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Substance abuse /chemical dependence |
CURRENT LEGISLATION
AND FUTURE OPTIONS
Drug abuse by anaesthetists can be divided into:
(1) chronic substance abuse
(2) suicide utilizing pharmacological knowledge.
Neither category of drug abuse will be totally prevented by
clerical methods of drug handling.
PREVENTION
OF DRUG MISAPPROPRIATION
In NSW Public Hospitals drug handling should comply with
NSW Health Department Circular 95/37. Failure to comply with
the mandatory requirements of this document may not be
noticed until a drug related critical incident occurs. At
that time causation may be suggested between the failure of
compliance and personal harm. This may or may not have some
basis in reality.
Broadly speaking only two rules significantly impact on
anaesthetic care. Firstly, all unused opioids should be
disposed of and these discards must be recorded (on the
anaesthetic sheet is acceptable). Secondly, opioids should
only be drawn up for the imminent use on one patient.
Labelling the anaesthetic drug trolley as an emergency or
resuscitation trolley may obviate the need to implement more
restrictive drug handling measures. Placing separate opioid
safes in individual theatres may also make compliance with
regulations easier.
MANAGEMENT OF DRUG DEPENDENCE
The management of chemical dependence in the
anaesthesia department requires awareness and planning.
Protocols exist and these are largely local modifications of
the 1991 American Society of Anaesthesiology Chemical
Dependence Guidelines.
These state that substance abuse is a medical disease
incompatible with safe anaesthetic practice. The Chief of
Anaesthesia, after expert consultation, decides if any staff
member is suffering from chemical dependence. The affected
member must accept this judgement. This person is
immediately placed on leave and assessment and treatment
begins. If there is an error in diagnosis all references are
expunged from the staff members employment records. Return
to work is governed by Chemical Dependence Re-entry
Policy.
A modification of this approach, reflecting different
departmental structures and work practices in this country,
is under consideration by the Australian and New Zealand
College of Anaesthetists.
(Copies of NSW Health Department Circular 95/38 are
available by phoning (02) 93919010)
Dr Peter Cook is an intensivist/anaesthetist in Lismore, NSW 2480, Australia
PHONE (02) 6622 1285
FAX (02) 6622 0740
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