Physician drug addictions: Additional data support the gold hypothesis

Abstract

We have previously reported the over-representation of anesthesiologists among physician addicts which has been evident in impaired professional programs for over a decade. This has been attributed to access to the drugs of abuse. We suggested that opioid abuse and dependence may be an occupational hazard and related to the quality of the air or second hand opioids in the operating room (OR). We have further noted that while physicians in general show very good recovery and return to workplace rates anesthesiologists have more relapses and a less able to return to their original workplace. We suggested re-exposure to low levels of the offending drug is responsible for the significant proportion of those physicians requiring a change of work environment following treatment. We have developed methods to measure nano-quantities of drugs in the OR air and consistently demonstrated that propofol, and fentanyl, are present in the OR air following IV administration. We have identified sources of exposure in the OR. We have found fentanyl and propofol in OR air samples. Fentanyl was recovered from the air over medical waste containers. Tests of the anesthesiologist's work surfaces revealed the presence of fentanyl which could be absorbed through the skin. Re sensitization does not require quantities of drug sufficient to produce blood levels or noticeable symptoms. We have suggested a novel hypothesis which may explain some of the cases of anesthesiologist addicts. This hypothesis is testable in every hospital.