SAN FRANCISCO – A monitoring program for physicians with substance use disorders greatly boosted the chances of anesthesiologists staying clean and returning to work after the program mandated 2 years of naltrexone therapy in addition to usual treatment, preliminary data suggest.
The study tracked 18 anesthesiologists and 4 anesthesiology residents with opiate abuse or dependence who entered the Florida Medical Association's Professionals Resource Network, the state-sanctioned “physician health program” that monitors impaired physicians. Half the cohort entered monitoring just before (and half after) a 2005 rule change requiring 2 years of naltrexone therapy in addition to usual program requirements.
In the group without naltrexone, 8 of the 11 physicians relapsed on opiates. Of the three who did not relapse, one left anesthesiology to become a consultant, one switched practice to pain medicine, and one successfully returned to anesthesiology.
In the group of 11 on naltrexone, only 1 anesthesiologist relapsed on opiates and another relapsed on nitrous oxide; 9 of 11 successfully returned to practice, Lisa J. Merlo, Ph.D., and her associates reported. The results with naltrexone might be more impressive, considering that 5 of the 11 physicians in the naltrexone group had a history of relapse on opiates or other drugs prior to starting naltrexone, added Dr. Merlo of the University of Florida, Gainesville.
These preliminary data suggest that adding naltrexone increased the chances of avoiding relapse ninefold and improved the chance of returning to work 11-fold.
Naltrexone is an opioid receptor antagonist used mainly in the management of alcohol or opioid dependence. If further research supports the small study's findings, naltrexone pharmacotherapy might be a useful addition to comprehensive treatment and monitoring contracts, but its potential advantages should be weighed against potential side effects when considering using naltrexone in specialists other than anesthesiologists, said Dr. Merlo, who received the society's 2010 Young Investigator Award for her study.
Naltrexone was taken orally as 50 mg 5 days per week or on 3 days per week in doses of 100 mg, 100 mg, and 150 mg, or by monthly injections. Ingestion was witnessed, with random urine testing to confirm the presence of naltrexone in urine.
Its use was added to the program's usual requirements for 2–5 years of monitoring for substance abuse or dependence, random urine drug screens, and attendance in monitoring groups and recovery programs.
The investigators said they have no pertinent conflicts of interest. The National Institute on Drug Abuse and the Florida Medical Association funded the study.