From the Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (M.G.F., K.B., E.L., W.M.Z.) Division of Cardiology, Department of Medicine (R.M.) Occupational Medicine (A.G.), Massachusetts General Hospital, Boston, Massachusetts.
Anesthesiology. 2018 Oct;129(4):821-828. doi: 10.1097/ALN.0000000000002348.
WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: The incidence of substance use disorders in the United States among residents in anesthesiology is between 1% and 2%. A recent study reported that the incidence of substance use disorders in U.S. anesthesiology residents has been increasing. There are no reports of effective methods to prevent substance use disorder in residents. A comprehensive drug testing program including a random component may reduce the incidence of substance use disorders.
The authors initiated a comprehensive urine drug screening program of residents, fellows, faculty physicians, and certified nurse anesthetists. The authors performed 3,190 tests over 13 yr. The authors determined the incidence of substance use disorders among residents in our large anesthesiology residency program during the decade before (January 1, 1994, to December 31, 2003) and for the 13 yr after (January 1, 2004 to December 31, 2016) instituting a random urine drug testing program. A total of 628 residents trained in the program over these 23 yr; they contributed a total of 1,721 resident years for analysis. Fewer faculty and certified nurse anesthetists were studied, so we do not include them in our analysis.
The incidence of substance use disorders among trainees in our department during the 10 yr before initiation of urine drug screening was four incidents in 719 resident years or 0.0056 incidents per resident-year. In the 13 yr after the introduction of urine drug screening, there have been zero incidents in 1,002 resident years in our residency program (P = 0.0305).
This single-center, comprehensive program including preplacement and random drug testing was associated with a reduction of the incidence of substance use disorders among our residents in anesthesiology. There were no instances of substance use disorders in our residents over the recent 13 yr. A large, multicenter trial of a more diverse sample of academic, government, and community institutions is needed to determine if such a program can predictably reduce the incidence of substance use disorders in a larger group of anesthesiology residents.
在美国，接受麻醉学培训的居民中，物质使用障碍的发病率在 1%至 2%之间。最近的一项研究报告称，美国麻醉学住院医师中物质使用障碍的发病率一直在上升。目前尚无预防住院医师物质使用障碍的有效方法。综合药物测试计划，包括随机成分，可能会降低物质使用障碍的发病率。
作者启动了一个针对住院医师、研究员、教职医师和认证护士麻醉师的综合尿液药物筛查计划。作者在 13 年内进行了 3190 次检测。作者确定了在我们大型麻醉学住院医师培训计划中，在实施随机尿液药物测试计划的十年前（1994 年 1 月 1 日至 2003 年 12 月 31 日）和之后的 13 年内（2004 年 1 月 1 日至 2016 年 12 月 31 日），居民中物质使用障碍的发病率。在这 23 年中，共有 628 名居民接受了该计划的培训；他们共为分析贡献了 1721 名居民年。由于研究的教职医师和认证护士麻醉师人数较少，因此我们未将其纳入分析。
在开始尿液药物筛查前的 10 年中，我们部门培训生中的物质使用障碍发病率为 719 名居民年中有 4 例，即 0.0056 例/居民年。在引入尿液药物筛查后的 13 年内，我们的住院医师计划中有 1002 名居民年中未发生 0 例（P=0.0305）。
这个包括入职前和随机药物检测的单一中心综合计划与我们麻醉学住院医师中物质使用障碍发病率的降低有关。在最近的 13 年中，我们的住院医师中没有物质使用障碍的情况。需要进行一项大型的、多中心的试验，以更广泛的学术、政府和社区机构样本来确定这样的计划是否可以预测性地降低更大群体的麻醉学住院医师中物质使用障碍的发病率。
