Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.05.002
Brazilian Journal of Anesthesiology
Clinical Research

Postmortem qualitative analysis of psychological, occupational and environmental factors associated with lethal anesthetic and/or opioid abuse among anesthesiologists: case series

Análise qualitativa pós-morte de fatores psicológicos, ocupacionais e ambientais associados ao abuso letal de anestésicos e / ou opioides entre anestesiologistas: uma série de casos.

Flavia Serebrenic, Maria José Carvalho Carmona, Paulo Jannuzzi Cunha, André Malbergier

Downloads: 2
Views: 106

Abstract

Background
Anesthetic and/or opioid abuse is more prevalent among anesthesiologists than in other medical specialties and it has been associated with high mortality. The aim of this study was to evaluate factors associated with lethal anesthetic and/or opioid abuse among anesthesiologists.

Methods
We evaluated psychological factors, and occupational history and circumstances of death of anesthesiologists who died from anesthetic abuse. Data were obtainedpost-mortem from colleagues, and relatives. After finding eligible cases, we identified the key informants, who were interviewed personally or via email, through the qualitative method known as “Psychological Autopsy”.

Results
Eighteen cases of death were identified, but we were able to interview 44% of them (n = 8), most of whom were young males. They died at home or at the hospital and were found “at the scene”. Being an introspective person who did not share personal issues at workplace was the most prevalent personal characteristic. At work, they seemed to perform very well their functions, but some presented subtle changes such as to staying more than usual at the workplace and and/or neglecting some of their responsibilities. The main reported factors to explain their substance abuse were emotional problems including psychiatric, excessive hours of work, and other health factors.

Conclusion
This study identified that emotional disturbances, compulsive work, and general health problems were the more prominent factors involved with those deaths. Further, larger studies are needed to better understand how these factors could be early identified in order to timely prevent anesthetic and/or opioid abuse and several deaths among anesthesiologists.

Keywords

Anesthetics Anesthesiologists Drug abuse

Resumo

Introdução: O uso abusivo de anestésicos e / ou opioides é mais prevalente entre anestesiologistas do que em outras especialidades médicas e tem sido associado a alta mortalidade. O objetivo deste estudo foi avaliar os fatores associados ao abuso letal de anestésicos e / ou opioides entre anestesiologistas. Métodos: Avaliamos fatores psicológicos, história ocupacional e circunstâncias de morte de anestesiologistas que morreram por abuso de anestésico. Os dados foram obtidos post-mortem de colegas e parentes. Após a localização dos casos elegíveis, foram identificados os informantes-chave, que foram entrevistados pessoalmente ou via e-mail, por meio do método qualitativo conhecido como “Autópsia Psicológica”. Resultados: Foram identificados 18 casos de morte, mas pudemos entrevistar 44% deles (n = 8), a maioria jovens do sexo masculino. Eles morreram em casa ou no hospital e foram encontrados “no local”. Ser uma pessoa introspectiva que não compartilhava de questões pessoais no local de trabalho foi a característica pessoal mais prevalente. No trabalho, pareciam desempenhar muito bem suas funções, mas alguns apresentaram mudanças sutis, como permanecer mais do que o normal no ambiente de trabalho e / ou negligenciar algumas de suas responsabilidades. Os principais fatores relatados para explicar o abuso de substâncias foram problemas emocionais, incluindo psiquiátricos, excesso de horas de trabalho e outros fatores de saúde. Conclusão: Este estudo identificou que distúrbios emocionais, trabalho compulsivo e problemas gerais de saúde foram os fatores mais proeminentes envolvidos nessas mortes. Além disso, estudos maiores são necessários para entender melhor como esses fatores podem ser identificados precocemente a fim de prevenir o abuso de anestésicos e / ou opioides e várias mortes entre os anestesiologistas.

Palavras-chave

Anestésicos; Anestesiologistas; Abuso de drogas.

