Original Investigation |

Substance Use Disorder Among Anesthesiology Residents, 1975-2009

David O. Warner, MD1,3; Keith Berge, MD1; Huaping Sun, PhD3; Ann Harman, PhD3; Andrew Hanson, BS2; Darrell R. Schroeder, MS2
[+] Author Affiliations
1Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
2Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
3American Board of Anesthesiology, Raleigh, North Carolina
JAMA. 2013;310(21):2289-2296. doi:10.1001/jama.2013.281954.
Text Size: A A A
Published online

Importance  Substance use disorder (SUD) among anesthesiologists and other physicians poses serious risks to both physicians and patients. Formulation of policy and individual treatment plans is hampered by lack of data regarding the epidemiology and outcomes of physician SUD.

Objective  To describe the incidence and outcomes of SUD among anesthesiology residents.

Design, Setting, and Participants  Retrospective cohort study of physicians who began training in United States anesthesiology residency programs from July 1, 1975, to July 1, 2009, including 44 612 residents contributing 177 848 resident-years to analysis. Follow-up for incidence and relapse was to the end of training and December 31, 2010, respectively.

Main Outcomes and Measures  Cases of SUD (including initial SUD episode and any relapse, vital status and cause of death, and professional consequences of SUD) ascertained through training records of the American Board of Anesthesiology, including information from the Disciplinary Action Notification Service of the Federation of State Medical Boards and cause of death information from the National Death Index.

Results  Of the residents, 384 had evidence of SUD during training, with an overall incidence of 2.16 (95% CI, 1.95-2.39) per 1000 resident-years (2.68 [95% CI, 2.41-2.98] men and 0.65 [95% CI, 0.44-0.93] women per 1000 resident-years). During the study period, an initial rate increase was followed by a period of lower rates in 1996-2002, but the highest incidence has occurred since 2003 (2.87 [95% CI, 2.42-3.39] per 1000 resident-years). The most common substance category was intravenous opioids, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. Twenty-eight individuals (7.3%; 95% CI, 4.9%-10.4%) died during the training period; all deaths were related to SUD. The Kaplan-Meier estimate of the cumulative proportion of survivors experiencing at least 1 relapse by 30 years after the initial episode (based on a median follow-up of 8.9 years [interquartile range, 5.0-18.8 years]) was 43% (95% CI, 34%-51%). Rates of relapse and death did not depend on the category of substance used. Relapse rates did not change over the study period.

Conclusions and Relevance  Among anesthesiology residents entering primary training from 1975 to 2009, 0.86% had evidence of SUD during training. Risk of relapse over the follow-up period was high, indicating persistence of risk after training.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours


Place holder to copy figure label and caption
Figure 1.
Ascertainment of SUD Cases

A total of 45 581 unique individuals were added to the American Board of Anesthesiology (ABA) data set over the period of study (1975-2009), with 44 612 participating in primary anesthesiology training and an additional 969 participating in only pain or critical care medicine subspecialty training. The substance use disorder (SUD) flag could be set either during or after training. Deceased individuals could have died during or after training. Methods of ascertainment are shown for the 384 individuals who used substances during primary anesthesiology training (ie, not including those who may have used substances during pain or critical care subspecialty training). NDI indicates National Death Index; DANS, Disciplinary Action Notification Service.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Incidence of Substance Use Disorder (SUD) According to Year of First Substance Use for Residents Entering Anesthesiology Training in 1975-2009 and Number of Residents Enrolled Each Year
Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Relapse of SUD

Relapse incidence is shown for individuals in whom SUD was detected in residency and who survived their initial episode (n = 310), showing the percentage of residents who relapsed as a function of the time that their initial episode was apparent. To compare relapse rates over the earlier and later periods of the study, data are shown for individuals whose date of first use was from 1975 to 1994 (n = 114) and from 1995 to 2009 (n = 196), as well as for the entire study period (1975- 2009; n = 310). Rates did not differ between the 1975-1994 and 1995-2009 periods. Numbers at risk are those who had not relapsed and were not censored at the time of last follow-up (December 31, 2010) in each group at each time point.

Graphic Jump Location



Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles