In 2012 former Nixon Drug Czar Robert Dupont, MD delivered the keynote speech at the Drug and Alcohol Testing Industry Association (DATIA) annual conference and described a “new paradigm” for addiction and substance abuse treatment. He advocated zero tolerance for alcohol and drug use enforced by monitoring with frequent random drug and alcohol tests. Detection of any substances is met with “swift and certain consequences.”
And then he proposed expansion of this paradigm to other populations including workplace, healthcare, and schools.
Robert Dupont was a key figure in launching the “war on drugs” — now widely viewed as the failed policy that has turned the US into the largest jailer in the world.
In the 1970s, Dupont administered the experimental drug rehab program called “The Seed” – that was later deemed by congress to use methods similar to those used on American POW’s in North Korea. He would later go on to consult for “Straight, Inc”, a rehab program that treated troubled teens as “addicts”, often for minor infractions or normal teenage behavior.
Deemed the “family oriented treatment program,” Dupont encouraged organization and expansion. Targeting the children of wealthy white families parents fears were used to refer their kids to the programs. Signs of 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 were 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 was used for ego deflation to facilitate canned and condensed 12-step as a preparatory step on the path of lifelong spiritual recovery.
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 for rehabilitation and treatment of addiction.
12 year old girl admitted to inpatient addiction rehabilitation for sniffing a “magic marker”–Once!
A Deficiency Correction Order was issued by the Executive Office of Human Services, Office of Children, Commonwealth of Massachusetts Services to Straight, Boston in 1990 that read in part:
|“Although Straight’s statement of services states that Straight serves chemically dependent adolescents, a review of records and interviews with staff demonstrate that Straight admits children who are not chemically dependent. For example, one twelve-year-old girl was admitted to the program although the only information in the file regarding use of chemicals was her admission that she had sniffed a magic marker.”
Straight was always making outlandish claims of success but there was no scientific evidence based data to support it. In September 1986 USA TODAY ran an article headlined: DRUGS: Teen abusers start by age 12 which opened with: “Almost half of the USA’s teen drug abusers got involved before age 12…”
The article was based on a study conducted by Straight, Inc.
Many former patients of Straight were so devastated by the abuse that they took their own lives. Since then, Dupont has been a key figure in the proliferation of workplace drug testing programs, and once advocated for drug testing anyone in the workplace under the age of 40.1,2
The Physician Health Program (PHP) blueprint is essentially Straight, Inc. for Doctors in both Mechanics and Mentality
The “new paradigm” Dupont speaks of before the Drug and Alcohol Testing Industry Association is modeled after state physician health programs (PHPs) and as was done with Straight, “remarkable” claims of success are being made.3-6 Promoted as “Setting the standard for recovery” PHPs are now being pitched to other populations7
Dupont and Dr. Greg Skipper proclaim 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.”8 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.8
In “Six lessons from state physician health programs to promote long-term recovery” Dupont and Skipper attribute this success rate to the following factors:8
(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.8
As with Straight, the majority of those admitted to PHPs are not even addicts. The Federation of State Physician Health Programs (FSPHP) was able to convince Federation of State Medical Boards, to adopt the notion of “potentially impairing” illness and “relapse without use” to promote early intervention using the same false logic as Straight, Inc. and the 12-year old with the magic marker. ( i.e. teen drug abuse starts by age 12 and that any sign or symptom inexorably progresses to impairment justifying “treatment”).
Signals for “impairment” can be as benign as not having “complete, accurate, and up-to-date patient medical records.” according to Physician Health services, the Massachusetts Physician Health Program and subsidiary of the Massachusetts Medical Society.
Despite the overwhelming amount of paperwork physicians now have, incomplete or illegible records could be construed as a red flag, since, as Associate Director of PHS Judith Eaton notes “when something so necessary is not getting done, it is prudent to explore what else might be going on.”
It is a false premise “feel-good fallacy” with faulty conclusions. And because it is being perpetrated on doctors (and those in the criminal-justice system) no one seems to care. But this is merely a wedge for a grander plan.
Dupont has been heavily involved in studies using non-FDA approved laboratory developed tests and other devices of unknown validity on doctors in PHPS and promoting the use of these tests for forensic monitoring.9,10
And they want to bring these tests to you. Propaganda and misinformation has been designed to sway public opinion.
