Breaking Really Bad, 25 Years Before Walter White–by Josh Bloom (Dupont chemist Michael Hovey synthesizes 3-methyl fentanyl in 1985 and ushers in “designer-drugs” that kill)

3MeFen

BB

In 1985, a scientist in Delaware decided to make drugs with the goal of getting rich.

We didn’t know it at the time but DuPont organic chemist Michael Hovey had ushered in the modern era of so-called “designer drugs” by cooking up a batch of 3-methylfentanyl in his lab. The batch had a street value of $112 million.

His choice was not arbitrary. It would be hard to pick a drug that gives you a better bang for your buck than 3-Methylfentanyl which, as you can tell by the name, is closely related to fentanyl, a synthetic heroin that is a legal but highly regulated narcotic 50 times more potent than heroin.

Fentanyl is used as a pain patch (Duragesic), an under the tongue (sublingual) lozenge, and as part of a general anaesthesia cocktail. It  is also the drug that is causing the surge of overdoses in heroin addicts, because the lethal dose in humans is estimated to be 2 milligrams— about the same weight as 5 grains of salt. It does not take much imagination to picture a scenario in which some stoned out mutant who is putting together a bag of heroin mixes in an extra milligram or two and kills people.

But, fentanyl is a bag of Skittles compared to 3-methylfentanyl (3MF), which is 100-times stronger. Yikes.

3MeFen3-Methylfentanyl: The seemingly trivial addition of a methyl group (red) is anything but.

Where did “Breaking Bad” inspiration Michael Hovey go wrong? It wasn’t in the synthesis, that was not at all difficult for any trained organic chemist. His error was that he didn’t actually know any drug dealers, so he offered a reward to chemists who could find him one. Fellow DuPont chemists instead alerted security and he was arrested when he tried to sell it to what turned out to be an undercover FBI agent. Four years later, after serving an 18-month federal prison term, he committed “suicide by police” by lunging with a knife at Delaware State troopers who came to arrest him for skipping his state trial on similar charges.

Back to the drugs.

To give you an idea of how powerful 3-methylfentanyl is, let’s play a guessing game: How much did 3MF did Hovey have to make to end up with $112 million worth of the stuff? A wheel barrel full? A thimble full?

While you are guessing, I will do some math, and you can ridicule me in the comments sections if I am wrong, which is all but certain.

Let’s assume that an addict’s dose of fentanyl is half (they are addicts, after all) of the lethal dose—1 milligram. Given that, an “effective” dose of 3MF would be 0.01 milligrams (ten micrograms). Assuming a street price of $5 per bag—about what “heroin” costs now—this means that Hovey would have had to make a whopping 8 ounces of it—the same weight as two lemons. Yep, by using four common chemicals that can easily be purchased from any number of chemical research supply companies for a few hundred dollars, Hovey made a drug so potent that $112 million dollars worth of the stuff could fit in his pocket.

When life gives you lemons, try to get rich and then do something really stupid.

lemons

Stories from his acquaintances say that Hovey had begun to believe that the world was going to end. He told prosecutors that he wanted a large fortune, which he would then to convert to gold, so that he could ride out the coming cataclysm in the Rocky Mountains, and then return when the apocalyptic dust settled. He was partly right, though his was the only world that would be ending soon.

Ironically, Hovey had already made something better to take to the mountains than gold. A gold brick weighs 12.4 kilograms, or 437 ounces. At the end of 1985, gold sold at $323 per ounce, so a brick was valued at a bit over $141,000. His two lemons worth of 3MF could have fetched 794 bricks (1,750 pounds) of gold. That’s an awful lot of weight to carry around.

Addendum: I mentioned Walter White because of the popularity of “Breaking Bad,” but White was a rank amateur compared to Hovey. One gram of crystal meth costs about $100 on the street. The same weight of 3-MF? Over $500,000.

Extra credit!!! Answer this question and you will win our new, doubly awesome ACSH coffee mug. First correct answer posted in comments sections gets the prize. 

Question: WHY WAS WALTER’S METH BLUE? (No internet cheaters, please. I will know!)

Update, 3/10- We have a winner. Congrats to Kailey. Your answer was almost perfect. Here’s the rest:

It was a trick question. Sort of. Walter’s meth should not have been blue. The show’s chemistry was very accurate (mostly), but this “error” was intentional. It was a plot element. The show implied that the blue color was a function of the purity of the meth because they needed a way to distinguish Walter’s meth from the rest, when in fact, if anything, any color would signify that it was less pure, not more. And even if there was a colored impurity, the chances that it would be blue are very small. Impure organic compounds are usually tan, yellow, or brown.

