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Criticism of Ronny Jackson Highlights Anxiety About Performance-Enhancing Drugs

The former V.A. nominee was charged with distributing sleeping pills and stimulants that helped people do their jobs.

Ron Sachs / NewscomRon Sachs / NewscomSome of the accusations that led to the withdrawal of White House physician Ronny Jackson as Donald Trump's nominee to run the Department of Veterans Affairs raised serious questions that were relevant to his fitness for the job. But the complaints about his distribution of sleeping pills and stimulants revealed more about our culture's hypocrisy and inconsistency on the subject of performance-enhancing drugs.

In a CNN interview on Tuesday, Jon Tester, the senior Democrat on the Senate Veterans' Affairs Committee, said Jackson, a Navy rear admiral who has directed the White House Medical Unit since 2013, would "hand out the prescription drugs like they were candy" during international flights. Jackson reportedly would offer journalists and White House staffers traveling with the president Ambien to help them sleep and Provigil to keep them awake and alert the next day.

Although Tester found this practice shocking (or at least pretended to find it shocking), White House Chief of Staff John Kelly called it "standard operating procedure." As CBS News noted, "Both officials and journalists have used sleep aids on overseas flights for practical reasons—in order to help them adjust to time zone differences more quickly in what is usually a compressed travel schedule. And Jackson is neither the first nor the only administration doctor offering sleeping aids to officials and journalists traveling on long overseas trips."

Politico interviewed "nearly a dozen current and former officials," including "some who were treated by Jackson while working in the Obama White House," who said "Jackson is being unfairly labeled as a 'candy man' and that casual use of some prescription drugs is an established fact of life at the highest echelons of government." Some of those sources said that without sleeping pills and stimulants, "it's impossible to keep up with the physical demands of working a full day off a long-haul flight, which is expected when U.S. officials travel overseas." Several of Tester's Senate colleagues, including Richard Durbin (D-Ill.), John Cornyn (R-Texas), and Marco Rubio (R-Fla.), agreed that Jackson's distibution of Ambien and Provigil was perfectly appropriate.

Tester was having none of it. "These are called controlled substances for a reason," he told CNN. "We have a prescription drug problem in this country," he told The New York Times, "and if we have doctors at the highest levels who are just handing them out like candy, we have a problem."

Yet there is no evidence that the sleeping pills and stimulants Jackson or his predecessors distributed caused any problems. To the contrary, they helped government officials and the reporters accompanying them sleep when they needed to sleep, stay awake when they needed to stay awake, and do the jobs they needed to do. So what's he problem? The problem is that such utilitarian, work-oriented use of psychoactive substances does not fit very neatly into our system for dispensing prescription drugs, which is based on the premise that doctors are using medicine to treat diseases.

Politico notes that "use of Provigil to help people stay awake in stressful situations or after long travel is not an FDA-approved use," although "doctors can legally prescribe medicines for unapproved uses." The FDA says Provigil "is indicated to improve wakefulness in adult patients with excessive sleepiness associated with narcolepsy, obstructive sleep apnea (OSA), or shift work disorder (SWD)." Although that last one sounds promising in the context of hard-working, hard-flying, jetlagged White House personnel and members of the press, shift work disorder is supposed to be a chronic problem rather than a one-time issue related to a particular trip or project.

How about "acute shift work disorder"? If Jackson had uttered that phrase or written it on a piece of paper while handing out Provigil, would that have made his prescriptions more ethical or legitimate?

The FDA's description of Ambien's function is more flexible. It says "Ambien is indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation." If you have trouble getting to sleep, you have insomnia, which is a disease your doctor can treat with sedatives like Ambien.

What if you don't actually have insomnia but anticipate that you will, as presumably was the case with most of the people who got sleeping pills from Jackson during presidential trips? No problem: Ambien also can relieve insomnia anxiety disorder, which certainly sounds like a credible off-label use, even if the condition is one I just invented.

