Abusive self-medication with opioid and non-opioid anesthetic drugs among anesthesia professionals:
A comprehensive integrative review associated with IRAMuTeQ analysis
DOI:
https://doi.org/10.25751/rspa.40038Keywords:
Clinical Competence, Opioid-Related Disorders, Professional Impairment, Substance-Related DisordersAbstract
Introduction: Substance abuse among anesthesiologists is a serious occupational health issue, impacting patient safety and the quality of care provided.
We aimed to identify the prevalence, determinants, and impacts of abusive self-medication with opioid and non-opioid anesthetics among anesthesiologists and propose prevention and monitoring strategies.
Methods: This is an integrative review conducted from February to November 2024 in the PubMed, Scopus, Cochrane, Embase, LILACS, Web of Science, and BVS databases. Screening was performed in Rayyan, and lexical and thematic analyses were conducted using IRAMuTeQ. The quality of studies was assessed using JBI, NOS, SANRA, CASP, and GRADE tools, applied according to each study’s methodology. A total of 20 studies were included, categorized according to patterns of abuse, occupational factors, and professional impacts.
Results: The mean prevalence of opioid and non-opioid abuse among professionals was 42.03 ± 22.03. The most commonly abused opioids were fentanyl and sufentanil, followed by propofol and benzodiazepines. Major associated factors included excessive workload, chronic stress, and occupational exposure, while the consequences encompassed overdose, deterioration of mental health, and increased risk of medical errors. Preventive strategies, such as toxicological screening and rehabilitation programs, demonstrated variable effectiveness, limited by institutional barriers, professional stigma, and regulatory deficiencies.
Conclusion: The findings reveal significant variability in the prevalence of substance abuse among anesthesiologists and the influence of occupational, psychological, and institutional factors. While intervention strategies show potential, they lack robust evidence. There is a pressing need for institutional policies that promote safe environments, reduce stigma, and strengthen preventive actions.
Downloads
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington: APA; 2013.
Barros GA, Duval Neto GF. Substance use disorder (SUD) among anesthesiologists. Braz J Anesthesiol. 2021;71:315-6. doi: 10.1016/j.bjane.2021.06.001.
Serebrenic F, Carmona MJ, Cunha PJ, Malbergier A. Post-mortem qualitative analysis of psychological, occupational, and environmental factors associated with lethal abuse of anesthetics and/or opioids among anesthesiologists: a case series. Braz J Anesthesiol. 2021;71:326-32.
Centro de Excelência para a Redução da Oferta de Drogas Ilícitas (CdE). 4º Informe do Subsistema de Alerta Rápido sobre Drogas (SAR): Fentanil: caracterização e presença no Brasil. Brasília: Ministério da Justiça e Segurança Pública; 2023.
Oreskovich MR, Caldeiro RM. Anesthesiologists recovering from chemical dependency: can they safely return to the operating room? Mayo Clin Proc. 2009;84:576-80. doi: 10.1016/S0025-6196(11)60745-3.
Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52:546-53. doi: 10.1111/j.1365-2648.2005.03621.x.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. PLOS Med. 2021;18:e1003583. doi: 10.1371/journal.pmed.1003583.
Othman MH, Santesso N. Rayyan: A web and mobile app for systematic reviews. [accessed Jan 2024] Available from: https://rayyan.qcri.org
Joanna Briggs Institute. Checklist for systematic reviews and research syntheses. Joanna Briggs Institute; 2017. [accessed Jan 2024] Available from: https://jbi.global/critical-appraisal-tools
Gold MS, Byars JA, Frost-Pineda K. Occupational exposure and addictions for physicians: case studies and theoretical implications. Psychiatr Clin North Am. 2004;27:745-53. doi: 10.1016/j.psc.2004.07.006.
Kintz P, Villain M, Dumestre V, Cirimele V. Evidence of addiction by anesthesiologists as documented by hair analysis. Forensic Sci Int. 2005;153:81-84. doi: 10.1016/j.forsciint.2005.04.033.
Maier C, Leclerc-Springer J. Lebensbedrohliche Fentanyl- und Propofolabhängigkeit: Interview mit einer Überlebenden. Anaesthesist. 2012;61:601-7. doi: 10.1007/s00101-012-2036-y.
Habchi KM, Li MT, Mallard CA, Baker M, Ortega R. The anesthesiologist’s armamentarium: From recreation to medication and back. J Anesthes Hist. 2020;6:17-26. doi: 10.1016/j.janh.2019.04.002.
