You might not think COVID and substance abuse go hand in hand but you’d be mistaken. It seems substance abuse, and particularly opioid usage, is on the rise among physicians since the COVID pandemic hit in March 2020. Medscape’s Substance and Opioid Abuse Report 2022 found that 51% of physicians think the problem has “increased” in their profession since the onset of COVID-19. But another 48% report it at the same level as in pre-pandemic years. Which perception matches reality?
Data is still anecdotal and somewhat mixed from physician health programs, where statistics on substance use disorder referrals are evaluated and managed, said Christopher Bundy, MD, MPH, executive medical director of the Washington Physicians Health Program in Seattle and immediate past president of the Federation of State Physician Health Programs. But there are “converging signs of evidence” that the problem is indeed on the rise.
“We know that problematic drinking and substance use has increased in the general population during the pandemic, and we don’t believe that doctors have any special protection [from that],” he says.
Michael McCormick, DO, medical director of the Healthcare Professionals Assessment Program at Caron Treatment Centers in Pennsylvania, said what he sees in his practice supports the idea of a bump in physician substance abuse since early 2020.
“The uptick that we saw [in physicians seeking treatment for addiction] definitely increased in March 2020 and shortly thereafter into the summer, and it has continued,” he said.
What’s Behind the Substance Abuse Increase Among Physicians?
It starts with a P. That’s right, the pandemic has put physicians under immense pressure for the last two-and-a-half years, resulting in overworked and overstressed clinicians. For example, a study in September published in Mayo Clinic Proceedings found that physical and emotional exhaustion spiked 63% in 2021, up from 38% in 2020.
“Burnout is at an all-time high, and we know that burnout is related to substance use disorders,” said Bundy. “Doctors with higher rates of burnout also tend to have higher rates of alcohol-related problems and substance-related problems.”
Doctors at the forefront of COVID-19 care dealt with a unique set of stressors, including higher rates of depression, anxiety, and PTSD.
“We saw an uptick in critical care docs, family docs, internal medicine docs, and emergency room docs [seeking treatment], because they were directly taking care of it,” said McCormick. “They’re [dealing with situations such as sitting] in an ICU setting… with the patient’s family as the patient passes away. That has an extremely powerful effect on people.”
In the meantime, other specialists saw their practices decline and even fold, leading to financial woes and unscheduled downtime that increased anxiety and depression in different ways, McCormick told Medscape.
“We saw a lot of physicians who suddenly had a lot of free time or who had a practice for 25 years and had to lay off their staff,” he said. “It wasn’t just those taking care of COVID. There are so many levels to this.”
Recognizing Addiction in Other Physicians
If you suspect a colleague is struggling with a substance abuse issue, what’s your role? Often, a direct conversation is the best start, especially if you’re not sure what they’re dealing with. In addition, lack of sleep, poorly controlled diabetes, or even overwhelming stress can sometimes impair a physician’s well-being in a way that can look like intoxication or impairment, so talking to them first may help clarify the issue.
“Take it head on — not in a confrontational way, but in a loving and caring way — and say, ‘Hey, these are the things I’m seeing. Do you need some help? What’s going on?’ ” said McCormick.
It’s essential to report higher up the chain if you suspect drug or alcohol use, though it’s common to feel paralyzed or fearful that you’ll cause a rift by doing so.
“Studies have shown that while more than 90% of individuals know that they would have an obligation to report a concern of impairment in a colleague, two thirds of individuals when faced with that concern did not act,” says Bundy. “There’s fear of negative professional consequences, [and] there’s stigma.”
If it’s time for you to go higher up the chain to report a problem, you don’t have to go to the medical board. Instead, talk to your clinic chief or seek out a Physician Health Program. Forty-seven states in the US have PHPs that serve as resources to promote physician wellness and assist with addiction treatment. Bundy said you can fulfill your mandatory reporting obligation by calling a PHP instead of the medical board.
Recognizing Addiction in Yourself
It can be difficult to admit when you have a problem or even to recognize it in the first place. Common signs include missing work, having unusual personal struggles, acting unprofessionally, withdrawing socially, or appearing disheveled or unkempt — not to mention using alcohol or other substances more frequently and feeling dependent upon them. If you notice these warning signs, talk to someone about the next steps for getting better.
Once you understand you need help, you may feel like your career is over, but McCormick said that’s the “furthest thing from the truth.”
“The greatest thing that can happen to a physician who has a problem with substances or alcohol is actually recognizing that problem, surrendering to that issue, and getting the help that they need,” he said. “The success rates that physicians and healthcare professionals have in recovery and have with regards to alcohol and substance use, those numbers are astronomical.”
Physician Health Programs are confidential and can help you detect, evaluate, treat, and monitor your condition so you can return to a healthier place. These programs also help combat discrimination based on past history of substance abuse problems so you can continue in your career posttreatment.
“One of the things that the pandemic did for health professionals was make it okay not to be okay,” said Bundy. “We’ve often felt the need to promote an unrealistic image of competence and perfection. But doctors are human beings, and the pandemic allowed us to see doctors as human beings.”
Bundy said that can help us systematically and systemically change the culture of medicine so that it becomes culturally acceptable — in fact, rewarded — to be vulnerable and open, and acknowledge when you’re having difficulty.
Rachel Reiff Ellis is an Atlanta-based freelance writer and editor specializing in health and medicine. She is a regular writer for WebMD and Fortune Well, with additional work appearing in Prevention, Oprah Magazine, Women’s Health, Good Housekeeping, Country Living, and Women’s Day.