William S. Jacobs
University of Florida, USA
Title: Pain and addiction
William S Jacobs, MD, is board certified in Anesthesiology, Pain Medicine, and Addiction Medicine. A Phi Beta Kappa, Magna Cum Laude University of Georgia undergraduate and graduate of the Medical College of Georgia, he did his Anesthesiology Residency at the University of Alabama-Birmingham before matriculating to UF for his Addiction Medicine Fellowship. He is currently Associate Professor in Psychiatry and Addiction Medicine: Co-Chief of Pain Medicine at the University of Florida. His work has included serving as Medical Director of multiple addiction treatment programs as well as expert witness work, consulting with state and federal agencies, authoring peer reviewed works and as on pharmacologic studies.
Background: Opioid abuse and dependence are significant health care provider health problems, and this is especially the case amongst anesthesia trainees and physicians. Methadone maintenance treatment (MMT) has been the most widely used maintenance treatment for decades in treating opiate addiction. But what about physician opioid addicts, even if they have identical intravenous or other elements of their history in common with other addicts do they receive the same treatment?
Methods: For 5 years, we followed all physicians who were identified by the Florida Board of Medicine and PRN for opioid abuse/dependence. Twenty-six physicians were identified in the pre-Buprenorphine era: all but ten had intravenous opioid use. They included 23 males and 3 females. Treatment referrals were made to various addiction treatment facilities and outcomes were collected.
Results: All signed PRN contracts requiring them to attend a specialized monitoring group, call a toll-free number for randomization to at least weekly urine monitoring and regularly attend a local recovery support group program. 0% were referred for MMT. 0/23 male addicts were treated with MMT. All were referred for detoxification and drug-free long-term physicians health program treatment and monitoring. As we have reported previously, physician addicts have a greater than 80% successful 5 year outcomes as assessed by written counselor reports, physician/psychiatrist evaluations, AA/NA attendance, return to work and frequent random urine testing.
Conclusion: Unlike treatment referrals for non-physicians, opioid addicted physicians are referred to detox and long-term treatment rather than MMT. Physicians may recommend MMT for others but an unusual NIMBY (not-in-my-backyard) phenomenon applies for their colleagues. The physicians behavior is to vote for detox and long-term treatment for themselves and colleagues and they may prefer this option to MMT if available for other opiate addicts.
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