Doctors who abuse prescription drugs often "self-medicate" for physical or emotional pain or stress relief, according to a new paper.

Based on focus groups with physicians in treatment for substance abuse, the findings lend insight into the reasons why doctors abuse prescription medications—as well as important implications for prevention and recognition. The lead author was Lisa J. Merlo, PhD, MPE, of the University of Florida, Gainesville.

In anonymous discussions, the researchers talked about reasons for prescription drug abuse with 55 physicians in recovery. The doctors were being monitored for substance abuse as part of their state's physician health program. Sixty-nine percent of the physicians had abused prescription drugs, in addition to alcohol and illicit drugs.

Of five major themes that emerged in the focus groups, three were related to "self-medication" using prescription drugs. The doctors reported using medications for self-treatment of:

• Physical pain—Many physicians initially developed their drug habit while using medications prescribed for chronic pain after trauma or surgery.
• Emotional pain and psychiatric symptoms—Some doctors found that prescription drugs finally gave them an effective treatment for " longstanding problems with anxiety or depression."
• Work and life stress—The physicians commonly used medications to relieve stress related to their personal or professional life.

Like other substance abusers, many of the physicians said they also used drugs recreationally—to "get high." Others said they used prescription drugs to treat symptoms of drug withdrawal. For many doctors, as their addiction problem progressed, managing withdrawal became an increasingly important reason for drug use.

The rate of drug misuse by doctors is similar to that in the general population. However, because they have access, physicians seem more likely to use prescription drugs. Substance use is the most common cause of impairment among physicians. Their professional colleagues are required to refer or report them when substance abuse is suspected.

Physician health programs provide referrals for long-term treatment, monitoring, and drug screening, with a high success rate in achieving long-term freedom from substance abuse. Asking physicians in recovery about their experience provides a unique opportunity to understand the reasons for substance abuse by health care professionals.

The findings highlight the importance of self-medication as a reason for prescription drug abuse by doctors, although recreational use is important as well. The study "provides additional evidence that health care professionals who misuse prescription drugs may represent a special population of substance users, who may use substances for various reasons and may require different methods of prevention and intervention to be most effective," Dr Merlo and coauthors write.

The researchers suggest that prevention efforts targeting prescription drug misuse by physicians should start during medical training, with required continuing education throughout their careers. Education should include strong messages to doctors that they must seek qualified medical care for pain or other medical problems, as well as for psychiatric or emotional concerns—rather than trying to treat themselves. Dr Merlo and colleagues add, "All physicians should learn the signs of substance abuse and the procedure for intervening with a colleague suspected of substance-related impairment."

Citation: Merlo, Lisa J., Singhakant, Supachoke, Cummings, Simone M., 'Reasons for Misuse of Prescription Medication Among Physicians Undergoing Monitoring by a Physician Health Program', Journal of Addiction Medicine, 7(5):349-353, September/October 2013 doi: 10.1097/ADM.0b013e31829da074