Opioid-Abusing Health Care Professionals: Options for Treatment and Returning to Work After Treatment

Abstract

We congratulate Mayo Clinic Proceedings and the authors Hamza and Bryson1 on their decision to publish an important and controversial article about the use of buprenorphine maintenance treatment in opioid-dependent health care professionals (HCPs). (Buprenorphine is a semisynthetic opioid agonist-antagonist drug with adverse effects shared with other opioids. It is sometimes used to treat opioid addiction, much as methadone is used.) The Hamza and Bryson article sheds light on some of the problems associated with this practice and with the state monitoring systems (eg, physician health programs [PHPs]) that are in place to secure recovery from addiction and protect the public. Our colleagues in addiction medicine have engaged in bipartisan clinical decision making related to the use of buprenorphine. There are zealots on both sides: some advocate for everyone with opioid dependence to have maintenance buprenorphine treatment, whereas others believe that no one should use it. Without scientific inquiry and data, we lack predictors to help determine the appropriate use of this treatment for our patients. Opioid-dependent HCPs are a distinct, singular group, but the literature reviewed by Hamza and Bryson and their documentation of state policies for the use of this treatment help us to understand buprenorphine's shortcomings in this population as well as limitations of the state monitoring systems, such as PHPs. This article exposes a buprenorphine practice that is relatively unsupported by literature and does not account for risks associated with cognitive deficits. The article also reveals how the lack of national standards for decision making on the timing of HCPs' return to work promotes variable decisions and potential risks.