This Is Your Government on Drugs

Ronny Jackson did not invent the practice of giving Ambien and Provigil to high-level government workers.

One of the fallouts of the Ronny Jackson scandal is the revelation of how common over-medication is in government circles.

A Friday CNN report (“Several White House medical unit staffers describe pressure to hand out meds“) is ostensibly about Jackson:

The White House medical unit frequently functioned as a “grab and go” clinic where mid-level staffers to the most senior officials could obtain prescription drugs without being examined by a doctor, casually pick up the powerful sleeping aid Ambien even for their children, and get drugs that were not prescribed to the person actually taking the medication.

These examples, described to CNN by five of the medical unit’s former and current employees and which appear to represent the more problematic practices there, were endorsed by Rear Adm. Ronny Jackson, a doctor.

[…]

The allegations shine light on a little-known office on White House grounds skirting some of the most basic medical protocols for years, including under former President Barack Obama. The medical unit serves some White House staffers who work around the clock on high-stakes issues and are unable to easily access their own personal physicians for ailments.

Four former and current White House medical unit employees — all of whom requested anonymity to discuss behavior they witnessed and were aware of during their tenures — said prescription medication was handed out readily. In fact, sometimes even the most basic medical consultation was unnecessary.

One person who worked at the medical unit under both the Obama and Trump administrations said there was such a “loose control of the controlled medications” that one high-profile Obama administration official who was leaving the White House went to the medical unit for Provigil. The drug promotes alertness and helps individuals stay awake.

It was treated as a “parting gift,” the person said, and the outgoing administration official was given around 20 Provigil pills. It is not clear whether this official was ever seen by a White House doctor.

Another of the sources said they witnessed similar requests for pills from outgoing White House staffers. They also recalled being present when one Obama White House staffer came into the outpatient clinic and demanded: “I need to pick up a Z-Pak for myself and my wife.”
Z-Pak is the common name for Zithromax, an antibiotic that treats infections. The doctor at the medical unit rejected the request, insisting that the staffer first receive an examination. The doctor was particularly concerned about serious cardiac issues that can result from taking Z-Pak. The staffer grew frustrated, this person recalled, and responded: “Dr. Jackson said I can just pick it up and I don’t have to be seen.”

Moments later, another colleague walked past the doctor, grabbed the Z-Paks and handed them to the White House staffer.

“You need to just give people these meds when they ask for it,” this colleague said — a message that multiple former medical unit employees said was in line with Jackson’s overarching philosophy.

“We would just hand them out. They’d come in and say, ‘Hey, can I have an Ambien?’ And we would just hand them out. Without having to sign a thing,” another person who has recently worked for Jackson told CNN. “We all had a huge problem with it.”

[…]

Some former Obama administration officials are defending Jackson, saying they were only given sleeping aids after being asked routine medical questions. He would ask staffers how long they wanted to sleep and whether they had to get any work done on the flight, before offering drugs ranging from Ambien to non-prescription drugs like melatonin.

“The people who are calling him ‘the Candyman’ are out to get him,” one of the officials said. “White House staffers were expected to make transatlantic flights sleeping on the floor. It wasn’t just him.”

[…]

The distribution of Ambien and Provigil on flights — including to journalists — has long been a widespread and accepted practice throughout the US government, including on White House, Defense Department and State Department trips.

Jackson told reporters in a January news conference that Trump himself takes Ambien “on occasion” on overseas travel.

“When we travel from one time zone to another time zone on the other side of the planet, I recommend that everyone on the plane take a sleep aid at certain times so that we can try our best to get on the schedule of our destination,” Jackson said.

What Jackson was doing defies medical protocols and I understand why it would be shocking to new members of the staff. But I guarantee you that Jackson did not invent this practice. Rather, he was continuing a practice that was part of a longstanding culture in the upper reaches—and some of the lower reaches—of government.

Several friends and acquaintances who have worked in higher reaches of government have noted how common—and necessary—the rather cavalier use of Ambien and Provigil were in conjunction with international trips. These aren’t people who generally traveled on Air Force One, so they weren’t doing it under Jackson’s direction. It was just understood that, if everyone is going to fly out in the middle of the night for a long trip to Asia or the Middle East and then be expected to function at a high level the minute they hit the ground, they needed some chemical help. And, generally speaking, these trips are stacked back-to-back-to-back, lasting several days, all of them long. Few people are built to withstand that amount of pressure without sleep. And, of course, constantly changing time zones and weird hours make getting decent sleep nearly impossible.

A related WaPo report (“Ambien should not be handed out ‘like candy,’ experts say of Ronny L. Jackson’s alleged practices“) also ostensibly about Jackson, confirms this several paragraphs down:

If Jackson did pass out the drug indiscriminately on long government flights, he is not the only physician to do so. Staffers and news media traveling with the secretary of defense also have received the same offer.

Experts said that when properly prescribed, Ambien has proven benefits beyond insomnia, including use when crossing many time zones. “It should not be taken in lieu of proper evaluation and treatment of other sleep issues,” said Jerald Simmons, founding director of Comprehensive Sleep Medicine Associates in The Woodlands, Tex. But “sleep loss itself has its downside,” including safety behind the wheel and the ability to perform other functions, he said.

“If you only get two hours of sleep,” Scammell said, “you’re not going to negotiate with the North Koreans as well.”

Similarly, Provigil — first developed to treat narcolepsy — and its successor Nuvigil, now have the approval of the Food and Drug Administration for treatment of “shift work disorder,” a circadian-rhythm condition caused by work schedules that do not jibe with natural sleep patterns.

