THE WAR AGAINST DRUGS
I think risk taking is something a lot of successful people undertake. I am the kind of person who seeks out different experiences - it was this side of my personality that led me to work as a trauma doctor in a war zone. These same qualities led me to intravenous drug use.
The trauma work placed me at physical risk and under mental stress. It involved exhuming bodies from mass graves and going into combat sites to prepare injured men and women for travel to medical facilities. You patch them up as much as you can, pack wounds, perform field surgery, give them blood, give them pain relief. If they aren’t unconscious, they are scared and screaming with pain. Sometimes, even though I did everything I could, they died.
I left that job pretty messed up. I had survivor guilt and Post Traumatic Stress Disorder (PTSD). I came back to Australia a different person. I was anxious, angry. I would lose my temper easily, strike out at people - even physically on occasion. One day I would be me, nice Louise, and the next I would be grumpy Louise, with a personality that would grate on a saint. One of the big problems was that although psychologists readily identified that I had PTSD, psychiatrists were more reticent to diagnose me. So I didn’t really get the help I needed as quickly as I needed it.
It only felt natural to me to start using drugs to take away some of the stress. I didn’t have a history of drug use and hadn’t used while I was working as a trauma doctor. But once it was all over, and I had the time and space to be confronted with the rawness of my emotions. I needed pain relief as surely as if I had a physical injury. If I had gone on an alcoholic bender instead of becoming an IV drug user, my life may have gone very differently.
I began to prescribe myself morphine. I didn’t try any deceit. I prescribed it myself, to myself and I went to the pharmacy to fill it myself. Because I could prescribe as much as I wanted, I did. I placed no limits on myself. I didn’t even try to hide my use. It’s hard to use as much as I was and hide it. I was not using to maintain or to function. I was using to forget. I was using to obliterate. It came to an end after a matter of months when a pharmacist reported me to the NSW Department of Health. They referred the case to the Australian Health Practitioner Regulation Agency (AHPRA) and my punishment began.
I didn’t really know much about treatment for people who use drugs, so I didn’t at first identify how cruel and inhuman my treatment was. It was punishment, pure and simple. I was placed in a public hospital to withdraw from a huge morphine habit “cold turkey” with no relief at all. No buprenorphine to assist with the pain, and very little symptomatic relief. I was so ill and my head was cloudy. While opiate detox is described as being short, around four or five days, I found that it took a few months to settle down.
Because the amount I had been using was very high, I was suspended from work until an investigation proved I was not trafficking. Then I had a “fitness to practice” hearing at AHPRA. It is an unsympathetic atmosphere for people who use drugs. I was allowed to continue to practice as a doctor, however I had conditions placed on my licence. There were a number of drugs I was not allowed to prescribe, morphine being number one. I had regular reviews, at first monthly, then bimonthly, then six-monthly. I am currently released but if I used again I would not get a second chance.
These things are judged on a case-by-case basis, but they have been clear about this with me. Within the Australian programs to manage doctors who use drugs, there is no option except abstinence and no second chances unlike other countries where drug use is expected and a certain amount is accepted. Neither are Australian doctors allowed any maintenance therapy - so no methadone, no buprenorphine, something that is against the evidence of many years of international research.
Although the World Health Organisation (WHO) has listed methadone as an essential medicine, AHPRA are a law unto themselves. I was mandated to go to a “twelve step fellowship”, without any documented evidence that this works. But unlike some of my doctor colleagues, I actually got something out of having a sponsor and going to meetings; I did find it quite useful.
I think I was successful at abstinence because I didn’t use for that long and, like the Rat Park model, I went to a good world, where there was family and love and a job that I had trained long and hard for and refused to give up. I had a lot to lose. It is well documented that the more we have to lose and the more support we have from our families, the easier it is to toe the line.
A doctor with conditions finds it hard to be employed. I ended up going from someone who was very respected in my field to only being able to do locum work when they had difficulty filling a position. I am now working as a GP. There was a robbery at a clinic I was working at a while ago. Given my history, I was investigated, but the CCTV footage showed I wasn’t there and the biological monitoring - all those urine tests - actually protected me in this case.
On the upside, I think I am a more compassionate doctor. I understand drug use. I understand mental illness. I am kinder, I think, more understanding of human frailty. And I know more about drug use, dependence and treatment than I ever really wanted to know.