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Clinical Crossroads Update
July 16, 2008

Update: A 35-Year-Old Physician With Opioid Dependence

JAMA. 2008;300(3):322. doi:10.1001/jama.2008.61

In a Clinical Crossroads article published in September 2004,1 John R. Knight, MD, discussed the epidemiology of physicians struggling with substance abuse, as well as risk factors, treatment options, and prospects for returning to practice. The patient, Dr L, was a 35-year-old specialist who began using hydrocodone after self-treating his symptoms for an upper respiratory tract infection with a codeine-containing cough suppressant. His use escalated, and Dr L was taking approximately 200 mg/d of hydrocodone during the course of his 18-month addiction. He sought no medical care during this period. After being confronted by his employer, Dr L was referred to a state physician health program, which required him to complete a 3-month inpatient stay at an addictions center if he wanted to retain his license. When we first interviewed Dr L, he was midway through his inpatient stay. In his article, Dr Knight recommended that Dr L complete treatment and enter into an agreement with the state health program. Dr Knight thought that frequent attendance at support meetings and ongoing therapy would be an essential element to Dr L's recovery. Finally, Dr Knight believed Dr L would benefit from working through the 12 steps of recovery.