The New York Times last week wrote that fentanyl is now the go to drug for former heroin addicts. Fifty times more powerful than heroin, fentanyl works faster and is cheaper to acquire on the streets. Last year in New Hampshire, fentanyl was attributed to 158 deaths while heroin only 32. A drug dealer can easily obtain fentanyl from his wholesaler and make $35,000 per week.
As the epidemic of drug addictions continues to spread around the country, to me it is a testament to the willpower and resolve of anesthesiologists that not more of us aren't addicts. Let's face it, anesthesiologists alone are the only physicians who routinely draw up and administer medications to patients without the aid of another person. All other doctors write orders for drugs which must be retrieved from the pharmacy and given to the patient by another party. We anesthesiologists have nearly unfettered access to highly addictive substances like fentanyl, methadone, ketamine, and yes propofol. Nobody bats an eye when we order up a narcotic and charts its use with nary any oversight. Whether we actually gave it to the patient is knowable only to the anesthesiologist.
Even the use of the Pyxis machine to dispense drugs is dependent on the trustworthiness of the anesthesiologist. When I need to document the return of any unused narcotic to the machine, I need to have another person witness my half used syringe as the drug I claim to be returning, usually a nurse in the recovery room. However, it is only a syringe of clear liquid with a label on top. It could be a syringe of sterile water that I labeled as fentanyl or dilaudid and the nurse would never know. They are trusting me as the physician to tell the truth about the drugs I am wasting. If an anesthesiologist is truly a drug addict, it would be all too easy to save the actual leftover narcotic for themselves and waste the fake syringe.
So instead of mischaracterizing anesthesiologists as junkies who got a medical degree, one should admire our fortitude to resist the enormous temptations that accompany our job every day. Though an unfortunate number of us do succumb to an addiction, the vast majority handle these dangerous substances with expert care and professionalism. Sadly, too many Americans are not able to do the same.