Subject:
(Merlo L et al, Journal of Substance Abuse Treatment, 2016;64:47–54)

Background:

When physicians are diagnosed with opioid or other drug dependence, they are required to receive treatment from special physician health programs (PHP) if they want to keep their medical licenses. Unlike treatment programs for the general population, PHPs do not use opiate agonists, such as methadone or buprenorphine. The rationale is that physician use of such agents would put their patients at risk. Therefore, PHPs rely on psychosocial treatments such as individual and group therapy. How well do such programs work? 

Researchers reviewed five years of charts for 702 physicians admitted to 16 different PHPs. None of the programs offered opiate agonist treatment. Instead, the physicians were required to attend a psychosocial-based abstinence program, usually consisting of psychoeducation; individual, group, family, and recreational therapy; and 12-step programs. They were also required to abstain from the use of mood-altering substances, submit to urine drug screens, and agree to a five-year monitoring period. The physicians fell into one of three substance use categories: alcohol use only (n = 204), opioid use with or without alcohol (n = 339), and non-opioid drug use with or without alcohol (n = 159).

These programs worked remarkably well. For example, among the opiate users, over three-fourths of physicians remained opioid free during the monitoring period, which lasted an average of slightly over four years. Only about 1 in 10 physicians lost their license (or were not licensed for some unknown reason) to practice medicine. The three addiction categories did not differ in number of positive drug screens or completion of treatment contracts.

CATR’s Take: Abstinence-based treatment programs can work remarkably well, at least for addicted physicians who are highly motivated to succeed in treatment, at the risk of losing their livelihoods. It’s not clear how well such programs would work for nonphysicians. But it seems likely that important lessons can be learned from PHPs as we seek better treatment programs for our addicted patients.