CHPR: Dr. Grinspoon, please tell us about yourself.
Dr. Grinspoon: I’m a primary care doctor at Massachusetts General Hospital, teaching at Harvard Medical School. My main interests are medical cannabis, addiction, physician health, and psychedelics. I’m also 17 years in recovery from a pretty vicious opioid addiction, which led me to write my memoir, Free Refills: A Doctor Confronts His Addiction.

CHPR: What makes addiction particularly challenging for doctors compared to other professions?
Dr. Grinspoon: Doctors face unique challenges with addiction—high stress, trauma, and easy access to medications. Combine that with the culture of medicine, where we’re expected to be stoic and self-reliant, and it’s no surprise that about 10%–12% of us will develop a substance use disorder (Berge K, Mayo Clin Proc 2009;84(7):625–631). In a perfect world, we’d all meditate, eat tofu, exercise, and do yoga. But in reality, many of us don’t have great coping techniques and turn to alcohol, pills, or cannabis to manage the stress. It’s part of the epidemic of burnout we’re seeing today.

CHPR: How do you see the connection between burnout and addiction?
Dr. Grinspoon: Burnout and addiction are two sides of the same coin. Burned-out doctors are stressed, they’re anxious, and they’re often suffering from moral injury. They’re not getting the satisfaction they used to from their work, and many are also worrying about money. For primary care physicians, in particular, the pay often doesn’t reflect the hours or stress. The quality of patient care has been declining over recent years, influenced by the corporatization of health care and the profit-driven priorities of hospitals (Kannan S et al, JAMA 2023;330(24):2365–2375). It causes us moral injury when we are unable to maintain ethical standards of care. These factors create the perfect setup for addiction. Burnout feeds unhappiness and despair, which in turn can lead to substance misuse. 

CHPR: And to make things worse, it’s often hard for doctors to ask for help. 
Dr. Grinspoon: Right. The culture of medicine plays a huge role. It can feel like we’re expected to be emotionless robots who show up to work every day and take care of everybody else, and seeking help has been seen as weakness. The old “physician, heal thyself” mentality creates a stigma around admitting vulnerability (Shanafelt TD et al, Mayo Clinic Proceedings 2019;94(8):1556–1566). On top of that, there’s the fear of punishment. Medical boards have a legitimate mandate to protect the public, but their approach is often unreasonably punitive. A doctor struggling with alcohol or pills knows that asking for help could mean losing their license. I mean, who wants to get in this type of trouble? People have mortgages and kids and are afraid of losing their livelihood. I think this fear keeps a lot of people from getting help earlier in their addictions. If the medical board weren’t so quick to suspend doctors’ licenses, I believe more physicians would feel safe seeking help. A monitored physician is far safer than one too afraid to seek assistance, leaving their addiction hidden and unchecked. That said, I understand the board must act swiftly when dealing with truly impaired physicians who pose an immediate risk to patients.

CHPR: What was your own experience like with the medical board? 
Dr. Grinspoon: When I was struggling with my addiction, the state police and DEA raided my office, fingerprinted me, and charged me with felonies for bad prescriptions. That was not a fun day, but it ultimately forced me to find a way into recovery. I spent five years under the Massachusetts Physician Health Service—the state’s physician health program (PHP)—where I underwent regular drug testing, therapy, and group support. They then invited me to become the associate director, and I found myself sitting in the role of overseeing and supporting other physicians in the early stages of their recovery. So, I’ve seen this issue from both sides and have come to realize how deeply the punitive approach discourages people from seeking help when they need it most. My interactions with the medical board felt adversarial and unempathetic at times, which made an already difficult process even more challenging. 

