In February 2020, the American Society of Addiction Medicine (ASAM) made a public policy statement addressing medical doctors and other healthcare workers with substance use disorders (SUDs, a.k.a. chemical dependency or addiction). By pointing out both a) physicians and healthcare professionals are as prone to becoming addicted to alcohol and/or drugs as anyone, and b) any consequential deterioration of their ability to practice medicine could endanger the safety of their patients, ASAM’s formal statement is aimed at reassuring the public the matter is being dealt with across several practical fronts, and puts forward 12 actionable recommendations for applying the most effective measures possible.
It should be noted the foundation of ASAM’s public policy announcement is the recognition that, for many years, confidential, evidence-based addiction treatment has shown itself to be successful in helping physicians, nurses, pharmacists and other healthcare workers with SUDs to recover from addiction and safely return to their particular healthcare field.
“With appropriate treatment, the issue of potential impairment may be resolved while the diagnosis of illness may remain.”[1]
In fact, citing a 5-year study by McLellan, et al., ASAM’s announcement calls attention to the importance of offering access to treatment to healthcare workers with SUDs as an alternative to punitive measures, given the relatively high success rate demonstrated by the study.[2]
“Depending on the stage of their illness, many healthcare professionals who develop addiction are able to function effectively, but if their illness progresses to cause impairment, available evidence for physicians indicates that treatment usually results in remission of disease and restoration of functioning, particularly if appropriate monitoring and continuing care is put in place.”[3]
When physicians or other healthcare professionals with an SUD seek treatment for their chemical dependency, the ASAM statement says, increased access to proper evaluative measures and supportive evidence-based treatment and continuing care and monitoring need to be made available, to ensure they can recover and return to their practice unimpaired, capable of competently addressing potential relapse triggers.
The need for non-discriminatory, supportive state laws and regulations, physician health programs (PHPs), and non-disciplinary referral tracks are included in ASAM’s statement, which embraces a wide-reaching approach to helping addicted doctors and other healthcare workers recover from any SUD. As the McLellan, et al. findings indicate, “Reported outcomes for substance use disorders in physicians who are PHP participants are among the best in addiction medicine.”[4]
A brief synopsis for each of ASAM’s recommendations can be found below — all 12 recommendations in their entirety can be reviewed at Physicians and Other Healthcare Professionals with Addiction (asam.org):
- Although an SUD (addiction) is a potentially impairing illness, “impairment” is used here as a practical term, and “illness” doesn’t necessarily comprise or establish impairment. A physician or healthcare worker with an SUD has an illness, and may be impaired, may be in recovery, or may not be either.
- The public’s health, safety and welfare are best served when a healthcare professional with an SUD gets early identification, proper evaluation and individualized treatment. Upon completion of such, he/she ought to be provided sufficient follow-up services (including from PHPs) that they may go back safely to work in their respective field of medicine.
- Any addiction treatment program for physicians and other healthcare workers must aim to meet the unique recovery needs of each client, and take into account all accessible resources.
- The widest possible use of evidence-based treatments, including addiction medicine, should be made available to each healthcare worker seeking treatment.
- Given that relapsing i.e., a repetition of symptoms) is an acknowledged feature of SUDs, after a healthcare worker satisfies the conditions of his/her agreed-upon treatment protocol and monitoring, formal follow-up recovery management provided is recommended to sustain his/her recovery and clinical intervention be used if relapse occurs.
- Appropriate management measures should be taken (including clinician-supervision) in cases where prescribed medications have been diverted by a healthcare professional — early identification, effective treatment protocols and enforced monitored recovery. Automatic disciplinary action should be avoided, and disciplinary responses to pharmaceutical diversion should be equivalent to the damage done by the occurrence of diversion.
- The privacy and confidentiality of a physician’s or other healthcare worker’s health information should be secured and not made public.
- As much as possible, a healthcare worker’s chemical dependency or addiction or potentially impairing condition should be addressed by efforts to help him/her recover from their affliction, instead of punitive measures.
- A doctor’s or healthcare worker’s professional licensure, clinical privileges, specialty certification or inclusion in medical professional panels should not be singled out for exclusion due to a past SUD diagnosis if that physician or healthcare worker has shown their affliction has been in a state of continued abatement, including his/her ongoing participation in or completion of a PHP-approved monitoring agreement or similarly recognized monitoring agency.
- Generally, a physician’s or healthcare worker’s accomplishment of the necessary administrative requirements and relevant re-licensing should satisfy those boards and medical societies to allow certification, eligibility for recertification, and/or membership.
- Continued research into PHPs and PHP practices is warranted to determine how consistently positive outcomes are replicable and which components are key in generating the most effective results.
- The latest research and cutting-edge education ought to be provided all healthcare workers in the area of addiction, as it relates to the specific occupational risk factors for their particular field of medical care. This includes training in healthy self-care, stress management practices, recognition of signs of chemical dependency and how to assist co-workers in finding treatment support.
ASAM’s public policy statement is well-summarized in expressing that, “The interest and safety of the public are best served when state regulatory agencies, PHPs and, when involved, clinicians with expertise in the treatment of addiction in healthcare professionals work in concert to develop a confidential process allowing for early intervention, evaluation, treatment and return to practice with subsequent monitoring of the professional with addiction.”[5]
[1] Federation of State Medical Boards (FSMB). “Policy on Physician Impairment.” April 2011.
[2] McLellan AT, Skipper GS, Campbell M, DuPont RL. Five-year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ. 2008;337:a2038.
[3] Ibid.
[4] Ibid.
[5] Physicians and Other Healthcare Professionals with Addiction (asam.org)
