{"id":16798,"date":"2023-11-14T19:17:40","date_gmt":"2023-11-14T19:17:40","guid":{"rendered":"https:\/\/drugprevent.org.uk\/ppp\/?p=16798"},"modified":"2024-01-16T20:05:48","modified_gmt":"2024-01-16T20:05:48","slug":"i-was-one-of-the-top-doctors-in-my-field-i-was-also-an-opioid-addict","status":"publish","type":"post","link":"https:\/\/drugprevent.org.uk\/ppp\/2023\/11\/i-was-one-of-the-top-doctors-in-my-field-i-was-also-an-opioid-addict\/","title":{"rendered":"I Was One Of The Top Doctors In My Field. I Was Also An Opioid Addict."},"content":{"rendered":"<p style=\"text-align: justify\"><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Opioids have become a full-blown national crisis of epidemic proportions, killing 130 people each day. Drug overdose is now the number-one cause of death for Americans under 50. One doctor at the top of her game\u2014who knew the risks better than anyone\u2014almost became another statistic.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Alison ran around her palatial six-bedroom house in Georgia on a crisp January night in 2016, preparing to depart the next day for a family ski trip in Colorado. She washed dishes, tidied counters, put in several loads of laundry, and crossed items off her packing list. Whenever she found a moment alone\u2014every 45 minutes or so\u2014she retrieved the syringe containing sufentanil she\u2019d tucked inside the Ugg boots she wore around her house, pulled a makeshift tourniquet out of her hooded sweatshirt, found a usable vein, and plunged the needle into her arm, delivering one tenth of a milliliter of the most powerful opioid available for use in humans.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">That night, as Alison hustled her house into order, she shot up in her 13-year-old daughter\u2019s closet (she once used her ballet-shoe laces as a tourniquet), her oldest son\u2019s bathroom (he was away at college), the kitchen pantry (she sometimes kept vials inside boxes of dry pasta), the laundry room (her favorite place to use), the bathroom (her least favorite), and the stairway leading up to the second floor, where she could gauge if family members were getting close.<\/span><\/p>\n<aside class=\"hawk-nest hawk-processed\" data-render-type=\"fte\" data-skip=\"dealsy\" data-widget-type=\"seasonal\" data-widget-id=\"ff2e809f-3ee9-44fa-bd3d-6b4a74d7ab3a\" data-result=\"missing\"><\/aside>\n<p style=\"text-align: justify\"><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">By the end of the night, she had polished off two milliliters, an amount that could kill an average-size adult if given in a single dose. Sufentanil is an opioid painkiller five to seven times more potent than fentanyl\u2014another powerful opioid\u2014at the time of peak effect and 4,521 times more powerful than morphine, but Alison wasn\u2019t intimidated. As an anesthesiologist, she\u2019d spent her entire professional life delivering such substances to patients during surgery.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">What Alison didn\u2019t know then was that in just over two months, her whole world would come crashing down. She had no idea that three nurses would grow wise to the ways she was stealing drugs from the hospital. Or that she\u2019d spend 90 days at an in-treatment center, followed by a five-year monitoring program for physicians. All she was thinking about that night was that her drugs of choice, sufentanil and fentanyl, made her happy at a time when her work demands were overwhelming and her second marriage was falling apart. \u201cIt was immediate; everything just chilled out. For me, it felt like when you have a really good glass of wine and you\u2019re like,\u00a0<em>\u2018Ahhh,\u2019<\/em>\u2009\u201d says Alison, now 46. \u201cDuring that time, that was the only thing I looked forward to. That was really the only thing that was good in a day of life for me.\u201d<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Before she started abusing opioids six months earlier, Alison had never used a drug recreationally other than a puff of marijuana during high school. (She didn\u2019t like it.) She enjoyed a glass of red wine with dinner once or twice a month but hadn\u2019t ever thought of using the substances she injected into patients all day, every day. \u201cI\u2019d been in anesthesia for 18 years, and it never even tempted me,\u201d she says. \u201cI never wondered what it felt like. It did not enter my mind.\u201d<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Alison was raised in a small town in Tennessee, the third youngest of seven children born to strict, conservative Christian parents. Her father is a physicist who liked to pose math questions at the dinner table (\u201cIn a group of 27 kids, there are 13 more girls than boys. How many girls and boys are there? Go!\u201d), and her mother is a stay-at-home mom. For vacation, \u201cwe didn\u2019t go to the beach or Disney World; we went to a place with a telescope or a planetarium,\u201d says Alison, recalling one trip in which they piled in a station wagon and drove to South Dakota to watch an eclipse.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Today, three siblings are physicians, one worked for the CIA, and another chaired a university department. Alison likes to joke that she\u2019s the underachiever in the family, and though she deserves no such title, the lifelong pressure she felt to outperform her siblings took a toll. \u201cI was raised in a family where the lowest thing that was allowed was perfection,\u201d she says. \u201cI felt like I needed to do more, always. That was a big thing that came up in treatment\u2014that my \u2018good enough\u2019 wasn\u2019t good enough.