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Domino KB, Hornbein TF, Polissar NL, et al. Risk Factors for Relapse in Health Care Professionals With Substance Use Disorders. JAMA. 2005;293(12):1453–1460. doi:10.1001/jama.293.12.1453
Author Affiliations: Departments of Anesthesiology
(Drs Domino and Hornbein) and Psychiatry (Dr Hankes), University of Washington,
Seattle; Mountain-Whisper-Light Statistical Consulting, Seattle (Dr Polissar);
and Washington Physicians Health Program, Seattle (Dr Hankes and Mss Renner
and Johnson and Mr Alberti).
Context Substance use disorders among physicians are important and persistent
problems. Considerable debate exists over whether use of major opioids, especially
among anesthesiologists, is associated with a higher relapse rate compared
with alcohol and nonopioids. Moreover, the risk factors for relapse with current
treatment and monitoring strategies are unknown.
Objective To test the hypothesis that chemically dependent health care professionals
using a major opioid (eg, fentanyl, sufentanil, morphine, meperidine) as drug
of choice are at higher risk of relapse.
Design, Setting, and Participants Retrospective cohort study of 292 health care professionals enrolled
in the Washington Physicians Health Program, an independent posttreatment
monitoring program, followed up between January 1, 1991, and December 31,
Main Outcome Measure Factors associated with relapse, defined as the resumption of substance
use after initial diagnosis and completion of primary treatment for chemical
Results Twenty-five percent (74 of 292 individuals) had at least 1 relapse.
A family history of a substance use disorder increased the risk of relapse
(hazard ratio [HR], 2.29; 95% confidence interval [CI], 1.44-3.64). The use
of a major opioid increased the risk of relapse significantly in the presence
of a coexisting psychiatric disorder (HR, 5.79; 95% CI, 2.89-11.42) but not
in the absence of a coexisting psychiatric disorder (HR, 0.85; 95% CI, 0.33-2.17).
The presence of all 3 factors—major opioid use, dual diagnosis, and
family history—markedly increased the risk of relapse (HR, 13.25; 95%
CI, 5.22-33.59). The risk of subsequent relapses increased after the first
relapse (HR, 1.69; 95% CI, 1.13-2.53).
Conclusions The risk of relapse with substance use was increased in health care
professionals who used a major opioid or had a coexisting psychiatric illness
or a family history of a substance use disorder. The presence of more than
1 of these risk factors and previous relapse further increased the likelihood
of relapse. These observations should be considered in monitoring the recovery
of health care professionals.
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