Prevention of drug diversion and substance use disorders among anesthesiologists: a narrative review

Diversion of substances from the care of the intended patient is a significant problem in healthcare. Patients are harmed by the undertreatment of pain and suffering, transmission of disease, as well as the risk associated with impaired vigilance. Healthcare providers may be harmed by the physical and mental impact of their addictions. Healthcare systems are placed in jeopardy by the legal impact associated with illegal routes of drug release including sanction and financial liability and loss of public trust. Healthcare institutions have implemented many measures to reduce diversion from the perioperative area. These efforts include education, medical record surveillance, automated medication dispensing systems, urine drug testing, substance waste management systems, and drug diversion prevention teams. This narrative review evaluates strengths, weaknesses, and effectiveness of these systems and provides recommendations for leaders and care providers.

Non-Opioid Anesthetics Addiction: A Review of Current Situation and Mechanism

Drug addiction is one of the major worldwide health problems, which will have serious adverse consequences on human health and significantly burden the social economy and public health. Drug abuse is more common in anesthesiologists than in the general population because of their easier access to controlled substances. Although opioids have been generally considered the most commonly abused drugs among anesthesiologists and nurse anesthetists, the abuse of non-opioid anesthetics has been increasingly severe in recent years. The purpose of this review is to provide an overview of the clinical situation and potential molecular mechanisms of non-opioid anesthetics addiction. This review incorporates the clinical and biomolecular evidence supporting the abuse potential of non-opioid anesthetics and the foreseeable mechanism causing the non-opioid anesthetics addiction phenotypes, promoting a better understanding of its pathogenesis and helping to find effective preventive and curative strategies.

Risk of burnout and depression: A survey of veterinary anaesthesia specialists in-training during COVID-19

OBJECTIVE

To investigate risk, risk factors and effects on adherence to adequate clinical standards, of burnout and depression in veterinary anaesthesia residents.

STUDY DESIGN

Closed online cross-sectional survey study.

STUDY POPULATION

A sample of 89 residents registered to the European and/or the American Colleges of Veterinary An (ae)sthesia and Analgesia out of a total of 185.

METHODS

A link to access an online questionnaire, which included the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), the Harvard National Depression Screening Day Scale (HANDS) and 28 questions developed to assess adherence to adequate clinical standards, was sent by email to 185 residents. The three components of the MBI-HSS namely emotional exhaustion (EE), depersonalization and reduced personal accomplishment were analysed separately. Analysis of proportions and two-step regression statistical modelling were used for data analysis, and p values < 0.05 were considered statistically significant.

RESULTS

The response rate was 48%. Based on HANDS and MBI-HSS scores, 49% of the residents were at high risk of both depression and burnout. These residents expressed greater concern of delivering inadequate animal care (p < 0.001), of decreased quality of supervision during COVID-19 (p = 0.038) and of negative impact of the pandemic on their training programme (p = 0.002) than residents at low-to-moderate risk. Working in a clinical environment for ≥ 60 hours/week was a risk factor for both depression (p = 0.016) and EE (p = 0.022), while female sex was a risk factor for EE only (p = 0.018).

CONCLUSIONS AND CLINICAL RELEVANCE

A large proportion of residents is at high risk of depression and burnout, a scenario likely worsened by the pandemic. The findings of this study suggest that reducing the clinical workload and increasing the level of support and supervision may help to improve residents' mental health.

Propofol misuse in medical professions: a scoping review

PURPOSE

We aimed to describe the current literature concerning propofol misuse in medical professionals, specifically relating to the individual demographics of those misusing propofol and the outcomes of propofol misuse.

METHODS

We conducted a retrospective scoping review of the literature using a modified PRISMA approach. We used MEDLINE, EMBASE, and PsycINFO databases to identify relevant studies based on search terms. Studies describing individual medical professionals misusing propofol were included.

RESULTS

Twenty-four articles describing 88 individual cases of propofol misuse were included for data charting and analysis. Anesthesiologists and certified registered nurse anesthetists were most commonly identified. Death was a common method of identification of misuse, while rehabilitation and death were common final outcomes associated with propofol misuse.