A Medscape article from “Drug abuse among Doctors: Easy, Tempting, and Not Uncommon” is a prototypical example of the propaganda and misinformation being used to sway public policy and opinion. Focusing on a small study ( n =55) done by Lisa Merlo (Director of Research for the Florida PHP). Dr.Marvin Seppala states in the article that impaired doctors are:
“….often described as the best workers in the hospital,” he says. “They’ll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They’ll sign up for extra call and show up for rounds they don’t have to do.” Physicians are intelligent and skilled at hiding their addictions, he says. Few, no matter how desperate, seek help of their own accord.”
There is no evidence base for a hidden cadre of drug-impaired doctors causing medical error. A critical review of the literature reveals no evidence base exists. Moreover, this blather does not even comport with reality. It defies reason and even basic common sense.
But through misinformation and deceptive propaganda similar to that used by Straight these groups have created “moral panics” aimed at physicians designed to separate them from everyone else.
To be sure, doctors who are practicing impaired due to substance abuse need to be removed from practice both to get the help they need and to protect the public. But that is not what is happening. Instead, what is occurring is that doctors can get caught up in this system for any number of reason. Indeed, some of these physicians have no history of drug-addiction—they are the equivalents of the 12-year-old girl caught sniffing a magic marker.
And this is how the scam works.
When doctors monitored by their PHP test positive they are forced to have an evaluation at a “PHP-approved” treatment center. In 2011 the American Society of Addiction Medicine (ASAM) issued a Public Policy Statement recommending physicians in need of assessment and treatment be referred only to “PHP approved” facilities. The medical directors of the “PHP-approved” facilities can be found on this list of “Like-Minded Docs”.
In 2011, The organization that oversees the licensing for all medical doctors, the Federation of State Medical Boards, adopted a new policy and approved the concept of “potentially impairing illness.” and the Orwellian notion of drug “relapse without use.”
This implies that they will be able to ruin any doctor who does not comply or who is found guilty, even if fraudulently.
The question might be, “Why?” As with anything, we have to think about who profits.
Indeed, Dupont has remained a vocal and influential spokesman for drug and alcohol testing. But he along with former DEA head Peter Bensinger run a corporate drug-testing business. Their employee-assistance company, Bensinger-Dupont is the sixth largest in the nation.
Now, they also want to extend these tests to drivers.11,12 and Federal Workplace Drug Testing Programs.
They would like to replace the current system used in pilots, bus drivers, and Federal Employees with “comprehensive drug and alcohol testing.”13 AND THEY ARE promoting hair testing, 14Their goal is 24/7 sobriety with complete abstinence 15, and zero tolerance.16
Their claims of success are based on a single retrospective cohort study looking at the outcomes of 904 physicians monitored by 16 different State PHPs.17
An 80% success rate is claimed but 102 of the 904 participants were “lost to follow up” and of the remaining 802, 155 failed to complete the contract.
So what happened to the 24 of who “left care with no apparent referral,” the 85 who “voluntarily stopped or retired,” and the 48 who “involuntarily stopped” or had their “license revoked.” Whether you leave a PHP voluntarily, involuntarily, or with no apparent referral it is the end.. The plug is pulled. Game over. Comparing this to other populations where the consequences are not as terminal is like comparing apples to oranges.
But the bigger question is what happened to the 157 physicians who left or stopped? How many of those killed themselves. The study reports 6 suicides, 22 deaths, and another 157 who are no longer doctors. How many of the 22 deaths were suicides and what happened to the 157 who stopped for no apparent reason? Using the last recorded clerical status as an endpoint obfuscates the true endpoints. Where are they now? Alive or dead?
Propaganda and misinformation is designed to sway public opinion and it is all hidden from public view and scrutiny. Absolutely no oversight or regulation from outside agencies exists for PHPs and very little exists for the “PHP-approved” up-front cash only assessment and rehabilitation facilities. The commercial drug-testing labs using non-FDA approved LDTs have no accountability either. No agencies exist to hold them accountable for errors or even intentional misconduct. The College of American Pathologists (CAP) is the only avenue for complaint and CAP is an accreditation agency that can only “educate” not “discipline.” It is a system that fosters and fuels misconduct as no consequences exist for wrongdoing and they built it that way.
