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May 2001
Volume 65 |
Number 5
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| Time
to Take Action on Chemical Dependence |
Arnold
J. Berry, M.D.,
Chair Committee on Occupational Healthe
It is not uncommon that I pick up the morning newspaper and discover,
say, headlines that report the death of several teenagers in an
automobile accident. Unexpectedly and without warning, young lives
are lost; promising futures are instantly obliterated. Parents,
siblings, friends and classmates mourn the loss. Public outcries
ensue, and parent groups aggressively lobby lawmakers to raise
the driving age to prevent similar tragedies from occurring in
the future.
It is interesting to compare the publicity and community activism
generated from teenage-driving deaths with the limited reaction
from the medical community when chemical dependence or drug-related
suicide takes the life of an anesthesiologist or other physician.
Rarely are there headlines or public outcries. But like the losses
that occur from teen accidents, anesthesiologists’ deaths associated
with chemical dependence are unanticipated and frequently occur
in trainees or recent graduates. Their promising futures are also
cut short. Parents, spouses, significant others, friends and colleagues
mourn the loss. They may have sensed a change in behavior or personality
in the chemically dependent anesthesiologist but often are unaware
of the true cause. After the tragic event, loved ones may look
back and realize that they overlooked warning signs.
Although many of us have been touched by the loss of a colleague
from a drug-related death, we have not been fully aware of the
true extent of the problem within the specialty of anesthesiology.
Reports from drug treatment programs have revealed a greater proportion
of anesthesiologist drug abusers than might be expected, but the
cause of this over-representation has been debated. A recent mortality
study funded by ASA has provided startling data on drug-related
deaths among anesthesiologists.1 Investigators
used death certificates from 1979 through 1995 to confirm causes
of death and calculated cause-specific mortality rates for anesthesiologists
for comparison with those of a control group of internists. The
adjusted risk of drug-related suicide was over two times greater
in anesthesiologists than internists, and the risk for all-drug
related causes was almost three times greater in anesthesiologists.
The lower mean age of death among anesthesiologists, 65.5 years
versus 69.0 years respectively, was partially attributable to
the larger number of deaths of young anesthesiologists from drug-related
causes. Premature deaths in anesthesiologists from all drug-related
causes resulted in a total loss of 2,108 life-years before age
65. Although this study provides data on deaths from chemical
dependence, it does not quantify the number of anesthesiologists
with chemical dependence who have been identified and treated.
Information on the number of these individuals is significantly
more difficult to ascertain.
For the past two decades, ASA and the Committee on Occupational
Health have organized multiple educational sessions and have instituted
several projects to address the issue of chemical dependence.
One of the most recent activities was an open meeting of the committee
held during the 2000 Annual Meeting, in which members and outside
consultants were invited to present their ideas and recommendations
on prevention of chemical dependence in anesthesiologists. The
articles that follow are based on these presentations. The committee
and its Task Force on Chemical Dependence will consider this information
for planning future initiatives.
It is clear that chemical dependence continues to be an occupational
hazard. Anesthesiologists can be proud of the success and national
recognition they have received as a leader in patient safety,
but now it is time to turn our attention to another problem. With
a better understanding and awareness of factors associated with
chemical dependence, we should begin to take a leadership role
in the prevention, recognition and treatment of substance abuse
among anesthesiologists.
Reference:
1. Alexander BH, Checkoway H, Nagahama SI, Domino
KB. Cause-specific mortality risks of anesthesiologists. Anesthesiology.
2000; 93:922-930.
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Arnold J. Berry,
M.D., is Professor of Anesthesiology, Emory University School
of Medicine, Atlanta, Georgia. |
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