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Hospital Research Institute; 2014. [accessed Jan 2024] Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
Fitzsimons MG, Baker K, Malhotra R, Gottlieb A, Lowenstein E, Zapol WM. Reducing the incidence of substance use disorders in anesthesiology residents: 13 years of comprehensive urine drug screening. Anesthesiology. 2018;129:821-8. doi: 10.1097/ALN.0000000000002348.
McAuliffe PF, Gold MS, Bajpai L, Merves ML, Frost-Pineda K, Pomm RM, et al. Second-hand exposure to aerosolized intravenous anesthetics propofol and fentanyl may cause sensitization and subsequent opiate addiction among anesthesiologists and surgeons. Med Hypotheses. 2006;66:874-82. doi: 10.1016/j.mehy.2005.10.030.
Skipper GE, Campbell MD, Dupont RL. Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs. Anesth Analg. 2009;109:891-6. doi: 10.1213/ane.0b013e3181adc39d.
Baethge C, Goldbeck-Wood S, Mertens S. SANRA—a scale for the quality assessment of narrative review articles. Res Integrity Peer Rev. 2019;4:5. doi: 10.1186/s41073-019-0064-8.
Álvarez Echeverri T. Anesthesiology and drug addiction. Iatreia. 1994;7:143-3.
Zuleta-Alarcón A, Coffman JC, Soghomonyan S, Papadimos TJ, Bergese SD, Moran KR. Non-opioid anesthetic drug abuse among anesthesia care providers: a narrative review. Can J Anaesth. 2017;64:169-84. doi: 10.1007/s12630-016-0698-7.
Jungerman FS, Palhares-Alves HN, Carmona MJ, Conti NB, Malbergier A. Anesthetic drug abuse by anesthesiologists. Rev Bras Anestesiol. 2012;62:375-86. doi: 10.1016/S0034-7094(12)70138-1.
Bryson EO. The opioid epidemic and the current prevalence of substance use disorder in anesthesiologists. Curr Opin Anaesthesiol. 2018;31:388-92. doi: 10.1097/ACO.0000000000000589.
Bryson EO, Silverstein JH, Warner DS, Warner MA. Addiction and Substance Abuse in Anesthesiology. Anesthesiology. 2008;109:905-17. doi: 10.1097/ALN.0b013e3181895bc1.
Critical Appraisal Skills Programme (CASP). CASP checklists. Oxford: CASP UK; 2020. [accessed Jan 2024] Available from: https://casp-uk.net/casp-tools-checklists/
Gravenstein JS, Kory WP, Marks RG. Drug abuse by anesthesia personnel. Anesth Analgesia. 1983;62:467–72.
Al-Maaz S, Abu-Dahab R, Shawagfeh M, Wazaify M. Prevalence and patterns of substance use and abuse among anesthesia healthcare professionals in Jordan. J Subst Use. 2019;24:317-22. doi: 10.1080/14659891.2019.1570366.
Palhares-Alves HN, Vieira DL, Laranjeira RR, Vieira JE, Nogueira-Martins LA. Clinical and demographic profile of anesthesiologists using alcohol and other drugs under treatment in a pioneering program in Brazil. Rev Bras Anestesiol. 201;62:356-64. doi: 10.1016/S0034-7094(12)70136-8.
Hamza H, Bryson EO. Exposure of anesthesia providers in recovery from substance abuse to potential triggering agents. J Clin Anesth. 2011;2:552-7. doi: 10.1016/j.jclinane.2011.03.002.
Van Der Westhuizen J. The prevalence of substance use in anaesthesia practitioners in South Africa. Faculty of Health Sciences, Department of Anaesthesia and Perioperative Medicine; 2020.
GRADE Working Group. GRADE. [accessed Jan 2024] Available from: https://www.gradeworkinggroup.org/.
Camargo BV, Justo AM. IRAMUTEQ: a free software for analysis of textual data. Temas Psicol. 2013;21:513-8.
Mavroforou A, Giannoukas A, Michalodimitrakis E. Alcohol and drug abuse among doctors. Med Law. 2006;25:611-25.
Statistical Software Package (SPSS). [accessed Jan 2024] Available from: https://www.sigmaxl.com/.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Everton O. C. Ribeiro, Wilkslam A. Araújo, André S. Santos, Kelle O. Silva
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Articles are freely available to be read, downloaded and shared from the time of publication.
The RSPA reserves the right to commercialize the article as an integral part of the journal (in the preparation of reprints, for example). The author should accompany the submission letter with a declaration of copyright transfer for commercial purposes.
Articles are published under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC).
After publication in RSPA, authors are allowed to make their articles available in repositories of their home institutions, as long as they always mention where they were published.