CONCLUSIONS

Despite knowledge of the pharmacokinetic and pharmacodynamic properties of propofol by those misusing this medication, death was a common outcome reported in the literature. Data related to long-term outcomes including re-entry to clinical practice or success of rehabilitation were limited.

Mental health and well-being of anaesthetists during the COVID-19 pandemic: a scoping review

The COVID-19 pandemic has imposed substantial burdens on clinicians and there is a need to better understand the impact on mental health and well-being. This scoping review investigates the prevalence of mental health concerns in anaesthetists, risk and protective factors for mental well-being, and anaesthetists' pandemic-related concerns and support. We searched online databases for articles published between January 2020 and May 2022, using search terms related to: anaesthesia; burnout, well-being, mental health or stress; and COVID-19. We identified 20 articles comprising 19 different populations of anaesthetists (n = 8680) from 14 countries. Studies identified the prevalence of the following condition in anaesthetists: burnout (14-59%); stress (50-71%); anxiety (11-74%); depression (12-67%); post-traumatic stress (17-25%); psychological distress (52%); and insomnia (17-61%). Significant risk factors for poorer mental health included: direct COVID-19-related issues (fear of self and family exposure to infection; requirement for quarantine); practitioner health factors (insomnia; comorbidities); psychosocial factors (loneliness; isolation; perceived lack of support at home and work); demographic factors (female gender; non-white ethnicity; LGBTQIA+); and workplace factors (redeployment outside area of clinical practice; increased work effort; personal protective equipment shortages). Protective factors identified included: job satisfaction; perceived organisational justice; older age; and male sex. Anaesthetists' self-reported concerns related to: personal protective equipment; resource allocation; fear of infection; fear of financial loss; increased workload; and effective communication of protocols for patient treatment. Support from family, colleagues and hospital management was identified as an important coping mechanism. Findings from this review may support the design of interventions to enhance anaesthetists' psychological health during pandemic conditions and beyond. Future research should include consistent psychological outcome measures and rigorous experimental design beyond cross-sectional studies.

Substance use among vocational trainees in Australia: differences between medical specialties

BACKGROUND

There have been few large-scale nationally representative studies on the prevalence of substance use among doctors. Additionally, the association of different medical specialties with the use of different substances requires further research.

AIMS

This study aimed to investigate how the use of alcohol, tobacco and illicit drugs varied between junior doctors enrolled in different specialty training programmes.

METHODS

A secondary analysis was conducted on a national survey of 12,252 Australian doctors. The population of interest was junior doctors currently enrolled in a specialty training programme, termed Vocational Trainees (VTs) (n=1890, 15.4% overall sample). Self-report prevalence of current alcohol, tobacco and illicit drug use were assessed, and hazardous alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Logistic regression was used to examine the association between specialty and substance use, adjusting for demographic characteristics when required.

RESULTS

One in six VTs reported hazardous levels of alcohol use (n=268, 17.3%). After adjusting for confounders, the association between the prevalence of alcohol use and the specialties of emergency medicine/ICU (OR=2.15, 95% CI:1.40-3.32, p<0.001), anaesthetics (OR=2.53, 95% CI:1.35-4.76, p=0.004) and obstetrics/gynaecology (OR=1.89, 95% CI:1.19-3.02, p=0.007) remained significant. No significant associations were found between tobacco use/illicit drug use/hazardous alcohol use and medical specialty.

CONCLUSIONS

While rates of substance use and hazardous alcohol use in VTs are similar, if not lower, to the general population, it poses a concern that there are higher rates of alcohol use in certain medical specialties. This article is protected by copyright. All rights reserved.

[Propofol: use, toxicology and assay features]

The study objective is to review the literature on the use, pharmacological properties, toxicology, and assay methods for intravenous anesthetic propofol. The scope and forms of propofol use, its pharmacokinetics, biotransformation features, which occurs more than 90% in the liver, and side effects associated with propofol use for anesthesia, are addressed. Propofol infusion syndrome (also known as PrIS) and deaths from propofol overdose due to medical errors, abuse, suicide attempts, and homicide are reported. Propofol identification and assay methods based on high-performance liquid chromatography (HPLC), gas chromatography with mass spectrometry (GC-MS), and liquid chromatography (LC) are described. The features of the methods performance are outlined; biological materials (the study objects) are listed: mainly blood and plasma, as well as urine, bile, hair, etc. The relevance of a comprehensive forensic chemical study of propofol is indicated, though there are few forensic studies of propofol.

The Antagonism of Corticotropin-Releasing Factor Receptor-1 in Brain Suppress Stress-Induced Propofol Self-Administration in Rats

Propofol addiction has been detected in humans and rats, which may be facilitated by stress. Corticotropin-releasing factor acts through the corticotropin-releasing factor (CRF) receptor-1 (CRF1R) and CRF2 receptor-2 (CRF2R) and is a crucial candidate target for the interaction between stress and drug abuse, but its role on propofol addiction remains unknown. Tail clip stressful stimulation was performed in rats to test the stress on the establishment of the propofol self-administration behavioral model. Thereafter, the rats were pretreated before the testing session at the bilateral lateral ventricle with one of the doses of antalarmin (CRF1R antagonist, 100–500 ng/site), antisauvagine 30 (CRF2R antagonist, 100–500 ng/site), and RU486 (glucocorticoid receptor antagonist, 100–500 ng/site) or vehicle. The dopamine D1 receptor (D1R) in the nucleus accumbens (NAc) was detected to explore the underlying molecular mechanism. The sucrose self-administration establishment and maintenance, and locomotor activities were also examined to determine the specificity. We found that the establishment of propofol self-administration was promoted in the tail clip treated group (the stress group), which was inhibited by antalarmin at the dose of 100–500 ng/site but was not by antisauvagine 30 or RU486. Accordingly, the expression of D1R in the NAc was attenuated by antalarmin, dose-dependently. Moreover, pretreatments fail to change sucrose self-administration behavior or locomotor activities. This study supports the role of CRF1R in the brain in mediating the central reward processing through D1R in the NAc and provided a possibility that CRF1R antagonist may be a new therapeutic approach for the treatment of propofol addiction.

Propofol as a Drug of Diversion: Changing Disposal Practices to Reduce Risk

BACKGROUND

Propofol is a drug of diversion because of its high-volume use, lack of prescribed control mechanisms, and accessibility. As a result, intensive care unit nurses and other health care professionals are placed at unnecessary risk. Decreasing the risk of drug diversion can save lives, licenses, and livelihoods.

LOCAL PROBLEM

Objectives were to reduce the risk of drug diversion and diminish the environmental impact of medication discarded down the sink. Disposing of residual propofol into activated carbon pouches was successful and sustainable in operating rooms at the study institution. Literature findings supported this intervention because of propofol's potential for abuse, ongoing diversion events, ease of access, poor control mechanisms, lack of standardization, excessive waste, and ecological impact.

METHODS

The intensive care unit with the highest propofol use was selected to replicate the propofol disposal process used in the operating rooms. Activated carbon pouches and bottle cap removal tools were located in each intensive care unit room at the nurses' workstation for ease of use. Audits of unsecured waste bins and staff surveys of institutional policy awareness, disposal processes, barriers, and concerns were completed before and after the intervention.

RESULTS

Survey results determined significant concern for drug diversion risk. The pilot project displayed success: 44.1% of propofol bottles in waste bins were full before the intervention and 0% were full afterward.

CONCLUSION

Following institutional approval, this propofol disposal process was replicated in all intensive care units and the emergency department in the study institution.

Behavioural responses of Intensivists to stressors in Intensive Care

BACKGROUND

The hospital intensive care unit (ICU) environment encompasses sick patients who present for care in health crisis. Healthcare in this setting is complex, often involving the co-ordination of multiple professional teams, all under significant time pressures. The sequelae for staff interacting in this dynamic and often volatile setting are variable, depending upon their coping skillset and their familiarity with the stressors.

AIMS

The primary aim of this study was to describe and in doing so, normalize the behavioural responses expressed by ICU doctors (Intensivists) in response to stressful workplace events. The secondary aim was to identify those responses that contributed to resilience.

METHODS

A prospective qualitative study of senior Intensivists using a semi-scripted iterative interview. Data were transcribed and thematically analysed with verbatim quotations selected to support coding choices.

