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Physicians With Opioid Dependence
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To the Editor: I would like to raise some points concerning the Clinical Crossroads article on opioid dependence by Dr Knight,1 based on more than 2 decades of interest in physician impairment and addiction.2 First, intervention can be tremendously stressful for all involved. Further, whether or not the outcome is successful, the subject is at risk of self-harm immediately afterward due to the dissolution of self-deception and denial, and a weekend at home "thinking things over" may be dangerous. Second, while drugs are usually diverted for self-administration, when the amounts are substantial resale becomes a possibility, with serious legal consequences.
Third, opioid antagonists as a part of recovery have several interesting features. To verify compliance, they can be tested for in urine, they can deter impulsive use, and in some situations, they may be the key to acceptance back into practice. Finally, the co-occurrence of medical and psychiatric disorders . . . [Full Text of this Article]
C. F. Ward, MD
cward2@san.rr.com
Anesthesia Service Medical Group, Inc
San Diego, Calif
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