BioEd Online

Do the faint traces of anaesthetics that waft around operating rooms somehow prime physicians to become drug addicts?

It's not as unlikely a proposal as it sounds. US researchers who have promoted the theory have released their latest findings, and the results strengthen fears that exposure to aerosolized drugs puts anaesthetists and surgeons at risk.

The new data comes from a trawl of records on health problems among medics working in Florida. Trainee surgeon Priscilla McAuliffe and colleagues at the University of Florida in Gainesville found that although anaesthetists make up less than 5% of the state's licensed physicians, they accounted for 12% of the 150 physicians who began treatment for substance abuse in 2002¹.

Surgeons also made up a good chunk of the physicians being treated for addiction. And these surgeons disproportionately took the opiates used in anaesthetics as their drug of choice, the team has found. Whereas around 25% of all physicians treated for addiction were abusing opiates, among surgeons this figure was 40%.

The data is particularly striking for a very common anaesthetic called fentanyl. Reporting their results in June last year at a meeting of the College on Problems of Drug Dependence in Orlanda, Florida, McAuliffe's colleagues have found that 94% of physicians reporting addiction to fentanyl were anaesthetists or surgeons.

Something in the air

Similar associations have been noticed before, and previously these results have been put down to the fact that anaesthetists and surgeons have easier access to opiates than most of their colleagues.

But the University of Florida team, which sampled air from operating rooms, say that traces of gaseous anaesthetics could be the cause. In McAuliffe's paper, for example, fentanyl was found near the needles used to inject the drug and in the air exhaled by patients.

Mark Gold, a psychiatrist at the University of Florida who has pioneered studies of the exposure hypothesis, says that research into other addictions suggests that the aerosolized opiates could be the root of the problem. Children of smokers are known to be more likely to take up smoking, for example. One cause is thought to be changes to areas of the brain involved in addiction, brought on by exposure to smoke.

Gold's team is currently assessing whether fentanyl can be detected in the blood of surgeons and anaesthetists after they have worked in an operating room.

"Length of procedure and dose of fentanyl and propofol administered during surgery are important variables," he says. "Anesthesiologists also have different practice habits. Some wear no mask even for an 8-hour procedure, and take no breaks whatsoever."

"I think this finding is striking," says Martin Plant, an addiction researcher at the University of the West of England in Bristol, UK. "It charts the need for new research related to this fascinating but preliminary discovery."

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