RESULTS

Nineteen experienced Intensivists from three sites in Australia and Israel participated. Clinicians described conscious, physiological and professional responses to stressors, including sense-making and taking time to process information with appropriate support. Two of the most important mitigation processes revealed were the use of reflective learning and preventative practice changes to prevent future errors. These were overlaid with the importance of disclosure and transparency in clinical work.

CONCLUSIONS

Repeated exposure to stressful events potentiates burnout, wherein staff no longer experience satisfaction and enjoyment in what they do. This paper presents the behavioural responses that experienced Intensivists described in relation to stressful events in the ICU, including steps taken to mitigate the effects of these events on their personal well-being.

Risk of mortality and suicide associated with substance use disorder among healthcare professionals: A systematic review and meta-analysis of observational studies

BACKGROUND

Previous studies have suggested that healthcare professionals may be susceptible to substance use disorders, and among the medical specialties, anaesthesia providers appear to be overrepresented.

OBJECTIVE

We aimed to compare the prevalence of substance use-related mortality and suicides between anaesthesia and nonanaesthesia professionals.

DESIGN

Systematic review of observational studies with meta-analyses. We defined anaesthesia providers as any healthcare professionals belonging to the specialty, regardless of age and duration of employment. Other healthcare professionals served as the control group.

DATA SOURCES

Ovid Medline, EMBASE, Web of Science, Scopus, Scielo, LILACS and ProQuest databases up to March 2020.

RESULTS

Thirty-nine studies were included, 31 cross-sectional studies involving 13 819 participants and eight cohorts with a total 129 811 participants proved eligible. Results suggested a higher rate of drug-related mortality with odds ratio (OR) 2.69 [95% confidence interval (CI), 1.80 to 4.00; P < 0.001; I2 = 0%, P = 0.55; high-certainty evidence] and suicide (OR 2.18, 95% CI, 1.33 to 3.58; P = 0.002; I2 = 0%, P = 0.68; moderate-certainty evidence) for anaesthesia providers compared with other healthcare professionals.

CONCLUSION

High-to-moderate-certainty evidence shows that there is more than a two-fold increased rate of substance use-related mortality and suicide among anaesthesia providers compared with other healthcare professionals. Investigations examining substance abuse between healthcare professionals, with particular attention to working conditions and exposure are essential to further develop preventive strategies.

Suicide in anaesthetists: a systematic review

Evidence suggests that healthcare professionals are at an increased risk of dying by suicide, with anaesthetists at particularly high risk. However, much of the data on which this is based are historical. With a focus on the epidemiology and methods used, we conducted a systematic review of evidence regarding suicide and suicidal behaviour among anaesthetists to provide a more contemporary summary. The systematic review process was adapted from a previous similar study in veterinary surgeons and was consistent with recommended guidance. We identified 54 articles published in or after 1990 that had anaesthetist-specific data and met the inclusion criteria. Seven of these reported epidemiological data, of which four were published after 2000. Although none of the more recent studies reported standardised mortality rates specific to suicide in anaesthetists, the proportion of anaesthetists dying by suicide was increased with respect to comparator groups, which is consistent with previous findings. Eleven studies that included information on suicidal behaviour reported suicidal ideation in 3.2-25% of individuals (six studies) and suicide attempts in 0.5-2% (four studies). Studies reporting methods of suicide highlighted the use of anaesthetic drugs, particularly propofol, supporting the suggestion that the increased risk of suicide in anaesthetists may be related to the availability of the means. We discuss our findings in relation to other recently published data and guidance concerning mental health problems in anaesthetists.

The Adenosine A2A Receptor Activation in Nucleus Accumbens Suppress Cue-Induced Reinstatement of Propofol Self-administration in Rats

Propofol has shown strong addictive properties in rats and humans. Adenosine A2A receptors (A2AR) in the nucleus accumbens (NAc) modulate dopamine signal and addictive behaviors such as cocaine- and amphetamine-induced self-administration. However, whether A2AR can modulate propofol addiction remains unknown. AAV-shA2AR was intra-NAc injected 3 weeks before the propofol self-administration training to test the impacts of NAc A2AR on establishing the self-administration model with fixed ratio 1 (FR1) schedule. Thereafter, the rats were withdrawal from propofol for 14 days and tested cue-induced reinstatement of propofol seeking behavior on day 15. The propofol withdrawal rats received one of the doses of CGS21680 (A2AR agonist, 2.5-10.0 ng/site), MSX-3 (A2AR antagonist, 5.0-20.0 μg/site) or eticlopride (D2 receptor (D2R) antagonist, 0.75-3.0 μg/site) or vehicle via intra-NAc injection before relapse behavior test. The numbers of active and inactive nose-poke response were recorded. Focal knockdown A2AR by shA2AR did not affect the acquisition of propofol self-administration behavior, but enhance cue-induced reinstatement of propofol self-administration compared with the AAV-shCTRLgroup. Pharmacological activation of the A2AR by CGS21680 (≥ 5.0 ng/site) attenuated cue-induced reinstatement of propofol self-administration behavior. Similarly, pharmacological blockade of D2R by eticlopride (0.75-3.0 μg/site) attenuated propofol seeking behavior. These effects were reversed by the administration of MSX-3 (5.0-20.0 μg/site). The A2AR- and D2R-mediated effects on propofol relapse were not confounded by the learning process, and motor activity as the sucrose self-administration and locomotor activity were not affected by all the treatments. This study provides genetic and pharmacological evidence that NAc A2AR activation suppresses cue-induced propofol relapse in rats, possibly by interacting with D2R.

Substance use disorder in anaesthetists: A personal perspective

In this article, I present a firsthand account as an anaesthetist with substance use disorder who has been through rehabilitation and returned to clinical anaesthesia, followed by an overview of substance use disorder in anaesthesia. Substance use disorder is prevalent within the anaesthesia community and can result in tragic consequences, including death in many cases. The incidence is around one to two per 1000 anaesthetist years and this appears to be rising, perhaps mirroring the population-wide increase in substance use disorder as a result of the opioid epidemic. Recognising substance use disorder in a colleague and intervening to try and help them and protect patients can be immensely challenging. Carrying out a successful intervention requires careful planning and coordination in order to protect the affected individual, their colleagues and patients. Returning to clinical anaesthesia following a diagnosis of substance use disorder is also contentious, with the high abstinence rate (relative to the wider substance use disorder population) having to be balanced against the risk of death following relapse. Any return to practice must be well planned and supported, and include appropriate toxicology screening. With such measures, rehabilitation and a return to clinical anaesthesia is possible in certain cases. For the affected individual regaining, then maintaining, their professional identity can be a powerful motivator to remain abstinent. Drug diversion and substance use disorder in anaesthesia is unlikely ever to be fully preventable, but strategies such as biometric dispensing, analysis of unused drugs, random toxicology and ongoing education may help to keep it to a minimum.

[Addictive disorders in physicians]

Despite their knowledge about the risks and treatment options for substance abuse disorders, physicians are not immune to them. Meanwhile, a number of studies have shown that physicians have an increased risk of depression, addictive diseases and burnout due to the occupation-linked mental and physical burden and in particular an increased prevalence of substance-related disorders, especially alcohol abuse or dependence and drug abuse. Drug dependence among physicians seems to be even higher than in the general population due to the relatively easy access to psychoactive medications, in particular hypnotic drugs, benzodiazepines, ketamine and opioids; however, the prognosis is good. According to data from the medical associations, three quarters of those affected for the first time and every sixth relapsed physician can be helped with preservation of the license and working as physicians.

Peer support in anaesthesia: Development and implementation of a peer-support programme within the Royal Brisbane and Women’s Hospital Department of Anaesthesia and Perioperative Medicine

Recent years have seen a shift in culture surrounding psychological wellbeing in doctors. As suicide continues to devastate medical families, friends and colleagues across the country, and significant rates of mental health issues persist, a greater focus on doctors’ psychological health has emerged. This, coupled with mounting evidence in favour of peer support, has driven the Royal Brisbane and Women’s Hospital Department of Anaesthesia and Perioperative Medicine to implement a unique peer support programme, which has been tailored to the needs of the perioperative environment. The programme provides a peer-driven, confidential, psychological safety net for all Royal Brisbane and Women’s Hospital anaesthetic staff. It focuses on collegial support in times of stress, as well as promoting a workplace culture of understanding for staff suffering psychological strain. The benefit of a formalised programme of this kind is that while staff have the option to obtain support at any time from a responder of their choosing, they do not need to seek it out actively in the event of a critical incident when it is automatically provided to them. Consultant anaesthetists trained in psychological first aid act as responders, offering support as well as resources and psychologist referral as required. It is our hope that its success will prompt other anaesthetic departments to continue the trend towards positive health strategies for doctors and implement similar programmes.

Dopamine D1 Receptor Within Basolateral Amygdala Is Involved in Propofol Relapse Behavior Induced by Cues

Propofol has been proven to be potentially abused by humans and laboratory animals; however, studies that have examined propofol relapse behavior are limited, and its underlying mechanism remains unclear. In this study, we examined whether basolateral amygdala-specific or systematic administration of the dopamine receptor antagonist alters cue-induced propofol-seeking behaviors in a rat model. Male Sprague-Dawley rats first received 14 days of propofol self-administration training, where active nose poke resulted in the delivery of propofol infusion paired with a tone and light cues. After 1-30 days of forced abstinence, the cue-induced propofol-seeking behaviors were tested in the operant chamber. We demonstrated, for the first time, after a few days of withdrawal from intravenous bolus administration of propofol, propofol-related cues could induce robust reinstatement of drug-seeking behavior. Systematic administration of dopamine D₁ receptor antagonist (SCH-23390) or dopamine D₂ receptor antagonist (spiperone) inhibited propofol relapse behavior induced by drug-related cues. Furthermore, we show that microinfusion of SCH-23390 into basolateral amygdala dose-dependently attenuated cue-induced propofol drug-seeking behavior, whereas infusion of spiperone had no effect on the propofol relapse behavior. Our results reveal the involvement of dopamine receptors within the basolateral amygdala in the cue-induced propofol relapse behavior in rats.

Stress and burnout in anesthesia residency: an exploratory case study of peer support groups

Stress and burnout are alarmingly prevalent in anesthesiologists, with the highest risk occurring during anesthesia residency training. To better understand this phenomenon, we conducted a mixed methods case study of our anesthesia training program to explore the residents’ accounts of stress and burnout and the potential value of peer support groups. Eight out of thirty eight residents participated in nine monthly peer support group (PSG) meetings followed by a focus group interview about stress and burnout in training and the value of PSG. We compared the participants’ mean pre-and post-PSG Maslach Burnout Inventory® (MBI) and Perceived Stress Scale® (PSS) and analysed the focus group interview for recurring themes. We captured the perspectives of twenty seven out of thirty residents who did not participate in support groups (non-participants) through an online survey on stress and burnout. We found evidence of a high prevalence of stress and burnout from the MBI and PSS scores and survey responses. Analysis of the focus group interview showed that the specific stressors of anesthesia training included: an individually-based model of training that predisposes to isolation from peers, an over-reliance on the quality of the faculty-resident relationship and the critical, high stakes nature of the profession. Residents strongly endorsed the value of PSG in decreasing isolation, enhancing validation, and support through the sharing of experiences. Lack of dedicated time and integration into the training program were major barriers to PSG participation. These barriers need to be overcome in order to fully realize its role in mitigating stress and burnout.

Neurobiology of Propofol Addiction and Supportive Evidence: What Is the New Development?

Propofol is a short-acting intravenous anesthetic agent suitable for induction and maintenance of general anesthesia as well as for procedural and intensive care unit sedation. As such it has become an unparalleled anesthetic agent of choice in many institutional and office practices. However, in addition to its idealistic properties as an anesthetic agent, there is accumulating evidence suggesting its potential for abuse. Clinical and experimental evidence has revealed that not only does propofol have the potential to be abused, but also that addiction to propofol shows a high mortality rate. Based on this evidence, different researchers have shown interest in determining the probability of propofol to be an addictive agent by comparing it with other drugs of abuse and depicting a functional similitude that involves the mesocorticolimbic pathway of addiction. In light of this, the Drug Enforcement Agency and the American Society of Anesthesiologists have put forth certain safety recommendations for the use of propofol. Despite this, the abuse potential of propofol has been challenged at different levels and therefore the preeminent focus will be to further validate the linkage from medicinal and occasional use of propofol to its addiction, as well as to explore the cellular and molecular targets involved in establishing this linkage, so as to curb the harm arising out of it. This review incorporates the clinical and biomolecular evidence supporting the abuse potential of propofol and brings forth the promising targets and the foreseeable mechanism causing the propofol addiction phenotypes, which can be called upon for future developments in this field.

Non-opioid anesthetic drug abuse among anesthesia care providers: a narrative review

PURPOSE

The objective of this narrative review is to provide an overview of the problem of non-opioid anesthetic drug abuse among anesthesia care providers (ACPs) and to describe current approaches to screening, therapy, and rehabilitation of ACPs suffering from non-opioid anesthetic drug abuse.

SOURCE

We first performed a search of all literature available on PubMed prior to April 11, 2016. The search was limited to articles published in Spanish and English, and the following key words were used: anesthesiology, anesthesia personnel, AND substance-related disorders. We also searched Ovid MEDLINE^® databases from 1946-April 11, 2016 using the following search terms: anesthesiology OR anesthesia, OR nurse anesthetist OR anesthesia care provider OR perioperative nursing AND substance-related disorders.

PRINCIPAL FINDINGS

Despite an increased awareness of drug abuse among ACPs and improvements in preventive measures, the problem of non-opioid anesthetic drug abuse remains significant. While opioids are the most commonly abused anesthesia medications among ACPs, the abuse of non-opioid anesthetics is a significant cause of morbidity, mortality, and professional demise.

CONCLUSION

Early detection, effective therapy, and long-term follow-up help ACPs cope more effectively with the problem and, when possible, resume their professional activities. There is insufficient evidence to determine the ability of ACPs to return safely to anesthesia practice after rehabilitation, though awareness of the issue and ongoing treatment are necessary to minimize patient risk from potentially related clinical errors.

Help seeking by health professionals for addiction: A mixed studies review

BACKGROUND

When health professionals practice with active and untreated addiction, it is a complex occupational and professional issue impacting numerous stakeholders. Health professionals are responsive to evidence-based addiction interventions and their return-to-work has been demonstrated to be achievable, sustainable and safe. Facilitating help seeking in health professionals with addiction is a priority for reducing associated risks to their health and to patient safety.

AIM

The purpose of this study was to identify the process by which health professionals seek help for addiction, and factors that facilitate and deter help seeking, through a review of the qualitative and quantitative literature.

METHODS

Both phases of this sequential mixed studies review followed the standard systematic review steps of: (1) identifying the review question, (2) defining eligibility criteria, (3) applying an extensive search strategy, (4) independent screening of titles and abstracts, (5) selecting relevant studies based on reviewing the full text, (6) appraising the quality of included studies, and (7) synthesizing the study findings. Our two searches of five databases from 1995 to 2015 resulted in the inclusion of eight qualitative and twenty-three quantitative studies. We first conducted a meta-synthesis of the qualitative literature to garner an understanding of the help seeking process for health professionals for addiction. We then conducted a narrative synthesis of the quantitative studies to generalize these findings through examining the data for convergent, complementary or divergent results.

RESULTS

Synthesis of the included qualitative studies revealed that the professional and experiential context of healthcare compromised the health professional's readiness to seek help for addiction. Typically, a pivotal event initiated the help seeking process. The studies in the quantitative review identified that help seeking most often resulted from reports of adverse events to formal organizations such as their employer and regulatory bodies. This process does not adequately address the scope of health professionals requiring help for addiction. Informal sources such as colleagues and family, often aware of the addiction earlier, preferred referral to voluntary, confidential treatment programs.

CONCLUSIONS

Facilitating the help seeking process for health professionals with addiction in as effective strategy to reduce the associated risks to the health professional, their families and colleagues, their employers and regulatory bodies, and to the general public. Our findings suggest that intervention is possible at multiple points in the help seeking process for health professionals with addiction. Confidential, compassionate and supportive alternatives offer potential for closing this gap.