Author: James Prudden
American Society of Anesthesiologists
I am writing in response to the article, “NIH Funds Program Aimed at Anesthesiology Drug Diversion” (Anesthesiology News 2020;46:4), that quotes Tom Knight, the CEO of Invistics Corp., about software that helps detect drug diversion, an issue that the American Society of Anesthesiologists (ASA) takes very seriously.
While Mr. Knight promotes his solution for drug diversion, many health care systems are already successfully using pre-employment and random drug testing. Harvard is a perfect example: They started doing random drug testing on their anesthesiology residents, and since implementation, the system has had zero diversion issues.1
Further, Mr. Knight makes several egregious statements casting aspersions on the profession as a whole with absolutely no research to back it up, including noting it’s “very common for anesthesiologists to steal the waste because they are typically using that narcotic, even addicted to it.” In fact, when comparing the published incidence of substance abuse in physicians as a whole with that in physician anesthesiologists, it is apparent that the overall incidence of abuse is no different than in other specialties and is significantly lower than in the population in general (1% vs. 16%).2
In fact, the vast majority of physician anesthesiologists are dedicated to patient care and safety. ASA supports a positive work environment and ensuring safety for our patients and physicians. This should include appropriate procedures for handling all controlled substances with testing of waste and monitoring use of narcotics for all personnel who may administer these potent drugs.
Vilifying the profession—particularly with no evidence or cause to do so—is not helpful. We all need to work together to address this issue and ASA is committed to doing so.
A Response From the Editor
I thank Dr. Peterson for this note, which is a strong defense of the profession. A few of our readers felt we had erred by publishing the article, saying it was an attack and unsupported by any evidence. I agree that a few of the off-the-cuff comments by Mr. Knight were, let us say, loosely argued and needlessly pointed. However, obtaining hard-to-get NIH funding, indeed more than once, for this technology indicates that there is a need and suggests the diversion software is effective for the task.
We report, of course, so we don’t change what someone might say to make it more palatable. But the core question of whether the anesthesiology department is a problem area for diversion remains. There is evidence to indicate that it is.
In “Chemical Dependency and the Physician,” a report from Mayo Clinic that was published in Mayo Clinic Proceedings (2009;84:625-631), the authors, in discussing enrollment in physician health programs designed to address addiction, note: “The authors found that certain specialties, such as anesthesiology, emergency medicine, and psychiatry, appeared to be overrepresented in these programs relative to their numerical representation in the national physician pool. Indeed, other investigators have suggested that these specialties seem to have a disproportionate propensity toward addiction.”
An accompanying editorial (Mayo Clin Proc 2009;84:576-580) noted: “Although they account for 5% of all physicians, anesthesiologists constitute 13% to 15% of populations receiving treatment for chemical dependency in centers specializing in the treatment of physicians and in programs that monitor such physicians after treatment.” The authors cited JAMA 1987;257:2927-2930, J Addict Dis 1999;18:1-7, and J Psychoactive Drugs 1991;23:427-431.
Another review from Mount Sinai Hospital, in New York City, titled “Addiction and Substance Abuse in Anesthesiology,” noted: “Despite substantial advances in our understanding of addiction and the technology and therapeutic approaches used to fight this disease, addiction still remains a major issue in the anesthesia workplace and outcomes have not appreciably changed” (Anesthesiology 2008;109:905-917).
So, is there a problem? The answer appears to be yes, to some degree, although those enslaved by addiction are massively outnumbered by anesthesiologists who go about their daily business in patient care with the highest levels of professionalism—and so need not worry about drug diversion software.