Mary Harris: Think about the best feeling you’ve ever had. Like a time when you would say, you actually experienced euphoria. What did that feel like?
Peter Grinspoon: It’s just like a feeling in your chest, sort of where your heart is, of pure absolute complete bliss. Like bliss so strong you just have to like close your eyes and stop what you’re doing. And just feel this like, pure complete happiness.
MH: This is Peter Grinspoon’s answer to that question.
PG: Like imagine that you’re starving and then you have a bite of your favorite food but then multiply that by 1,000.
MH: For him that feeling came from taking Vicodin.
Grinspoon’s a doctor. But the first time he tried vicodin, he was still in medical school. His girlfriend, another medical student had gotten a bunch of pills. He remembers looking up the ones they hadn’t tried before in a pharmacology textbook.
PG: And it said you know beware, causes euphoria and a false sense of wellbeing. And once we read that we were sort of destined to try it. There is a reason why people take drugs. You know, they, drugs can be fun and they can make you feel really good. I can say first hand that they can also incinerate the rest of your life.
MH: I’m Mary Harris, this time on Only Human a physician with a charmed life crashes and burns. It’s the story of one person with a drug problem. But it’s also a story of an epidemic taking hold. Peter Grinspoon tells it with his new book Free Refills.
Grinspoon had experimented with a lot of drugs before Vicodin. But he says the first time he tried it was like he split in two. On the outside, he was finishing medical school and moving onto residency at Harvard, but on the inside he couldn’t stop chasing that euphoric feeling.
PG: You know, I still was me, studying, going along with my daily life. But a part of me had a radar on looking for more Vicodin.
MH: Did you understand at the time that you were becoming an addict?
PG: Ummm. I was so deeply in denial about this. I was very good and very successful at stuffing that thought way to the bottom of my consciousness. I would say at some very deep level I knew it, but on most conscious levels I was blithely unaware of the fact that I was sinking deeper and deeper into addiction.
MH: How were you getting the drugs?
PG: Well, medicine is a land of opportunity for a drug addict. So there is sort of an infinite way of procuring medications. People would prescribe it for me. Honestly, I’d steal it from friends and family members. You could be in your clinic and an elderly patient would say: Oh, They gave me sixty of these pills in the ER and they hurt my stomach, so I’m giving them back to you. And then you would have fifty-nine Percocet sitting there on your desk that no one would be supervising. I mean, it’s almost infinite the access we have to medications.
MH: You’re describing this kind of double life. Because, at the same time you are stealing prescriptions from patients and friends, you are still a pretty successful student. How did you manage it?
PG: I was a super motivated student. And I don’t know quite how I managed it. I just think that the one thing that had always been engrained in me is a kind of scholarship and the love of learning and reading and writing and doing well in school. And really that was the last thing to go. Umm, during the day I would work really heard in medical school and at night to relax I would just take as many pills as I had.
MH: So how many are we talking here?
PG: Umm, I would take probably ten Vicodin. I never ever injected it, never took dozens upon dozens. It was creeping up; it started at two and then it was four and then it was six. And I would say that it was ten to twelve to fifteen by the end.
MH: Do you think it ever impaired your performance as a physician?
PG: Well, I never took it before work, and I was never quote, unquote “impaired” at work. So that enabled me to rationalize and justify that the answer to that question is no. In reality during the day I was withdrawing, I was grouchy ‘cause I was withdrawing, I was restless and sweaty, I was in a bad mood. I was little bit foggy from the night before. So, I would say, no, I was not directly impaired while taking care of patients, but yes, I was at by no means at my best when caring for patients.
MH: And you said you would take ten. What’s a normal dose?
PG: One or two, but if you take one or two you don’t get much euphoria. If you take ten it really is euphorigenic, which is why these pills are so dangerous.
MH: After a while it wasn’t just Vicodin, any opiate would do. He took Phentenol, Oxycodone, Percocet, Codeine. At the same time he met someone and got married. And then came his honeymoon.
PG: My honeymoon was during residency. And I went from this really intensive training to honeymooning in Maine and just relaxing on the beach. And it was just a very surreal transition. And I was withdrawing pretty bad. At first I didn’t realize that I was withdrawing; it occurred to me that I hadn’t been away from the hospital for a couple weeks in a really long time.
You know, you just do the most desperate things when you are addicted to drugs. Things you would never think of doing in a million years. Things that you abhor. So what I did was, I called in a medication for Peter Grinspoon under the name of someone else. Then I went in and picked it up as Peter Grinspoon and kind of chilled out the rest of my honeymoon.
