Buprenorphine and Naltrexone for Impaired Physicians

Photograph by W Eugene Smith from Life Magazine 1948

Professional Health Monitoring programs that restrict access to MAT may need to rethink their approach

STUDY: Araujo CNP et al, J Addict Med 2026

STUDY TYPE: Retrospective cohort study

FUNDING: Professionals Resource Network, National Institutes of Health

Background

Physician health programs monitor doctors and pharmacists recovering from substance use disorders, with the dual goal of restoring health and protecting patients. Buprenorphine and naltrexone work in the general population, but many programs have hesitated to prescribe opioid agonist medications to practicing clinicians, fearing cognitive impairment or patient safety risks.

The Study

• 82 physicians and pharmacists enrolled in one state physician health program between 1993 and 2023 who used medication-assisted treatment during monitoring
• Most had opioid use disorder (77%), alcohol use disorder (55%), or both; over half had co-occurring chronic pain
• Medications included oral naltrexone (43%), oral buprenorphine (37%), extended-release naltrexone (24%), and methadone (6%)
• Monitoring averaged 5 years and included random toxicology testing, weekly group meetings, and 12-step attendance

Over 70% of participants graduated monitoring or were in good standing. Only 5% were turned over to the licensing board for noncompliance, and 5% discontinued against medical advice. Medication-assisted treatment was not linked to worse outcomes or increased impairment.

Extended-release naltrexone had the cleanest toxicology results: 79% of participants on it had no aberrant tests, compared to 45% on buprenorphine and 43% on oral naltrexone. Neurocognitive testing showed deficits in some participants, but improvements were equally common, and deficits appeared with and without medication use.

Limitations

Retrospective design, small sample, no control group, non-blinded outcome assessors, and results from a single state program.

Practice Implications

1. Extended-release naltrexone (Vivitrol) looks like the best first choice: clean toxicology, no diversion risk, and no concerns from licensing boards about agonist therapy.
2. For patients where agonist treatment is needed, buprenorphine is a reasonable option with appropriate monitoring.
3. If you care for a clinician in recovery, consider neurocognitive testing before return to practice.