References

1 NIDA. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Acessed in 3/20/2017.

2 E.O. Bryson The opioid epidemic and the current prevalence of substance use disorder in anesthesiologists Curr Opin Anaesthesiol, 31 (2018), pp. 388-392

3 F.S. Jungerman, H.N. Alves Palhares, et al. Anesthetic drug abuse by anesthesiologists Rev Bras Anestesiol, 62 (2012), pp. 380-386

4 B.H. Alexander, H. Checkoway, S.I. Nagahama, et al. Cause-specific mortality risks of anesthesiologists Anesthesiology, 93 (2000), pp. 922-930

5 N.J. Farber, S.G. Gilibert, B.M. Aboff, et al. Physicians’ willingness to report impaired colleagues Soc Sci Med, 61 (2005), pp. 1772-1775

6 K.H. Berge, M.D. Seppala, A.M. Schipper Chemical dependency and the physician Mayo Clin Proc, 84 (2009), pp. 625-631

7 R.A. Fry, L.E. Fry, A. Weeks Substance use disorder amongst Australian and New Zealand anaesthetic trainees: an analysis of 30 years of data Anaesth Intensive Care, 43 (2015), p. 530

8 D.O. Warner, K. Berge, H. Sun, et al. Substance Use Disorder Among Anesthesiology Residents, 1975-2009 JAMA, 310 (2013), pp. 2289-2296

9 G. Burnett, R.A. Fry, E.O. Bryson Emerging worldwide trends in substances diverted for personal non-medical use by anaesthetists BJA Education, 20 (2020), pp. 114-119

10 M.R. Levine, W.P. Rennie Pre-employment urine drug testing of hospital employees: future questions and review of current literature Occup Environ Med, 61 (2004), pp. 318-324

11 CDC Wonder. https://www.cdc.gov/drugoverdose/opioids/fentanyl.html Acessed in 5/10/2017.

12 D.O. Warner, K. Berge, H. Sun, et al. Risk and outcomes of substance use disorder among anesthesiology residents: a matched cohort analysis Anesthesiology, 123 (2015), pp. 929-936

13 S. Boulis, P.K. Khanduja, K. Downey, et al. Substance abuse: a national survey of Canadian residency program directors and site chiefs at university-affiliated anesthesia departments Can J Anesth, 62 (2015), pp. 964-971

14 G.D. Talbott The impaired physician and intervention: a key to recovery J Fla Med Assoc, 69 (1982), pp. 793-797

15 G.B. Collins, M.S. McAllister, M. Jensen, et al. Chemical dependency treatment outcomes of residents in anesthesiology: results of a survey Anesth Analg, 101 (2005), pp. 1457-1462

16 S.T. Samuelson, E.O. Bryson The impaired anesthesiologist: what you should know about substance abuse Can J Anesth, 64 (2017), pp. 219-235

17 K. Hawton, L. Appleby, S. Platt, et al. The psychological autopsy approach to studying suicide: a review of methodological issues J Affect Dis, 50 (1998), pp. 269-276

18 F. Lefevre, A.M.C. Lefevre, J.J.V. Teixeira Discourse of the Collective Subject: a new methodological approach in qualitative research Educs, Caxias do Sul (2000)

19 F. Lefèvre, A.M.C. Lefèvre Testimonials and speeches: a proposal of analysis in social research Liber Livro, Brasília (DF) (2005) p12

20 E.O. Bryson The impact of chemical dependency on health care professionals involved with the delivery of anesthesia Int Anesthesiol Clin, 58 (2020), pp. 45-49

21 H.N. Alves, J.C. Surjan, L.A. Nogueira-Martins, et al. Clinical and demographical aspects of alcohol and drug dependent physicians Rev Assoc Med Bras, 51 (2005), pp. 139-143

22 N. Robb University acknowledges special risks, introduces drug program for anesthetists Cmaj, 153 (1995), pp. 449-452

23 P.H. Hughes, N. Brandenburg, D.C. Baldwin Jr., et al. Prevalence of substance use among US physicians Jama, 267 (1992), pp. 2333-2339

24 E.O. Bryson, J.H. Silverstein Addiction and substance abuse in anesthesiology Anesthesiology, 109 (2008), pp. 905-917

25 K.H. Berge, M.D. Seppala, W.L. Lanier The anesthesiology community’s approach to opioid- and anesthetic-abusing personnel: time to change course Anesthesiology, 109 (2008), pp. 762-764

26 J.E. Wilson, N. Kiselanova, Q. Stevens, et al. A survey of inhalational anaesthetic abuse in anaesthesia training programmes Anaesthesia, 63 (2008), pp. 616-620

27 Tetzalff Chemical dependency and anesthesiology Congress presentation (2009)

28 A.T. McLellan, G.S. Skipper, M. Campbell, et al. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States BMJ (Clinical research ed.), 337 (2008), p. a2038

29 L.S. Rotenstein, M.A. Ramos, M. Torre, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students Jama, 316 (2016), pp. 2214-2236
 

60cb673ca95395601a5f2b23 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections