HCPs in pharmacotherapeutic treatment for opioid addiction should not return to clinical practice

March 2, 2012

Many health care professionals (HCPs) have easy access to controlled medications and the diversion and abuse of drugs among this group may be as high as 10%. Controversy surrounds the safety of allowing addicted HCPs to return to clinical practice while undergoing medical treatment with opioid substitution therapy such as buprenorphine. In the March issue of Mayo Clinic Proceedings, Heather Hamza, CRNA, MS, of the Department of Anesthesiology, Los Angeles County Medical Center at the University of Southern California, and Ethan O. Bryson, MD, of the Departments of Anesthesiology and Psychiatry, Mt. Sinai Medical Center, New York, review the evidence and call for abstinence-based recovery instead.

"Because are typically engaged in safety-sensitive work with considerable consequences when errors occur, abstinence-based recovery should be recommended until studies demonstrate that it is safe to allow this population to practice while undergoing opioid replacement therapy," says Dr. Bryson.

is not completely free of abuse potential. Ms. Hamza and Dr. Bryson comprehensively reviewed a number of studies that examine the risk. "Opioid-addicted HCPs are masters of drug diversion. In this population, intelligence can be used to cleverly circumvent narcotic accountability and drug substitution. It does not seem reasonable to prescribe this medication to an HCP with a history of drug addiction," Ms. Hamza says.

Many trials have assessed psychomotor performance, decision-making ability, and neurocognitive functioning under the influence of buprenorphine. "Most found some degree of impairment when participants were subjected to a variety of tests designed to assess particular nuances of higher cerebral function," Dr. Bryson reports. "Studies using standardized patients or operating room simulation, presenting realistic scenarios that require rapid analysis and action, complex decision making, and fine motor skills are needed."

Most state medical and nursing societies provide professional health programs (PHPs) which allow for the eventual return of addicted practitioners to . Many were unavailable or declined to comment on their policies regarding the re-entry of HCPs while undergoing buprenorphine therapy, an indicator of the controversy surrounding this issue. However, published literature suggests that the success rates of PHPs is higher than in other populations, and most PHPs that use an abstinence-based model for physicians in recovery report success rates in excess of other programs.

"Abstinence from all potentially addictive drugs remains the criterion standard for HCPs in recovery," Hamza and Bryson conclude. "HCPs are engaged in safety-sensitive work that requires vigilance and full cognitive function. We therefore recommend abstinence-based recovery until studies with this specific population document that highly safety-sensitive tasks can be performed without deterioration in performance."

Explore further: Suboxone is most effective in treating painkiller addiction

Related Stories

Suboxone is most effective in treating painkiller addiction

November 7, 2011
Individuals addicted to prescription painkillers are more likely to succeed in treatment with the aid of the medication buprenorphine-naloxone (Suboxone), report McLean Hospital and Harvard Medical School researchers in today's ...

Recovery housing and treatment programs reduce relapse among recovering opioid addicts

February 28, 2012
Opioid-dependent individuals who want to kick the habit typically begin the road to recovery with detoxification. But detox is ineffective as a stand-alone treatment, with relapse rates ranging from 65% to 80% just one month ...

Making sense of addiction terminology

February 3, 2012
A new editorial released this week offers clarity and structure on confusing drug and alcohol addiction terminology for prescribers, users and regulators. "Through a glass darkly: can we improve clarity about mechanism and ...

Recommended for you

Concern with potential rise in super-potent cannabis concentrates

July 21, 2017
University of Queensland researchers are concerned the recent legalisation of medicinal cannabis in Australia may give rise to super-potent cannabis concentrates with associated harmful effects.

Findings link aldosterone with alcohol use disorder

July 18, 2017
A new study led by scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, demonstrates that aldosterone, a hormone produced in the adrenal glands, may contribute ...

Depression among young teens linked to cannabis use at 18

July 17, 2017
A study looking at the cumulative effects of depression in youth, found that young people with chronic or severe forms of depression were at elevated risk for developing a problem with cannabis in later adolescence.

Why does prenatal alcohol exposure increase the likelihood of addiction?

July 7, 2017
One of the many negative consequences when fetuses are exposed to alcohol in the womb is an increased risk for drug addiction later in life. Neuroscientists in the University at Buffalo Research Institute on Addictions are ...

Researchers say U.S. policies on drugs and addiction could use a dose of neuroscience

June 23, 2017
Tens of thousands of Americans die from drug overdoses every year – around 50,000 in 2015 – and the number has been steadily climbing for at least the last decade and a half, according to the National Institute on Drug ...

Study provides further support for genetic factors underlying addictions

June 13, 2017
Impairment of a particular gene raises increases susceptibility to opioid addiction liability as well as vulnerability to binge eating according to a new study.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.