They can’t wear long sleeves in the operating room, which would hide the track marks on their arms, so they inject the drugs into less visible veins in their legs, thighs or the folds between their toes.
It’s not difficult; anesthesiologists are extraordinarily skilled at finding veins.
Some will tape an IV needle and tubing from a vein in their foot to their ankle, or from an arm vein to their back, with a port hanging over their shoulder beneath their scrubs. It makes it easier to secretly inject at work that way.
Anesthesiologists — the doctors who keep patients alive during surgery, who essentially take over our breathing — make up just three per cent of all doctors, but account for 20 to 30 per cent of drug-addicted MDs. Experts say anesthesiologists are overrepresented in addiction treatment programs by a ratio of three to one, compared with any other physician group, an occupational hazard that could pose catastrophic risks to their patients.
Their drugs of choice are most frequently fentanyl and sufentanil, opioids that are 100 and 1,000 times more potent than morphine. They “divert” a portion of the doses meant for their patients to themselves, slipping syringes into their pockets. And later, alone in the bathroom or the call room, when the drug hits their own bloodstream, the relief, the sense that all is well in the world, the mild euphoria, is immediate.
It can feel as if they’re floating.
Unlike heroin addicts, drug-seeking anesthesiologists can’t shoot up with a friend, someone who knows what to do if they accidentally overdose, says Dr. Ethan Bryson, author of Addicted Healers: 5 Key Signs Your Healthcare Professional May Be Drug Impaired, due to be published in September.
When everything you have worked so hard for is on the line, when your career is at constant risk, you use alone, he says.
Sometimes, that means dying alone.
“These drugs can take somebody who is at the top of their game, and bring them down very hard and very fast,” says Bryson, an associate professor in the departments of anesthesia and psychiatry at the Mount Sinai School of Medicine in New York. “It’s a story that a lot of people aren’t talking about.”
Dr. Paul Farnan has worked in the field of addiction and occupational medicine for more than 20 years. The Burnaby, B.C., doctor’s specialty is assessing and followup monitoring of health professionals — doctors, nurses, dentists, pharmacists and paramedics — with substance-use disorders.
None is more frightening than the anesthetist with an intravenous opioid addiction, he says, “because they are the colleagues who could die.”
Farnan adds: “The danger about writing about this is that it can terrify the public.”
The reality, he says, is that the phenomenon of anesthesiologists addicted to the drugs they use on their patients is relatively rare.
Yet the shame and guilt associated with addiction is so deeply entrenched and so profound — especially in professions that command so much public trust, the “pedestal professions,” as Farnan calls them — that people are unable to bring themselves to seek help. “And the biggest risk with undiagnosed, evolving addiction in anesthesia,” Farnan says, “is accidental fatality by overdose.”
Farnan says he cannot think of a case in more than 20 years that he was involved with where a drug-addicted anesthesiologist used in the OR while their patient was under anesthesia.
But Bryson says it happens. Addicts sometimes will inject themselves during cases in the operating room, if they have access, he says, like a hidden “indwelling port” in one of their veins, or during a quick bathroom break. In many cases they use drugs intended for their patients — meaning the patient might get a diluted dose, less than they need, or nothing at all.
A drug-addicted anesthesiologist’s patients can arrive in recovery rooms with pain out of proportion to the amount of narcotics they supposedly received during surgery.
Bryson has described how entire cases have been conducted with other drugs that treat the body’s physiological responses to pain — drugs that lower heart rate or blood pressure — even though they were “charted” as narcotics. “If the chart says one drug was administered, but the patient is still in a lot of pain, the next logical step is to switch to a stronger agent, because obviously this drug isn’t working, and the patient ends up getting an overdose in the recovery room.”
Even when they don’t feel “high,” the drugs can make them feel as if nothing matters in the world. They become distracted and less vigilant — less bothered, Bryson says, by “minor annoyances.”
In the U.S., a Demerol-addicted anesthesiologist caused irreversible brain damage to a woman undergoing a routine tubal ligation after he removed her breathing tube too soon while she was still under the influence of anesthesia. Anesthesia drugs paralyze the muscles of the body, including the diaphragm.