Despite Taboo, Med Students, Doctors Use Substances Too

Some young European medical students and residents were recently candid with VICE Belgium about their off-duty substance use habits.

Using pseudonyms, VICE Belgium detailed how the young doctors partied regularly — often using substances ranging from alcohol and cannabis to MDMA and cocaine. Despite some scary situations, as a whole they didn’t think their substance use reached problematic levels.

“According to them, taking drugs is pretty common in the medical field, but people don’t talk about it as that would call into question the sacred status of the entire profession,” the article stated.

Experts caution that substance use can lead to problems and it’s important for anyone — especially doctors — to seek help if things start to get out of control.

Peter Grinspoon, MD, of Massachusetts General Hospital and instructor in medicine at Harvard Medical School in Boston, is outspoken about his past experiences with opioid use disorder. He told MedPage Today that while the doctors in the article didn’t think they had substance use problems, “it really didn’t sound like any of the different doctors had it completely under control.”

And it can’t be overlooked that doctors have unique jobs in which others’ well-being is at stake. “When you’re a doctor, you take an oath to do no harm. You can’t be up all night drinking or doing ecstasy the day before seeing patients because you just won’t be at your best and you have an obligation to help people,” Grinspoon said. “At the same time, I think there are ways that doctors can use drugs, and use alcohol, and use cannabis that don’t at all impact their ability to practice medicine.”

The line between recreational use and a problem can be fuzzy. Grinspoon is now 15 years in recovery, but his history with addiction informs his work as a physician. He said that doctors, like anybody else, can be curious about drug use.

“People have always used drugs and it’s very arbitrary which drugs our society calls the good drugs or the bad drugs,” he noted. “I think people hear about these drugs, and in some ways they’re stigmatized and in other ways sort of glamorized in the media.”

“There’s just an epidemic of burnout — two-thirds of doctors — plus moral injury and people feeling like they just can’t do a good job or they’re just beaten down,” he added. “I think doctors are experiencing a lot of guilt, a lot of shame, a lot of stress and a lot of nihilism, and a lot of despair about the future. So I think that doctors are particularly susceptible to drugs.”

Earlier this year, the Association of American Medical Colleges wrote about physicians’ mental health challenges — from anxiety to burnout. Physicians die by suicide at twice the rate of the general public and residents report depression at more than three times the rate of non-physicians. Data from the American College of Emergency Physicians from 2020 also revealed that the vast majority of emergency physicians reported feeling more stressed than usual due to the COVID-19 pandemic. Even in non-pandemic times, the medical field is a high-stakes profession.

Then there’s the intense training to become a doctor in the first place. Anees Bahji, MD, clinical assistant professor of psychiatry at the University of Calgary in Alberta, Canada, said the substance use patterns in the VICE Belgium article likely apply to North America as well, since the training and roles are similarly intense.

“Medical students and residents may experience high levels of stress and pressure, which could contribute to drug use as a coping mechanism,” Bahji told MedPage Today.

Plus, doctors face cultural pressure to practice what they preach, in part because of their deep understanding of the body’s systems.

“In some cases, there may be a culture of secrecy or reluctance to openly discuss drug use among medical professionals due to the potential stigma and professional consequences,” Bahji said. “However, the [VICE Belgium] article suggests that some doctors do engage in drug use, albeit discreetly, and may have their own peer groups or communities where this behavior is more accepted or normalized.”

“Doctors often have access to pharmaceuticals and medical knowledge that may influence their choices and perceptions of drug use,” he added.

Erin Ayala, PhD, a sports psychologist listed on the U.S. Olympic & Paralympic Committee Mental Health Registry, whose previous postdoc research involved creating self-care and mental health programming for medical students, said she’s witnessed an “if you know better, do better” mentality directed at physicians’ substance use habits. She also saw partying as a part of the med school cycle; med students push really hard for several weeks to learn a topic, test on the material, then party hard to celebrate before the cycle repeats.

“There was this sense of … before we have to ramp up again for this next unit, we have to blow off steam,” Ayala said. “They’re human too. And they have stressors too. And this is an outlet that some people go to.”

When it came to meeting scholastic demands, Ayala came across many med students using stimulants like methylphenidate (Ritalin) and mixed amphetamine salts (Adderall) to increase focus.

But if drug use becomes a problem, it’s hard to seek help, especially when professional consequences are on the line. For instance, the National Practitioner Data Bank has guidelines for reporting impaired providers.

Grinspoon advocates for destigmatizing substance use among medical professionals — so that people can get the help they need and continue to be responsible providers.

“If you allow these things to be publicly discussed, and don’t just take a reactionary attitude, there’s much more opportunity for dialogue, education, harm reduction,” he said. “So I tend to think when things are out of the closet, and you know, not hidden away, they’re much safer.”

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