Massachusetts General Hospital and the Cleveland Clinic Foundation have started random urine drug testing in anesthesia residency teaching departments, doing battle with an addiction problem that has long plagued a profession with easy access to powerful drugs, ABC News reported Nov. 12.

Doctors in favor of drug testing argue that early detection and deterrents can significantly decrease the impact of addiction among anesthesiologists. Michael Fitzsimons, administrator for the substance abuse program of the department of anesthesia and critical care at Massachusetts General Hospital in Boston, estimates that treatment and rehabilitation costs alone may reach $100,000 per doctor, without even accounting for time spent out of work.

Obstacles to implementing a drug-testing program for anesthesiologists include the expense associated with testing, the ability of doctors to mask their drug use or manipulate test results, and the impression that the tests are demeaning. But Fitzsimmons reports few problems with the Mass General program.

Anesthesiologists are at highest risk of addiction during residency, according to Gregory Collins, section head of the Alcohol and Drug Recovery Center, at the Cleveland Clinic Foundation, when they are in a high-stress environment and have seen the powerful effects of drugs, but do not have a lot of experience.

"These kids think they can manage this, that they know how to use the drugs. They'll take that risk and do it," said Collins. "They think they'll just take a little bit and be done, but it really doesn't work that way."

According a survey conducted by the Cleveland Clinic, 80 percent of anesthesiology residency training programs report difficulties with drug-impaired doctors, with 19 percent reporting an overdose death.

Arnold Berry, an anesthesiologist and member of the Committee on Occupational Health of the American Society of Anesthesiologists, estimated that one to two percent of anesthesiologists are addicted to medication. "The most recent study in training programs suggests the (addiction) rate has stayed the same for 20 years," he said.

"The problem is that we are exposed to, and we have the use of, very highly addictive and potent medications," said Fitzsimons. The drugs fentanyl, which is 1,000 times stronger than morphine, and sufentanyl, which is 1,000 times stronger than fentanyl, are often misused, according to Collins.

"Although the percentages are not high, when you do have a case, often you discover it when they're dead. The first thing you often realize in these cases, it's a kid dead in the bathroom with a needle in his arm," said Collins.