Risk of mortality and suicide associated with substance use disorder among healthcare professionals

Article in review: da Silva Rodrigues, J.V., Guimaraes Pereira, J.E., Passarelli, L.A,, Guatura, G.M.G.B. & El Dib, R. (2021). Risk of mortality and suicide associated with substance use disorder among healthcare professionals – A systematic review and meta-analysis of observational studies. Eur J Anaesthesiol, DOI: 10.1097/EJA0000000000001447

Summary

This research is based upon previous studies which have suggested that healthcare professions, particularly those in anesthesia, may be more susceptible to substance use disorders. The prevalence of substance use-related mortality and suicides between anesthesia and non-anesthesia medical professionals was assessed through existing observational studies determined relevant to the research. The meta-analysis of relevant articles found that there were indeed higher rates of drug-related mortality and suicides with substance use in anesthesia providers compared with other healthcare professionals.

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Research

There is international consensus that ongoing occupation-related health concern for healthcare professionals is the abuse of alcohol and other substances. It is estimated that between 10 and 15% of healthcare professionals misuse alcohol or other substances during their careers. It has also been identified that amongst medical professionals, those in the field of anesthesia appear to have higher incidences of substance misuse and substance use-associated mortality and suicide. The stress of their roles, combined with working long hours and their access to anesthetics, analgesics and other medications are cited as potential explanations for higher rates of suicide and accidental overdoses.

A search of the literature was conducted over multiple medical databases. There were no language, year of publication status restrictions. Potentially eligible studies were identified and reviewed for relevance to be included. Of the 5156 studies identified, 189 were considered for full text review. Of these, 39 proved eligible. Thirty-one were cross-sectional studies (78.4%) and eight were cohort studies (21.7%). Publications had originated from the United States, Central and South America, Australia, New Zealand and Canada and publication dates ranged from 1983 to 2019.

Findings from the research by theme

• All-cause mortality- Results from four prospective cohort studies with a total of 119,070 participants failed to suggest a possible association for mortality between the use of psychoactive drugs among anesthesia providers compared with other healthcare professionals.
• Drug-related mortality – Results from two prospective cohort studies of 5,126 participants suggested a higher rate of drug-related mortality among anesthesia providers compared with other healthcare professionals.
• Drug-related suicide – Results from two prospective cohort studies with 5,011 participants suggested a higher rate of suicide of anesthesia providers compared with other healthcare professionals.
• Mood disorders – Results from one prospective cohort study of 4,834 participants did not suggest an association between mood disorders and the use of psychoactive drugs among anesthesia providers compared with non- anesthesia providers

In some of these cases, certainty in evidence was reduced due to potential bias.

Other findings

The meta-analysis of the relevant articles also indicated that there was no association between mood disorders or all-cause mortality in relation to drug use. However, drug-related mortality and suicide rates among anesthesia providers using narcotics and abusing prescription drugs were more than double the respective rates of medical professionals.

With regard to drugs used in the featured studies, alcohol was the most frequently used substance among the psychoactive non-anesthetic drugs (reported in 17 studies), and the most common anesthetics used were opioids (reported in 21 studies).

The key factors for substance use and adverse outcomes were:

• Health (depression, anxiety)
• Work environment (job stressors, organisational bonding, burnout related to stress)
• Individual behaviour-related issues (stressful home)

However in one study, despite a high prevalence of burnout syndrome among anesthesia providers, there was not an association with substance use.
The possibility that waste anesthetic gases (WAGs) present in operating theatres could be a contributing factor is considered but explained that it is hard to the causal relationship between these drugs and professional drug abuse.

Next steps

With findings strongly suggesting a higher rate of drug-related mortality amongst anesthesia specialists, it is suggested that substance use amongst this group be further researched in the context of working conditions, job satisfaction and physical, psychosocial and environmental work-related risk factors. Such investigations are essential to enable specific preventative strategies to be developed.