In this argument, I'm not talking about any interpersonal problems such as robbing a bank, personal injury, rape, or pedophilia, just intrapersonal (drug use) behaviors of the addict. Likewise, just because addiction may be dangerous and damaging to other people, damage to others is not assumed to part of the
disease. In fact, dangerousness to others is not in the definition. Anyone who assumes an addict is automatically dangerous without actual evidence is breaking the rules of the definition of the disease of addiction. Danger must be proved, not assumed, unless, as in DWI, there is a specific law stating that driving a car while drunk, addicted or not, is illegal. There is no DWI law for practicing doctors and thus there is no basis for the statement
that doctors are automatically dangerous while practicing medicine while on drugs. In fact, there is no evidence that doctors on opiates are more dangerous than doctors who aren't on them. That isn't to say that any doctor should practice on drugs, they should not, it just means that it's not a fact. It isn't. There is no evidence for it and there is plenty of evidence against it. Of course, this evidence is ignored. There is evidence that drunk drivers cause an inordinate number of auto disasters and deaths, justifying DWI laws. There is no similar evidence for medical disasters being caused by addicted physicians, particularly addicted
to the drug to which I was addicted. My statement to the restoration hearing boards that I wasn't dangerous (in fact, I was not) was used against me. Was I potentially dangerous? Possibly, but the assumption that I was dangerous is exactly the same as saying a doctor with Leukemia, schizophrenia or manic-depression is dangerous and for the same reasons. Both these diseases can affect thinking and judgment impairment. However, this doesn't mean that they always do affect judgment.
All diseases can possibly cause decision mistakes, as can depression, getting divorced, a death in the family, losing money in a bad investment, and other personal disasters. We don't stop doctors from practicing medicine in these cases and automatically assume, to the doctor's detriment and total destruction, that he is dangerous in these situations, yet they may even be more dangerous than stable opiate addicts because these instances acutely affect doctor's decision-making. Yet, stable opiate addiction is assumed to be quite dangerous for doctors because of the demonization of the drugs themselves, not the facts about their addiction.
Surprisingly, however, despite this blanket indictment of addicted doctors, the health dept. knowingly allows certain doctors on methadone to practice medicine when this drug is prescribed by a doctor. They say that opiate addiction is automatically and categorically dangerous yet they sanction some doctors on methadone. Are we clear about this hypocrisy?
They say, "Doctors are categorically dangerous to the public if addicted to opiates, and Dr. Umanoff is likely to relapse. If he were to relapse he would be automatically dangerous. Thus, he should never practice medicine again." But, they allow doctors to practice already addicted to methadone. Does this make sense? Because opiates are so dangerous to patient care that I can't get my license restored even though clean and sober for 8 years because of their fear about my relapsing right under their noses while being closely monitored by several different monitors, yet other opiate addicts are deemed safe to the public while actually on the opiate methadone? Their OK makes it OK, but my being clean
still makes me dangerous? Does anyone see a problem here? Yes. Their sanctions towards me have nothing to do with public safety, but rather to me as an individual who, in their minds, disrespects their authority because I have opinions different from theirs about addictions, recovery and associated feelings, like remorse for being an addict. Their argument is so specious as to be absurd, unbelievable, and outright consciously, conspiratorially, and intentionally discriminatory.
This destruction to me began 10 years ago and is continuing to this day despite over 8 years of continuous sobriety and cooperation with and advocacy from my addiction monitors who are under the auspices of the NYS Medical Society, the same monitoring group that clears and closely observes all other addicted physicians for the sake of public safety. My advocacy from them is discounted by the heath department just because of my differing views on addiction. Can you imagine this happening to a Leukemic or an AIDS patient in remission for 8 years?
When viewed this way at the start, we have leveled the playing field for the future discussion of how my drug addiction has been handled by our society as embodied by the NYS Health and Education departments. Try to be aware when your prejudices and biases enter your mind while reading this article. Remember, if you substitute the word "Leukemic" or "smoking addict" for the word "Addict," it may help prevent bias.
A. Diagnosis and Intervention: I was called into the health dept. because they became aware of my addiction in some manner associated with my writing prescriptions for myself. This drug obtaining behavior is, again, part of the disease. The health dept. police made this intervention in my medical office in front of my staff, patients, and partners. FIRST DISCONNECT. All confidentiality was broken and ignored. There are clear laws against breaking patient's confidentiality. Yet the health dept. can break those laws for public health purposes? Absolutely not!
"To declare that in the administration of criminal law the end justifies the means-to declare that the Government may commit crimes in order to secure conviction of a private criminal-would bring terrible retribution."-Justice Louis D. Brandeis, 1928 Dissent, Olmstead v. United States.
Can you imagine a doctor with leukemia being confronted this way with his diagnosis of leukemia and by the police? Being busted in public had enormous implications on my partner's future dealing with my DISEASE. They immediately kicked me out of the practice that I had started and made possible because of my credentials, not theirs, and stopped sending me money from our business as a way to force me to rapidly negotiate a forced buyout to their financial advantage. They claimed they needed to do this due to fear of association with an addict. Can you imagine a leukemic treated this way as he is going to the hospital for chemotherapy and bone marrow transplant? This is exactly what happened to me though. The health dept. could have contacted me secretly and thus avoided a personal scandal. They knew exactly what they were doing. They intentionally came to my office so that I was sure to be booted from my own business due to my partner's fears of damage to their "reputation." All this, notwithstanding that they aren't board certified in nephrology while I am. The health dept. removed the only credentialed doctor from our practice (I was medical director and CEO and president) and they say they
were protecting the public from a dangerous doctor. It was just backwards. They removed the only safe doctor from the practice and left it in the hands of unqualified doctors. That's "protecting public safety?" That's their true motivation? No. Their motivation was destroy an addict, Dr. Umanoff, by publicly identifying him as an addict.
My anger at these occurrences was used against me 10 years later during my attempts at license restoration as current evidence for lack of recovery. (You see, you're not allowed to be angry at your abusers and persecutors when you're an addict and in good recovery from addiction. That's one of the recovery "spirituality" no no's. If you were angry then you aren't in good recovery and therefore you aren't in recovery, according to the State of New York).
Following this public bust, I went into the health dept. in NYC and agreed with them that I was addicted. It was stipulated right up front that there was no patient care issues involved with my addiction. NO DAMAGE TO ANY PATIENTS OR ANYONE ELSE! They wanted me to stop practicing while addicted to ensure there would be no possible future patient damage. I agreed with that and promised not to practice until cleared with them. That wasn't enough for them, however. I was forced by threats of a criminal trial to surrender my license to them at that moment. Can you imagine a LEUKEMIC being intervened upon this way and forced to give up his medical license upon diagnosis of leukemia? This forced surrender was the SECOND disconnect and discrimination against me. I was addicted to a drug only
obtainable by prescription. Prescriptions can only be written legally by a licensed physician. Although the apparent motivation by the health dept. for getting my license was to keep me from practicing medicine on my patients while addicted, which I agreed with, it also had the effect of making it illegal for me to get drugs for myself if I relapsed as I had in the past, again, part of my disease. At the time, I didn't even object to this because I didn't see myself breaking the law by getting my drug via writing prescriptions. I didn't think of the legal consequences of what was happening to me at that time because I was in a state of shock
just from the intervention on behalf of the public welfare. But, refer back to the definition of addiction, relapse is part of the definition. Relapse means using the drug again even while
attempting recovery. As it turned out, this little legal nuance went right by me at the time and would come back to haunt me every step of the way back to recovery and in the relicensing process. My future relapses, if they occurred, now illegal and judgable as felonious, as evidence of bad character, as evidence of antisocial behavior would no longer be seen as part of my disease but as a crime. My relapses during that period of time, instead of being seen as part of my disease and part of the recovery process, as it is for all other addictions and chronic diseases, was later used to legally revoke my license, then used as a reason not to restore my license even after 8 years of solid recovery. Can you
imagine a Leukemic being threatened with criminal prosecution for a leukemic relapse and then using that relapse against him eight years later as evidence for being still dangerous? Yet, this was how I was handled, right up until today. I was ushered out of the health dept. building being told to stop my addiction willy-nilly while still addicted. The odds were about 100% that I would write a prescription for my drug in the next 10 seconds but absolutely no contingency was made for this inevitable occurrence.
This was the THIRD disconnect. Although relapse is part of the definition of addiction, no way to get my drug was made available to me. I was to become a criminal the next time I got my drug which was inevitable according to the definition of the word addiction. Can you imagine a Leukemic being legal when he walked into the doctor's office with complaints of weakness, and after the doctor makes the diagnosis of Leukemia and tells the patient to "Go get rid of that right now, goodbye, get out of my office and take care of that nasty disease yourself," the patient becomes a felon when he walks out of the office? This would be unheard of. This occurrence would be protested by all people around the world immediately as malpractice, unfair, unethical, against all known human rights, unconstitutional, and there would be a fire storm of protest in all newspapers and media as absolutely inhumane. This is exactly what happened to me when I walked out of the health dept. This happens to addicted doctors countless times each month throughout the country. Yet, when I complained about how I was treated by the health dept. my complaints were
used against me in my restoration hearings (10 years later) as evidence of bad recovery (lack of remorse) making me dangerous to future patients and thus unable to return to work as a doctor. Remember: Being a patient with the disease of drug addiction, as defined by addiction doctors, is illegal in our country. Again, it's either a disease or it isn't. It's not a disease one minute and not a disease the next. One or the other!
I signed the contract with the Health Dept. hoping I would rapidly get back into recovery, have my license returned, and go back to practice. As you will see, this was not to happen because of multiple relapses to follow, relapses that were not
intentional but part of my disease. However, they were perceived as intentional and defiant by the Health Dept.
Following this intentional set up by the health dept. who was knowingly prepared and eagerly awaited turning me into a felon if I relapsed, I walked out of their office and on my own had to find a detox and rehab in order
to get sober. Absolutely no help or help resources were made available to me, especially no way to get drugs, which is an inevitable need for an addict, by definition and by physiology. The absence of a centralized clearinghouse for the advocacy of addicted doctors, or any addicts for that matter, is one of the failings of the present system for dealing with addicts' needs. Whatever systems actually exist, such as the CPH of the NYS Medical Society, all
have their own axes to grind, their own agendas and rules. These groups have not been formed to advocate for and protect the addicted doctor, but to supposedly protect the public or the Medical Society, a different agenda altogether.
I went home and began the search for a detox so I could rebegin the process of recovery and reentry into society and medicine. The detox, rehab, and relapse mess that was to follow, however, turned into a nightmare for me and my family. There are
many factors involved that caused this mess, as I will list, but none were about my being anything other than an addict and the effect my disease had on my efforts to recover. I have been personally blamed and punished for the entire mess as if it were all strictly disrespect, defiance, willful misconduct and criminal behavior on my part.
Here's a list of problems that interfere with an opiate addict getting straight:
- Incomplete, inadequate, and abusive detox.:
Being individually, completely and physiologically detoxed before being released to go to a rehab. Detox problems include the attitude that the patient must fit the detox's regimen rather than the detox meeting the addict's personal physiological and addiction
(withdrawal) needs. This backwards attitude, unknown in any other medical disease, causes addicts to walk out of detoxes prematurely due to inadequate medication dosing and withdrawal symptomatology or leave the detox not completely detoxed. This problem causes immediate resumption of the drug and hard feelings and anger toward the detox personnel by the addict, something the addict doesn't need. The addict distrusts detox and rehab personnel in the future. This problem may prolong an addict's addiction and prevent future recovery. For this, the addict is always blamed. This happened to me and was used against me in my revocation and restoration hearings.
Many detoxes use improper or inadequate amounts of medications and detox too rapidly for financial considerations. Inadequate medications are justified by, "We don't want this addict to think he can get off the hook too easily. He needs to suffer so he knows who's boss. It's not him. He needs to take responsibility for his addiction by being tortured in detox a little. It's good for him." What this teaches the addict is that no one gives
a shit about how he feels. This is the worst conclusion an addict can reach since his recovery is dependent on trusting his caretakers. Inadequate detox is frequently used to "break his denial." Torture in detox will definitely have the opposite effect. He will never return for real detox and will never get into recovery because of this approach. Many addicts end up on methadone for life because they are never detoxed appropriately and give up
on ever getting drug free. Besides, the methadone programs like having him dependent. "Some addicts can never get off drugs. They need methadone. Why bother?" Of course, these addicts never get the freedom of real recovery either. Real recovery should be and is available to all addicts.
Inadequate detox ensures relapse when the addict walks out the door. Then the detox personnel blame the patient for the relapse. "He didn't want to get off those drugs anyway. He was in denial all along. He'll learn his lesson on the street or in jail where he belongs." Some methods of detox are even lethal besides being stupid although highly profitable.13
Every detox and rehab I went to over the next two years, except the last one which I would deem an acceptable rehab. and the only one, and, all administrations dealing with my addiction, manifest these problems stemming from recovery conflicts of interest. There is only one reason to be involved in the recovery process of an addict: To help the addict make the difficult transition into recovery. There should be absolutely no other motive involved. If there is an authority involved in someone's recovery outcome, such as a license or job, they need to stay out of this process. The addict needs to be turned over to a helper person who has no ties whatsoever to the authorities. When the process is complete, the addict returns to the authority in order to reenter his job or career under the supervision of that authority and only at that point. This does not occur in
the recovery process of doctors where the authorities insinuate themselves throughout the recovery process in order to control its outcome. In a difficult recovery process, as occurred in my case, not following this principle caused many resentments between me and my monitors which were entirely unnecessary and which continue to this day, 8 years into my recovery and is being discounted because of these personal involvements. My license restoration is being denied because of these misperceived power and control issues on the authority's part.
- Being treated with lack of equanimity, acceptance, or in accord with the disease model in the recovery process: In no other medical treatment recovery process is the patient held responsible and punished
for the outcome of his recovery. All recovery from chronic relapsing disease require patience and perseverance by both the patient and the doctors (or advocates) during the process of entering remission of the disease (recovery). As long as the addict keeps trying there is no reason to change the process (longer, harsher, stricter treatments, etc.) There is a definite transition from active disease to recovery for addicts. This transition can be bumpy, irregular and unpredictable. There is no way to tell beforehand how smooth it will be, and the roughness of the process is in no way predictive of the ultimate outcome or prognosis. In addictions, however, the less successful the recovery is, the more the addict is blamed and punished. This is manifest by recovery monitors who 1) insist on longer and more severe rehabs for each relapse, 2) turn replapsers into the criminal justice system 3) threaten
to or punish relapses one way or another, 4) kick relapsers out of monitoring programs (for misperceived lack of cooperation), 5) for doctors who relapse, increased sanctions such as license revocation and criminalization ensue. Each of these manifestations was used on me by people involved in my case. My process became so abusive and punitive that I quit and reigned myself to die an addict. That should never be an appropriate or acceptable outcome.
- The recovery process becomes a power struggle between the addict and the administration overseeing his recovery: Any time this occurs, the addict loses and frequently dies. Luckily, I lived. These power struggles occur when the authorities perceive the addict's failures as defiant and disrespectful to their authority. This occurrence goes back to the concept of "axes to grind." If this authority (or monitor) takes the addict's disease and relapses personally, disasters will result. This happened in my case throughout the entire process. This kind of problem occurs when the monitor's motives for being a monitor are not about helping the addict, but about being in control and having power issues. These kind of people frequently take monitoring positions. They are the absolutely worst people for these jobs and are the most frequent people in these roles; the exact opposite of who should be in these positions. In order to assert their authority, these people will conspire to injure and punish, break addict's confidentiality, and manipulate other people such as rehabs and detoxes to abuse the addict when he is under their auspices. All to punish and get revenge for what they misperceive as willful defiance of them personally. This occurred to me with the CPH and the Health and Ed. Depts.
- Criminalization of relapses: The prosecutor for the NYS Health Dept. turned me over to the DEA for prosecution under the drug war laws. Instead of doctor's addictions being handled as a consequence of an occupational hazard, as suggested by most addictionologists, it is handled, in difficult cases, as a crime. Can you think of any other disease handled this way, especially in the case of doctors who have spent their entire lives helping other people? This is routine as much as it is a travesty. Yet, it is the case. Relapsers need to start over. That's all. Try again. How many times? As many as is needed. No different from leukemics.
- Breach of confidentiality: Your previous record of failures follows you from detox to detox and rehab to rehab. Instead of looking for better ways to help the relapsing addict, these relapsers are looked upon as insincere and interlopers; misfits; not trying; not caring enough; lazy; good for nothings; maybe hopeless, and as abusers of the system just to get drugs. Rumors and stories are passed from one treatment program to the next; from monitor to program, and vice versa. This results in abuse as you are passed down the line. In general, not always, instead of more care, they believe you need more strict and abusive treatments, longer and harsher. This happened to me and I refused. I eventually had to find recovery outside rehabs.