\u201d She had an eating disorder as a young teen and remembers dropping 30 pounds from her petite frame one summer by consuming only iceberg lettuce and fat-free French dressing. She says she felt like a failure because a younger sister weighed 15 pounds less.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">One of Alison\u2019s older brothers taught her square roots when she was two years old. (\u201cIt was like his little dog and pony trick to show me off to his friends,\u201d says Alison, laughing.) She took up the violin at age four and started piano lessons when she was six. She skipped first and seventh grades and completed high school in three years, graduating days after she turned 16. She finished college in three years too and enrolled in medical school in California at 19. A wunderkind, yes, but she wonders now about the damage racing through her youth caused. \u201cPerfectionism is horrible,\u201d Alison says. \u201cI know that I didn\u2019t develop good coping mechanisms. Some of my treatment team thinks I got stunted.\u201d<\/span><\/p>\n<div id=\"teads-desktop\" class=\"in-article ad-unit\" style=\"text-align: justify\">\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Medical school was the first time Alison had to study in her life. She chose to specialize in anesthesia because of how tangible it was. \u201cI liked how when someone\u2019s blood pressure is high, you give them medicine and it goes down,\u201d she says. \u201cThat immediate gratification.\u201d She married a man she met while she was in medical school when she was 22 and had her first son one month before graduation. (Her second son was born during her residency.)<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Three years of her medical schooling were paid for by the Navy (\u201cWith my dad being a teacher and me being one of seven kids, there was no money,\u201d she explains), so after finishing her residency, she paid the military back with three years of service, during which she was stationed at Walter Reed National Military Medical Center in Bethesda, Maryland. True to form, Alison was not just any anesthesiologist in the Navy, she was the one asked to do the anesthesia for a president (\u201cA huge honor,\u201d she says) and a high-ranking senator. (She was called in from maternity leave after giving birth to her daughter at the surgeon\u2019s request.)<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Alison left the Navy in 2003 and moved to Georgia, about an hour from where she grew up. She and her husband wanted to raise their kids in the South, and she was eager for a slower pace. The years of schooling and success with three young children had been hard on her marriage. \u201cI fell in love with my kids immediately, and I let the marriage slip,\u201d Alison explains. \u201cI put my kids before my husband.\u201d<\/span><\/p>\n<div id=\"bordeaux-static-slot-1\" class=\"bordeaux-slot bordeaux-filled-slot\" data-feat-ref=\"bordeaux-feat-id-54\" aria-hidden=\"true\">\n<div id=\"bordeaux-incremental-ad-0\" data-google-query-id=\"CL3Wi_yR7IEDFXVmFQgdi4AHyA\">\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">For years, she bounced between area hospitals, taking a position at whichever had the best team, reputation, and equipment at the time. In the spring of 2007, she began an affair with a charismatic nurse. She originally wanted to set him up with one of her sisters, but one late night while they were on call together, he said, \u201cI\u2019m not interested in your sister.\u201d By June, her husband had found out after seeing the nurse\u2019s number on the caller ID. When he asked Alison about it, she confessed; they divorced after 11 years of marriage.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">She continued to date the nurse on and off in the years after the affair. Their relationship was fiery and unstable, in the way that intensely passionate but ultimately destructive relationships can be. Alison knew he wasn\u2019t good for her, but she was hooked. \u201cLooking back on it, I\u2019m sure on some level that was addiction too,\u201d she says. \u201cHe was something super bad for me who I was with despite bad consequences.\u201d They rekindled their romance a final time in 2011 and married just before Christmas the following year.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">To outsiders, Alison\u2019s life looked rosy. The newlyweds lived in a dream house they had built in the lush foothills of the Appalachian Mountains and took Alison\u2019s kids on family trips to beaches in Florida and ski slopes in Idaho and Wyoming. In 2012, Alison accepted a job as the medical director of the anesthesiology department at one of the hospitals where she\u2019d worked and quickly became the most-requested anesthesiologist by patients and surgeons alike. \u201cHer quality was absolutely phenomenal,\u201d says Lindsay Dembowski, her boss at the time. Other doctors would complain, \u201c\u2018It\u2019s not fair, she\u2019s getting all the good cases,\u2019\u201d Dembowski says. \u201cIt was because she was so good.