Although Jackson's distribution of sleeping pills and stimulants seems perfectly defensible, it is still a bit jarring to see John Kelly defend it. After all, this is the former Marine Corps general who, according to Attorney General Jeff Sessions, refused to take prescription opioids after he had hand surgery, despite the fact that he was in considerable pain. I'm not sure what principle Kelly thought he was defending by rejecting drugs that could have safely and effectively relieved his pain. But apparently that principle is consistent with relying on drugs to sleep while off duty and stay alert while working. In fact, as Politico notes, the military has a long history of relying on "go" and "no-go" pills.

To some extent, the perceived propriety of using performance-enhancing drugs depends on who you are. While it is pretty common for Americans to take sedatives like Ambien while traveling, obtaining prescription stimulants is harder and may require discovering a hitherto undiagnosed case of attention deficit hyperactivity disorder. Air Force pilots do not have that problem, and neither do people who work "at the highest echelons of government."

Special exceptions aside, we prefer to think that people who use prescription stimulants are treating a disease or compensating for a disability, as opposed to hitting a deadline, cramming for an exam, impressing their bosses, or beating the competition. Medicalizing drug use is reassuring, since it puts the experts in charge and certifies that "controlled substances" are not being abused. But the difference between use and abuse depends on costs and benefits, not the presence or absence of a doctor's note.

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  • Eidde||

    "Yet there is no evidence that the sleeping pills and stimulants Jackson or his predecessors distributed caused any problems. To the contrary, they helped government officials and the reporters accompanying them sleep when they needed to sleep, stay awake when they needed to stay awake, and do the jobs they needed to do."

    Keeping public officials awake so they can do their jobs? Maybe they could take more naps instead.

  • Eidde||

    Keep the journalists awake until they finally agree to do some journalism.

  • Agammamon||

    Sorry, but this dude is unfit for government service.

    Not because he passed out pills, but because he exemplifies the 'one law for you, different law for us' attitude that permeates all levels of government.

    Jackson is being unfairly labeled as a 'candy man' and that casual use of some prescription drugs is an established fact of life at the highest echelons of government."

    No, he's not being unfairly labeled here. He *is* a 'candy man'. That's how he got to where he is in the first place. We can both agree that what he did shouldn't be against the law - but not only is it, he's would tell you right to your face, *sincerely*, that you shouldn't be allowed to do the same thing that his 'patients' were doing.

    Fuck that guy. He just got caught being corrupt.

  • loveconstitution1789||

    He is an easier target being a military man.

    Corruption by civilian bureaucrats is more important for the media to hide.

  • Nardz||

    " he's would tell you right to your face, *sincerely*, that you shouldn't be allowed to do the same thing that his 'patients' were doing."

    Citation needed.
    Otherwise this is just your imagination, the same place all progressives fears come from

  • Echospinner||

    There is no evidence of prescription abuse.

    He did need to log into a medical record and report for every patient. If he did not than we might see evidence for insufficient documentation requirements. I doubt that he made that mistake.

    Performance enhancing is bull crap. Show me the records and what he prescribed. There is nothing wrong or illegal about Ambien or provigil under licensed medical supervision.

  • loveconstitution1789||

    Jackson reportedly would offer journalists and White House staffers traveling with the president Ambien to help them sleep and Provigil to keep them awake and alert the next day.

    I am sure all these recipients of the various completely legal prescriptions will turn themselves into federal authorities.

    This seems like a hatchet job by lefty media from the get-go.

  • Robert||

    Big dif above between "into" & "in to".

  • Rossami||

    Or maybe (and here's a radical thought), those drugs don't need to be prescription drugs in the first place!

    Can they be abused? Sure. So can peppermint candies. So can caffeine. Not everything that might in some circumstance be dangerous should be regulated. How about letting adults be adults for a change?

  • loveconstitution1789||

    YOU are wrecking the lefty narrative! Stop it!

  • Echospinner||

    Yep after near 12 years training and education you can administer all kinds of dangerous drugs, radiation and surgery. It is all adult.

  • StackOfCoins||

    Medicalizing drug use is reassuring, since it puts the experts in charge and certifies that "controlled substances" are not being abused.