Walter did not add the color, but Vince Gilligan, who wrote and produced the show surely did. If you have seen the show, Gilligan’s regular use of color made the already-extraordinary camera work even more stunning.

Kailey, if you email me at bloomj@acsh.org, I will personally deliver your mug to the post office. Thanks to all of you who played. Let’s do it again some time.

coffee cup ACSH

By Josh Bloom

Senior Director of Chemical and Pharmaceutical Sciences

 

 

 

 

 

 


 

Josh bloomDr. Josh Bloom earned a Ph.D. in organic chemistry from the University of Virginia,  followed by postdoctoral training at the University of Pennsylvania.
He worked for more than two decades in new drug discovery research at Lederle Laboratories,  which was acquired by Wyeth in 1994, which itself was acquired by Pfizer in 2009.

During this time he conducted research in a number of therapeutic areas, including diabetes and obesity, antibiotics, HIV/AIDS, hepatitis C, and oncology. His group discovered the novel antibiotic Tygacil®, which was approved by the FDA for use against resistant bacterial infections in 2005.

He is the author of 25 patents, and 35 academic papers, including a chapter on new therapies for hepatitis C in Burger’s Medicinal Chemistry, Drug Discovery and Development, 7th Edition (Wiley, 2010), and has given numerous invited lectures on how the pharmaceutical industry really works.

Dr. Bloom joined the American Council on Science and Health in 2010 as ACSH’s Director of Chemical and Pharmaceutical Sciences, and has written op-eds for numerous periodicals, including for The Wall Street Journal, Forbes, New Scientist, The New York Post, National Review Online, The Boston Herald, and The Chicago Tribune. In 2014, Dr. Bloom was invited to become a featured writer for the site Science 2.0,  where he wrote more than 75 pieces on topics ranging from to the pharmaceutical industry, medicine, quackery, junk science, or anything else that pissed him off. That’s a pretty long list.


 

 

Screen Shot 2017-06-05 at 4.07.26 PM

Advertisements

The “PHP-Blueprint”–A Trojan Horse for Profit and Wider Social Control

 

 

Screen Shot 2016-02-19 at 2.47.54 AM.png“In the small world of drug testing, these four—Angarola, Bensinger, DuPont and Willette—are affectionately referred to as the Gang of Four. Dr. John Morgan explains, “They are the ones responsible for a good deal of drug testing’s success, and some of the fear that goes along with it. Remember these names. These men are among the most competent and knowledgeable about drug testing—scientifically and politically. They are well-informed: they have to be. Their livelihoods depend upon their credibility. Unfortunately their expertise represents the greatest threat to the civil liberties we seek to protect. Know your enemy.” 1

Steal This Urine Test – Fighting Drug Hysteria In America – By Abbie Hoffman with Jonathan Silvers. 1986


A recent Huffington Post article written by Maia Szalavitz, The Rehab Industry Needs to Clean Up Its Act Here’s How, describes the need to radically rethink and reform American addiction treatment.. The article quotes Dr. Mark Willenbring who states

“What we simply need is a nice bulldozer, so that we could level the entire industry and start from scratch.”

Agreed, but the chances of this are slim to none if the “PHP-blueprint” becomes the “New Paradigm.”  To prevent this from happening it is critical to disprove the claims, recognize the threat, and address the matter directly and collectively.   We need political and social activism in the same spirit as Abbie Hoffman whose words from three decades ago are aptly accurate.  His prescient warnings remain unknown, forgotten, or irrelevant to us today but their accuracy is crystal clear.  Few people know the enemy.

Screen Shot 2016-02-19 at 2.45.36 AMOn April 23, 2015 Dr. Robert Dupont, MD addressed the House Subcommittee on Oversight and Investigations Combatting the Opioid Abuse Epidemic and proposed widespread application of a “New Paradigm” for substance abuse management based on the nation’s physician health program (PHP) model of care.

This model is being brandished as “gold standard for addiction treatment” to the drug and alcohol rehabilitation community and general public. The medical literature contains numerous articles claiming the high success rate of these programs4,6,9,10 and they are being promoted to set the “ standard for recovery” as a replicable model to be used for treating “other addicted populations.”11  In his speech before the House Subcommittee Dupont states critics call the expansion “utopian” but many would beg to differ. “Dystopian” would be more like it.