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Behind the scenes was a different reality. On the business side, anesthesiology was run by an outside management group that Alison says cut corners and costs to the point where the department was chronically understaffed. \u201cIt was a horrible environment,\u201d she says. Still, she ran herself ragged trying to be the best, as always. \u201cI can\u2019t shut it off,\u201d Alison says. \u201cI can\u2019t go home and say, \u2018We did a really good job today. I\u2019ll do the rest tomorrow.\u2019 I could never do enough. I was trying to fix things that were impossible to fix.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">The workload wasn\u2019t good for her new marriage either. Her husband was pulling away, they were fighting constantly, and she had learned he was using opioids recreationally. They were in the car one day, talking about fentanyl, and Alison remembers saying something like \u201cYou can\u2019t even use it once or you\u2019re addicted.\u201d Her husband replied, \u201cYeah, that\u2019s not true,\u201d and told her he used it sometimes. \u201cHe was the first face I ever put to drug use, and I worshipped the ground he walked on at that point, so I thought,\u00a0<em>This person is not a loser, he knows what he\u2019s doing, he\u2019s good at what he does,<\/em>\u201d she says.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Soon, her husband was asking her to get some from the hospital for him. \u201cI didn\u2019t have to ask anyone to write me a prescription; I had absolute access,\u201d Alison says. She resisted at first but gave in a few times, bringing home fentanyl left over in a syringe at the end of surgery. (The needle is uncontaminated, as it is injected into an intravenous line rather than directly into a person.) There\u2019s an official protocol for the disposal of unused drugs at the end of an operation. Waste procedures vary from hospital to hospital, but generally doctors are supposed to have a nurse or assistant physically watch them drain the syringe into a sink or trash can. But in a fast-paced hospital environment, doctors will often ask someone to watch who isn\u2019t really paying attention. \u201cIt\u2019s pretty easy,\u201d Alison says. \u201cNo one stands there and looks.\u201d In hospitals where the person serving as a witness has to enter a code, doctors commonly know nurses\u2019 codes and enter them even if no witness is present. (To prevent this, some hospitals now require both the physician and the witness to identify themselves using a thumbprint scanner.)<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">On Father\u2019s Day in 2015, Alison was home alone; her husband was with his dad, and her kids were with their dad. She was putting away laundry in her husband\u2019s closet when she found pockets and shoes full of empty fentanyl vials\u2014more than she\u2019d ever stolen for him. She confronted him when he got home, but \u201che tried to downplay it, and I just made up my mind that I would never give it to him again,\u201d she says.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Alison already had a vial of fentanyl she had swiped for her husband sitting in a drawer at home; she\u2019d slipped it into her pocket when a surgery she\u2019d already prepped for was canceled a few weeks earlier. \u201cFor whatever reason, I hadn\u2019t given it to him yet,\u201d she says, \u201cand when I decided I wasn\u2019t ever going to again, instead of squirting it out, I just let it sit there.\u201d There were \u201cmore bad days than good\u201d those weeks, and the vial was still sitting there six weeks later, after she and her husband had another big blowup. \u201cI was like,\u00a0<em>You know what? He says fentanyl is what makes life better for him when the world\u2019s falling in. I\u2019m gonna go try,<\/em>\u201d Alison says. She went into her bathroom and injected a \u201ctiny, tiny, tiny\u201d dose in a vein on the back of her right hand. \u201cAll of a sudden, everything was OK,\u201d she says. \u201cI would say it\u2019s like immediately going from zero to the happiest buzz you\u2019ve ever had.\u201d<\/span><\/p>\n<div id=\"bordeaux-static-slot-2\" class=\"bordeaux-slot bordeaux-filled-slot\" data-feat-ref=\"bordeaux-feat-id-55\" aria-hidden=\"true\">\n<div id=\"bordeaux-incremental-ad-2\" data-google-query-id=\"CMDK9PyR7IEDFc5jFQgd1C8BSg\"><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">She shot up because she was \u201ccareless and reckless with a fuck-it mentality\u201d at that point. \u201cMy justification was that I was a victim. I was a martyr. Work was terrible to me, my marriage was a sham, so I deserved it,\u201d she says. \u201cIn an instant, my whole idea about myself, my moral code\u2014I let it go.\u201d<\/span><\/div>\n<div data-google-query-id=\"CMDK9PyR7IEDFc5jFQgd1C8BSg\">\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Maybe a week or so later, she used again. She came home and made dinner, and at around 8:30 p.m. she went into her laundry closet. \u201cI was like, \u2018<em>Ohhh,<\/em>\u00a0OK,\u2019 and finished whatever I needed to do, watched TV in peace, and was able to sleep. That was a big thing\u2014because I definitely had been having trouble sleeping.\u201d Within a few months, she went from using once to using every so often to using as soon as she walked in the door from work. Sometimes even that wasn\u2019t soon enough: She would shoot up in her car in the hospital parking lot or after working out at her gym before driving home. She\u2019s mortified to admit that at least once she picked up her daughter from dance practice and drove her home while high.