Australian hospitals should consider random drug testing of doctors to deter them from abusing dangerous drugs such as propofol, a leading anaesthetist says.
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Deputy director of anaesthesia and pain management at Canberra Hospital Lisa Zuccherelli said although it was difficult to know how many health professionals misused prescription drugs, anaesthetists, emergency physicians and psychiatrists were thought to be at particularly high risk because of their stressful jobs and constant exposure to addictive drugs.
She said surveys had shown about 1 to 2 per cent of anaesthetists abused substances, including alcohol. However, the most commonly misused drugs were opioid painkillers such as morphine and fentanyl, followed by propofol, a hypnotic anaesthetic that killed Michael Jackson. There are about 5000 anaesthetists, including trainees, in Australia.
While all of the drugs are dangerous, Dr Zuccherelli said propofol was unregulated in hospitals, making it very easy to obtain from unlocked drawers across many hospital departments. Furthermore, she said the drug could provide a euphoric and relaxing high which wore off quickly without a hangover, making it appealing to doctors who could use it and return to work.
''The literature says 10 to 15 minutes after a a single dose of propofol, your psycho motor function practically returns to normal … so there can be almost no obvious signs,'' she said. ''During my research, I found that some people were injecting up to 50 and 100 times a day because it has such a short-lived effect.''
However, Dr Zuccherelli said the drug could easily kill someone if they were not being monitored. She knew of seven anaesthetists who had died from a propofol overdose.
Given the drug was often required quickly, making it hard to lock it up, she said random drug testing of anaesthetists could work well as a deterrent.
Random drug testing had recently been introduced at the Massachusetts General Hospital in the United States and had long been used successfully in the military and transport industries. ''I know it's a big infringement on people's rights to privacy and confidentiality, but certainly if a hospital like the Massachusetts General Hospital in Boston, a world famous hospital, has introduced a program like this, they must have given it a lot of long and hard thought … One cannot deny that you would potentially be saving lives,'' Dr Zuccherelli said at the Australian and New Zealand College of Anaesthetists annual meeting in Perth.
She said the Massachusetts hospital was spending about $50,000 a year on drug tests for its staff, but weighed this against the estimated $100,000 required to treat someone for drug dependency.
President of the Australian and New Zealand College of Anaesthetists Kate Leslie said although random drug testing could be considered for hospitals with a drug abuse problem, she thought it was better to invest in education and monitoring of doctors to ensure they were coping with the stresses of their jobs and looking after their health.
''We prefer to have a preventative approach. As we can tell from years of drug testing in sport, it's labour intensive and expensive and it's not precise enough, because people can always work out ways of not getting caught,'' she said. ''It also creates an atmosphere of suspicion which is unhelpful in the treatment of this kind of problem.''
