Substance Abuse Issues in Health Professionals

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Substance Abuse Issues in Health Professionals

• Shannon V Chavez, MD
• Chair, UCSD Physician Well-Being Committee
• Director, UCSD Health Professional Program
• Medical Director, UCSD Outpatient Psychiatric
  Services
• UC San Diego School of Medicine

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Defining Substance Abuse

• Use of legal substances (alcohol, prescribed
  medications eg opiates) in an uncontrolled
  fashion, or
• Use of illegal substances
• Common Denominators
• Impairment at work
• Negative life impact family, legal, health

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Definition of Disorders

• Substance Use Disorders
• Abuse
• Dependence
• Substance Induced Disorders

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Substance Abuse

• OVER A 12 MONTH PERIOD ONE OR MORE HAS OCCURED
• Failure to fulfill major role obligations
• Use of drugs in hazardous situations
• Recurrent legal problems secondary to drug use
• Continued drug use despite persistent
  social/interpersonal problems BECAUSE of use

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Substance Dependence

• Tolerance
• Withdrawal
• Drug is taken in larger amounts than intended, or
  over longer time than intended
• Efforts to cut down or control use are
  unsuccessful
• Excessive time is spent obtaining, using and
  recovering from drug effects
• Important activities social, professional,
  recreational are reduced or given up completely
• Continued use DESPITE knowledge these problems
• likely caused by the substance/drug

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Substance Induced Disorders

• Depression suicidal thoughts
• Anxiety
• Psychotic symptoms hallucinations, paranoia
• Mood swings

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Health Care Professionals

• We have a unique relationship with other human
  beings
• Trust and faith in a health care professional is
  inherent in any relationship whether patient,
  client or employer
• ANY healthcare professional with ANY type of
  contact (talk, touching, interpreting data etc)
  has the potential to harm a patient

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Examples of Impairment

• A physician can ignore pages and miss important
  diagnoses
• A nurse can give substandard bedside care, divert
  prescriptions, forge prescriptions
• A pharmacist can make errors in filling
  prescriptions
• A therapist can give ineffective or inappropriate
  therapy with boundary violations or patient
  abandonment
• A dentist can give substandard care, fail to give
  appropriate treatment, divert drugs
• A CNA or Home Health Assistant can fail to give
  care to patients who cannot perform their own
  ADLs, abuse patients, divert drugs

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More Examples for Health Care Professionals

• Missed calls and pages
• Late and increased sick days
• Disheveled appearance/change in appearance
• Erratic performance/mood
• Slurred speech
• Tremors
• Unusual medication prescribing/missing medication
• Arrests DUI, DV, shoplifting

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Does Treatment Work?Federation of State
Physician Health Programs

• 80 of participants had successful completion of
  treatment programs with return to work under
  monitoring
• Almost 80 of physicians were working
  successfully as physicians at 5 years

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Does Treatment Work?

• There is not a lot of data in addiction as to the
  effectiveness of treatment
• HOWEVER
• HEALTH CARE PROFESSIONALS ARE HUMAN BEINGS WITH
  THE SAME PERCENTAGE OF SUBSTANCE ABUSE AS THE
  GENERAL POPULATION.

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Does Treatment Work?

• Health Care Professionals are subject to medical
  diseases, other than addiction that can also
  impair performance.
• Q HOW DO WE ADDRESS THE HEALTH OF OUR HEALTH
  CARE PROFESSIONALS?
• Q Do we throw all of these practitioners out?
  Take their licenses?
• And if not, how would we go about monitoring
  their other potentially impairing illnesses -
  diabetes, high blood pressure, seizure disorders?
  
• Q Can these practitioners be of service to the
  public if they are treated and monitored?

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Does Treatment Work?

• A So although data is sparse and many health
  professionals seek and receive successful care on
  their own without DCA/Board involvement
• Data does show that treatment PLUS monitoring can
  work to create safe health practices in all the
  healing arts

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Monitoring Programs

• Monitoring Programs do work, with the following
  caveats
• Monitoring should be CONFIDENTIAL to maintain
  patient protected rights (when the patient IS the
  health care provider)
• Monitoring should be STANDARDIZED across all the
  health care professions to ensure all providers
  meet the criteria of reporting, abstinence and
  compliance
• Substance Abuse/Dependence is a chronic, lifelong
  illness that may require LIFELONG MONITORING

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Treatment plus Monitoring

• ONE MODEL
• Health Care Provider is evaluated and referred to
  appropriate level of treatment per evidence based
  standardized placement criteria (may be voluntary
  or ordered by DCA)

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Treatment plus Monitoring

• Provider agrees to participate in a formal
  program that will maintain confidentiality if
  100 compliant if not, reporting laws are
  enforced
• Random body fluid testing (appears to be the
  single most effective monitoring tool) to detect
  any relapse following treatment
• Worksite monitor reports and open communication
  with monitoring staff to ensure timely reporting
  of any concerning behavior
• Participation in an abstinence based self help
  program

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Treatment plus Monitoring

• Multi-system checks in place to ensure
  practitioner is quickly taken from practice if
  not 100 compliant
• Strict and enforceable rules across all
  specialties to conform to safe practice standards

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Voluntary vs Forced Treatment

• Very few enter treatment voluntarily pressure
  from family, work, judicial system, not just
  professional boards
• Change occurs when addictive behavior is
  interrupted and tools are given to change
  lifestyle and attitude
• Change does not happen quickly, most programs are
  5 years
• If provider is unable to be compliant for 5
  years, or is chronically relapsing and unable to
  follow direction, then loss of licensure may be
  only answer

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Addiction, Treatment, Punishment, Recovery

• Addiction WILL happen at rate of regular
  population (10 13)
• Impairment MAY happen if addiction not detected
  and treated
• Recovery and productive return to work CAN happen
  in monitored and standardized settings that allow
  Boards to communicate effectively with
  participants and monitoring programs

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