But it shouldn’t be prescribed in conjunction with Ambien, to help travelers stay awake, as Tester alleged, the experts said.

“For a sleep physician there is virtually no situation where we would be prescribing a hypnotic medication at night, like Ambien, and then a stimulating medication in the morning,” Goldstein said. “If somebody has residual sedation the next morning, the treatment is no more Ambien.”

In all things, risks have to be balanced against rewards. For those in stressful, important jobs, being able to function in the short term is likely sufficiently vital to be worth the relatively minimal health risks of associated with mixing schedule IV controlled substances under extremely loose medical supervision.

Many of you will remember the reports from after the killing of Osama bin Laden back in 2012 such as “How Does SEAL Team 6 Get to Sleep? Lots of Ambien.” Special operators have long taken heavy doses of painkillers and stimulants. It’s not shocking that, as the chemistry has improved, they’ve fine-tuned their intake to include Ambien. While some soldiers always had the legendary ability to fall asleep any time they got a few minutes—whether crammed into the back of a truck or aboard a loud cargo jet or helicopter—most couldn’t. Half of the Army’s Ranger school was about learning that it’s possible to complete the mission even when so sleep-deprived as to be constantly fighting it. Yes, taking Ambien without careful medical control has its risks; they’re much lower than going into a fight with a team of zombies.

Honestly, my major concern with all of this is not so much the handing out of these drugs “like candy” so much as the fact that they’re not supposed to be consumed in conjunction with alcohol. Given the vast number of people in this space who are functional alcoholics, that protocol is almost certainly violated on a regular basis.

FILED UNDER: Government, Health
James Joyner
About James Joyner
James Joyner is a Security Studies professor at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. Mark Ivey says:

    Trump is on Provigil at least. Just a feeling..

  2. Hal_10000 says:

    It’s always amazing how the casual use of drugs is OK for the upper classes but suddenly becomes a problem when it’s the rest of us. If someone set up a “grab and go” clinic at an observatory, where astronomers are frequently sleep-deprived and disoriented by switching to night shifts (to the point where my doctor once wrote me a provigil prescription in case I needed to drive home after a run), they’d be arrested. Least of all if this happened in a factory or any other place of business.

  3. James Joyner says:

    @Hal_10000: I don’t deny that in the abstract but, again, we know our special operations troops have been doing the same thing. Ambien is incredibly widely prescribed and Provigil, which was intended to treat narcolepsy, is widely prescribed off-label. Yes, that’s under a physician (or at least a physician assistant) order. But that’s almost a formality.

    1
    2
  4. Lounsbury says:

    @Hal_10000: “It’s always amazing how the casual use of drugs is OK for the upper classes but suddenly becomes a problem when it’s the rest of us.”
    Not particularly.
    It rather really reflects the usual upright-ape status sorting and isn’t the least bit unusual when looked at in historical context – it looks spot on ‘normal’ in its hypocrisy.
    Upright apes shall never live up to the idealized abstractions they imagine for themselves.

  5. Kathy says:

    I wouldn’t be concerned much about Ambien and Provigil. But I wonder whether amphetamines and opioids were also handed around freely.

  6. steve says:

    We used to pass out stop and goes for the pilots during Desert Storm. (An amphetamine and a barb IIRC, but could have been a benzo.) They didn’t need to see a physician. They just went directly to the pharmacy and they handed them out to them.

    Steve

  7. Andy says:

    During my military service, I saw this kind of thing all the time. For every deployment, Ambien and “go” pills were there if I wanted them. He just seemed to take what is a common practice in the military and applied it to the White House.

    Are there risks? Sure, but given the lack of evidence of actual medical problems arising from it, it appears the risk is pretty small.

  8. Raoul says:

    This is beyond outrageous. Essentially the rules apply to the little people as if there is no stress in everyone’s life. Rules exist for a reason and the fact that so many seem to ignore them then perhaps they should be changed; but partaking in an activity where is done by others could lead in ruination of their lifes (ironically by the rulebreakers themselves) is beyond the pale. Shame on everybody who condones this.

  9. steve says:

    Andy- I think there is probably a bit of difference between active duty people who will almost all be relatively young and healthy vs office workers in DC. How much amphetamine can you safely give that 55 y/o guy whose most extreme form of exercise is walking to the coffee machine? Would also seem to have some risk for abuse since it sounds like it wasn’t being monitored.

    Steve

  10. Tyrell says:

    A doctor once told me that Americans are “over medicated, over tested, over doctored, and over insured”
    “Let’s run that test again”
    “Your bp is a little high. I’m going to put you on some medicine”
    “Your tests were fine, but you need to come in to discuss them”

  11. gVOR08 says:

    @Hal_10000:

    It’s always amazing how the casual use of drugs is OK for the upper classes but suddenly becomes a problem when it’s the rest of us.

    Cocaine use by the upper class was regrettable. Crack cocaine use by inner city black people was a crisis of law and order. But opioid use by whites is a public health crisis. From what I’ve see, it was expected that alcohol prohibition in the 20s would be effective for the working class, but the upper class expected to be able to work around it. For that matter, wealthier women can go overseas for an abortion and a shopping spree, poor women need the shrinking pool of clinics in the country.

  12. An Interested Party says:

    @gVOR08: This seems to be connected to the other thread about fixing schools…it’s so sad about those inner city schools, it’s probably the parents’ fault and, anyway, what can be done? But don’t you dare do anything to change the suburban upper-class schools, especially sending certain kids to those schools…

  13. Tyrell says:

    There are many inner city schools that are excelling. They set high standards, put up with no nonsense, and the decision making is at the school-local level, not with some bureaucrat or judge!