I am still being punished for not getting straight their way.
- Manipulation of the addict with threats of pulling advocacy or criminal referral: Compliance or else, irrespective of the effect it has on your already warped self perception is the motto here. Mandated compliance leads to anger and resentments, not helpful or self-loving feelings, not "spiritual," and not conducive to trust or reaching out for help from the manipulators. It stimulates paranoia and fear rather than trust and appreciation. All this leads to fearful
pseudorecovery, not for yourself but for preservation of your license and career. These lame motives can lead to poor recovery attitudes and the inability to attain a trusting relationship
with anyone, even your sponsor, the most basic recovery need. This can lead to isolation from people who can and want to help with no motive other than their love for other recovering addicts. These are the people we need to hang with.
- Treatment and psychiatric diagnosis abuse:
This kind of manipulation and coercive brain washing is the most despicable of all because the doctors in charge of most monitoring and treatment programs are psychiatrists who have fluency in misdiagnosis for the purpose of stigmatization and control. With the wrong psychiatric diagnosis label stuck in your chart, an addict can be abused indefinitely and has no defense except from his own psychiatrist who has no weight in the power struggle. Since the same people who are diagnosing you
and monitoring you also have advocacy power over you, you must agree and comply with this manipulation and so-called "appropriate" therapy. They have no need, desire, or willingness to provide studies showing their treatments are beneficial or proven which, of course, they aren't because the studies have never been done. And, they won't be done because psychiatrists know they won't pan out. The studies done don't prove benefit or improved prognosis. Psychiatric treatment may be intuitively meaningful if one believes
the psychiatric model of addiction for which there is no evidence, besides the lack of evidence that psychiatric treatment provides anything to the patient other than placebo effect if the patient happens to believe in "psychiatry," but no effect if the patient doesn't have that belief. The concept of intuitive benefit is not science but belief in magic. This has no place in recovery. Science has spent much time and effort proving intuition wrong, especially in addictions. This is just one more example of intuition being not only wrong, but abused.
- Mandated mind and mood controlling drugs:
This would include mandated methadone maintenance, Naltrexone maintenance, or antianxiety and antidepression
drugs instead of adequate attempts to affect drug free recovery. Replacing drug addict's addictions with seemingly acceptable "psychiatrist approved" drug addictions or using drugs to alter the drug receptor mechanisms (which simultaneously alter the addicts natural
neurotransmitter receptors and thus block natural reward neurotransmitters) is fine for society but absolutely not fine for the addict. Real recovery, what every addict needs, is thus precluded. This is severe and unconscionable abuse. Presently, real recovery is unknown, so mind control medications seem reasonable.
The first detox I went to detoxed me with methadone in 5 days (about a week or so too short a time period). I was discharged and went immediately to a drug store to write an illegal prescription. From there I went to a rehab in Pennsylvania the
next day. When I told them I wasn't detoxed and requested more detox there, they insisted on their non-methadone detox. (basically cold turkey) which I refused and went home and wrote more prescriptions, even one while in Pennsylvania just to get home. I then entered
another detox who used 10 milligrams methadone for detox, a dose way too low to start. I walked out and went to a drug store again. I then went to another detox. who detoxed me too fast again. When I asked for a slower tapering of the methadone, they accused me of "medication seeking behavior" and refused to alter the regimen to suit my needs. I walked out.
Can you imagine going to a detox voluntarily, not mandated by any authority, paying out of your own pocket, and when you were being detoxed incorrectly, something only the patient can attest to, being told your motivation for being there was only to get more drugs? This is what I was being accused of. It makes no sense. Why go to a detox to get drugs that would only keep you addicted, and in the case of methadone, a worse addiction than the one you came in with? That's how they assessed my requests for a slower withdrawal. I went to detoxes to be detoxed, not tortured.
When I explained to the revocation hearing why I had left these detoxes, they assessed my story as rambling and deflecting the blame to the detoxes rather than accepting "responsibility" for my volitionally defiant "choices" and my uncooperative behavior. Their assessment of this behavior was absurd, just as was the "drug seeking behavior" assessment by the detox I just described. If my motive was not to cooperate with the detox, I wouldn't have gone there in the first place. This kind of illogic
pervaded the detox's and health dept's attitudes in assessing my detox travails. GO TO PAGE 3.