CHPR: What could have been done differently in your case?
Dr. Grinspoon: I definitely needed to be taken out of practice, but the process could’ve been more modern and compassionate. I was forced into a 90-day rehab that was outdated, overly religious, slogan-based, unscientific, and alienating for someone with a scientific background like a physician. I believe we should focus more on evidence-based treatments like buprenorphine-naloxone, commonly known as Suboxone, or intensive outpatient programs. The stigma around medications like Suboxone is another concern. Suboxone reduces overdose deaths by 50%–80% (Sordo L et al, BMJ 2017;357:j1550). However, physicians have often been denied access to buprenorphine-based treatments based on the belief that it causes cognitive impairment (Hamza H and Bryson EO, Mayo Clin Proceedings 2012;87(3):260–267). That’s a reckless and dangerous attitude. Suboxone isn’t any more impairing than medications doctors are permitted to use, like benzodiazepines, antihistamines, and alcohol. Denying access to Suboxone based on unfounded impairment concerns overlooks its lifesaving benefits and perpetuates harmful stigma. The whole experience was unnecessarily punitive. Addiction already comes with immense guilt—we feel like we’ve let down our families, colleagues, and patients. Treatment should be about healing, not shame and punishment. 

CHPR: Is the attitude toward Suboxone changing?
Dr. Grinspoon: There’s been some progress. After an article in the New England Journal of Medicine criticized medical boards for denying Suboxone to doctors, they now state that they allow it on a case-by-case basis (Beletsky L et al, N Engl J Med 2019;381(9):796–798). But I doubt much has changed in practice, as there is bias against it, along with a widespread failure to incorporate the latest scientific evidence into rehab facilities (National Academies of Sciences, Engineering, and Medicine. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press; 2019). Physician health programs remain conservative, and the stigma persists despite the evidence base supporting treatments like Suboxone for addiction or medical cannabis for pain and anxiety management. And now, we’re seeing promising data about the potential of psychedelics in helping some people recover. We need to adopt a more flexible and evidence-based approach to recovery instead of clinging to rigid abstinence models. Unfortunately, the punitive nature of medical boards and mandatory drug testing often prevents doctors from accessing these treatments, and that’s something I believe must change.

CHPR: Are certain specialties at higher risk for addiction?
Dr. Grinspoon: Yes, anesthesiologists are at particularly high risk. They often misuse potent injectable drugs like fentanyl and hydromorphone (Dilaudid), which are more immediately life-threatening than pills or alcohol (Mayall RM, BJA Education 2016;16(7):236–241). I’ve lost two friends, both anesthesiologists, who overdosed and died lonely deaths in hospital bathrooms. It was heartbreaking. There’s still debate about whether anesthesiologists with a history of opioid addiction should be allowed back into the operating room. The risks of returning to use in that environment are so high, and the consequences can be fatal.

CHPR: What should colleagues do if they suspect a doctor is struggling with addiction?
Dr. Grinspoon: That’s a tough situation because we’re mandated reporters, but reporting someone often triggers unhelpful punitive actions. If you notice personality changes, poor hygiene, or declining work quality, approach the person empathically. It might not be addiction—it could be depression or another issue—but it’s worth checking in. If you’re sure it’s addiction, I think it’s better to give the person a chance to seek help before resorting to the nuclear option of reporting them to the board. Say, “I know you’re struggling. Please get help, or I’ll have to report you.” If they refuse, involve their chief or report them to your hospital’s physician well-being committee, or to your PHP, which most states have. (Editor’s note: See box.) Ultimately, if they’re impaired and refuse help, you have an obligation to report them. These situations are incredibly stressful for everyone involved, but the goal should always be to get the person help.

CHPR: What can a physician who’s been referred to their hospital committee expect to happen once that process has been started? And how is it different from what would happen if the PHP gets involved? 
Dr. Grinspoon: It depends on how experienced the hospital committee is with addiction. In some cases, they might suspend the doctor out of concern for patient safety. In others, they might take a more supportive approach and help the physician get into treatment. But many hospital committees aren’t set up to deal with such a complex issue, so they often turn to the PHP for guidance and support.

CHPR: Is the physician’s addiction struggle kept confidential from their colleagues and patients while they go through recovery if they are kept in practice? 
Dr. Grinspoon: At the PHP, confidentiality is taken very seriously, and the protections are quite strong. Ideally, this is also the case with hospital administration. Other doctors dealing with similar issues often know about your plight because you’ll see each other at the PHP when you are getting drug tests or at the physician support group meetings. But it would be very unusual for one of these doctors, your sort of comrades in recovery, to violate confidentiality.

