Among anesthesiology residents entering training from 1975 to 2009, 0.86% had a confirmed substance use disorder during training, with the incidence of this disorder increasing over the study period and the risk of relapse high, according to a study appearing in the Dec. 4 issue of JAMA.
The analysis included nearly 45,000 physicians (178,000 years) who began training in anesthesiology residency programs from July 1975 to July 2009, and who were followed for incidence through the end of training, and for relapse was until December 2010 (up to 30 years; median, 8.9).
There were 384 documented cases of substance abuse disorders. While 26% of all trainees were women, female substance abusers were 8% of all abusers. 15% of all abusers had a prior history of substance abuse before training.
An initially high rate was followed by a period of lower rates in 1996 to 2002, but the highest rates have occurred since then. Intravenous opioids were most common, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. 28 individuals (7.3%) died during the training period, all related to substance abuse.
About 43% of survivors experienced at least 1 relapse within 30 years after the initial episode. Rates of relapse and death did not depend on the category of substance used. Risk of relapse during the follow-up period was high, indicating persistence of risk after training. Risk of death was also high; at least 11% of those with evidence of substance abuse disorder died of a cause directly related to it.
Researchers noted that substance abuse disorders have increased over the study period and that relapse rates are not improving. Meanwhile, residency program directors did not consistently report substance abuse issues, representing lost opportunities for physician and patient safety.