Better than their reputation? - Do hotel and restaurant students drink more?

Hazardous drinking among restaurant workers

BACKGROUND/AIMS

We address three research questions pertaining to Swedish restaurant workers: (i) What is the prevalence of hazardous drinking? (ii) How is the consumption of alcohol distributed? (iii) Does the prevention paradox apply?

METHODS

Data were collected by administering the Alcohol Use Disorders Identification Test (AUDIT) among restaurant workers who attended a 2-day Responsible Beverage Service training in Stockholm during the period from October 2008 to December 2009. The control group comprised a sample representative of the general Swedish population. We restricted the analyses to the age span 18-59 years, which yielded a sample size of 579 for restaurant workers and 434 for the general population.

RESULTS

The prevalence of hazardous drinking as measured by AUDIT (8+ for men and 6+ for women) was markedly higher among restaurant workers than in the general population. The difference was especially pronounced among females below 30 years of age. We found no difference between restaurant workers and the general population in the distribution of alcohol consumption. About 76% of the drinking problems were found in the lower part of the consumption distribution (bottom 88%), which supports the prevention paradox.

CONCLUSIONS

Restaurant workers comprise a high-risk group with respect to drinking.

Second-hand exposure to aerosolized intravenous anesthetics propofol and fentanyl may cause sensitization and subsequent opiate addiction among anesthesiologists and surgeons

We hypothesize that aerosolization of anesthetics administered intravenously to patients in the operating room may be an unintended source of exposure to physicians. This may lead to inadvertent sensitization, which is associated with an increased risk for developing addiction. This may contribute to the over-representation of certain specialties among physicians with addiction. We retrospectively reviewed the de-identified demographic information of all licensed physicians treated for substance abuse in the State of Florida since 1980, to determine if medical specialty was associated with addiction in this group of individuals. Then, to identify the potential for exposure, two mass spectrometry assays were developed to detect two intravenously administered drugs, fentanyl and propofol, in air. Since 1980, 7.6% of licensed Florida physicians underwent treatment for addiction. Addiction in anesthesiologists was higher than expected. Opiate abuse was greater in anesthesiologists and surgeons compared to other specialties. Aerosolized fentanyl was detected in the air of the cardiothoracic operating room, in patients' expiratory circuits, and in the headspace above sharps boxes, but not in adjoining hallways. Aerosolized propofol was detected in the expirations of a patient undergoing transurethral prostatectomy. While access and stress may place anesthesiologists and surgeons at greater risk for substance abuse, an additional risk factor may be unintended occupational exposure to addictive drugs. This report provides preliminary evidence of detection of aerosolized intravenous anesthetics using two newly developed analytical methods. We conclude that the potential exists for chronic exposure to low levels of airborne intravenously administered drugs. Further studies are under way to determine the significance of this exposure.

Occupational exposure and addictions for physicians: case studies and theoretical implications

Risk of addiction through occupational exposure to drugs of abuse is an important but relatively neglected public health problem. Stress and access may have much less of a role in addiction among certain populations than originally was thought. Risk of addition may be increased dramatically by unintentional exposure in the workplace to potent substances that sensitize the brain. Everyone knows that second-hand inhalation of crack vapors is a very dangerous proposition, but rarely has alarm been raised about exposing anesthesiologists to second-hand fentanyl. Additional studies of the relationship between exposure in the workplace and addiction are necessary. These studies should include biological measures, such as blood levels in exposed workers, and sensitive assays that quantitatively assess levels of exposure in the workplace.