not much else. I just thought I would try it and thats it. Very easy to slip and lose sight of everything. Thanks for the tidbits and PMs.

Good luck! This is not the end of the world. It may be all for the best, given where anesthesiology is heading. Keep applying. Sooner or later your luck will turn, I am sure.

 

[deleted162650]

The way I stay away from trouble is by avoiding any situation that could get me into it. Why? Because my job and the future of my family are highly-dependent on it, and neither is worth even a moment of stupidity. Those who don't play with fire won't get burned. Curiosity killed the cat.

So I won't take opiates, unless there is no way around it (hasn't happened yet). Not only don't I get drunk (ever), but I never drive if my alcohol level is above zero, regardless what the law allows (that's also because I don't believe in "safe" alcohol limits for driving). I never take controlled substances without a prescription written specifically for me (and generally try to stay away from anything potentially addictive - e.g. benzos). I will not touch marijuana, even in a state where it's legal, because it's still a federal offense. Generally, you could test me anytime I am on duty or in public and I will be clean.

I do realize that I work in a very trust-dependent position, so I cannot compromise my integrity in any way. I am anal about my drug waste reports, and I will follow up even the tiniest pharmacy problem with them. I consider my controlled substance license the equivalent of a firearm license (as importance), including the responsibilities that come with it.

Well you sound like alotta fun.

Maybe we could grab a drink sometime.

 

[deleted171991]

Well you sound like alotta fun.

Maybe we could grab a drink sometime.

Anytime I am in your part of the world, with pleasure. As long as you're OK if I stop after two beers.

I am actually funnier if I don't drink.

Btw, the post above was mainly for residents. I developed that mindset during residency. Before then, I wasn't so anal about that stuff, but I remember how they had an ex-anesthesiologist with a history of addiction talk to us during orientation, including the impact it had on his career. I have heard more of these stories since, including about people found dead with the needle in their arm. We should also remember the long list of celebrities who have died from overdose.

 

[sciatica123]

what are your step scores?

230s 240s lower step 3

 

[deleted162650]

Anytime I am in your part of the world, with pleasure. As long as you're OK if I stop after two beers.

Deal. We'll make 'em proper West Coast DIPA's. It only takes 2.