To the Editor:—
One issue incompletely addressed by Bryson and Silverstein1and by the accompanying editorial of Berge et al. 2is the problem of the quality of care delivered by the anesthesia care provider who is relapsing into opioid addiction.
The time between relapsing addiction and diagnosis typically extends into many months, as in a recent case presented on the first page of a Sunday Boston Globe article.3
In this rather long time period the anesthesia care provider will be treating a few hundred patients while either under the influence of self-administered opioids or during a withdrawal syndrome. It is doubtful that his or her care would be in accordance with the principles of the American Society of Anesthesiologists. For one, vigilance would be obviously and seriously impaired either by the psychic effects of self-administered opioids or by signs and symptoms of a withdrawal syndrome. Given the suggested rate of relapse in opioid addiction from the pragmatic review of the Mayo Clinic experience (“[…] there has been a nearly 100% relapse […] )2and the high rate of individuals lost to formal follow-up in other studies, it is likely that many thousands of patients have been treated by anesthesia care providers in the course of their relapsing addiction to opioids.
I am therefore totally in accord with the proposal of Berge et al. to direct anesthesia caregivers who have become addicted to or abuse anesthetic drugs and supplements away from the practice of clinical anesthesia, once and for all and at the first diagnosis. As we struggle to improve our care and to diminish the tragic effects of medical errors, we cannot allow hundreds of future patients to predictably suffer and possibly die because of laxity and misplaced kindness in our approach to opioid addiction in anesthesia providers.
Massachusetts General Hospital, Boston, Massachusetts. atorri@partners.org