There has been an increasing scrutiny of these programs recently  not yet covered by mainstream media.  The link between the marked increase in physician suicide (which is much more than the oft quoted medical school class of 400 per year is directly related to the FSPHP takeover of PHPs).  A recent Medscape article   describes the coercion, control, secrecy and conflicts-of-interest between the PHPs and their “PHP-approved” assessment and treatment centers.  The simple fact is the majority of doctors referred to these programs do not have a substance use disorder or psychiatric problem but are given one nevertheless. This removes their locus of control and puts the PHP in complete power.  Their fate is in the hands of the PHP.

The assessment and treatment facilities used by PHPs do not take insurance and require payment up front. It is all out of pocket because if insurance was involved the fraud would have been discovered long ago. The PHPs have no accountability.  There is no oversight by medical boards or medical societies and answerability and justification for actions are absent.  And as we are hearing the rehabilitation industry itself is unregulated.  So too are the junk-science lab tests used in PHP programs as these non-FDA lab tests and the corrupt labs that use them have no oversight form the FDA or any other agency able to hold them to account.  It is a free for all.

Those ensnared in this web do know the enemy but can do nothing about it.   I am hearing story after story of doctors seeking help from their medical societies, law enforcement,  the media and the ACLU only to be turned away.

Their stories are remarkably similar An increasing number of complaints involving PHPs and the preferred assessment and treatment centers and contracted commercial labs are being reported.   A recent lawsuit filed by a doctor against the North Carolina PHP and Medical Board reported on Medscape last week is a prototypical case. The scenario typically goes like this: An accusation is made against a doctor who has had no previous disciplinary history or concerns (alcohol on breath, throwing a surgical instrument) and referred to the state PHP; An assessment is recommended by the PHP at an out-of-state “PHP-approved” assessment and treatment center; the assessment confirms a psychiatric problem or substance use disorder and recommends typically three-months of inpatient treatment followed by a 5-year contract with the state PHP for monitoring. It is becoming clear that doctors who do not fit the diagnostic criteria for a disease are being diagnosed with a disease. There are also complaints of laboratory misconduct and forensic fraud.

It is important to recognize that State PHP programs require strict adherence to 12-step doctrine11 and limit assessments to not only ASAM facilities but to a specific constellation of 12-step assessment and treatment centers with medical directors who belong to a group called like-minded docs.  It is in fact a “rigged game.”

In “Six lessons from state physician health programs to promote long-term recovery” Dupont and Dr. Greg Skipper attribute this success rate to the following factors:12

(1) Zero tolerance for any use of alcohol and other drugs;

(2) Thorough evaluation and patient-focused care;

(3) Prolonged, frequent random testing for both alcohol and other drugs;

(4) Effective use of leverage;

(5) Defining and managing relapses; and

(6) The goal of lifelong recovery rooted in the 12-Step fellowships.12

In truth the sole basis for these claims is a single retrospective cohort study of 904 physicians monitored by 16 state PHPs initially published in the British Medical Journal in 2008.2 In 2009 the same study was published in the Journal of Substance Abuse Treatment3 and deemed the “PHP-blueprint. Methodologically flawed and rife with conflicts-of-interest this study is the sole foundation of all of the claims.   Of the 904 participants 102 were “lost to follow up” and of the remaining 802, 155 failed to complete the contract but despite the small numbers this study has been hashed and rehashed to brandish the claims of an 80% success rate physician including subsets of psychiatrists,4 surgeons5 and anesthesiologists6  In his address to the House Subcommittee Dupont, who is a co-author on every one of these papers, claims similar success in a subgroup of opioid addicted doctors.

None of this has been subjected to normal scientific peer-review procedures and represents a serious departure from the normal standards of scientific inquiry

The same forces that have created and sustained the current monopoly of 12-step oriented treatment in America have grand plans through links  forged though government, private agencies and the drug and alcohol testing assessment and treatment industry.

Through a combination of large-scale funding, rhetorical persuasion and moral panics they have gained both tremendous sway and power in the profession of medicine and the collateral damage they have caused is widespread and permanent.   They are poised to do the same to others using the  same methods and the procedural protections afforded to those currently being tested for substances of abuse in Federal Workplace Drug Testing programs will be removed without your consent or knowledge.   I recently heard from someone  that these groups are lobbying the Nuclear Regulatory Commission into accepting this model with some resistance.

