by Peter Grinspoon, MD September 16, 2022
Deep down I knew something was profoundly amiss but, as they say, denial isn't only a river in Egypt. I was showing up to work and taking good care of patients in my primary care clinic. What else did they want? Other people consumed alcohol at night, I snorted oxycodone -- what is the difference? Which substances are legal is sort of arbitrary, isn't it? You do you, I'll do me, and we'll all be fine.
If only it were that simple.
A few months before the DEA and the state police raided my office, I had confidentially presented myself to a prominent addiction specialist in my hospital after I miscalculated and woke up from a blackout. I truly didn't think I would survive an unexpected bonanza that had come my way: a large bottle of 80 mg OxyContin. If you've never been addicted, your first thought is, "Just don't take the pills." But addiction is a compulsion that wins out in the end if you don't address it. I knew of a doctor who put a picture of his small children on each different bottle of Percocet, trying to encourage himself not to take them -- it didn't work. The allure of the pills is just too strong, even if, as in my scenario, you know the dosage is potentially lethal.
Once my colleague flushed the Oxys I had surrendered to him, he urgently cautioned me to get formal treatment immediately for my serious opioid addiction -- before everything imploded. He said I couldn't come back to him or he'd have to report me. With the immediate crisis solved, my addicted brain reverted to short-term concerns. I put his suggestion slightly higher on my mental list, along with the other things I would eventually get to, such as going to the dentist and getting my car's oil changed. Doctors are busy and important; these things can wait. Physician heal thyself (when you get around to it).
As I say to medical students, your addiction will get addressed, eventually. The only question is if it is on your terms -- you straightforwardly get the help you need -- or on someone else's terms, which are astronomically more painful. Case in point: I ended up with three felony charges, 2 years of probation, 90 days of mandated rehab, a loss of my medical license for more than 3 years, and 5 years participating in a monitoring regimen that required so much drug testing that I calculated it came out to 20 gallons of urine. Not fun.
Why are doctors so susceptible to addiction? We have the same problems as everyone else -- depression, divorce, sick kids, elderly parents, financial problems -- and we have to deal with the unique stresses and toxic culture of medicine. Burnout scores consistently measure between 60-70% or higher, and even before COVID-19, many doctors began fleeing the field. Each year, it only becomes more stressful to practice, with hospitals acting like corporations, with corporations buying up practices, with insurance companies continuously harassing us and our patients, and with less pay and more work, leaving us tethered to our electronic medical records and clicking into the night instead of relaxing with our families.
Once you have a problem, be it addiction, depression, anxiety, bipolar disorder -- or any problem that comes with stigma attached -- it is difficult to access treatment. The medical boards tend to be oriented toward punishment and a CYA ("cover your a**") approach -- they don't wish to be accused of leniency. Who would voluntarily sign up for added punishment, especially if you are already struggling to hold it together? We also practice in a dangerously antiquated culture where doctors are viewed as robots who perform reliably regardless of what is happening at home. As such, there is no one truly "caring for our caregivers." Doctors who are suffering feel trapped and hopeless.
But help is available, and it can either be guided by you, such as working with a private addiction psychiatrist unaffiliated with your hospital, or at the hands of the board and the criminal justice system. I highly recommend the former. First, you have to admit you have a problem and ask for help. This is the hardest part as it is ego-dissonant with our images of ourselves as healthy, independent, and successful.
The type of help you need depends on what you are addicted to and what problems are fueling your addiction. The way Physician Health and the medical board treated me was blunt, "Clockwork Orange"-like "contingency management": keep flunking drug tests and you don't get to practice medicine again. In my case, this is the component that was effective -- not the mandated, expensive, unscientific, 90-day rehab I was sent to that seemed stuck in the 1930's, when AA was born.
Now, 15 years into recovery, I am grateful for my successful outcome, but the treatment I received was not particularly humane and it certainly doesn't work for everyone. I know several physicians who died lonely overdose deaths locked in bathrooms, and others who are living on the streets.
If you take control of your own treatment, such as with a private clinic, you can access medications such as buprenorphine which, due to stigma and superstition, the medical boards and physician health programs have not historically allowed. It remains astounding to me that practicing doctors can drink alcohol and use benzos, Ambien, gabapentin, muscle relaxants, and so on, yet the medical boards and the physician health programs prohibit buprenorphine because it is "impairing." It is flatly unethical (and not at all backed by science) to deny doctors the one category of treatment that has consistently been shown to save lives. Hopefully this is changing.
There is infinitely more to being in recovery from drugs or alcohol than merely abstaining from their use. I used to say that is necessary but not sufficient; I'm not even sure that is true. There's no science demonstrating that one must, for example, abstain from a glass of wine at dinner for life if you were addicted to uppers as a teen. This discussion is for another day.
To get over an addiction, you have to take a deep, fearless look at what's under the hood. It takes humility and compassion -- for yourself most of all. Many of us are people pleasers and problem avoiders, but until you confront your traumas, demons, and challenges with courage and honesty, there will always be the temptation to escape your present reality with drugs or alcohol. As a profession, we need to make being a doctor more sustainable by pushing back against the hospitals, insurance companies, and corporations slowly turning us into cogs in someone else's machine. We need to retain the collegiality that makes practicing medicine so special and to regain the curiosity and enthusiasm that initially propelled us into this profession.
The physicians I know who have managed to put themselves into stable recovery are exemplary doctors: they listen, they care, they are humble, and they connect. They have the tools needed to deal with the stresses of being a doctor: self-care, mindfulness, and the confidence to ask for help. Addiction is a disease of isolation. As it progresses, your social connections are increasingly supplanted with an emotional attachment to your drug of choice. Only with the help of others can we heal. Peer support is critical. If a colleague is struggling, don't judge them, as this just contributes to stigma, which is harming so many of us. Rather, embrace them, be kind and encouraging, and steer them toward the care they need and deserve.
Peter Grinspoon, MD, is a primary care physician and cannabis specialist at Massachusetts General Hospital and a certified health and wellness coach. He is a national media figure, a popular contributor to Harvard Health Publications, as well as a TEDx Speaker. His forthcoming book Seeing Through the Smoke: A Cannabis Specialist Untangles the Truth About Marijuana will be released on April 20, 2023. He is also the author of the groundbreaking memoir Free Refills: A Doctor Confronts His Addiction.
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