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Members of the American Medical Association (AMA) endorsed new policies to support physicians receiving treatment for substance use disorders, as well as for those with disabilities or illness, during the House of Delegates special meeting on Tuesday.

The policy affirms "that no physician or medical student should be presumed impaired" because of a decision, in collaboration with their treating physician, to receive medication for opioid use disorder.

Author of the proposed policy, Frank Dowling, MD, an addiction psychiatrist and delegate of the Medical Society of the State of New York, explained during the virtual reference committee meeting on Sunday that half of the rehabilitation facilities in the country do not allow medication for opioid use disorder or else "frown against" it. Likewise, physician assistance programs too often refer participants to programs where such medications aren't available, they said.

Promoting Treatment, Ending Stigma

Rodney Alford, MD, an alternate delegate from the Illinois State Medical Society, speaking on his own behalf, said a "very close friend" of his and a "promising neurosurgeon" died because there wasn't a program where he could receive medication for his opioid use disorder.

"He should have had this treatment available to him without the fear of stigma or being labeled 'impaired' due to his medical condition or its treatment," Alford said.

During the House of Delegates "floor" discussion on Tuesday, proponents of the policy succeeded in amending the resolution to include both buprenorphine and methadone as potential treatments.

While at least one delegate raised concerns that methadone could impair physicians' judgment, others argued that the benefits of treatment outweighed any potential harms.

A lot of medications influence how people think -- for instance, by making them sleepy -- said Jerry Halverson, MD, a delegate for the American Psychiatric Association, speaking for himself.

But methadone is "cheap," "effective," and "saves lives all over the place," he said. "Discrimination against methadone is discrimination against addiction."

The amended resolution was adopted with more than 90% of delegates voting in its favor.

Embracing Physicians With Disabilities

Joanna Bisgrove, MD, speaking for the American Academy of Family Physicians, as a physician with a disability, wholeheartedly embraced a policy report focused on physicians' responsibilities to colleagues with disabilities or other illness: "The fact that physicians with disabilities are finally being seen as who we are and what we're capable of, and not as impaired, is huge," said Bisgrove, who has hearing loss.

The draft policy report notes that "while some conditions may render it impossible for a physician to provide care safely, with appropriate accommodations or treatment, many can responsibly continue to practice, or resume practice once those needs have been met."

The report specifically called on physicians to intentionally promote processes that differentiate between conditions that are "permanently incompatible with the safe practice of medicine from those that are not."

The report also urged physicians to care for their own physical and mental health; to seek assistance when it's needed, particularly when continuing to practice would be unsafe for patients; to intervene when another physician is unable to practice safely; and to promote inclusive training standards that support individuals with disabilities entering the profession.

While Michael Miller, MD, a delegate from Wisconsin, stressed the importance of ensuring that evaluations of a physician with a disability or illness are conducted independently and not by a "competing" physician, he did not ask for the report to be referred back to the council.

Dowling, speaking on behalf of their delegation, said they had "mixed feelings" about the report, because it did not include mention of the importance of independent assessments, separate from the individual's health system or employer. However, "there's so much good that comes forward [in this report] ... I think we should still pass this today," they said.

They noted the possibility of a resolution focused on appropriate evaluations at the next meeting of the House of Delegates.

The report on physicians disabilities, illness, or impairment was adopted in a vote of 406-31, with 93% of the delegates in favor.

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