It’s only in retrospect that I realize how crazy this was. Crazy on so many levels; its illegal, it’s just the wrong thing to do. And it also wasn’t fair to my new wife who deserved not to have someone who was completely drugged out on their honeymoon.
MH: But at the time it must have seemed kind of magical, like oh, I can solve this problem.
PG: To the crazy addicted part of my brain I thought I was Albert Einstein. This seemed like a genius solution. At the time I thought I was brilliant, and like ha! No one can keep up with me and I really got this under control. Yeah, at the time I felt great about it.
MH: So eventually, to keep getting pills you started sharing prescriptions with your patients.
PG: Yeah, this is the part that I’m not that comfortable talking about. But again, in my crazy addicted thinking and in my desperation to procure medications, cause the thing about addition, you sort of need to procure more and more and more because you develop tolerance. So, I was so desperate and in my crazy addicted thinking it just seemed like a good idea. I certainly had some patients that were taking too many opiates who I think in retrospect were probably selling them or abusing them. And I can’t even describe how it came about, but we sort of like joined forces. I would write them for a little extra and they would give them back to me. I was basically, you know, taking advantage of these patients. I was doing the one thing you are not supposed to do as a doctor, so this is very upsetting for me to think about.
MH: You described this relationship you had with a patient that was like a parasite-host kind of thing. Where she would ask for meds and you would give them and then talk about your migraines; it sounds like a complicated dance.
PG: Yeah, it was a complicated dance. On another level it was very simple. I was on drugs and she was on drugs and we were both procuring drugs. The only problem was that I was a physician and I was supposed to be the responsible adult in the room and I wasn’t.
MH: When I read scenes like this in his book and think about the patients he took advantage of , I find it really really hard not to dislike him. And looking back on it, Peter Grinspoon can see exactly how bad this was, but he says that at the time it all felt okay. Until the cops showed up.
MH: So after you’d been addicted for almost ten years. You got caught. Tell the story how that happened.
PG: Well, I was coming back from lunch. Some drug rep was feeding us pizza probably. I came back to my office expecting to see patients, kind of busy hectic afternoon. Instead, I came back to my office the state police and DEA were sitting in my office and this really surprised me. I didn’t quite immediately connect the fact that they were in my office for the fact that I had been basically committing criminal acts for the last ten years. So, I hedged a little bit and the DEA agent said: “Doc., cut the crap we know you’ve been writing bad prescriptions.”
MH: Another way he used to get pills was calling in a prescription for someone else and then picking them up himself. After a while a pharmacist got suspicious.
PG: At the time, when the pharmacist figured out that I was writing bogus prescriptions. I was so angry and resentful at her and now that the years have gone by, I’m very grateful to her. Because, who knows what would have happened if she didn’t stop my descent into like, ever worsening addition. I could have easily overdosed or hurt someone.
MH: So the way ultimately you got caught was that a pharmacist turned you in?
MH: Do you know her? It sounds like you do.
PG: Well, I know who she is. She was like the friendly pharmacist at the local CVS I used to go to. I would love to see her now and just say thank you. You know this was eleven years ago, actually twelve years ago. I don’t know how I would find her.
MH: Peter Grinspoon was charged with fraudulently prescribing controlled substances. He was suspended from practicing medicine and sent to rehab. And his wife kicked him out of the house they shared with their young kids.
After the break, the long climb back. I’m Marry Harris and this is Only Human.
MH: I’m taking to Dr. Peter Grinspoon who talks about his addiction to pain killers in his new book Free Refills. He was 39 when the DEA showed up at his office a decade ago. He had been an addict for years at that point, but his fascination with drugs started much earlier.
MH: Did drug feel glamorous to you, when you were a kid?
PG: Drugs felt glamorous to me as a kid. Drugs felt glamorous to me in high school. Drugs felt glamorous to me in college and then drugs felt glamorous to me when I was in medical school.
MH: So pretty much always.
PG: Yeah, they have always. I have just been obsessed with them. I mean, not anymore, but I was and you know pharmacology was always my favorite subject in medical school. I just thought they were so interesting. I mean they are so interesting, but that doesn’t mean you have to take all of them.
MH: Laugh. The fascination was at least a little bit inherited. Peter Grinspoon’s dad is a well-known psychiatrist, named Lester Grinspoon who researched marijuana in the 60s and concluded it wasn’t as harmful as people believed. He also advocated for medical marijuana. Peter says growing up, his family wasn’t like other families he knew.