As far-fetched as all of this sounds all one has to do is look. The greatest threat to the civil liberties we seek to protect is no longer a threat but a reality.

Examine the documents below and connect the dots to see the coming Trojan horse for systemic application of a flawed substance abuse management program with no evidence base.

Medicalization of 12-step  will be accomplished when “addiction medicine” becomes recognized as a bona-fide medical specialty by the American Board of Medical Specialties.(ABMS) which is slated to occur within the next couple years. At that point this group will deem 12-step ideology as best practice  “evidence-based” doctor recommended care. This will “sanctify” the  ideology as medical “standard of care” and can then be imposed on anyone with impunity and immunity.   Medicalization subverts the Establishment clause of the 1st Amendment and the propaganda supporting this has already begun.   See the 12-step “facilitation”  piece below giving the reasoning they will use.  This is not facilitation but coercion.

The ASAM White Paper on Drug Testing promotes random testing of everyone using the Non-FDA approved tests of unknown validity currently used in state physician health programs. This will be implemented through the healthcare system by removing procedural protections currently in place under federal guidelines. This is sure to be a boon for anyone battening and fattening off the Drug and Alcohol Testing Industry Association or rehab racket gravy train but a burden and pain for the rest of us.

The conflicts of interest are unfathomable.

Dupont and fellow “Gang of Four” member Peter Bensinger (DEA chief, 1976–1981) run a corporate drug-testing business. Their employee-assistance company, Bensinger, DuPont & Associates is the sixth largest in the nation and managing drug testing for some 10 million Americans including Kraft Foods,  the FAA and even the Justice Department.  They sell drug-testing management programs.  The “New Paradigm” is simply a ruse to get non-FDA approved testing into the wider workplace via loopholes and workarounds.  His ties to the drug and alcohol testing and treatment industry are easy to find.  Drug testing is a multi-billion-dollar-a-year industry. DATIA [Drug & Alcohol Testing Industry Association] represents more than 1,200 companies and employs a DC-based lobbying firm, Washington Policy.  Many of the non-FDA approved tests they are using in the “PHP-blueprint” they in fact introduced to the market themselves with no evidence base. It is reprehensible.

And the people who will suffer most in the “New Paradigm” will be those who are already marginal in American society. That’s a given. I have heard from doctors who are gay or belong to a minority group who claim they were referred to a PHP due to discrimination but had no recourse.

Medicalization of behavior  removes due process as the victimized are simply put in a labeled group and via actuarial logic that safely that removes the underlying prejudice from view by categorization of risk.   Discrimination is justified and rationalized.   So read the documents below and connect the dots. Then do something about it.  Say something. Write something.  Do something.  The Emperor has no clothes and this needs to be exposed. Either defend what you read below or protest this New Inquisition.  We need revolt and Revolution.  The Federation Of State Physician Health Programs (FSPHP) regime is simply another front-group designed to force the medical profession in line for the profits of the rehab racket.  The FSPHP is the enemy and State PHPs need to be reformed and repaired  with transparency and accountability. And to accomplish this the entire long running mess needs  to be bulldozed  and rebuilt from scratch.

  1. Robert Dupont’s 2012 Keynote speech before the Drug and Alcohol Testing Industry Association
  2. Robert Dupont’s address before the House Subcommittee on Oversight and Investigation Combatting the Opioid Epidemic
  3. 2014 Journal of the American Medical Association (JAMA) article entitled “Addiction Medicine: The Birth of a New Discipline
  4. The ASAM White Paper on Drug Testing
  5. Why good addiction centers connect clients to AA or NA

