Will Doctors Be Able to Escape Random Drug Testing?

Leigh Page, MS

Disclosures

April 22, 2015

In This Article

Is Physician Drug Abuse That Big of a Problem?

Many physicians question whether physician drug and alcohol abuse is a big enough problem to warrant the cost and inconvenience of random testing.

"Not that many doctors are abusing drugs, and most of those who do aren't a threat to patients," one doctor told Medscape in its 2014 Ethics Survey Report. There may be some truth to this.

Proponents of random testing rarely have examples of drug-abusing physicians harming patient safety. For example, "Why Aren't Doctors Being Drug Tested?" was the headline of an opinion piece[14] in the New York Times last year, cowritten by Inspector General Daniel Levinson of the Department of Health and Human Services (HHS). But in making its case, the article relied entirely on the abuses of a single medical technician who injected himself with fentanyl from syringes prepared for patients, and as a result infected those patients with hepatitis C. No doctors were mentioned.

It's not surprising that the HHS inspector general was hard-pressed to find examples. The identity of most drug-abusing doctors is usually a secret. All but four states allow impaired doctors to work with physician health programs (PHPs), which in many cases have the authority to protect them from being identified or disciplined by medical boards, as long as they stay clear of drugs and alcohol and follow the program's rules.

The extent of such protections came to light in 2014 after the overdose of an anesthesiology resident at the University of Michigan. MLive, a local news organization, reported[15] on the incident by obtaining confidential university reports under the Freedom of Information Act.

In December 2013, MLive said, the resident was found in cardiac arrest, with a syringe and drug kit, in a locked bathroom on campus. He told university police he had injected himself with fentanyl and that he had been pilfering meds meant for patients.

The university immediately put him on leave. He was charged with larceny and possession of controlled substance. However, the larceny charge was dropped. A month later, the MLive reporter could no longer find the case in court records, and a spokesperson for the state licensing board told him no disciplinary action would be taken.

Such protections are unfathomable to many Americans. A reader commenting on the MLive article said that a friend caught with a half-smoked marijuana joint in his car paid a $500 fine, spent 90 days in jail, and has a felony conviction on his record. "This doctor has a clean record and no jail time?" the reader asked. "The scales of justice [were] definitely leaning his way!!!"

Defenders, however, argue that PHP protections help encourage impaired doctors to come forward and seek help, and the anonymity boosts their chances of recovery. These doctors are allowed to continue practicing, but are constantly being randomly tested for drugs. They end up having unusually high recovery rates. According to a 2008 study,[16] 80% of physicians who completed their PHP contracts didn’t have any relapses.

Still, this secrecy makes it hard to get a clear picture of physician drug abuse, and it allows proponents of random testing to claim that abuse figures are going through the roof. In the Prop 46 debate, some claimed that as many as one third of doctors have substance abuse problems. This is not the case. A 2013 study[17] estimated that the rate of physician drug abuse is actually 10%-15%, which is about the rate in the general population.

But rather than surveying lifetime drug abuse, the more pertinent question is, "How many doctors are currently abusing drugs or alcohol?" according to Gregory Skipper, MD, director of professional health services at Promises Treatment Centers in Santa Monica, California. On the basis of his experiences running the Alabama PHP for a dozen years, Dr Skipper estimated that only 0.5%-1% of physicians have a drug or alcohol problem at any one time.

Dr Skipper said he supports random drug testing of physicians, because even a few abusing physicians endangering patients would be a problem. But he doesn’t think physician drug abuse is a major patient safety issue.

On the basis of unpublished data from a study he participated in, only about 7% of doctors with substance use disorders actually had significant impairment at work, he said. Even in these cases, Dr Skipper said physicians rarely put patients at risk, like the medical technician did when he infected patients' syringes with hepatitis C. In most cases, he said, abusing doctors take drugs from wastage or pilfer from stock, neither of which spreads disease.

A respondent to the Medscape poll agreed with this finding. "I have reviewed more than 600 disciplinary decisions of my medical board," the doctor said. "I find no correlation, much less causation, between MD drug use and adverse events."

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