PG: The other houses were, you know conservative, affluent, suburbs sort of non-descript. And our house, the 60s were still going strong with the drugs and over dinner we would have really interesting visitors and the peace pipe would be going around. And people would be having these incredibly deep and intense discussions about you know, why do people still believe in religion when science explains the world? Or how can we solve hunger now that we have the technology to produce the food. They would be having these really deep conversations.
MH: Carl Segan was a family friend and a regular at those dinners. It sounds exciting.
PG: Yeah, no, it was really really fun and interesting, but it was not a great childhood for fitting into conservative high school. We were always like the kids who stuck out.
MH: Grinspoon would never say that his freewheeling childhood lead to his drug problem. Instead, he says he has a seeker’s personality and a biological weakens for opiates and that’s what set him up to tear his own life apart.
MH: After your arrest for overprescribing pain medication and writing fraudulent prescriptions. You moved out of the house you shared with your wife and kids and you moved back in with your parents.
MH: How much did you talk with them about your drug use?
PG: Well, it was sort of a painful topic and I was pretty embarrassed about the mess I had made of my life. So, I didn’t really talk about it that much, but they knew I was getting drug testing, they knew I was in trouble with the board, they knew that I had criminal charges, they knew that I was meeting every month with my probation officer, so they, I was very honest and open with them about like, the objective circumstances that I was undergoing. As bleak as they may have been, but I didn’t really feel comfortable talking to them. The only person, I felt comfortable talking to were my brothers actually. My older brother and my twin brother.
MH: Why didn’t you feel comfortable taking to your parents?
PG: I don’t know. It’s a different dynamic with your parents. You feel like you let them down. You feel like they invest so much in you and here you are not practicing medicine and with criminal charges hanging over your head. I don’t know, I just felt really bad about myself. I think addicts in general suffer from like, just overwhelming guilt and shame. I think physician addicts who have booted from their job feel like, profound guilt and shame. I just felt so bad about myself; I just didn’t feel comfortable talking about it.
MH: But your dad made a career out of researching drug use, so I’m kind of wondering how they handled your addition.
PG: Well, you know, I was thinking about that. It’s a very different skillset. Like being an expert on drug use. He wrote a book on marijuana, several books on marijuana, several books on psychedelic drugs, a book on speed, a book on cocaine, a book on drug policy. He is definitely an expert in drugs of abuse, but I think it’s a very different skillset and part of your personality and part of your brain when a love one gets addicted. So, I’m not sure that one really prepares you for the other. I think he was just, sort of in the category of a bewildered, concerned parent like anybody else and I don’t think all this knowledge about illicit drugs really helped him that much.
MH: It wasn’t easy for Peter Grinspoon to get sober. He did a three month stint in rehab and after that the medical board monitored him with random drug test. He failed some of them because he kept relapsing. He and his wife went through a messy divorce. Grinspoon knew his addition could separate him. Not only from his career, but from his kids. SO he kept trying to get better. And eventually he did.
That he managed to recover is significant. In the past fifteen years, overdose deaths from painkillers and heroine have gone up two-hundred percent. Pill addiction has spread. Prescription pill addicts have turned to heroine because it’s a cheaper way to get high.
MH: You know, the country’s in the middle of this opiate epidemic, and ten years ago you were overprescribing pills to your patients.
MH: How complicit do you think doctors are in what’s happening now?
PG: Well, like there are like a very small subset of doctors who are just like bad actors. They are the ones you read about in the “pill mills” that are just prescribing tons of opiates to make quick cash. Everybody agrees that they are awful and very complicit. But, your average pain specialist or your average primary care doctor sees a patient that’s suffering and I think they mean to do well, but they are prescribing too many opiates. But then, you know it’s a little bit complicated by the fact that the pharmaceutical companies have manipulated the whole debate. They contributed in in a myriad of ways to be overprescribing, by advertising, by providing samples, by providing educational materials, by lobbying the government to make pain the “fifth vital sign” to raise the prominence of pain. So, it’s fine for someone to want to treat someone else’s pain, but if industry has such a direct interest in selling pills, there is sort of like the wolf in the hen house.
MH: So you’re working again, you’re a primary care physician at a clinic in Boston.
PG: Yeah, I’ve been back at work for eight years.
MH: How hard was it for you to trust yourself going back into the medical setting where you knew you would have access to drugs again?
