Context Substance use disorders among physicians are important and persistent
problems. Considerable debate exists over whether use of major opioids, especially
among anesthesiologists, is associated with a higher relapse rate compared with alcohol
and nonopioids. Moreover, the risk factors for relapse with current treatment and
monitoring strategies are unknown.
Objective To test the hypothesis that chemically dependent health care professionals
using a major opioid (eg, fentanyl, sufentanil, morphine, meperidine) as drug of
choice are at higher risk of relapse.
Design, Setting, and Participants Retrospective cohort study of 292 health care
professionals enrolled in the Washington Physicians Health Program, an independent
posttreatment monitoring program, followed up between January 1, 1991, and December
31, 2001.
Main Outcome Measure Factors associated with relapse, defined as the
resumption of substance use after initial diagnosis and completion of primary treatment
for chemical dependency.
Results Twenty-five percent (74 of 292 individuals) had at least 1 relapse. A family
history of a substance use disorder increased the risk of relapse (hazard ratio
[HR], 2.29; 95% confidence interval [CI], 1.44-3.64). The use of a major opioid
increased the risk of relapse significantly in the presence of a coexisting psychiatric
disorder (HR, 5.79; 95% CI, 2.89-11.42) but not in the absence of a coexisting
psychiatric disorder (HR, 0.85; 95% CI, 0.33-2.17). The presence of all 3 factors—
major opioid use, dual diagnosis, and family history—markedly increased the risk of
relapse (HR, 13.25; 95% CI, 5.22-33.59). The risk of subsequent relapses increased
after the first relapse (HR, 1.69; 95% CI, 1.13-2.53).
Conclusions The risk of relapse with substance use was increased in health care
professionals who used a major opioid or had a coexisting psychiatric illness or a family
history of a substance use disorder. The presence of more than 1 of these risk factors
and previous relapse further increased the likelihood of relapse. These observations
should be considered in monitoring the recovery of health care professionals.
JAMA. 2005;293:1453-1460

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