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Soon, she was injecting fentanyl first thing on a Sunday morning and, because the effect wears off after one to two hours, reupping as many times as it took to make it to bedtime. \u201cFor me, that\u2019s what I liked; it was my hobby, my favorite thing to do,\u201d she says. Her dosage and the number of times she used in a day increased rapidly as well. \u201cI remember a couple of times thinking,\u00a0<em>Let\u2019s try a little more this time,\u00a0<\/em>and it was way too much,\u201d she says. \u201cOne Saturday night we were watching a movie and I could not keep my eyes open. I\u2019m sure my family just thought I was super tired.\u201d Alison also began using the more potent sufentanil when she could get it. \u201cWhen you\u2019re getting the needle out, you\u2019re almost salivating,\u201d she says. \u201cIt\u2019s like you\u2019re just about to eat. You\u2019re starving. It means relief is about to happen; you\u2019re almost there. It\u2019s very primal.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">That\u2019s not to say using was always a positive experience. She took some fentanyl to a friend\u2019s Halloween party she attended with her husband (she hid it up her sleeve) and locked herself in the bathroom after they arrived. \u201cI was very, very irritated with myself,\u201d Alison says. \u201cI remember being like,\u00a0<em>All the people out there are socializing, and this is what you\u2019re doing?<\/em>\u201d She and her husband never used together; when he found out about her fentanyl abuse six weeks in, he was furious and began trying to thwart her efforts by checking her bag before she left the hospital when their shifts overlapped. Alison once put a vial in her shoe and tried to limp out without him noticing, but he caught her and threw it in the trash. On Thanksgiving morning, Alison discovered her husband had thrown out a whole vial of fentanyl she had hidden in a duffel at the back of her closet. Seething, she locked herself in her daughter\u2019s room. (She was spending the holiday at her dad\u2019s.) Alison called her parents, who were expecting her for dinner, to tell them she wasn\u2019t going to make it. (She lied and said work had called her in.) \u201cThat made me feel pretty lame about myself,\u201d she says. Another night, Alison mistook ketamine, a heavy sedative, for fentanyl and was unable to talk or move for hours. \u201cThat was very scary. I was lying on the bathroom floor like,\u00a0<em>Oh, shit, what have I done?<\/em>\u201d Alison says. \u201cI remember cussing to myself,\u00a0<em>You\u2019re an idiot and this is disgusting. This is the level you\u2019ve now dropped to!<\/em>\u00a0And yet, that wasn\u2019t the last time I used.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">There were many days when Alison woke up thinking,\u00a0<em>I\u2019m not going to use. I have to stop.<\/em>\u00a0But then she would walk into work and \u201cit was almost like my brain was someone else\u2019s\u2014it was a switch, like a zombie in a movie\u2014like,\u00a0<em>Of course you\u2019re going to get some, you need it,<\/em>\u201d she says.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Alison swears she never shot up before work, but when she was at the hospital, looking for opportunities to steal leftover drugs preoccupied her mind. \u201cI would make a plan,\u201d she says. \u201cIn the morning, I\u2019d already be thinking,\u00a0<em>Will I be able to use today? When\u2019s there going to be time? Will I be able to get some? What cases does it look like I\u2019ll be able to steal from? What\u2019s the best chance?<\/em>\u201d As director of the department, she could pop into whatever surgeries she wanted, so she would often come by when an operation was finishing up to see if she could snag any unused drugs. Other times, she would check out more opioids than a procedure required, ensuring there would be some remaining, or add sufentanil to the cocktail of drugs given to a patient even when it wasn\u2019t required. \u201cSometimes the only reason I gave sufentanil was so I could get it to me,\u201d Alison says. \u201cIt\u2019s not harmful, but it wasn\u2019t necessary.\u201d She also swapped syringes filled with saline for those filled with drugs to trick the person watching her waste, or she marked an opioid on a patient\u2019s chart that he or she had never been given. Alison never resorted to pouring the liquid from the sharps bucket, where syringes are disposed, but she\u2019s heard of others who have (despite the risk that the mixture of unknown substances at the bottom of the bucket could be a lethal combination). She also knows of physicians who steal pills from prescription bottles patients bring with them to appointments.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">When Alison started regularly using after hours, she never paused to reflect on how the drugs could impact the work she did from home every night. \u201cI had to make the schedule, talk to surgeons, answer questions,\u201d she says. \u201cI was cognizant enough, but I wonder if any of them would say, \u2018Well, yeah, she acted a little more spacey.\u2019 I don\u2019t know if someone felt that and just didn\u2019t tell me.