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.