What is anesthesia abuse?

Causes

As with any addiction, biological and environmental factors contribute to anesthesia abuse. Addicts have a genetic predisposition and a chronic, compulsive need for the substance of choice. For the anesthesia abuser, these substances include a variety of potentially addictive agents. Generally, insatiable cravings compel chronic use (abuse) of a particular drug, which results in damage to internal organs. However, because many anesthesia drugs have the potential to cause apnea or paralysis within seconds, abuse of anesthetic agents can lead to death.

Risk Factors

Although laypersons abuse anesthesia drugs, the most frequently cited anesthesia abusers are anesthesia providers such as certified registered nurse anesthetists, medical residents, and anesthesiologists. Easy access to anesthetic medications enables anesthesia providers to experiment with controlled substances such as fentanyl and other opioids, which are highly addictive.

Anesthesia providers often work long and irregular hours under stressful conditions with access to anesthetic agents. Propofol abuse is increasingly popular because the substance has a short half-life and is quickly eliminated from the body. Nitrous oxide, commonly known as laughing gas, is an inhaled anesthetic that also is abused. The primary risk of inhaled nitrous oxide is hypoxia, which results from inadequate oxygen supply to the body’s tissues and particularly the brain.

Symptoms

A variety of symptoms occur from using common anesthetic medications. These symptoms (and their symptom-producing medications) include amnesia and anxiolysis (midazolam), pain relief (opioids), and sedation and apnea (opioids and propofol). Abusers experience impaired functioning because of these drugs. The dose associated with abuse is often less than that required for general anesthesia. However, the effects of anesthetic medications are dose dependent and may also lead to dysphoria and mood changes. Therefore, abusers may exhibit behavioral changes; may appear fatigued, irritable, euphoric, dysphoric, drowsy, or depressed; or may simply appear out of character. Recognition of these signs is imperative to protect the abuser and to aid health care providers who have a legal responsibility to report colleagues known or suspected of chemical dependency. This not only protects the abusers but also the patients under their care.

Screening and Diagnosis

The screening test commonly used to confirm drug use is typically a urine drug screen. However, many anesthetic medications (such as fentanyl, propofol, naltrexone, and ketamine) are not included in standard drug screens and must be specifically requested. Because of the short half-lives of these anesthesia drugs, many are quickly eliminated from the body and, therefore, are difficult to detect. In some cases, the metabolites of these drugs can be detected in urine samples, while hair samples fulfill other testing needs. Although more expensive than urine testing, hair-sample testing can detect chronic exposure to certain drugs; urine drug screens are limited to detecting drug use only within hours or days of use.

Treatment and Therapy

The American Association of Nurse Anesthetists and the American Society of Anesthesiologists are two national organizations that govern the practice of anesthesia providers. These organizations and many others not affiliated with medical and nursing personnel recommend inpatient treatment for persons with chemical dependency.

Short- and long-term therapy combined with support-group attendance and abstinence monitoring offer the highest success rates. Various peer assistance groups are available to monitor and assist those undergoing treatment. Narcotics Anonymous offers a twelve-step program that protects anonymity and offers the addict a structured plan for recovery that includes admitting loss of control over the compulsion (the repeated use of anesthetics) and the aid of a sponsor to evaluate mistakes made by the addict. In return, the addict offers help to others who have the same type of addiction.

Prevention

The US Drug Enforcement Administration (DEA) establishes standards and substance schedules and enforces these standards to prevent and control drug abuse. The DEA has plans to treat propofol as a controlled substance, and doing so would institute more accountability and address the overwhelming availability of the drug to anesthesia providers. Random drug screening in accordance with the US Substance Abuse Mental Health Services Administration’s guidelines and employing the proper chain of custody are two methods that various organizations use to deter and detect drug abusers, including anesthesia abusers.

Bibliography

Bryson, Ethan O., and Jeffrey H. Silverstein. “Addiction and Substance Abuse in Anesthesiology.” Anesthesiology 109.5 (2008): 905–17. Print. An excellent overview that covers manifestations, legal issues, diagnosis and treatment, prognosis, prevention, and testing methodologies.

Sinha, Ashish C. “The Drug-Impaired Anesthesia Provider.” Audio-Digest Anesthesiology 50.7 (2007). Print. Through use of several studies, discusses incidence, influencing factors, reasons for suspicion, intervention, treatment, and therapy.