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Some of her co-workers were indeed taking note. In March 2016, about eight months after Alison started using, her boss got a call from a nurse anesthetist who said she and two others\u2014Alison\u2019s three best friends at the hospital\u2014had been conducting an investigation after noticing some missing narcotics. \u201cI remember thinking, <em>Who in the world?<\/em>\u201d Dembowski says. When she sat down with the nurse anesthetist the next morning to hear the evidence, she was shocked. \u201cI thought,\u00a0<em>There is absolutely no way.<\/em>\u00a0Of all the people\u2014Alison was my best doctor\u2014she would have been the last one on my list of suspects.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">The nurse anesthetist had been tipped off back in January when she noticed Alison had marked on a chart that she\u2019d given sufentanil to a patient not long after the nurse had given fentanyl. \u201cThe nurse anesthetist was like, \u2018Why would she give sufentanil when I was giving fentanyl?\u2019 The patient must have been in a lot of pain,\u201d Dembowski says. (The nurses declined to be interviewed.) But of course the patient wasn\u2019t in that much pain and had never been given the sufentanil. Alison had pocketed it. The nurse had documented a number of similar incidents. \u201cThere was enough evidence,\u201d Dembowski says. \u201cThere was no way she could deny it.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Alison remembers one Friday when she\u2019s sure one of the three nurse anesthetists who turned her in saw a syringe in her pocket as she was leaving work. \u201cWe were talking and I noticed her staring at it,\u201d she says. \u201cShe didn\u2019t say anything; she was just looking. Of course I had a guilty conscience, but then I was like,\u00a0<em>No, no, she\u2019s not going to think that.<\/em>\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">The following Tuesday, Alison got a text from her boss saying, \u201cHey, are you around? We need to meet with you.\u201d Dembowski and her boss sat Alison down and told her what they knew. At first, she got defensive and denied it. \u201cNope. Nope. Didn\u2019t do it,\u201d Dembowski remembers her saying. But when they told Alison she was going to have to take a drug test, she broke down. \u201cShe was like, \u2018What do we do from here? I did it,\u2019\u201d Dembowski says. Alison knew she\u2019d never return to work at that hospital (she later resigned), but she was told she could keep her medical license if she immediately enrolled in treatment. \u201cMy heart sank,\u201d Alison says. \u201cI felt like my life was over.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">The risk of suicide is high when addicts are caught, Dembowski says, so she couldn\u2019t let Alison out of her sight. They escorted her from the building, Dembowski drove her home to pack a bag, and they set off on a two-hour drive to a treatment center in Atlanta. Alison called her husband and her children from the road. (Once she arrived at treatment, she would be barred from talking to them and everyone else on the outside for 30 days.) \u201cI\u2019m sure she probably hated me,\u201d says Dembowski, remembering how Alison worried about how she would pay her bills, what would happen to her kids, and whether she would be home in time for Easter and Mother\u2019s Day. \u201cIn her mind, I\u2019d just ruined her whole life.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">She took Alison to Talbott Recovery, an in-treatment center started in 1989 by George Talbott, an internist who struggled with alcohol abuse and pioneered the first treatment program specifically for doctors like himself. \u201cIt\u2019s very easy, with the stigma addicts face, to say, \u2018You\u2019re an addict, you\u2019ll always be an addict, you\u2019re good for nothing,\u2019\u201d says Navjyot Singh Bedi, Talbott Recovery\u2019s medical director. \u201cDr. Talbott decided he must find a way to not only get physicians the help they need but also advocate for them returning to practice medicine, because addiction does not take away their ability to care for other human beings. They don\u2019t lose their medical knowledge or skills.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Alison spent the required 90 days at Talbott, far longer than what\u2019s offered at most in-treatment programs, which typically last 30 days at most (a length, Bedi says, that was \u201cmanufactured by insurance companies,\u201d not proven by science). The treatment cost was about $45,000; Alison paid nearly $30,000 out of pocket. The rest was covered by insurance.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Opioids are the second most frequently abused substance among physicians, after alcohol, so there were other fentanyl users in Alison\u2019s group. Though Talbott also offers programs for the general public, the doctors interact only with one another because, well, their egos are too large. \u201cYou put a physician in a regular treatment center and all of the oxygen in the room gets taken over by this narcissist who thinks they know everything and doesn\u2019t ever discuss their own vulnerabilities or sadness,\u201d says Bedi, who notes doctors don\u2019t use their honorific titles at treatment. \u201cWe want them to leave their credentials at the door and focus on the disease that\u2019s coming to kill them.