What happens when you combine extreme stress with easy access to drugs that seem to make that stress go away? In Peter Grinspoon’s case, the answer was a descent from highly respected doctor — a “star,” as a performance review once described him — to an addict who didn’t hesitate to lie, steal and manipulate others to feed his habit. It’s that journey down and the hard road back to sobriety that he chronicles in Free Refills: A Doctor Confronts His Addiction, a candid and darkly witty memoir that not only tells his story but shines a light on the growing problem of substance use disorders in the medical profession. The tale begins with Grinspoon’s sweat-inducing realization that the men in his waiting room aren’t patients but law enforcement officers ready to bust him for writing prescriptions for opiates in the name of a former nanny. In time comes being booted from his medical practice, the nuclear meltdown of his marriage, a two-year probation sentence, and a much-protested stint in rehab that ultimately leads him from resentment to self-awareness and recovery. Now nine years sober and a practicing physician once again as well as an instructor in medicine at Harvard Medical School, Grinspoon calls writing the book “cathartic. It was such an intense experience, in some ways horrible and in some ways wonderful — the recovery part of it. Writing just helped me process it.” There was also the hope that others could learn from his abundant mistakes. “If I could save people some misery, that would be something good coming out of something very bad.”
Stress and Access
The “why” behind his turn to drugs defies a neat explanation. But of one thing he’s sure: the pressures of being a modern physician played a role, and it’s doing the same for many others in the medical profession. An estimated 69% of doctors, in fact, abused prescription drugs “to relieve stress and physical or emotional pain,” according to a 2013 study, Grinspoon noted. “It’s never been stress-free to be a physician, of course, but it is increasingly stressful with the HMOs and the electronic medical records and all the performance measurements and the time pressures and so much to learn that it’s impossible to keep up,” he said. It doesn’t help that physicians are expected to never admit weakness and to always be in control, he added. “It’s this God-like attitude. It’s kind of bred into us in the training.” As a result, he said, “there’s an epidemic of physician burnout. It’s something like one out of six primary care doctors leaves in the middle of their career. I don’t know any other professions where that’s the case.” For some medical professionals, the proximity to drugs that offer at least a temporary respite from distressing feelings can be too much to resist. “The access is infinite,” Grinspoon said. “The drug companies send medications. And you’ll be in clinic and an elderly patient will say, ‘Oh, they gave me these pills for my backache and they gave me a stomachache, so I only took one. What do I do with the rest of them?’ And they’ll plunk 59 oxycodone on your desk. If you combine the stress with the access, it’s kind of the perfect storm.” Most troubling is that when doctors realize they need help, few reach out for it voluntarily because of what they stand to lose, Grinspoon said. “They get in trouble with the medical board, they get sort of pilloried in the press, they get stripped of their license and their livelihood, and I think because of that, a lot of doctors don’t get help until they are forced to get help, like me.” In the meantime, the addiction becomes more entrenched and tougher to overcome and the danger to the patients under their care grows.
A Call for Less Punishment, More Help
Grinspoon hopes his book will help prompt the medical community to embrace the same mindset taking root across the country — that addiction is a disease, not a moral failing, and that it should be met with compassion. “I think if the treatment and the climate were less punitive, people would be a lot less scared of coming out of the shadows and saying, ‘Hey, I’m having trouble controlling this. I’m having a problem. Can you help me?’” There are some positives in the picture. Medical professionals have higher rates of addiction than the general public, but they also have much higher rates of recovery. Grinspoon credits that to several factors. For one, they tend to have support networks in place. For Grinspoon, it was the Physician Health Services, which connected him with treatment, held him accountable and monitored his progress. After his recovery, Grinspoon worked with the organization as an associate director for two years, helping addicted doctors. Another factor is simply what’s at stake. “You work for 10 years, you spend hundreds of thousands of dollars in tuition, and you’re not going to be allowed to be a doctor — and it’s what you wanted to do your whole life — unless you take recovery seriously. It’s a real motivator.” Looking ahead, he feels optimistic that the sea change he’s seen in the way addiction is being talked about in the media, in the public sphere and even among the presidential candidates will eventually trickle down to what he terms the “superconservative environment of the medical board and the hospitals.” With his book, he aims to add his voice to those calling for less stigma and more support. “I wanted people to understand that a nice, friendly primary care doctor can get addicted without intending to harm anybody and can do all these awful things. That’s what opiate addiction does to you.”