Screen Shot 2016-02-19 at 2.47.37 AM.png

  1. Hoffman A, Silvers J. Steal This Urine Test: Fighting Drug Hysteria in America. 1 ed: Penguin Books.
  2. DuPont RL, McLellan AT, Carr G, Gendel M, Skipper GE. How are addicted physicians treated? A national survey of Physician Health Programs. Journal of substance abuse treatment. Jul 2009;37(1):1-7.
  3. White WL, Dupont RL, Skipper GE. Physicians health programs: What counselors can learn from these remarkable programs. Counselor. 2007;8(2):42-47.
  4. Skipper GE, Campbell MD, Dupont RL. Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs. Anesthesia and analgesia. Sep 2009;109(3):891-896.
  5. Yellowlees PM, Campbell MD, Rose JS, et al. Psychiatrists With Substance Use Disorders: Positive Treatment Outcomes From Physician Health Programs. Psychiatric services. Oct 1 2014.
  6. DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs. Journal of Medical Regulation. Mar 2010;95(4):10-25.
  7. Dupont RL, Skipper GE. Six lessons from state physician health programs to promote long-term recovery. Journal of psychoactive drugs. Jan-Mar 2012;44(1):72-78.
  8. McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. Bmj. 2008;337:a2038.
  9. DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs. Journal of substance abuse treatment. Mar 2009;36(2):159-171.
  10. Buhl A, Oreskovich MR, Meredith CW, Campbell MD, Dupont RL. Prognosis for the recovery of surgeons from chemical dependency: a 5-year outcome study. Archives of surgery. Nov 2011;146(11):1286-1291.


Please donate here:  https://www.gofundme.com/PHPReform

There is a very urgent need for a “counterpower” to state physician health programs (PHPs). On average five or six medical students, doctors or residents contact me each week and I want to continue to help them and work toward advocacy and watchdog groups.  Unfortunately I am losing ground quickly.  We have made tremendous advances in the last year and I am working in many different venues to expose the problems written about here.  Those involved in this corrupt system are hoping that I will run out of resources and simply go away and have done everything they can to accomplish this. Without your help this will occur and it will unfortunately occur soon.

 

 

 

 

 

Robert Dupont claims PHPs result in a “lifetime of well-being” LMAO

Screen Shot 2016-02-14 at 11.15.40 PM

The Medscape article  Physician Health Programs- More Harm Than Good? by Pauline Anderson shed some light on coercive, controlling  secretive lair of Physician Health Programs.    Coercive v. supportive is the question Alissa Katz presents in todays Emergency Medicine News.  Supporting coercion, John Knight and J. Wesley Boyd claim that any doctor caught in the maw of their state PHP must abide by whatever the PHP requests in order to continue practicing medicine. Susan Haney concurs who notes the unwary self-referrer who unwarily steps into the lions den.

Screen Shot 2016-02-14 at 11.34.00 PM

 

 Former White House Drug Czar (1973-1977) Robert Dupont, M.D. disagrees claiming the programs are worth the price of a “lifetime of well-being.”

You don’t say?     Robert Dupont’s ties to the Drug and Alcohol Testing Association (DATIA) are thick  and the designs of the former National Institute on Drug Abuse Director are spelled out in the ASAM White Paper on Drug Testing as well as his keynote speech before DATIA proposing expansion of this paradigm to other populations including workplace, healthcare, and schools.  He profits from both drug tests and employee assistance program management.  The “PHP-blueprint” is simply Straight, inc. for doctors and the same propaganda, fabricated studies, 12-step indoctrination, coercion, control and abuse remain unfettered and just as vile.

Screen Shot 2014-02-07 at 8.38.55 AM

Dupont wants to swindle the PHP system into other EAPs such as as DOT proclaiming the “need to reach more of the 1.5 million Americans who annually enter substance abuse treatment, which now is all too often a revolving door.”1 They conclude:

This model of care management for substance use disorders has been pioneered by a small and innovative group of the nation’s physicians in their determination to help other physicians save their careers and families while also protecting their patients from the harmful consequences of continued substance abuse. In fulfilling the professional admonition “physician: first heal thyself,” these physicians have created a model with wide applicability and great promise.1image1

“Based on abundant evidence, a “new paradigm” for substance abuse treatment has evolved that is the exact opposite of harm reduction. This paradigm enforces a standard of zero tolerance for alcohol and drug use that is enforced by monitoring with frequent random drug and alcohol tests. Detection of any drug or alcohol use is met with swift, certain, but not draconian, consequences.”

 

Straight, Inc. –Torture as treatment

 

In 1981 Dupont made similar claims about Straight, Inc., a non-profit teenage rehabilitation center.   The predecessor of Straight, Inc., the Seed, was started in 1970 in Florida with a start up grant of $1 million dollars from the federal governments National Institute on Drug Abuse (NIDA). Director of NIDA, Robert L. DuPont, Jr. had approved the grant.on the antidrug cult Synanon founded in 1958. Deemed a the “family oriented treatment program,” Dupont encouraged organization and expansion. Targeting the children of wealthy white families they exploited parents fears for profit. Signs for hidden drug use such as use of Visine, altered sleep patterns, and changes in clothing style were used as indications for referral. Any child who arrived would be considered an addict in need of their services. Coercion, confrontation, command and control as the guiding principles,. Submit or face the consequences. .We know what’s right. The idea was to strip the child of all self-esteem and then build him back up again in the straight image. Abused dehumanized, delegitimized, and stigmatized-the imposition of guilt, shame, and helplessness for ego deflation and murder of the psyche to facilitate canned and condensed 12-step as a preparatory step on the path of lifelong spiritual recovery.