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">The program is lengthy, which is particularly good for doctors because \u201cthey are really, really smart, and the smarter you are, the harder it is to get the basics of recovery because you can kind of outthink your feelings,\u201d says Debbie Ray, Alison\u2019s case manager at Talbott. \u201cWe have to get them to put themselves out there and be vulnerable, which is not an easy thing for a physician to do. I always tell my patients, \u2018You\u2019re going to see a sadistic-looking smile on my face when you\u2019re in the middle of telling the hardest story of your life.\u2019 Because when I hear them do that, that\u2019s where the work begins.\u201d In treatment, Alison had to \u201clearn I\u2019m a regular person, not superhuman,\u201d she says. \u201cThis whole experience has brought me into the human race.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">At Talbott, participants live, eat, and do everything with at least one other person. \u201cWe couldn\u2019t go anywhere by ourselves, which as an adult is difficult,\u201d Alison says. \u201cBut I know I wouldn\u2019t have gotten better otherwise. I was sick, and it was absolutely what I needed.\u201d When they grocery shopped, they did it as a group\u2014no splitting up to grab tortillas while another person gets fruit. (One time, at CVS, a member of her group somehow snuck away to drink Listerine, which contains alcohol, Alison remembers.)<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">They woke around 7 a.m. Talbott staffers would inspect the group apartments, looking for cleanliness and contraband. \u201cThere were all these rules, like the coffee maker had to be unplugged,\u201d Alison says. \u201cIt reminded me of being in the military.\u201d They would arrive at the treatment center by 8 a.m.; when they walked in the door, they would learn if they had to take a randomized drug test. If not, they went to a morning meditation session, followed by hours of lectures, group discussions, and meetings where they worked on the 12 steps common in many treatment programs. Like Step 4, which requires addicts to make a \u201csearching and fearless\u201d moral inventory. Before that, \u201cI hadn\u2019t let myself acknowledge that I could be hurting other people with my drug use,\u201d Alison says. \u201cI really thought I was only hurting myself.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">After in-treatment ended, Alison signed a five-year monitoring agreement with her state\u2019s physician health program (PHP). Doctors in recovery who are enrolled in PHPs can continue to practice in the vast majority of situations as long as they remain healthy and meet requirements like checking in every day to see if they have to take a drug test and attending support-group meetings and other therapy. If they fail to comply or prove to be a risk to public safety, the PHP may need to report them to the medical board and they could lose their license.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Every Tuesday, Alison drives to Atlanta to attend a small group meeting with nine other physicians, followed by a large meeting with around 80 other doctors, physician assistants, and respiratory therapists. She\u2019s also required to attend self-help group meetings, like Alcoholics or Narcotics Anonymous. She had to go to a meeting every day in the beginning, but that tapers off over time; three years in, she goes three or four times a week.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">All but four states\u2014California, Nebraska, South Dakota, and Wisconsin\u2014have independent PHP programs. The first was founded in New Jersey in 1982; Georgia\u2019s is the newest and was started in 2012. Similar long-term aftercare monitoring programs exist for impaired pilots, who, like physicians, put the public at risk if they relapse. \u201cThe consequences of treatment failure are high, so we might even overtreat them a bit to make sure we reduce the likelihood of relapse,\u201d Bedi says.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">The PHP model has shown remarkable results. The first national study of state PHPs, which was published in the\u00a0<em>Journal of Substance Abuse<\/em>\u00a0in 2009, found that of 904 physicians enrolled in 16 state PHP programs, 78 percent had no positive test for either drugs or alcohol during the five years of intensive monitoring, and 72 percent continued to practice medicine. \u201cAlmost all my people get better,\u201d says Dr. Paul Earley, medical director of Georgia\u2019s PHP and president-elect of the American Society of Addiction Medicine. \u201cPHPs have a success rate which is unparalleled, and the reason physicians do so well is they get a ton of treatment. Everyone should get that kind of care.\u201d Smaller studies have shown similar results. \u201cAddicted physicians treated within the PHP framework have the highest long-term recovery rates recorded in the treatment outcome literature: between 70 percent and 96 percent,\u201d the authors of the 2009 national study wrote.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Such outcomes raise a question: Why do addicts have to have a medical or pilot\u2019s license to receive such high-quality care? There\u2019s no official estimate for how often treatment works for the general public nationwide, but a frequently quoted figure is that just 30 percent of people abstain from using for a year after treatment. (And that\u2019s only among those who complete a program; anywhere from 20 to 60 percent of addicts drop out, according to a 2013 study published in\u00a0<em>Clinical Psychology Review.<\/em>)<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">With 130 people dying of opioid overdoses in the U.S. every day\u2014nearly 50,000 people died in 2017 alone\u2014wouldn\u2019t we want as many people as possible to have access to the most effective treatment? Why that isn\u2019t the case is simple: Insurance won\u2019t pay for more-expensive long-term care unless a person has already flunked out of less extensive and costly options, Bedi says.<\/span><\/p>\n<div id=\"bordeaux-static-slot-5\" class=\"bordeaux-slot bordeaux-filled-slot\" data-feat-ref=\"bordeaux-feat-id-58\" aria-hidden=\"true\">\n<div id=\"bordeaux-incremental-ad-8\" data-google-query-id=\"CJ7N2f-R7IEDFalPFQgdsB0Nfw\">\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Even worse is that 80 percent of opioid addicts are not getting any treatment at all, according to a research letter published in\u00a0<em>JAMA: The Journal of the American Medical Association<\/em>\u00a0in 2015. Of the treatments available to the general public, few mirror the PHP model. There are two standouts that do. One is Hawaii\u2019s Opportunity Probation with Enforcement (HOPE) program, which aims to reduce alcohol and drug use and recidivism among high-risk felony probationers. A one-year independent randomized control study of HOPE conducted in 2009 found participants were 72 percent less likely to use drugs, 55 percent less likely to be arrested for a new crime, and 53 percent less likely to have their probation revoked. Similarly, a study of 4,009 people enrolled in South Dakota\u2019s 24\/7 Sobriety program, designed to reduce the state\u2019s unusually high rate of drunk driving, found 99.4 percent of participants passed the twice-daily alcohol tests they were given each day.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">The reason doctors get such high-quality care is that the medical profession treats addiction not as a character defect but like the serious condition it is. \u201cAddiction is a chronic brain disease that cannot be treated with short-term measures,\u201d Earley says. \u201cPHPs look at addiction as a chronic disease\u2014more like diabetes than appendicitis. And like diabetes, you have to educate patients on how to care for themselves.\u201d Such care can be expensive: Georgia\u2019s PHP costs $430 per month for five years, for a total of $25,800, plus an additional $120 per month for drug tests, all of which the physicians pay out of pocket\u2014but it\u2019s cheaper than dealing with the health conditions or imprisonment that can come with sustained relapse. (For PHPs in other states where costs are offset by physician licensure fees, hospitals, and malpractice carriers, rates may be as low as $150 per month; Georgia\u2019s state legislature mandates the costs of the PHP be covered by participants.)<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">The stigma on addicts in society as a whole has started to decrease amid the opioid crisis, thanks in part to the fact that\u00a0<a class=\"hawk-link-parsed\" style=\"color: #0000ff\" href=\"https:\/\/www.marieclaire.com\/health-fitness\/a19685213\/heroin-addicts-female-opioid-epidemic\/\" target=\"_blank\" rel=\"noopener\" data-component=\"Inline Links\">people of privilege like Alison got hooked<\/a>, cluing the public in to what researchers have always known to be true: Anyone can become addicted. \u201cA silver lining to the opioid epidemic is it has brought the disease into the conversation,\u201d Bedi says. \u201cPeople are beginning to see these are our friends, our coworkers, our relatives. We cannot discriminate against them, we cannot deny them access to treatment\u2014this is a lethal condition.\u201d It\u2019s an overdue change from the crack epidemic in the 1980s, which notoriously led to mass incarceration as African Americans were sent to prison rather than treatment programs. \u201cPeople are realizing that you can\u2019t just wish away addiction by saying, \u2018We\u2019re not going to treat it,\u2019\u201d Bedi adds. \u201cYou will have this enormous burden explode in your face if you ignore the disease.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">There has been a lot of progress, but we\u2019re not there yet. There\u2019s still so much disgrace surrounding physicians in recovery that Alison worried she\u2019d never work again. \u201cIt\u2019s a small town; everyone knows,\u201d she says. \u201cI was the biggest news in town.\u201d A majority of anesthesiologists do not return to that specialty after struggling with addiction because the easy access makes the temptation too real. \u201cMost would say, \u2018Well, this tiger might not bite me, but I\u2019m not going to hang around and pet it all day long,\u2019\u201d Earley says.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">But Alison is not most people. Because she had no prior history of drug abuse, had practiced anesthesia for nearly two decades without incident, is doing well in treatment, and gets a monthly injection of naltrexone, an anti-addiction drug that blocks opioid cravings, she was allowed to return to the operating room. She landed a job in the anesthesiology department at a hospital about 30 minutes away from where she lives. Fentanyl is used in almost every surgery, so she has to handle it constantly. \u201cThey say it\u2019s the equivalent of an alcoholic as a bartender,\u201d Alison says. She thought she might think,\u00a0<em>You\u2019re the thing that ruined my life\u00a0<\/em>when she touched a vial again for the first time, but instead she felt neutral. The drug had lost its power.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Upon her hiring, she offered to take additional precautionary measures\u2014like returning all leftover drugs to the pharmacy or having someone regularly review her charts\u2014but so far, her new workplace hasn\u2019t required her to do anything extraordinary. \u201cI\u2019m not going to relapse. That\u2019s what I tell myself every day,\u201d Alison says. \u201cI will do whatever it takes to stay sober, even if it means quitting anesthesia.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Alison says she hasn\u2019t been tempted, but she\u2019s always careful to add a\u00a0<em>yet<\/em>\u00a0to the end of that sentence. \u201cI don\u2019t want to get complacent,\u201d she says. Sometimes when she has a lot of leftovers at the end of a surgery, she thinks,\u00a0<em>There you go, you could have all of that right now,<\/em>\u00a0but then she goes to the garbage can and squirts it out. \u201cI haven\u2019t had any physical cravings at all,\u201d she says, noting that the only time it even crossed her mind was when she and her second husband divorced 10 months into her treatment. \u201cIt was one of the really bad days. I was home by myself, and I was like,\u00a0<em>Man, I miss when I used to use.<\/em> It wasn\u2019t a craving; I just remembered how it fixed that feeling, temporarily at least.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Eventually, Alison was able to reconcile with most people in her life, except for the three nurse anesthetists, with whom she\u2019s had only brief interactions and text exchanges. Her old boss, Dembowski, says she gets a text from Alison every few months saying, \u201cThank you for saving my life.\u201d Her children forgave her, and they\u2019re closer than ever. They meet for Orange Theory workouts, cheer for her now-15-year-old daughter at volleyball games, and gobble down pizza at the best spot in town.<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">She thinks recovery has made her a better, more empathetic doctor. She doesn\u2019t tell patients about her history. (It\u2019s a liability issue.) \u201cI want to say, \u2018Look, I\u2019m in recovery myself,\u2019\u201d she says. \u201c\u2018I\u2019m often the smartest person in the room, and I made the dumbest decisions. There is no judgment.\u2019\u201d Instead she says something like \u201cI\u2019m very familiar with recovery.\u201d She\u2019s also been approached by friends seeking help for family members struggling with opioid addiction. \u201cTo see the pain I caused my family used to help someone else\u2019s, it\u2019s amazing,\u201d Alison says. \u201cThat something good came out of something horrible that\u2019s something, whatever it is, greater than me. And it\u2019s pretty cool.\u201d<\/span><\/p>\n<p><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Alison hopes sharing what she\u2019s been through will help to reduce shame. \u201cAddiction is a nondiscriminating disease. It doesn\u2019t care what color you are, what age, what sex, what religion, your socioeconomic status; it is an equal-opportunity offender,\u201d she says. \u201cMaybe 20 years from now my story will help to change the stigma and people won\u2019t automatically think their doctor is a horrible person just because they\u2019re in recovery.\u201d To that end, she wanted to use her full real name in this story, but her bosses wouldn\u2019t allow it, which is why we\u2019ve used her middle name here. They were afraid of what her patients would think if they Googled her.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p style=\"text-align: justify\"><span style=\"font-family: verdana, geneva, sans-serif;font-size: 10pt;color: #0000ff\">Source: <a style=\"color: #0000ff\" href=\"https:\/\/www.marieclaire.com\/health-fitness\/a26443838\/top-doctor-opioid-addict\/\">An Opioid Addict Who Was Also a Top Doctor Shares Her Story of Recovery | Marie Claire<\/a> February 2019<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Opioids have become a full-blown national crisis of epidemic proportions, killing 130 people each day. Drug overdose is now the number-one cause of death for Americans under 50. One doctor at the top of her game\u2014who knew the risks better than anyone\u2014almost became another statistic. Alison ran around her palatial six-bedroom house in Georgia on [&hellip;]<\/p>\n","protected":false},"author":12,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34,37,86,36],"tags":[],"class_list":["post-16798","post","type-post","status-publish","format-standard","hentry","category-heroin-methadone","category-hiv-injecting-drug-users","category-prescription-drugs","category-treatment-addiction"],"_links":{"self":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/16798","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/comments?post=16798"}],"version-history":[{"count":0,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/16798\/revisions"}],"wp:attachment":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/media?parent=16798"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/categories?post=16798"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/tags?post=16798"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}