Substance use disorder in South African departments of anaesthesiology: profile and management experiences

Abstract

Background: Substance use disorder (SUD) is the most common cause of impairment amongst physicians and anaesthesiology is one of the specialities with the highest rates of SUD. The aim of this study was to describe the experiences of clinical heads of departments of anaesthesiology with regards to management of SUD and to profile SUD amongst anaesthetists in academic public sector hospitals in South Africa over the past 10 years (January 2009 - December 2018). Methods: This was a prospective, contextual, descriptive study. A survey was sent to clinical heads of academic departments of anaesthesiology throughout South Africa via SurveyMonkey. Questions addressed the clinical heads of departments¶ experience and training on SUD management and specific cases of SUD, including substances abused and identifying signs. Results: The sample realisation was 69%. Sixty-five percent of academic departments of anaesthesiology had a wellness committee, 25% had a formal policy on SUD management and 10% offer formal education or training to their employees. Ten percent of the clinical heads of department had received training on SUD management. With regards to SUD management, 65% of clinical heads of department felt equipped and 55% felt confident. The major limiting factor in reporting a case of SUD was a fear of harmful consequences or disciplinary action against the employee. Twenty confirmed cases of SUD were reported, with 94.7% of departments reporting one or more suspected case of SUD. Opioids were abused in 65% of the confirmed cases reported and fentanyl was the most common opioid abused. Two deaths were reported. Conclusion: This study emphasises the problem of SUD amongst anaesthetists and highlights the limited training on SUD management received by clinical heads of departments, as well as the limited formal training of anaesthetists about SUD