Recommendations on SUD - American Society of Anesthesiologists (ASA)

Committee on Occupational Health
Advisory Group on Substance Use Disorder

Substance Use Disorder (SUD) is a serious and continuing threat to anesthesiologists’ health and well-being, as well as to patient safety. While resident anesthesiologists are at greatest risk, all anesthesiologists with access to potent anesthetic drugs are in danger of losing their careers or lives to SUD. Even though it is impossible to completely eliminate the threat of SUD, several interventions have shown promise in mitigating the risk.

Ongoing education on SUD is essential to prevent, recognize and react when SUD is identified in oneself or a colleague. This education is necessary for residents, practicing anesthesiologists and families of anesthesiologists. Annual education for residents should be mandatory. The model curriculum on the “Members Only” section of the ASA website ( provides much of this educational material. Additional resources are recommended for the website to assist members confronted by SUD concerns in a colleague or wishing to create a more robust surveillance and educational program. Consideration should be given to making this information available to non-members and to providing the link to these resources prominently on the ASA main webpage.

Improved control of anesthetic drugs in the workplace can decrease the risk of diversion and SUD. Cooperation between anesthesia departments and pharmacy departments is essential to minimize the possibility of diversion of anesthesia drugs. By creating barriers to diversion and improving surveillance of medication transaction records and the physical contents of drugs returned to the pharmacy as wastage, the safety of all personnel in the operating room environment and patients can be improved. A departmental (or preferably system-wide) protocol for drug screening “for cause” and/or monitoring should be established. Random urine drug screening (RUDS) programs are currently mandated by some anesthesiology training programs as well as the Department of Defense for anesthesia providers working in military facilities. Consideration should also be given to occasional hair drug screening, given the long detection period for hair. Examples of surveillance policies and procedures from these programs should be available on the ASA website as guidance for others considering implementing improved control of anesthetic drugs with potential for abuse. 

If an anesthesiologist develops SUD, treatment in a residential inpatient Chemical Dependency treatment facility skilled in the specialized care of anesthesia providers is vital. A list of such programs should be available on the ASA website. Appropriate and effective treatment of anesthesiologists with SUD is essential in the determination of their ability to return to work in locations with proximity to anesthesia drugs with potential for abuse. There is a high relapse rate, accompanied by an elevated risk of death among anesthesiologists who have undergone treatment for SUD (Warner et al. Anesthesiology. 2015). Because relapse rate increases for anesthesiologists working after their recommended period of RUDS (usually 5 years), an anesthesiologist in recovery should be considered for drug testing during the remainder of their career. 

By incorporating these recommendations into regular practice in anesthesia departments nationwide, the threat to life and career that SUD presents to anesthesiologists can be reduced, although never eliminated.

This committee work product/resource has not been approved by ASA’s Board of Directors or House of Delegates and does not represent an ASA Policy, Statement or Guideline.

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