title: Mandatory naltrexone treatment prevents relapse among opiate-dependent anesthesiologists returning to practice.
abstract: OBJECTIVE
  Anesthesiologists with opioid use disorders are at high risk for relapse. In 2005, the impaired professionals monitoring program of the State of Florida implemented a policy whereby anesthesiologists referred for opiate use disorders were contractually obligated to take naltrexone for 2 years. Naltrexone ingestion was witnessed and verified via random urine drugs screens or administered via intramuscular injection.
  
  
  METHODS
  Charts were reviewed for the 11 anesthesiologists who underwent mandated pharmacotherapy with naltrexone, and 11 anesthesiologists who began monitoring immediately before implementation of this policy.
  
  
  RESULTS
  Eight of 11 anesthesiologists who did not take naltrexone experienced a relapse on opiates. Only 1 of 11 anesthesiologists experienced a relapse on opiates after taking naltrexone, whereas another relapsed on an inhalant (nitrous oxide). It is noteworthy that 5 of the 11 anesthesiologists who took naltrexone had relapsed before naltrexone treatment, and 7 of the 11 anesthesiologists who did not take naltrexone experienced multiple documented relapses. Only 1 of the 11 anesthesiologists who did not take naltrexone successfully returned to the practice of anesthesiology. This individual suffered primarily from alcohol dependence, and suspected opiate abuse was never verified. Others who attempted return to anesthesiology (n = 7) suffered a relapse. In comparison, 9 of the 11 anesthesiologists who took naltrexone have returned to the practice of anesthesiology without a relapse (as verified by continued random urine and hair testing).
  
  
  CONCLUSIONS
  Mandatory naltrexone treatment may provide anesthesiologists with an additional safeguard to successfully return to work.
authors: University of Florida, Gainesville, FL, USA. lmerlo@ufl.edu
authors: Lisa J
authors: LJ
authors: Merlo
authors: William M
authors: WM
authors: Greene
authors: Raymond
authors: R
authors: Pomm
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education; D032982:Contracts / Q000331:legislation & jurisprudence; D004353:Drug Evaluation, Preclinical; D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency; D008297:Male; D037141:Mandatory Programs / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D009271:Naltrexone / Q000009:adverse effects / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000534:rehabilitation*; D010815:Physician Impairment / Q000331:legislation & jurisprudence* / Q000523:psychology; D012050:Rehabilitation, Vocational; D055502:Secondary Prevention
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone