Comments on

by Advisory Committee to the Federal Bureau of Narcotics

JULY 3, 1958.

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From The Bulletin, Los Angeles County Medical Association, April 3, 1958

The article on page 19 outlining the experiences of the California State Board of Medical Examiners with narcotic addiction in physicians should be required reading for all physicians.

The number of narcotic addicts in the country is probably not much greater now than half a century ago, although wider press coverage dramatizes the situation. The situation is serious, however, and particularly so to the family, friends, and colleagues of the addicted person.

Eleven years' experience on the Board of Medical Examiners leaves me with moderate optimism about the control of addiction in physicians. At first, there was a feeling of shock in finding addiction among men whose ability and integrity I had admired over the years. The second thought was that since they were intelligent men, it would be easy to talk to them about the problem and convince them to do something about it. Unhappily, the problem couldn't be handled that simply as they would always promise anything and while their intentions were good, the end results were nil because they would continue to divert narcotics for their own use.

While certain published articles imply that addiction is tremendously higher in physicians than in the general population, these are usually based on figures obtained from hospitals for treatment of

addiction and represent evidence that the physician addict will commit himself in an effort to be cured, whereas, most addicts enjoy being addicted and don't desire to be cured.

The rehabilitation rate of 92 percent is astonishing in view of the figures of 5 percent being somewhat optimistic for nonphysician addicts. Several fundamental differences exist. One is that the ordinary addict returns to the company of other addicts. But the really fundamental difference is the control that the licensing agency--namely, the Board of Medical Examiners, has over the physician.

Conversations with most physician addicts reveal a fairly consistent pattern. Their approach is that as intelligent men, they feel that as with alcohol, they can either take it or leave it alone. They don't realize that, once addicted to narcotics, they are not in the least bit different from any stumblebum on skid row. The only effective approach is to be tough about it and point out to them that it is merely cause and effect and the result is entirely up to them.

he doctor who is committed to an institution soon discovers that he can think things out for himself; he soon realizes and finally admits to himself that he can break the habit only if he is locked up where he has no access to narcotics. He is encouraged by the board members, and it is pointed out that if others can do it, he ought to be able to do so also, but it's not going to be left up to him. It is pointed out that 92 percent of doctors have been rehabilitated and also pointed out that the other 8 percent invariably commit suicide.

The crux of the matter, however, is a very neat arrangement of the doctrine of the fear of punishment and the hope of reward. His license to practice medicine is revoked, but there is a stay of execution an the revocation for a period usually of 5 years. The probationary terms as noted include surrender of his narcotic privileges, the possession of narcotics or prescribing them for patients constituting a violation of probation for which his license to practice medicine would be automatically revoked.

Medicine is not just a way of earning a living with most doctors, it is a way of life. Many times doctor addicts have told me they thought we were pretty tough in prohibiting narcotic privileges for a period of 5 years when they themselves felt they were completely rehabilitated.

But invariably, the same men thanked us later because they stated that several times during the 5 year period, when the going was a little rough, had they had narcotics available they would have taken one shot "just for tonight" and then would have been on their way to habituation again. Their philosophy after 5 years is generally that-- ,"if I can do it for 5 years, I can do it forever," and the results rehabilitation-wise bear this out.

The idea of establishing clinics for narcotic addicts where the addict can be furnished narcotics cheaply intrigues many people. Proponents of the idea naively assume that the person is quite normal as long as can obtain narcotics. They should talk to doctor addicts who point out how their whole lives are meaningless except for one and that is getting a shot 4 hours from now. Family, children, and patients mean nothing to them. For example, in delivering a baby they will nonchalantly cut through into the rectum with no sense of remorse whatsoever, since in their state of mild euphoria nothing else is particularly important anyway.

Narcotic clinics were tried in the early '20's in major cities in this country without success, as addiction and crime instead of diminishing apparently increased. Actually, the experience of the physician addict himself would disprove the clinic theory since he has had narcotics available to him and diverts his own supply or writes fictitious prescriptions as a rule for a long time before he is apprehended. It is unusual for a physician to abandon the habit before he is apprehended.

The physician addict may need psychiatric help, but it is seldom effective unless he is institutionalized where narcotics are unavailable to him. One must individualize, however, and I well remember when one physician addict was asked whether or not he had sought psychiatric help. His explosive and indignant answer of "hell no" so impressed the board members that they felt he was a good risk for restoration. His subsequent good record justified their judgment.

While effective enforcement of the law seems a rather blunt way of approaching the problem, it should be pointed out that during the war years when there was complete control and inspection of ships entering and leaving our ports, addiction in this country was at a minimum.