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Why doctors should face mandatory drug tests

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Pilots have to undergo random drug and alcohol tests. So do truck drivers. But right now, your doctor could operate on you while high or drunk, and no one would be the wiser.

California could change that with Proposition 46. The state statute would — among other things — require doctors to undergo random drug and alcohol testing and report positive results to the California Medical Board.

It's a tough proposal, but one that Stephen Loyd thinks is necessary to protect patients. A physician, associate professor at the East Tennessee State University, and recovering addict, Loyd says he operated on patients for years while high — and it wasn't his peers who stopped him.

Prop. 46 is on the state ballot on Nov. 4, and a recent state poll suggests it has more support than opposition. Fifty-eight percent of respondents said they were inclined to endorse the proposition, and it was opposed by 30 percent of potential voters. To explain why he's championing the legislation, Loyd spoke with Vox. Here's a transcript of our conversation, lightly edited for clarity.

Julia Belluz: So what's at stake here? Why do we need mandatory drug testing of doctors?

Stephen Loyd: The easiest way for me to explain what's at risk is to go back to the airline industry: how comfortable would you be getting on the plane of a pilot who is using narcotics? None of us would feel comfortable with that. Pilots are subject to random drug screening, and doctors are not. Doctors have the same rate of abuse and addiction as the rest of the population — about 2 percent prevalence at any time, and a lifetime prevalence of 10 to 18 percent. That's a lot of people. That's a lot of health-care providers that can have an impact on a lot of patients.

JB: Is this kind of screening happening anywhere in the US?

SL: It's not happening anywhere. It's amazing to me that it doesn't. We rely on the physicians to police themselves. I support drug testing for physicians because it is a safety-sensitive position, just like an airline pilot, just like a bus driver. A physician can impact many people, maybe not all at once but over time. I can tell you, in my own substance abuse, I impacted thousands of patients during the years when I was using.

JB: So you were abusing while you were treating patients?

SL: I was on the equivalent of 100 pills a day. The first time I ever used an opiate, I used half a pill. Within three years, I was using the equivalent of 100 Vicodin a day, which is 500 mg of opiates a day. I haven't had anything in over 10 years, and I took those drugs now it'd probably kill me, but my tolerance then was very high.

JB: Did you ever hurt a patient?

SL: The real danger of impaired health-care providers, and the real danger when I was using, was that I thought I was a better doctor when I was on drugs. I overestimated my ability to be a doctor. I felt I didn't need to sleep or eat like a normal person, that my mind was sharper. Those things weren't true. The only thing that prevented me from hurting patients was the competency of the other staff. Any potential errors, they'd bring to my attention.

JB: Did your peers — other doctors, nurses, hospitals staff — do anything to intervene?

SL: When I got intervened on, it wasn't by my practice or peers or the medical school or the hospitals I worked at. It was my dad. He saw physical changes in me, and he became worried, and he went to my colleagues and to nurses to try to get them to help him intervene. He couldn't get any help. He finally showed up at my house one day and confronted me.

When I got help, I felt like a guy out in the middle of the ocean drowning and a boat comes by and someone throws you a life ring. I learned about advocacy programs and high-quality treatment that doctors can get. I look at Prop. 46 way differently than people who are advocating against it. Those people say we don't want to drug test doctors, that it's punitive. I say it can save people from a path that will cause them to lose everything they have and potentially hurt patients.

JB: Do you think your peers knew you were addicted?

SL: Addiction is hidden. Six weeks before I went to rehab, the graduating students at our medical school identified me out of 200 faculty members for having a positive influence on their medical education. I had used drugs in the bathroom during the ceremony. I was a drug-using doctor and my job performance didn't yield a lot of clues, and the whole time I'm dying a bit on a daily basis. If you drug screened me then, I would have tested positive for opiates I didn't have a prescription for.

JB: There are critics of Prop. 46 — from doctors' groups to the state Chamber of Commerce. What are their main arguments?

SL: On the drug screening, they say it'll cost all this money and it won't identify anyone; that it's an invasion of privacy. I intervene on doctors now who have substance abuse issues. I can tell you it's extremely difficult to identify those providers. No one wants to get involved. Peers don't want to get involved. Subordinates — their incomes and lives are dependent on productivity of the doctor, so it puts people in a bad position. We've failed at trying to police ourselves. The only recourse we have is to require random drug screening.

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