In December 2003, Brent Cambron gave himself his first injection of morphine. Save for the fact that he was sticking the needle into his own skin, the motion was familiar--almost rote. Over the course of the previous 17 months, as an anesthesia resident at Boston's Beth Israel Deaconess Medical Center, Cambron had given hundreds of injections. He would stick a syringe into a glass ampule of fentanyl or morphine or Dilaudid, pulling up the plunger to draw his dose. Then he'd inject the dose into his patient. If the patient had been in a panic before her surgery, Cambron would watch her drift into a pleasant, happy daze; if the patient had been moaning in pain after surgery, he'd watch the relief spread across her face as the pain went away. It was understandable, perhaps, that Cambron was curious to experience these sensations himself, to feel what his patients felt once the drugs began coursing through their bodies. It could even be considered a clinical experiment of sorts. "I had thought about it for a long time," he later confessed.The article goes on to discuss the various explanations for why this may be the case. Access to the drugs in question is the most commonly-given answer, but I find this a poor explanation. Any physician with a DEA number and any ingenuity at all can get narcotics. As a pediatrician, it would be easier for me to obtain stimulants, given what is typically prescribed in my specialty, but I could obtain a great many controlled substances if I chose to. (Having developed a liking for my job, my health, the Better Half, my home and my sanity, I choose not to.) Admittedly, anesthesiologists have easy access to the Big Guns on a regular basis, so it's a different kettle of fish, but access alone cannot explain the predilection. (I find the theory expressed by one addiction specialist that it is long-term, low-level exposure to aerosolized narcotics implausible.)
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In 1987, the addiction medicine doctor G. Douglas Talbott reviewed the files of 1,000 M.D.s who had enrolled in the Medical Association of Georgia's Impaired Physicians Program. He wanted to know how the drug-addicted physicians broke down by age, gender, and, most importantly, medical specialty. What Talbott discovered, and subsequently published in the Journal of the American Medical Association, was disturbing: Although anesthesiologists made up only 5 percent of the physician population, they accounted for 13 percent of those physicians being treated for drug addiction. The numbers Talbott found for younger physicians were even worse: While anesthesia residents constituted 4.6 percent of all resident physicians, they accounted for 33.7 percent of residents in treatment for drug addiction.
Reading about Cambron, it is obvious that he had addiction issues before he entered anesthesiology, despite his high level of achievement in medical school.
Cambron was no stranger to recreational drug use. According to a journal he kept, he was a heavy drinker in college and in medical school; he also occasionally smoked marijuana. But maintaining a hard-partying lifestyle in the midst of an ambitious academic career seemed like the type of challenge that Cambron thrived on. "We would go out and party all night and do the things college kids do," recalls one of Cambron's college friends, "and then he'd get up the next day and study for an hour and go take a midterm and ace it."I don't wonder if access to narcotics is a reason some people choose anesthesiology in the first place, and if blaming access as a risk factor after people enter the field isn't getting the chicken-egg question wrong. One of my best friends is an anesthesiologist, and she is a successful non-addict, like most people in the field. (She is also an occasional commenter on this blog, and would murder me with her bare hands if I were not to make that clear.) I wonder if she might have some light to shed?
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Nothing really new here. I do not have any studies to cite, but it is pretty well described that physicians who develop addictions most often have histories of drug use even prior to entering medical school. They, in all probability, even possibly unwittingly, choose anesthesiology due to readily available drugs. Since this has been pretty well recognized, what I do not understand is the failure of both medical schools and residency programs to establish significant programs to first find and then provide treatment for those physicians at risk.
ReplyDeleteAnd there you have it, ladies and gentlemen.
ReplyDeleteBy the way, thank you for soliciting my input.
ReplyDelete