The American Society of Addiction Medicine erected this scaffold state-by-state. And that is how it must be removed. It is a system of coercion, control, and fear. Crimes like the ones being committed here in Massachusetts must be investigated as crimes. The perpetrators must be held accountable.
It is a system of institutional injustice that is killing physicians by driving them to hopelessness, helplessness, and despair. The general medical community needs to awaken to the reality of the danger to expose and dismantle it at the State level. And many of the doctors caught in this maw do not even have an addiction or substance abuse issue –equivalent to the 12-year old girl in referred to Straight for sniffing a magic marker. On the other hand many of those in charge of the administration of these programs have engaged in egregious even horrific misconduct and have a history of manipulating the system.
Secondly, all of the so-called “research” must be subject to evidence base review. It is not there.
And thirdly, the numerous, intertwined and myriad conflicts of interest must be addressed – because it’s money that is the big driver of this “benevolent” interest in whether or not you are sober.
With over 20 years experience as Associate Directors of the Massachusetts PHP, Physician Health Services, Inc. (PHS,inc.), Dr.’s J Wesley Boyd, MD, PhD and John R. Knight of Harvard Medical School published an Ethical and Managerial Considerations Regarding State Physician Health Programs pointing out serious conflicts of interest and ethical issues involving PHP programs and the need “to review PHP practices and recommend national standards that can be debated by all physicians, not just those who work within PHPs.”
They recommend ethical oversight of PHPs, a formal appeals process for physicians, periodic auditing, a national system for licensing, and recommend “the broader medical community begin to reassess PHPs as a whole in an objective and thoughtful manner.” Unfortunately, this has not occurred. It urgently needs to. Because the Physician Health Program “Blueprint” is essentially Straight inc. in both mechanics and mentality. and those killing themselves are the equivalent of the 12-year old girl caught sniffing a magic marker.
Unlike Straight, inc., no FaceBook site dedicated to the “memory of those gone” yet exists for the many many doctors killed and being killed by the “PHP-blueprint.” It should and someday, believe me, it will.
- Engs RC. Mandatory random testing needs to be undertaken at the worksite. Controversies in the Addiction Field. Vol 1. Dubuque, IA: Kendall/Hunt; 1990:105-111.
- Dupont RL. Never trust anyone under 40: What employers should know about Molly Kellogg in the workplace. Policy Review. Spring 1989:52-57.
- 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.
- White WL, Dupont RL, Skipper GE. Physicians health programs: What counselors can learn from these remarkable programs. Counselor. 2007;8(2):42-47.
- 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.
- 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.
- 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.
- 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.
- Skipper GE, Thon N, Dupont RL, Baxter L, Wurst FM. Phosphatidylethanol: the potential role in further evaluating low positive urinary ethyl glucuronide and ethyl sulfate results. Alcoholism, clinical and experimental research. Sep 2013;37(9):1582-1586.
- Skipper GE, Thon N, DuPont RL, Campbell MD, Weinmann W, Wurst FM. Cellular photo digital breathalyzer for monitoring alcohol use: a pilot study. European addiction research. 2014;20(3):137-142.
- Voas RB, DuPont RL, Talpins SK, Shea CL. Towards a national model for managing impaired driving offenders. Addiction. Jul 2011;106(7):1221-1227.
- DuPont RL, Voas RB, Walsh JM, Shea C, Talpins SK, Neil MM. The need for drugged driving per se laws: a commentary. Traffic injury prevention. 2012;13(1):31-42.
- Reisfield GM, Shults T, Demery J, Dupont R. A protocol to evaluate drug-related workplace impairment. Journal of pain & palliative care pharmacotherapy. Mar 2013;27(1):43-48.
- DuPont RL, Baumgartner WA. Drug testing by urine and hair analysis: complementary features and scientific issues. Forensic science international. Jan 5 1995;70(1-3):63-76.
- Caulkins JP, Dupont RL. Is 24/7 sobriety a good goal for repeat driving under the influence (DUI) offenders? Addiction. Apr 2010;105(4):575-577.
- DuPont RL, Griffin DW, Siskin BR, Shiraki S, Katze E. Random drug tests at work: the probability of identifying frequent and infrequent users of illicit drugs. Journal of addictive diseases. 1995;14(3):1-17.
- 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.