Risk factors for relapse in health care professionals with substance use disorders.
BACKGROUND
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.


METHODS
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.


METHODS
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.
Domino
Karen B
KB
Department of Anesthesiology, University of Washington, Seattle 98195-6540, USA. kdomino@u.washington.edu
Hornbein
Thomas F
TF
Polissar
Nayak L
NL
Renner
Ginger
G
Johnson
Jilda
J
Alberti
Scott
S
Hankes
Lynn
L
D000328:Adult; D000776:Anesthesiology; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010815:Physician Impairment; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013038:Specialization; D017211:Treatment Failure