PG: Well, I had changed so much in that three and a half years that I was out. I changed; I’m more mature, more aware of my addiction. I was a lot happier. There were so many changes for the better. That I think I was much less of a setup for addiction. I have no desire or craving or anything to take opiates. But, if there are ten bottles of pills on the table, and one of them happens to be Vicodin, I’ll notice the difference. All bottles are not equal. I’ll notice that there are nine bottles and there’s a bottle of Vicodin. I won’t want to take the Vicodin, but my brain will always be sensitized to the opiates.
MH: You said, you had this lifelong fascination with drugs. Did that fascination go away?
PG: Yeah, I think it’s like someone who has a lifelong fascination with lighting fires, like a young pyromaniac who then burns his hand off. I think they become less fascinated with fire once they burn themselves to shreds.
PG: So I think I sort of burnt out my fascination by engulfing my life in flames.
MH: Are you allowed to write prescriptions now?
PG: Oh, absolutely. I wasn’t allowed to for like the first year that I got back. But for the last seven years, I’ve been allowed to write prescriptions. I’m much more thoughtful about how I write them.
MH: I was going to ask about that. Do you prescribe differently now?
PG: Well, my office mate jokes that I don’t prescribe anything stronger than Tylenol. But, that’s absolutely not true, if someone has shingles, a broken leg, really bad sciatica; I’ll definitely give them opiates. I just try not to get too many people on chronic opiates, that’s where people get in trouble. The other thing I would say, there’s any age old adage for addicts, which is “you can’t bullshit a bullshitter.” So, I think I’m an awful person to try and scam narcotics from because I’ve heard all the stories. Either, I’ve tried to do all the scams myself to get opiates or in all the support group meetings, in all the Alcoholics Anonymous meetings and the Narcotics Anonymous meetings that I’ve been to, I’ve heard the different scams. So I’m just an awful person for someone to come in and try and scam drugs from.
MH: Grinspoon describes the place that he works now as an inner city clinic. He sees patients fighting and feeding addiction all the time. And he says doctors just don’t have enough options for helping patients who they know are in trouble.
MH: Do you deal with addicted patients now and you just don’t feel like you have things to offer them?
PG: Well, it’s really amazing how hard it is to get someone into treatment. A lot of times, all I have to offer people is like a four day detox program where they get off the drugs, but then are not in recovery, they are just detoxed and then get kicked back to the street. It can feel like banging your head against the wall, because you keep trying to help and trying to help, but they keep relapsing and relapsing. I mean, I find treating addicts to be really challenging and frustrating and I’m the person who should be most sympathetic. Because, I’ve been through it. Other doctors must have a really hard time with this.
MH: So, I have to say in this interview you’re really likable, but in this book you have some really bad moments.
PG: That’s what addiction does! It’s awful; can you imagine having to live with this? I feel so guilty about it.
MH: Do you worry about say, your kids reading this book?
PG: Well, my kids are teenagers and they are going to read it. I spoke with my fourteen year old son. And I said, look I’m not so sure this is something you should read it says some pretty tough things about your mom and about me and I made a lot of mistakes and he said: “Screw you, I’m going to read it. I’m really curious, I’ll buy it in a bookstore with my own money or I’ll get it in the library, so I’m going to read it no matter what.” I just don’t think you have that much control when your kids are teenagers.
MH: But, Grinspoon is really aware that because he’s an addict his kids have a higher risk of becoming addicted, so I wanted to know, what does he tell them?
PG: The advice I give them, basically is don’t try pot until you’re in college and alcohol can wreck your life and all other drugs are evil.
MH: All other drugs are evil.
PG: Yes, it’s pretty true. Cocaine, meth, all the other drugs people do in college, they’re crazy. I mean, the stuff is so dangerous.
MH: Do you worry about it?
PG: Well, yeah, I worry about it like all parents worry about it, but I also hope that my situation and the fact that they know so much about it and I’ve been so open, that will have a protective effect. So, I think they’re going to be okay. I mean, I think you can’t really predict whose going to get in trouble. You know, my daughter is just an extremely serious student, she’s 15, and you know my son is a good student too, they’re just you know, you never know whose going to end up getting in trouble with drugs.
MH: You were a really good student too, but you still ended up in this situation.
PG: Well, anybody can. I mean, I think that’s the interesting thing. There’s no stereotype that actual fits. I have a patient that’s like a 78-year old grandmother who’s a heroin addict.
PG: Yeah, she’s like a white seventy-eight year old grandma who’s a heroin addict and it could be anybody.
MH: Peter Grinspoon, thank you so much for talking to us.
PG: It’s been a pleasure.
MH: Peter Grinspoon’s book, Free Refills, is out this week.