Chemical dependence is a devastating disease that must be recognized before it can be treated. In most cases, the addict is the last to acknowledge the problem. Thus, it is imperative that we—the friends, colleagues, and relatives of the addict—gain a clear understanding of the disease before we are confronted with it.

Chemical dependency, especially opioid addiction, is an occupational hazard for anesthesia providers. We have access to highly potent synthetic opiates in anesthesia practice and work in a stressful environment. Opioid abuse in anesthesia personnel typically occurs in the workplace; independent of the geographic location in which the abuse takes place, there are many tragic reports of anesthesia providers suffering severe illness (e.g., anoxic encephalopathy) or even fatality from an overdose of self-administered opioids.

Although anesthesia providers are at risk of becoming addicted to the same licit (e.g., ethanol) and illicit drugs (e.g., cocaine) as society at large, the “drug of choice” for anesthesia providers undergoing rehabilitation for chemical abuse is typically fentanyl or sufentanil, although ethanol, propofol, marijuana, and cocaine remain common drugs of abuse. Of 45,581 residents entering the American Board of Anesthesiologists certification process in the years 1975-2009, 384 were confirmed to have developed a substance use disorder (SUD) while in residency, for an overall rate of 2.16 per 1000 resident years. Of those, 26 died in training and 2 died shortly after completing residency, all of SUD-related causes. Despite efforts to educate residents on the dangers posed by SUD, the incidence is increasing.

Fentanyl, available as a street drug, is considered by addiction medicine specialists to have an addictive potential similar to that of “crack” cocaine. It carries the risk of extremely rapid addiction (Figure 254-1). This rapid effect is in contrast with that of ethanol or even other opioids, such as morphine or meperidine, for which a longer period of abuse is typically required before psychological and physical addiction occur.