Addiction – A Tale of Two Survivors Michael Sprintz, DO Mark Baskerville, MD Anesthesiology and Perioperative Medicine July 21, 2014

Circa 1998

JAMA – December 2013

Substance Use Disorder Incidence 1 in 80 will develop a Substance Use Disorder

Occupational Mortality Rate per 100,000 worker years Commercial Fisherman 21.2 Police Officers 18.6 Truck Drivers 13.3 Firefighters 2.5 Healthcare Workers 0.7

15.7 6 times Fire Fighters 22 times Healthcare Workers

Monitor Your Own Pulse Leave Control in the OR Respect Boundaries 4. Learn to Ask for Help

I care about your health

Low-tech Audience Response! Do you know of someone in anesthesia found to be diverting controlled medications? Do you know of someone who has died of a drug overdose who is in a healthcare related field?

Prevalence of Burnout in Residents and Physicians in Practice Burnout rates of 30 to 76% seen across 15 studies of residents: multiple years, types of programs, US and International teaching hospitals represented (Thomas, 2004) Similar burnout rates among physicians in practice (Chopra et al., 2004) 46-80% moderate to high EE 22-93% moderate to high DP 16-79% moderate to low PA Lower rates of burnout among academic physicians (Tait, 2003) 37-47% burnout in academic physicians vs. 60% burnout in physicians in private practice

Physicians in Training and Practice vs. General Population Higher rates of burnout, stress Similar to higher rates of depression Similar rates of substance abuse Higher rates of suicides—especially for women 300 to 400 physician suicides (Center et al., 2003; Shanafelt et al., 2012)

OHSU Resident & Faculty OHSU Resident and Faculty Wellness Program OHSU Resident & Faculty All OHSU and Legacy residents and fellows All OHSU SOM faculty (0.5 , >FTE) Started in 2004 Left to right: Sydney Ey, Ph.D., Dan Helfet-Hilliker, M.D., Mary Moffit, Ph.D., Mark Kinzie, M.D.

How to Reach RFWP Clinicians To schedule an appointment or get consultation re: trainee/faculty concern: Directly email or page any of the providers listed at www.ohsu.edu/rfwp Urgent consultation: RFWP pager 1-0975

Resident and Faculty Wellness Program Confidential, free coaching, counseling and medication management Limits to Confidentiality: risk to patient safety or danger to self or others Private, on-site location EMR: but not in EPIC and you can opt-out of EMR Meeting w RFWP is not reportable to medical board “Impairment is reportable, treatment is not” Schedule directly by emailing any of 3 providers Hours: Mon-Thurs 9-7, Fri 9-5 Briefly mention that we are trying to lower known barriers to physicians’ seeking help—stigma, time, confidentiality, reportability, helpfulness of counseling

Positive Outcomes (Ey, Moffit, Kinzie, Choi & Girard, 2013) 88% of OHSU residents, fellows (N = 448; 71%) knew about our program 87% OHSU residents, fellows “somewhat to very willing” to seek counseling Utilization rate (new cases per yr) from 5% to 17% in 8 yrs 93.9% of clients “very or mostly satisfied” PDs satisfied w/ referral process/consult

(Ey, Moffit, Kinzie, Choi & Girard, 2013) Barriers Still Exist (Ey, Moffit, Kinzie, Choi & Girard, 2013)

“Reaching Out” Research Aims IRB approved study, funded by GME Suicide prevention among medical residents, fellows, and SOM faculty by: Reducing risk factors of untreated depression and substance use, hopelessness and isolation Increasing protective factors of greater self-awareness, strong coping skills, increased connection, and access to effective MH treatment if needed

Stress and Depression Survey We invite all OHSU residents, fellows and School of Medicine faculty to participate in this important new physician wellness initiative. Please take the OHSU Stress and Depression Survey. Click on this link: https://www.ohsuwellness.org/welcome.cfm

Invitation to Take Stress and Depression Survey User can take the Stress & Depression Survey by creating a self-assigned User ID and Password (encrypted) The User ID is the only way user is known to our clinicians Only aggregate data reported

Our Clinician Response & Dialogue User may provide an email address to be notified when our team’s response is posted or sign back on to the ISP site User’s email address is encrypted to protect identity, not known to anyone, including our clinical team Our clinician responds with feedback, resources, offer to meet in person if appropriate

Pilot with OHSU SOM Trainees/Faculty April-June 2014 Response rate: 23% (N=91) 78% of OHSU users reviewed clinician response 16% of OHSU users dialogued with clinician High distress: 15% Suicidal ideation in past 2 weeks: 6% Due to survey, sought treatment at RFWP: 12% “realized that I needed to take better care of myself” “survey made it easier to come in”

Strategy to keep our team members safe Encourage balanced approach to life Readily available counseling within department and OHSU More stringent monitoring of pharmacy transactions and returned medications More realistic guidelines for testing for drug use.