Commentary: A review of literature on substance abuse among anaesthesia providers

Abstract

The United States is witnessing a spiralling opioid crisis. Drug overdoses, fuelled by addiction to prescribed painkillers such as OxyContin, street heroin and, more recently, illicit synthetic opioids such as fentanyl and carfentanil, are the leading cause of death for Americans under the age of 55 years, with an estimated 200 people dying per day in 2017 (Beletsky and Goulka, 2018). The source of blame for this devastating epidemic has variously and vehemently been attributed to overprescribing physicians, overzealous drug manufacturers, health insurance companies’ reimbursement policies, rural poverty and unemployment, and a paucity of specialist treatment services and harm reduction options (Macy, 2018). In one sense this unfolding public health emergency is about chronic pain management and the desirability of alternatives to opioid analgesics. Such an understanding serves to foreground the role of physicians and anaesthetists in ‘advancing safe and effective pain treatments’ (Griffis et al., 2017: 1). The reviewed study is not explicitly concerned with unpicking the complexities of the engulfing opioid crisis. Rather, its focus is more specific if no less pressing; namely, the rising tide of substance abuse among US certified registered nurse anaesthetists (CRNAs). The reviewed study is informed by a narrative review constructed on, and running along, three main lines of investigation. The authors’ first line of inquiry is to establish the prevalence of substance abuse (i.e. alcohol, tobacco, recreational drugs, opioids and anaesthetic agents) among anaesthesia practitioners. What we learn from this initial foray into the research literature is that not only are anaesthetists particularly susceptible to substance use, but this disposition towards the use of substances, particularly in the form of controlled medication, constitutes the ‘main occupational hazard’ for those working in the field of anaesthesia. To underline this point the authors draw on research findings which would seem to suggest that 15% of practitioners will engage in some form of substance use at some point in their professional careers (Valdes, 2014). Further evidence of the pernicious effects of substance abuse is apparent in two related areas. First, patient deaths due to drugrelated medical errors, and second, near-fatal overdoses among anaesthesia providers.