Use of major opioid drugs combined with a history of previous relapse increased the likelihood of another relapse

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The risk of relapse is significantly increased for health-care professionals treated for substance use disorders if they have coexisting psychiatric illness or a family history of substance abuse.

An article in the March 22 edition of the Journal of the American Medical Association by Dr. Karen B. Domino, professor of anesthesiology in the University of Washington School of Medicine, said use of major opioid drugs combined with a history of previous relapse increased the likelihood of another relapse.

"A family history of substance use disorder and the presence of co-existing psychiatric disorders, such as depression for example, make the risk of relapse worse," Domino said. "Use of a major opioid pain-killer plus having an underlying psychiatric disorder or the combination of all 3 risk factors further magnified the risk."

Domino's article is based on a retrospective cohort study of 292 health care professionals enrolled in the Washington Physicians Health Program, an independent post-treatment monitoring program. Data on the subjects were originally gathered between January, 1991, and December, 2001. Domino became interested in the problem of drug use among health care professionals after surveying the cause of death among physicians and noting that anesthesiologists, who can easily obtain potent pain-killers, were more likely to die from drug use, compared to internal medicine physicians.

"State physician health programs may want to consider ways of treating substance abuse among professionals who have one or more of these three risk factors and a history of prior relapse," Domino noted. "This study does not mean that professionals with substance abuse disorders cannot adhere to plans to abstain from using drugs, including alcohol or medications that may be available to them through their jobs. It does mean that these special concerns need to be addressed for treatment to be effective."

Domino added that some health care workers may have to change specialties, thereby removing themselves from ready access to major opioids and other drugs, in order to successfully overcome drug dependence.

"Remaining in the same professional role and providing these drugs to legitimately help their patients may be difficult for physicians who have been addicted to abusing these same pain killers," Domino said.

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