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Correspondence  |   June 2009
The Quality of Care by Opioid- and Anesthetic-abusing Personnel
Author Notes
  • Massachusetts General Hospital, Boston, Massachusetts.
Article Information
Correspondence
Correspondence   |   June 2009
The Quality of Care by Opioid- and Anesthetic-abusing Personnel
Anesthesiology 6 2009, Vol.110, 1425. doi:10.1097/ALN.0b013e3181a1fb70
Anesthesiology 6 2009, Vol.110, 1425. doi:10.1097/ALN.0b013e3181a1fb70
To the Editor:—
One issue incompletely addressed by Bryson and Silverstein1 and by the accompanying editorial of Berge et al.  2 is the problem of the quality of care delivered by the anesthesia care provider who is relapsing into opioid addiction.
The time between relapsing addiction and diagnosis typically extends into many months, as in a recent case presented on the first page of a Sunday Boston Globe  article.3 
In this rather long time period the anesthesia care provider will be treating a few hundred patients while either under the influence of self-administered opioids or during a withdrawal syndrome. It is doubtful that his or her care would be in accordance with the principles of the American Society of Anesthesiologists. For one, vigilance would be obviously and seriously impaired either by the psychic effects of self-administered opioids or by signs and symptoms of a withdrawal syndrome. Given the suggested rate of relapse in opioid addiction from the pragmatic review of the Mayo Clinic experience (“[…] there has been a nearly 100% relapse […]  )2 and the high rate of individuals lost to formal follow-up in other studies, it is likely that many thousands of patients have been treated by anesthesia care providers in the course of their relapsing addiction to opioids.
I am therefore totally in accord with the proposal of Berge et al.  to direct anesthesia caregivers who have become addicted to or abuse anesthetic drugs and supplements away from the practice of clinical anesthesia, once and for all and at the first diagnosis. As we struggle to improve our care and to diminish the tragic effects of medical errors, we cannot allow hundreds of future patients to predictably suffer and possibly die because of laxity and misplaced kindness in our approach to opioid addiction in anesthesia providers.
Massachusetts General Hospital, Boston, Massachusetts.
References
Bryson EO, Silverstein JH: Addiction and substance abuse in anesthesiology. Anesthesiology 2008; 109:905–17Bryson, EO Silverstein, JH
Berge KH, Seppala MD, Lanier WL: The anesthesiology community’s approach to opioid- and anesthetic-abusing personnel: Time to change course. Anesthesiology 2008; 109:762–4Berge, KH Seppala, MD Lanier, WL
O’Brien K: Something, anything to stop the pain. The Boston Globe– Sunday Edition. P1 Published November 9, 2008