Anesthesia providers are trained to administer pain medication to patients. And with the surge in drug diversion within healthcare settings, they’re coming under scrutiny for their medication-management practices.

While many healthcare professionals have increased their efforts to address and slow the rate of drug diversion, it’s important to recognize the depth of the problem in developing solutions.

Here are six statistics that highlight the problem of drug diversion among anesthesiology providers, including physicians and nurses.

1. An anesthesiologist is 2.79 times more likely to die of drug-related causes than an internist
   Anesthesiologists are far more likely than internists to die of drug related causes and about 4 times more likely to die of viral hepatitis, which is linked with intravenous (IV) drug use, according to a study. The study, which compared mortality risks of anesthesiologists to those of internal medicine physicians between 1979 and 1995, noted the risk to anesthesiologists of drug-related deaths was highest in the first 5 years after medical school graduation. But the risk still remained higher than that of internists throughout the span of one’s career. Researchers concluded that since the risk of substance abuse and suicide represent significant occupational hazards for anesthesiologists, more needs to be done to address drug diversion and substance-use disorders.[1]
2. Nearly 10 percent of certified registered nurse anesthesiologists (CNRAs) divert drugs for self-administration
   According to one study, based on self-administered surveys mailed to 2,500 actively practicing CRNAs in the United States, 9.8 percent for CRNAs self-reported misuse of one or more controlled drugs commonly used in the clinical practice of anesthesia. The four most common medications abused were benzodiazepines, nitrous oxide, potent opioids, and propofol.[2]
3. Anesthesiologists are 5 times more likely to abuse opioids than the general public.
   As part of a study, impaired anesthesiologists (IAs) seen by the Medical Association of Georgia Impaired Physicians Program were compared to all other impaired physicians within the program. “When each IA was matched to a control with respect to age, sex, race, professional activity status, and year of admission to the program, the IAs were found to be more likely to abuse drugs than alcohol, to abuse narcotics, and to abuse drugs intravenously,” according to researchers.[3]
4. Fentanyl is the most abused controlled substance, prevalent in 36 percent of cases.
   A study of American academic medical centers revealed the incidence of known drug abuse was 1 percent among faculty members and 1.6 percent among residents – and fentanyl was the controlled substance most often abused, followed by propofol and nitrous oxide.[4]
5. Anesthesiologists account for at least 13 percent of physicians receiving treatment for chemical dependencies.
   Anesthesiologists account for just 5 percent of all physicians but constitute a reported 13 percent to 15 percent of populations receiving treatment for chemical dependency in programs that specialize in the treatment of physicians, according to one study (The programs also monitor physicians after treatment).[5]
6. Most reports underestimate the scope of the problem.
   As noted in one report, which summarized the body of research related to anesthesiology and substance use disorder, “several studies support that abuse of potent opioids is greater than the general population and among physicians in general. … anesthesiologists were more likely to abuse opioids and to abuse these medications intravenously.”[6]

Sources:

[1] “Cause-specific mortality risks of anesthesiologists” by BH Alexander, H Checkoway, SI Nagahama, KB Domino; Anesthesiology; Oct. 2000;93(4):922-30.

[2] “Controlled drug misuse by Certified Registered Nurse Anesthetists” by DM Bell, JP McDonough, JS Ellison, EC Fitzhugh; AANA Journal, Apr. 1999, 67(2): 133-40.

[3] “Addiction in anesthesiologists: drug access and patterns of abuse,” Gallegos KV, Browne CH, Veit FW, Talbott GD; Quality Review Bulletin; 1988; 14(4):116-122.

[4] “Substance abuse among physicians: a survey of academic anesthesiology programs” by JV Booth, D Grossman, J Moore, C Lineberger, JD Reynolds, JG Reyes, D Sheffield; Anesthesia Analgesia; Oct. 2002; 95(4):1024-30.

[5] “Anesthesiologists Recovering From Chemical Dependency: Can They Safely Return to the Operating Room?” by Michael R. Oreskovich, MD; Mayo Clin Proc. Jul. 2009; 84(7): 576–580.

[6] “Opioid abuse among nurse anesthetists and anesthesiologists.” by Wright EL,  McGuiness T, Moneyham LD ,  Schumacher JE ,  Zwerling A ,  Stullenbarger NE, AANA Journal Apr. 2012, 80(2):120-128