Featured Research

from universities, journals, and other organizations

Programs for treating addiction in doctors pose ethical issues

Date:
October 15, 2012
Source:
Wolters Kluwer Health
Summary:
State physician health programs (PHPs) play a key role in helping doctors with substance abuse problems. But the current PHP system is inconsistent and prone to potential conflicts of interest and ethical issues, according to a new review.

State physician health programs (PHPs) play a key role in helping doctors with substance abuse problems. But the current PHP system is inconsistent and prone to potential conflicts of interest and ethical issues, according to a new review.

The review is available as publish ahead of print content from the December 2012 issue of Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine. The journal is published by Lippincott Williams & Wilkins, a part ofWolters Kluwer Health.

In the article, Drs J. Wesley Boyd and John R. Knight of Harvard Medical School point out "substantial variability in states' PHP policies and practices, often raising serious ethical and managerial questions." Collectively the authors served as PHP associate directors for more than 20 years; based on that experience they write, "We recommend that the broader medical community begin to reassess PHPs as a whole in an objective and thoughtful manner."

'Coercive' Nature of PHP System Raises Ethical and Managerial Issues

Most states currently have PHPs, which help physicians with substance abuse disorders. State PHPs meet with, assess, and monitor doctors referred for substance abuse or other mental and behavioral health problems. hey also make provisions for follow-up and monitoring of treated physicians, including random drug testing.

The PHP system achieves good results in treating substance abuse disorders in physicians, with much higher success than reported for other groups of patients. However, Drs Boyd and Knight identify several ethical concerns related to the "coercive" nature of the system. They write, "Once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations if they wish to continue practicing medicine."

One issue is the high cost of evaluation and treatment. Insurance sometimes does not reimburse physicians for evaluations recommended by PHPs -- a cost sometimes exceeding $4,500. If treatment is recommended, the cost may be prohibitive: as high as $39,000 for a "standard" 90-day length of treatment. That's much longer than the 20- to 28-day stay typical for other patients undergoing substance abuse treatment -- despite a lack of evidence that health care professionals need longer treatment.

Many centers who provide PHP-recommended evaluations also provide treatment, thus raising the potential for financial incentives for treatment recommendations. Drs Boyd and Knight note that close relationships between treatment centers and state PHPs are "replete with potential conflicts of interest."

The authors also point out problems related to the practice of some PHPs that "any and all" positive test results be reported to the state licensing board -- even if they don't indicate substance abuse or relapse. Today's highly sensitive tests can give a positive result even in a person who has used alcohol-based hand sanitizer, as well as some types of asthma inhalers and pain medications. PHPs may instruct doctors to avoid these exposures to simplify interpretation of test results, "rather than what might be in the best interests of the physician."

Use of information about physicians in research by PHPs and their closely intertwined relationships with state licensing boards raise concerns as well. Because most doctors know little about them, PHPs "operate outside the scrutiny of the medical community at large," the authors write. "Physicians referred to PHPs are often compromised to some degree, have very little power, and are therefore not in a position to voice what might be legitimate objections to a PHP's practices."

Drs Boyd and Knight outline recommendations to address the perceived problems. They believe that some form of independent ethical oversight of PHPs should be considered, along with a formal appeals process and a nationwide system for licensing and periodic auditing. They also call on specialty organizations such as the American Society of Addiction Medicine "to review PHP practices and recommend national standards that can be debated by all physicians, not just those who work within PHPs."


Story Source:

The above story is based on materials provided by Wolters Kluwer Health. Note: Materials may be edited for content and length.


Cite This Page:

Wolters Kluwer Health. "Programs for treating addiction in doctors pose ethical issues." ScienceDaily. ScienceDaily, 15 October 2012. <www.sciencedaily.com/releases/2012/10/121015112842.htm>.
Wolters Kluwer Health. (2012, October 15). Programs for treating addiction in doctors pose ethical issues. ScienceDaily. Retrieved October 1, 2014 from www.sciencedaily.com/releases/2012/10/121015112842.htm
Wolters Kluwer Health. "Programs for treating addiction in doctors pose ethical issues." ScienceDaily. www.sciencedaily.com/releases/2012/10/121015112842.htm (accessed October 1, 2014).

Share This



More Science & Society News

Wednesday, October 1, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

US Police Put Body Cameras to the Test

US Police Put Body Cameras to the Test

AFP (Oct. 1, 2014) Police body cameras are gradually being rolled out across the US, with interest surging after the fatal police shooting in August of an unarmed black teenager. Duration: 02:18 Video provided by AFP
Powered by NewsLook.com
Ebola Cases Keep Coming for Monrovia's Island Hospital

Ebola Cases Keep Coming for Monrovia's Island Hospital

AFP (Oct. 1, 2014) A look inside Monrovia's Island Hospital, a key treatment centre in the fight against Ebola in Liberia's capital city. Duration: 00:34 Video provided by AFP
Powered by NewsLook.com
Ebola Puts Stress on Liberian Health Workers

Ebola Puts Stress on Liberian Health Workers

AP (Oct. 1, 2014) The Ebola outbreak is putting stress on first responders in Liberia. Ambulance drivers say they are struggling with chronic shortages of safety equipment and patients who don't want to go to the hospital. (Oct. 1) Video provided by AP
Powered by NewsLook.com
App Teaches Kindergarteners to Code

App Teaches Kindergarteners to Code

AP (Oct. 1, 2014) They can't all read yet, but soon kindergarteners may be able to create basic computer code. Researchers in Massachusetts developed an app that teaches young kids a simple computer programming language. (Oct. 1) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Science & Society

Business & Industry

Education & Learning

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins