Drug diversion by anesthesiologists: Identification through intensive auditing

Physicians’ rates for misuse of opioids are up to five times higher than those in other professions,1 and anesthesiologists are up to four times more likely to be treated for drug addiction than physicians in other specialties.2 Furthermore, physician drug abuse has been linked to an increased risk of suicide,1,3 and the physician suicide rate is twice that of the general population, with anesthesiologists having the highest suicide rate of all physicians.1 Because of its fast-acting effects and highly effective pain relief, fentanyl has consistently been the most commonly abused medication among anesthesiologists.1,4 Despite measures in more recent years to monitor controlled substances and restrict their availability to anesthesiologists, these physicians’ relatively easy access to these drugs continues to be the major theory advanced for the high rate of diversion and abuse within the specialty.2 We intermittently audit all surgical procedures in our institution for a given time period (usually one month) by extracting data from anesthesia records and comparing them with proof-of-use documents such as narcotic records and automated dispensing machine (ADM) records. Variables such as patient age and weight, surgery time, anesthesia time, and use of reversal agents are included. These data are then compared for individual anesthesiologists. We have observed not only the usual problems associated with poor record keeping but also identified a practitioner who appeared to be diverting fentanyl. Although the individual’s record keeping was impeccable, with good agreement between the anesthesia record and the ADM documentation, his use of fentanyl (in terms of amount per patient weight) was 1.5–2.5 times that of his peers (table). His use of other agents was similar to that of his peers, as were his anesthesia and surgery times and his use of reversal agents.