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Risk Factors for Relapse in Health Care Professionals With Substance Use Disorders
Karen B. Domino, MD, MPH;
Thomas F. Hornbein, MD;
Nayak L. Polissar, PhD;
Ginger Renner;
Jilda Johnson;
Scott Alberti;
Lynn Hankes, MD
JAMA. 2005;293:1453-1460.
Context Substance use disorders among physicians are important and persistent problems. Considerable debate exists over whether use of major opioids, especially among anesthesiologists, is associated with a higher relapse rate compared with alcohol and nonopioids. Moreover, the risk factors for relapse with current treatment and monitoring strategies are unknown.
Objective To test the hypothesis that chemically dependent health care professionals using a major opioid (eg, fentanyl, sufentanil, morphine, meperidine) as drug of choice are at higher risk of relapse.
Design, Setting, and Participants Retrospective cohort study of 292 health care professionals enrolled in the Washington Physicians Health Program, an independent posttreatment monitoring program, followed up between January 1, 1991, and December 31, 2001.
Main Outcome Measure Factors associated with relapse, defined as the resumption of substance use after initial diagnosis and completion of primary treatment for chemical dependency.
Results Twenty-five percent (74 of 292 individuals) had at least 1 relapse. A family history of a substance use disorder increased the risk of relapse (hazard ratio [HR], 2.29; 95% confidence interval [CI], 1.44-3.64). The use of a major opioid increased the risk of relapse significantly in the presence of a coexisting psychiatric disorder (HR, 5.79; 95% CI, 2.89-11.42) but not in the absence of a coexisting psychiatric disorder (HR, 0.85; 95% CI, 0.33-2.17). The presence of all 3 factors—major opioid use, dual diagnosis, and family history—markedly increased the risk of relapse (HR, 13.25; 95% CI, 5.22-33.59). The risk of subsequent relapses increased after the first relapse (HR, 1.69; 95% CI, 1.13-2.53).
Conclusions The risk of relapse with substance use was increased in health care professionals who used a major opioid or had a coexisting psychiatric illness or a family history of a substance use disorder. The presence of more than 1 of these risk factors and previous relapse further increased the likelihood of relapse. These observations should be considered in monitoring the recovery of health care professionals.
Author Affiliations: Departments of Anesthesiology (Drs Domino and Hornbein) and Psychiatry (Dr Hankes), University of Washington, Seattle; Mountain-Whisper-Light Statistical Consulting, Seattle (Dr Polissar); and Washington Physicians Health Program, Seattle (Dr Hankes and Mss Renner and Johnson and Mr Alberti).
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