Addicted Healers: Behind the Curtain
When Dr. Ethan Bryson trained in anesthesiology, he became familiar with a secret held from the public – addicted healthcare professionals. Easy access to prescription narcotics is just too tempting for some in the healthcare arena. One to two percent of the medical profession is estimated to have a substance abuse problem at any one time, and 12 to 15 percent will have a problem sometime during their careers. It’s difficult to track though -- access to high-potency drugs and the level of trust makes it easier to conceal the behavior unless it spins out of control.
Prescription drug abuse represents a serious and growing public health problem in the medical profession. The public has a right to know the situation when walking through the doors of a hospital or doctor’s office. To this end, Dr. Bryson wrote ”Addicted Healers: 5 Key Signs Your Healthcare Professional May Be Drug Impaired” as a way to bring attention to the issue.
We talked with Dr. Bryson to get the inside story.
How Are They Different?
Although all addicts are alike in some ways, the addicted healer has a unique set of problems.
• Opportunity – they have access the public is denied. Further, healthcare professionals aren’t dependant on street sales and less likely to run afoul of law enforcement.
• Training – this allows medical personnel a false sense of being in control while giving them the skills to circumvent the system, play with dosing and customize routes of administration. Using a syringe is a significant barrier to progression in the lay community while for the medically trained, needles are an everyday fact of life.
• Trust – by being part of the system, doctors, nurses and others aren’t supervised as closely and can use this to manipulate the system.
• Drivers – the stresses and emotional upheaval that come with making life and death decisions in a high pressure working environment.
• Concealment – healthcare professionals are more likely to maintain employment and a facade to keep working, past where others would show up as addicted.
Signs and Symptoms
According to Dr. Bryson, the signs of addiction in the healthcare community are often concealed from patients. “Sadly, the signs are very subtle. What we need to do is be more proactive.”
He gives this example: “I can walk into Home Depot and be assured that the person operating the forklift has been screened for the abuse of illicit drugs and is not currently under the influence. But I don’t have that same confidence in a hospital, because the majority of hospitals don’t randomly screen their employees for these drugs.”
Dr. Bryson points out that the only way we will do better is if the public demands it.
The Good News
Treatment for addicted healthcare workers is usually anonymous and not reported to patients or even the state medical board. Medical associations in each state offer these programs. The good news is that once in treatment, medical personnel usually do much better than the general public. The background rate for recovery in rehab is estimated at a 50-50 shot, even in a shorter, month-long treatment program. The stats get even better with a longer course of treatment and for medical professionals.
“If you look at the success rate of the physician programs in each state… it’s between 70 to 90% relapse free at five years with the longer programs,” said Dr. Bryson. These are very expensive, in-patient programs that last a minimum of eight weeks and some extend up to a year. The longer programs are needed because it takes a while for doctors to step out of the role of authoritative care giver and take on the role of someone needing help. Coupled with an initial (as long as a month) period to clear narcotics from the body (opioids being the most common addiction in healthcare workers) and allow someone to think clearly again.
Part of the effectiveness comes in a carrot and stick model. If recovery is successful, they get to keep their license to practice, if not, they face disciplinary action and possible criminal charges. This combination is highly motivating.
The extremely high success rate for physicians in treatment presents a challenge for the addiction treatment community generally. With such a great outcome, why not make it available to the using public at large?
The main challenge is one of cost. Physicians and other healthcare professionals are high income earners. There’s a real value in keeping a medical license intact, and expenses are largely out of pocket – extended, inpatient addiction treatment isn’t covered by insurance.
Dr. Bryson describes it this way: “If you can imagine an inpatient rehab runs $3,500 a week and you are asking someone to stay 8 to 12 weeks, that’s an immense expense, and it doesn’t end there. There’s mandated psychotherapy and group therapy sessions which can be as much as a couple of hundred dollars per session at two a week.” Added to that is the cost of monitoring, with randomized drug testing on a consistent basis, work site monitoring and a case manager.
Dr. Bryson asserts that even with these high costs, gold-standard addiction treatment is still worthwhile for the general using community. He points out that someone in recovery not only removes the burden of crime and other social ills (damage to families, inability to work) but returns someone as a functioning member of society. By seeing addiction as a disease, and one worth treating, we can move to a model of recovery instead of management, prison, or blaming the addicted victim.