Pubdate: Fri, 01 Oct 2004
Source: Daily News, The (South Africa)
Copyright: 2004 The Daily News.
Author: Jillian Green


Dependency problems begin from as early as their student years

Increasing numbers of doctors are becoming drug addicts, because it is so
easy to prescribe themselves potent drugs.

Pethidine (a pain killer), morphine and even marijuana seem to be the drugs
of choice of some medical practitioners who are battling to cope with their
demanding jobs.

Forty-eight-year-old Jenna (not her real name), a medical professional and
specialist in public health, has been a dagga addict for the "better part of
my life" and until recently she did not think that her habit was a problem.

"I was a functioning addict, I have four degrees and had even been granted a
scholarship to further my studies. And when my professional life started
falling apart I blamed it on the work I was doing, not my drug habit."

It was only when Jenna's therapist told her that she needed to give up drugs
that she started to see her addiction for what it was - a hindrance to her
ability to get the job done.

Before going on to a rehabilitation programme, Jenna was smoking at least
two joints before going to work and then more when she got home.

"For three years I was trying to pull myself together, but I did not see the
problem drugs were causing," she said.

While Jenna was on dagga, she had difficulty facing problems and
difficulties at work, "but that has all changed now".

Jenna enrolled herself into a drug rehabilitation programme at First Step
Recovery Centre and has been "clean" for more than six months now.

"I am more focused on my job, I am able to tackle problems head on. My whole
life has turned around. Suddenly life is exciting. Six months ago I would
not have believed this would have happened," she said grinning.

But Jenna is not alone in her drug addiction.

According to a study highlighting the use of drugs by doctors, published in
the South African Medical Journal (SAMJ), substance abuse by doctors begins
from as early as their student years and continues well into their careers.

The study, done by Dr Elca Erlank of the Stabilis Treatment Centre in
Pretoria, was based on in-depth interviews with 15 general practitioners and
three anaesthetists - all of whom are recovering addicts.

According to the SAMJ report, seven of the participants (35%) developed a
substance dependency problem during their training years.

Meanwhile, 77% of the anaesthetists said the lack of any support system
within their profession was a contributing factor to the development of
their addiction.

"A full 75% of the respondents had been clean for less than 24 months and
were still practising. All had personality traits which predisposed them to
experiencing stress more intensely," the SAMJ report read.

In the study, a military doctor describes how he succumbed to the use of
Pethidine after working three straight days.

"I remember reading somewhere that if you're very tired you could inject
just a little bit of Pethidine. So I did it, worked for another day and then
slept," he said.

This became the norm for the doctor and he even started using the drug when
he was depressed. Soon he was using morphine as well.

"I was buying in bulk from SA Druggists. You know what con artists we
become. I would pull on my military uniform and say 'it's top secret and I
can't tell you why I need it' or something like that . . ."

Before long the doctor had opened drug accounts around the country and the
lack of computer co-ordination and monitoring by chemists allowed him to
continue undetected.

An anaesthetist who is quoted in the study said he started using drugs
because he found himself unable to handle the stress of difficult cases.

"I was doing incredibly difficult cases on my own at night without
supervision," he said.

The increase in the use of drugs by health practitioners, particularly
prescription drugs, has resulted in the Health Professions Council of South
Africa incorporating the management of these practitioners, previously
managed by the Medical and Dental Professions Board's Health Committee, into
their functions.

"The health committee is now accountable to the council's executive
committee and will be responsible for establishing policies and procedures
and will seek co-operation and support for the prevention or alleviation of
circumstances which may lead to impairment in students and practitioners.

"The committee will also establish mechanisms and procedures for the early
identification of impairment in students and practitioners and oversee the
implementation of treatment programmes for such individuals," spokesman for
the HPCSA Phephela Makgoke said.

Makgoke said a process which involved non-punitive measures seemed to be
working well with an increase in co-operation by the profession.

"The committee assumed the role of providing support to practitioners in
effectively managing their impairment rather then penalising them for it.

"Where necessary practitioners have been restricted to supervised practice
while undergoing suitable treatment or, in more severe cases, temporary
suspension linked to specific measurable achievements in treatment," Makgoke

He said that what was of particular concern to the committee as well as the
HPCSA was the high incidence of dependence on Pethidine among practitioners.

According to psychologist Dan Wolf, at First Step Recovery Centre, Pethidine
has the ability to obliterate any level of emotional turmoil.

"The user is left with a euphoric feeling and addicts talk about their drug
as if it's a lover. This is their primary relationship," Wolf said.

Meanwhile, Makgoke said urgent discussions with the Pharmacy Council aimed
at devising means to restrict the availability of Pethidine were needed.

"The Medical and Dental Professions Board recommended to the HPCSA that the
Medicines Control Council be approached so that the sale of Pethidine in
pharmacies be abolished and its use be limited to hospitals, in particular
to the practice of obstetrics."

He added that the committee was also looking at ways of regulating
self-prescribing in conjunction with the Committee on Human Rights, Ethics
and Professional Practice.

"A policy ruling will be made available soon," he said.
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