Medical Student Spirituality and Substance Use.

OBJECTIVES: Although medical students report relatively high levels of substance use, little is known about the risk and protective factors associated with substance use in this population. This study sought to examine the link between spirituality and substance use among medical students. METHODS: As part of a larger study, medical students from all 9 medical schools in the state of Florida were invited to complete an anonymous survey pertaining to distress and well-being. Responses to items assessing self-reported spirituality and substance use were examined and descriptive statistics were analyzed. RESULTS: Data from 868 medical students (57% female) were included. Of these, 22.6% described themselves as "non-spiritual," 31.0% described themselves as "spiritual," 18.5% engaged in informal spiritual practices, and 27.9% reported formal spiritual/religious practices. Students who reported stronger spirituality also reported lower rates of substance use. Though 31% of respondents across all levels of spirituality reported that their alcohol consumption increased since starting medical school, rates of binge drinking after exams were inversely related to level of spirituality. CONCLUSIONS: Self-reported spirituality appears to be associated with decreased risk of substance use in medical school. Future studies should examine this relation in greater depth.

Mandatory naltrexone treatment prevents relapse among opiate-dependent anesthesiologists returning to practice.

OBJECTIVE: Anesthesiologists with opioid use disorders are at high risk for relapse. In 2005, the impaired professionals monitoring program of the State of Florida implemented a policy whereby anesthesiologists referred for opiate use disorders were contractually obligated to take naltrexone for 2 years. Naltrexone ingestion was witnessed and verified via random urine drugs screens or administered via intramuscular injection. METHOD: Charts were reviewed for the 11 anesthesiologists who underwent mandated pharmacotherapy with naltrexone, and 11 anesthesiologists who began monitoring immediately before implementation of this policy. RESULTS: Eight of 11 anesthesiologists who did not take naltrexone experienced a relapse on opiates. Only 1 of 11 anesthesiologists experienced a relapse on opiates after taking naltrexone, whereas another relapsed on an inhalant (nitrous oxide). It is noteworthy that 5 of the 11 anesthesiologists who took naltrexone had relapsed before naltrexone treatment, and 7 of the 11 anesthesiologists who did not take naltrexone experienced multiple documented relapses. Only 1 of the 11 anesthesiologists who did not take naltrexone successfully returned to the practice of anesthesiology. This individual suffered primarily from alcohol dependence, and suspected opiate abuse was never verified. Others who attempted return to anesthesiology (n = 7) suffered a relapse. In comparison, 9 of the 11 anesthesiologists who took naltrexone have returned to the practice of anesthesiology without a relapse (as verified by continued random urine and hair testing). CONCLUSION: Mandatory naltrexone treatment may provide anesthesiologists with an additional safeguard to successfully return to work.

Addiction liability of pharmacotherapeutic interventions in obesity.

Obesity and substance use disorders are rapidly growing problems throughout the world. Of the current mainstay therapies of diet, exercise, behavioral modification, surgery, and medications, drugs have the greatest risk for abuse and dependence. As each of these disorders share similar underpinnings mediated by the dopaminergic brain reward pathways, clinicians must seriously consider the safety of both the patient's physical and mental health when prescribing treatments. Specifically, balance and awareness of the factors involved in the variable abuse potentials of these prescribed medications is paramount. A cursory review of weight loss medications commonly used is performed with attention to FDA status, mechanism of action, and abuse potential. Concurrent strategies to minimize risk such as drug screening, ruling out doctor shopping, temporal considerations, monitoring for signs and symptoms of abuse and/or dependency, and a safety-tiered prescribing approach is also discussed in order to optimize best treatment practice. As the understanding of these disorders progresses along with the evolution of agreed nomenclature and awareness of compulsive behavioral disorders in general, greater safety and more appropriate interventions may be achieved. Further areas of research will help to elucidate nuances of the coocurrance and treatment of these disorders and perhaps guide drug research and development in the area of drug treatments of obesity.

Physician views regarding substance use-related participation in a state physician health program.

Physician Health Programs (PHPs) safeguard the public by monitoring impaired physicians, but participation is not always voluntary, and many physicians resist referral. In this study, 80 physicians (85.1% male) who were referred to a state PHP for substance use-related problems completed an anonymous online survey regarding their experiences in the program. Results indicated that 78.1% of program completers had a 5-year contract, with 100% including random drug screening. In addition, 84.8% continued participation in 12-step fellowships after the required monitoring period. Participants were generally satisfied with the program, and 92.5% indicated that they would recommend it to others. They provided suggestions to increase the acceptability and efficacy of PHPs for physicians.