    No. It's not reassuring. It's a pain in my fucking ass.

    I want to walk into the pharmacist and buy whatever pills I want. Having to go through an authority is statism.

  • Nardz||

    Truth

  • loveconstitution1789||

    And pay for that authority, which ends up back in some politician's purse.

  • Tony||

    Should some kid be able to do that as well?

  • Echospinner||

    Go ahead. Really think you could manage your own heart attack. Hip fracture whatever.

    You just want a bowl of Percocet in the waiting room. You are welcome to that.

    Really just google web md. All you need.

  • Fist of Etiquette||

    Although Tester found this practice shocking (or at least pretended to find it shocking)...

    I'd say Senator Jon Testes ought to do more thinking and less whining.

  • loveconstitution1789||

    Testies....testies...one...two.

  • Jerryskids||

    But the difference between use and abuse depends on costs and benefits, not the presence or absence of a doctor's note.

    The difference between use and abuse is whatever the Top Men say it is. You sure as hell aren't the one who gets to decide the costs and benefits of drug use. You're arguing that using sleeping pills and pep pills is okay if you're a really important person with a really important job and the pills make the job easier, what if I want to use them just because I feel like it? It's the same argument about why is it if I want to come home and relax with a couple of drinks it's okay but if I want to come home and relax with a couple of bong hits I'm some kind of immoral monster? Am I abusing drugs just because I don't "need" to use them according to some tight-ass, prissy moral scold in Washington?

  • Tony||

    Dear God can Trump ruin a person's life quickly.

  • Tom Bombadil||

    "Although Jackson's distribution of sleeping pills and stimulants seems perfectly defensible, it is still a bit jarring to see John Kelly defend it. After all, this is the former Marine Corps general who, according to Attorney General Jeff Sessions, refused to take prescription opioids after he had hand surgery, despite the fact that he was in considerable pain. I'm not sure what principle Kelly thought he was defending by rejecting drugs that could have safely and effectively relieved his pain. But apparently that principle is consistent with relying on drugs to sleep while off duty and stay alert while working"

    This is a stupid paragraph.

  • ||

    Good discussion, but c'mon, everyone. Prescription (or any kind of) drugs had nothing to do with Jackson's pounding by these Congress critters and their handmaiden "journalists."

    In reality, they were all scared to death that the Admiral might just "privatize" or "outsource" (Oooohhhhhh) some or all of the VA's work on behalf of veterans, and thereby actually provide a meaningful service to them while, importantly, also displacing some number of otherwise secure federal employees (and reliable union voters).

    These guys have proven that they couldn't care less about helping veterans. Their mission is to keep everyone they can on the GS payroll. Handing out drugs, getting parking tickets, walking on the wrong side of the street -- all a smoke screen for derailing the bogeyman who would put their loyal constituents out of work -- oh, and actually make the VA more efficient and effective.

  • MargeBouvier||

    Not to mention all these hypocrites were perfectly fine with him doing the exact same thing under Obama for 8 years!

  • Michael S. Langston||

    This is just another example of the ruling elites hypocrisy. Drugs like Adderall and Xanax are used frequently by people with no real need because they are very useful to increasing productivity and overall feeling of wellness. Both of which help people succeed.

    Hard to stay self righteous in prosecuting "drug users" when everyone in the family is on daily cocktails they don't need if they simply chose less stressful/ambitious goals.

    Don't get me wrong - I'm happy people have insanely ambitious goals. To quote Martha, "It's a good thing". And I honestly don't care if some, many, or all use Adderall and other drugs to help.

    But the ruling elite with money claim PEDs are immoral, as are many illicit drugs such as meth. They tell everyone, who in their right minds would use meth? All while ensuring all their children are getting it by prescription.

  • markm23||

    There are cautions about driving the morning after using Ambien as a sleep aid, and the military have a no-fly for six hours rule. But it's OK for government officials to be negotiating with other countries and making high level decisions?

    That's right, they don't need all their faculties because it's only government work.

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