Sleeping pills

Jackson troubles shine light on a fact of Washington life: Sleeping pills

The White House physician is battling allegations he was overly loose about handing out sleep aids and alertness pills on Air Force One.

By ELIANA JOHNSON, BURGESS EVERETT, BRYAN BENDER and SARAH KARLIN-SMITH

Ronny Jackson, the White House physician who is battling to save his nomination to be the secretary of veterans affairs, regularly handed out the sleep drug Ambien and the alertness drug Provigil to West Wing officials traveling on overseas flights.

Jackson’s nomination has inadvertently exposed the widespread use of sleep and alertness drugs among government officials from the White House and State Department to the Pentagon and Congress itself.

Allegations about Jackson’s liberal dispensation of Ambien and Provigil come at a time when opioid abuse — some of it enabled by doctors — has ravaged communities across the country, increasing awareness about the dangers of casual pill-popping among the public at large.

But nearly a dozen current and former officials — including some who were treated by Jackson while working in the Obama White House — say 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.

“Not everyone wants it. But anyone who does gets it,” said a former Trump administration official who traveled extensively with Jackson and the president.

Jackson, who served as physician to President Barack Obama and stayed on to treat President Donald Trump, was nominated last month to replace David Shulkin as secretary of the Department of Veterans Affairs, the second-largest federal agency by staff.

Senators hit pause on his confirmation hearing—originally scheduled for Wednesday—after hearing allegations of potential misconduct involving loose pill dispensing as well as inappropriate behavior and mistreatment of staff.

A document circulated by Sen. Jon Tester (D-Mont.) summarized allegations from 23 current and former colleagues, including that Jackson “got drunk and wrecked a government vehicle” at a Secret Service going-away party.

The document also includes claims that Jackson provided Ambien and Provigil on Air Force One trips without asking patients questions or tracking the pills.

By themselves, the charges that Jackson liberally doled out sleep drugs may not be enough to disqualify him in the eyes of lawmakers on Capitol Hill — because, they say, they use them liberally, too.

“It does happen. I’m not one of those. I might have tried that once; it didn’t work, and I’ve never tried it again,” said Senate Minority Whip Dick Durbin (D-Ill.). “But people trying to avoid jet lag and go back to work and have a normal life? Sure!”

“I’ve seen it used. Like if you’re going across multiple time zones, people use Ambien to get their sleep schedule right,” said Sen. Marco Rubio (R-Fla.). “I don’t think it’s uncommon for people traveling across like eight time zones to get their sleep schedule right. But I don’t know if that’s what he did or not.”

The use of sleeping pills extends to the diplomatic corps and the military, where pill-popping in the ranks for performance and to encourage rest between missions has been standard practice for decades. Jackson himself is a two-star Navy officer who came up through military ranks.

Retired Air Force Gen. Merrill McPeak, who served as chief of staff during the first Iraq War, said “when you walked out of the hangar, the doc would be standing at the door handing them out.”

McPeak made it clear when he was the top Air Force officer from 1990 to 1994 that he wanted pilots and air crews to give up chemical aides such amphetamines because he felt they were being abused. But his efforts were ultimately unsuccessful and he opted against official regulations because of opposition, he said.

Sleeping pills — often prescribed for long flights and so that pilots could come down from the high of so-called go-pills — have also long been a problem, in his view. “I never used them because I felt that if you needed them to be a warrior you were in the wrong business.”

But others said 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.

Brian McKeon, who served as National Security Council chief of staff and as a senior Defense Department official under Obama, said he used Ambien while traveling both at the White House and at the Pentagon.

“On a long trip or multiday trip, if people needed an Ambien to try to get to sleep, you could get some Ambien. I thought that was appropriate because when people are working 16-hour days and going across time zones, that was pretty hard,” McKeon said.

Jonathan Wackrow, a former Secret Service agent who worked with Jackson for 14 years, told CNN on Wednesday that, for the White House Medical Unit, dispensing Ambien on foreign trips was "part of their medical protocol pursuant to the job requirements" and that he had never seen Jackson do anything inappropriate. Another former Obama official said White House staff viewed Jackson as their physician too, going to him for routine medications.

But Jackson’s nomination and the accusations that he handed out potentially addictive sleep pills freely coincide with a growing awareness among lawmakers and the American public of the dangers of addiction as the opioid epidemic has ravaged communities across the country. Tales of doctors treating pain with potent and wildly addictive drugs have sparked crackdowns on providers and patients alike.

White House press secretary Sarah Huckabee Sanders opened Wednesday’s briefing by noting that Saturday is national prescription takeback day, during which medical professionals and emergency responders accept unused drugs. “Disposing of unused pills can prevent the misuse of commonly prescribed opioids,” she said.

But Sanders defended Jackson, saying his tenure as White House physician “has been impeccable.”

Medical professionals say it’s inappropriate for a doctor to hand out prescription pills without taking a full medical history.

“If a doctor is nicknamed ‘Candy Man’ because he or she hands out pills to people who are not officially their patients, that should not be considered acceptable for a physician in a high-level position in the federal government — and certainly not for the VA, where the quality of health care is an essential responsibility,” said Diana Zuckerman, president of the nonpartisan National Center for Health Research.

Giving Ambien to someone who has never taken it before “requires some caution,” because the drug can cause confusion and impairment, said Adriane Fugh-Berman, a professor of pharmacology and physiology at Georgetown University.

“Except for rare instances, I don’t think physicians should be handing out prescription drugs to people who they don’t have a doctor-patient relationship with,” Fugh-Berman said.

Medical experts sounded the same warnings about Provigil, which was hailed by many as a miracle drug for its ability to keep people awake without many of the side effects, like jitteriness, of other substances like caffeine.

Jackson’s behavior “should be investigated,” said Lisa Schwartz, co-director of the Center for Medicine and Media at the Dartmouth Institute, but more information is needed before coming to a conclusion about whether his behavior was inappropriate, including details about what dosages he was giving or his relationship with the people he was providing the drugs.

Schwartz said use of Provigil to help people stay awake in stressful situations or after long travel is not an FDA-approved use. Doctors can legally prescribe medicines for unapproved uses, but she said there aren’t a lot of studies to inform physicians and patients of the benefits and safety risks of using Provigil in these situations.

Provigil has addiction potential, so caution should be taken in prescribing it, she added. Because it’s a stimulant, doctors also need to carefully consider whether patients have heart problems or anxiety — conditions that could be exacerbated by use of the drug.

For Jackson, the question is whether his doling out of such pills without a prescription would concern members of Congress whose states are dealing with drug addiction problems. But his long history as a physician to presidents of both parties suggests he would not hand out such medications without doing his due diligence.

“On overseas, yeah, sure. People take Ambien to help them transition through time zones. It’s pretty common, I’m led to believe,” said Senate Majority Whip John Cornyn. Asked whether that’s acceptable without prescriptions, he replied: “He’s a doctor!”