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 July 24, 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 July 24, 2014).

Share This




More Science & Society News

Thursday, July 24, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Boeing Ups Outlook on 52% Profit Jump

Boeing Ups Outlook on 52% Profit Jump

Reuters - Business Video Online (July 23, 2014) Commercial aircraft deliveries rose seven percent at Boeing, prompting the aerospace company to boost full-year profit guidance- though quarterly revenues missed analyst estimates. Bobbi Rebell reports. Video provided by Reuters
Powered by NewsLook.com
Thousands Who Can't Afford Medical Care Flock to Free US Clinic

Thousands Who Can't Afford Medical Care Flock to Free US Clinic

AFP (July 23, 2014) America may be the world’s richest country, but in terms of healthcare, the World Health Organisation ranks it 37th. Thousands turned out for a free clinic run by "Remote Area Medical" with a visit from the Governor of Virginia. Duration: 2:40 Video provided by AFP
Powered by NewsLook.com
Six Indicted in StubHub Hacking Scheme

Six Indicted in StubHub Hacking Scheme

AP (July 23, 2014) Six people were indicted Wednesday in an international ring that took over more than 1,000 StubHub users' accounts and fraudulently bought tickets that were then resold. (July 23) Video provided by AP
Powered by NewsLook.com
9/11 Commission Members Warn of Terror "fatigue" Among American Public

9/11 Commission Members Warn of Terror "fatigue" Among American Public

Reuters - US Online Video (July 22, 2014) Ten years after releasing its initial report, members of the 9/11 Commission warn of the "waning sense of urgency" in combating terrorists attacks. Mana Rabiee reports. Video provided by Reuters
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:
from the past week

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