This Editorial accompanies the following original article: da Silva Rodrigues JV, Guimarães Pereira JE, Passarelli LA, et al. Comparative risk of mortality and suicide associated with substance use disorder among healthcare professionals: A systematic review and meta-analysis of observational studies. Eur J Anaesthesiol 2021; 38:715–734.
Too many of us have known of a colleague with substance use disorder (SUD) whose behaviour resulted in severe consequences to the person or to others. SUD is not specific to our specialty, but doctors are at the top of the occupational risk ranking and the anaesthesiologist is at the top of these, as witnessed by the pattern of reports and complaints to the General Medical Council in the UK.1
Use is not misuse and misuse is not addiction. However, in this issue of the EJA, da Silva Rodrigues and co-workers show that there is high to moderate certainty that, compared to other health professionals, there are more than twice as many deaths from substance use among anaesthesia providers.2 They also show that while alcohol is one of the most frequently used psychoactive substances, opioids are the most commonly used substances during anaesthetics. Interestingly, no association was found between mood disorders and all-cause mortality associated with drug abuse.
This is consistent with previous reports that indicate that the problem can affect any of us.3 We work in a stressful environment and with access to highly addictive substances. According to Bryson, the problem is far from solved and could even get worse.4 Bryson reported that while the incidence of SUD among anaesthesia providers decreased during the 1990s, it has increased since 2000. Moreover, as the incidence of SUD among anaesthesia providers may follow the incidence in the general population, a more recent increase can be expected, at least in countries where the problem is on the increase overall.
Da Silva Rodrigues and his colleagues did not specifically study evolution over time. They mainly analysed data from the USA and unfortunately little data from Europe, despite this being a global problem that must be addressed worldwide.
If not for ourselves, we need to put in place strategies to support our colleagues and be pro-active in educating all of our employees. Mayall clearly outlined why and how every anaesthesia department in a hospital setting should develop and maintain a set of pro-active and preventive measures integrated into a dedicated strategy with dedicated and competent individuals.3 When problems are identified, actions should to be conducted with the greatest respect to the individual in a nonjudgemental and destigmatising fashion but one that is equally balanced with clarity around the governance process to minimise harm to oneself or others.5,6 So, while it is probable that we have not overlooked the issue, we should provide evidence of what we are doing and share best practices without stigma or reactive decisions, such as reducing access to the drugs we need in our practice.
No preventive strategy can be declared effective without an established monitoring and audit process. This should lead to high-quality, forward-looking research that is not only able to better quantify the problem, but also to highlight successful solutions and suggest implementation elsewhere. If the strategies may be different from one country to another, the context being sometimes very different (for example, self-prescription, though common in some countries is prohibited in others), the solution could be, at least partially, similar, in that recognising its existence is the common denominator.
Acknowledgements relating to this article
Assistance with the Editorial: none.
Financial support and sponsorship: none.
Conflicts of interest: none.
Comment from the Editor: this article was checked and accepted by the Editors, but was not sent for external peer-review.
1. Gerada C. The Practitioner Health Programme: a free and confidential health service for doctors and dentists in London. London J Prim Care (Abingdon)
2. da Silva Rodrigues JV, Guimarães Pereira JE, Passarelli LA, et al. Comparative risk of mortality and suicide associated with substance use disorder among healthcare professionals. A systematic review and meta-analysis of observational studies. Eur J Anaesthesiol
3. Mayall RM. Substance abuse in anaesthetists. BJA Education
4. Bryson EO. The opioid epidemic and the current prevalence of substance use disorder in anesthesiologists. Curr Opin Anaesthesiol
5. Oliver D. Doctors with drink problems deserve help. BMJ
6. Gerada C. Protecting practitioners’ health. Available from: https://blogs.bmj.com/bmj/2019/10/31/clare-gerada-protecting-practitioners-health/
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