Screen Shot 2014-12-02 at 12.46.18 AM

Children were coaxed or terrorized into signing confessions, berated, and told they were in “denial. Inaccurate and false diagnoses were given to wield greater control. Reports and witness accounts now indicate that many of the kids did not even have drug problems but by creating a “moral panic” about teenage drug use they exploited parents fears for profit. Straight, Inc. became the biggest juvenile rehabilitation center in the world. Health officials in Boston cited Straight for treating a 12 -year old girl for drug addiction when her records revealed all she did was sniff a magic marker! Pathologizing normality.

Screen Shot 2014-02-22 at 1.39.26 AM

Methodologically flawed research , deceptive marketing, and propaganda were all used to support the continuation of the program. Designed to be hidden from public view. Straight, Inc. had no regulation or oversight. These programs of torture and abuse resulted in many suicides, suicide attempts, post-traumatic stress disorder and other psychological   and grave psychological trauma.There is a FB page dedicated in memory to all of those who died.

Of course Dupont brandishes the “PHP-blueprint” claiming  remarkable success in the same old saw we have heard ad nauseam.  This paper is paraded around as ifs the holy grail but it is methodologically bottom of the barrel and the conflicts-of-interest are obscene.  This retrospective five year cohort study published in 2008 is their flagship and shining star and they claim an 80% success rate in treating doctors which sounds pretty good until you consider 80% of the doctors therein do not have a substance use disorder.

The 2008 Physicians Health Program study inexplicably excluded resident physicians because they “were both younger than the average practicing physician and therefore at higher risk of substance abuse.”  Other than cherry picking to favor success what is the logic behind that.

Screen Shot 2014-11-25 at 7.09.15 PM

More importantly, however, is the 24 that “left care with no apparent referral” and the 48 that “involuntarily stopped or had their licenses revoked.”  It is my understanding they chose these endpoints due to the large number of doctors who died by suicide so instead of identifying “suicide” they chose what they did to them as an endpoint.  “left care with no apparent referral” sounds better then “left care and shot himself in the head.”

Dupont is bragging and flagging  the “blueprint” as a successful model applicable to other populations and plans to bring it to you.  Why?  To sell long-term inpatient treatment and frequent drug testing.   Dupont once recommended everyone under 40 be tested when he was 41.  This man wants to test everyone.  If he could he would test infants–hell he’d test fetuses if he could.  One thing is for certain though–if the blinkered masses don’t wake up from their apathetic slumber they will not too far from now be waking up to pee in in a cup and won’t be able to do a damn thing about it.Screen Shot 2016-02-15 at 12.09.01 AM

 

 

IMG_8894

 

Emergency Medicine News:
doi: 10.1097/01.EEM.0000480794.97823.49
News

News: Physician Health Programs: Coercive or Supportive?

Katz, Alissa

You wouldn’t think physician health programs — designed to help doctors recover from substance abuse — would be such a contentious topic. But more than a few physicians complain that participation is “coercive” if a physician wants to retain his license.

Figure. No caption a...

Image Tools

The programs are run on a state level, and have evolved into for-profit entities, according to physicians who have been through one. You can find one in all 48 states and Washington, D.C., charged with preventing “substance abuse problems among physicians and to detect, intervene, refer to treatment, and continuously monitor recovering physicians with substance use disorders.” (J Subst Abuse Treat 2009;37[1]:1.)

Physician health programs (PHPs) are funded a variety of ways depending on location, including state licensing board grants, fees charged to participants, and contributions from state medical associations, according to reports. When a physician agrees to cooperate with the PHP and adhere to any and all recommendations, it decreases the probability he will be subject to disciplinary action and increases the likelihood he will be able to remain in practice, PHP proponents say. But not everyone agrees.

“Participation is coercive, and once a PHP recommends monitoring, physicians have little choice but to cooperate if they have any intention of ever practicing medicine again,” J. Wesley Boyd, MD, PhD, and John R. Knight, MD, former PHP associate directors in Massachusetts, said in an editorial in the Journal of Addiction Medicine. (2012;6[4]:243.)

Physician health programs report results of compliance, including drug test results to licensing boards, credentialing agencies, and employers whether the physician is sober, compliant with his treatment, and capable of safely practicing medicine.

“Programs are generally structured to encourage professionals to get help early before the onset of problems in the workplace, but the consequences depend on the situation and the state policies,” said Warren Pendergast, MD, a psychiatrist and the CEO of the North Carolina PHP (NCPHP)

Compliance Mentality

North Carolina’s PHP was audited in 2013-2014. “There were a number of protections they wanted us to institute. There was a conflict of interest issue raised about our every-other-year retreat having a small amount of contribution from assessment and treatment centers, and we stopped that in 2012. Our policy was similar to many medical meetings sponsored by vendors,” said Dr. Pendergast.

Drs. Boyd and Knight said in their editorial the programs have a compliance mentality that reports physicians to their medical board for possible disciplinary action if they don’t comply with the program’s recommendations, depriving the physicians of having a say in their own treatment.

So why are physicians opting into these programs? Colleagues can recommend them for an evaluation and they have to comply, and others who self-refer just don’t know any better, said Susan Haney, MD, an emergency physician in Oregon, who went through treatment assigned by her state’s PHP.

“That’s the problem. You assume, as I assumed, that the medical board is staffed with caring and competent physicians, and that the health program is there to help. So you go to them naïvely asking for help or your colleagues refer you to them thinking you’ll get help. I guess some people find help. But a lot of physicians are exploited by the system,” she said.

Robert DuPont, MD, the president of the Institute for Behavior and Health and a supporter of physician health programs, said such criticisms aren’t looking at what the programs have achieved. “Outcomes are very positive, with only 22 percent of physicians testing positive at any time during the five years and 71 percent still licensed and employed at the five-year point,” according to a study Dr. DuPont co-authored. (J Subst Abuse Treat 2009;37[1]:1.)

Abstinence rates among substance-abusing physicians who engage with PHPs are in the 75 to 80 percent range, which is far higher than almost any other form of substance abuse treatment. This can be attributed to PHPs’ demographic and higher socioeconomic status, compared with those in other substance abuse programs, and the risk-to-reward ratio is often higher for PHP participants. (BMJ2008;337:a2038.)

“Programs have no leverage. They have no punishment; they have no consequences. The consequences are all kneaded out by other organizations, by the medical boards or the hospitals. I think all these critics have gotten it mixed up. The physicians who are coming to the PHPs have big problems; they’re under a lot of pressure, not from the PHP but from somewhere else.”

Back to Top | Article Outline

Costly Treatment

Dr. DuPont’s study said PHPs don’t provide formal addiction treatment, either, but instead function as long-term case managers and monitors for participants. Evaluations through PHP-recommended treatment centers aren’t usually covered by insurance, for example, and can cost as much as $4,500 for a 96-hour evaluation, if not more, and can go as high as $39,000 for a typical three-month length of stay.

“If treatment is priced so high that it is out of the reach of potential physician-patients, it does not serve the purpose for which it was created and thus represents an administrative and management failure on the part of the PHP,” Drs. Boyd and Knight wrote. (J Addict Med 2012;6[4]:243.)

Because many centers that specialize in evaluating health care professionals also provide costly treatment, Drs. Boyd and Knight said they are left wondering whether financial incentives play a role in the recommendation. Reports argue that physicians charge a lot for their time and services, so they are financially able to pay more than a non-physician would for the same treatment. “In our experience, it is far more common for physicians to simply stay at the same facility for treatment rather than packing up and moving elsewhere,” they wrote.

Evaluation and treatment centers support PHPs financially, too, adding to a potential conflict of interest between the two. Dr. DuPont said he thinks the price to pay for assessments and treatment, however, is small compared with the perspective of a lifetime of well-being. “My experience is that PHPs are certainly willing to work with physicians on cost issues. I think it’s not realistic to think the people in the programs are not going to need treatment. To me it goes without saying the treatment is part of the package,” he said.

North Carolina has a scholarship program administered through the state’s Medical Society Foundation, and the several-thousand-dollar assessments are part of the reason the program screens. “We don’t send everybody for assessment,” said Dr. Pendergast.

Share this article on Twitter and Facebook.

Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com.

Comments? Write to us at emn@lww.com.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.