CHPR: Do you have advice for physicians who are personally struggling with addiction? 
Dr. Grinspoon: Yes! Get help now. Be honest with yourself about your addiction. Keep in mind that you will need to get help eventually, as addictions almost always escalate over time. It’s much better to check yourself into a clinic or sign up with an addiction specialist than have the state police and the DEA come knocking at your door. 

CHPR: What preventive measures could reduce addiction among physicians?
Dr. Grinspoon: First, we need to make being a doctor less stressful. Right now, primary care feels like The Hunger Games. Doctors are burned out, quitting, retiring early, or avoiding certain specialties altogether. (Editor’s note: For more on preventing burnout, see our interview with Dr. Norris on page 1.) Physician unions will likely play a key role in addressing this issue and help to push back against the increasing demands from hospitals and insurance companies who, these days, often prioritize corporate profits over the well-being of both patients and doctors. Second, we need a culture shift where doctors feel safe admitting they need help without fearing for their licenses. There should be pathways to recovery that are supportive, not punitive; you can’t just have it be this heavy, heavy hammer. And the third thing—which is why I’m really glad you’re shining a spotlight on this—we need to give this critical issue more attention. I think the more we acknowledge the fact that physicians struggle with the same problems that everyone else does—they get depressed, they get divorced, they have bad days, and they get addicted—the more likely they are to come forward and get help. We need to ditch all the stigma.

CHPR: What are some practical ways to foster a more supportive environment for physicians struggling with addiction? Could supportive conversations between colleagues be a starting point, or should this involve advocating for wellness programs and awareness education through administration?
Dr. Grinspoon: Wellness programs, in my experience, tend to be bland and only marginally effective. A better approach is using trained physician coaches to provide one-on-one, confidential support to doctors who are struggling. We started doing this at my hospital with great benefit. Collective efforts, like unionizing, can also help physicians advocate for systemic changes and have a stronger voice in addressing workplace challenges. Finally, education and empathy can go a long way toward dismantling the stigma. We need more doctors in recovery to speak out about their experiences to normalize them.

CHPR: Are there specific addiction resources, organizations, or recovery groups for health care workers that you recommend?
Dr. Grinspoon: PHPs, such as those that are affiliated with state medical societies or boards, are often a good starting point, though some physicians find their approach can feel rigid or overly focused on monitoring. Many cities also have physician recovery groups, and you can typically find out about them confidentially through your local PHP. If you’d like to consult a directory of state programs, I recommend visiting the Federation of State Physician Health Programs (FSPHP) at www.fsphp.org/state-programs.

CHPR: Do you see signs of progress in how addiction among physicians is being addressed?
Dr. Grinspoon: There’s been some progress. Societal attitudes toward addiction are shifting—it’s generally seen more as a disease than a moral failing. That’s trickling down to medical boards and PHPs, but the change is slow. There’s still a deeply ingrained culture of punishment. On the bright side, more doctors are speaking out. I hope that by sharing my story, I’ve helped show that addiction can happen to anyone and that recovery is possible. Ironically, doctors in recovery often become some of the most compassionate and mindful physicians. 

CHPR: Is there any final message you’d like to leave with our readers?
Dr. Grinspoon: Just that recovery isn’t a one-size-fits-all process. The traditional Alcoholics Anonymous model of lifelong sobriety has its place, but with advancements in our understanding of Suboxone, methadone, cannabis, and psychedelics, many of us now recognize that being on these medications is recovery—it’s not just replacing one addiction with another. I strongly believe that all of these treatments should be available to doctors. I just don’t buy into the medical board’s attitude of, “You must be abstinent for life.” That’s not how people work, that’s not how recovery works, and that’s not how addiction works. As long as a physician’s life is in order and they’re safely treating patients, their recovery should be supported in whatever form works best for them. I really advocate for meeting people where they are and embracing a more flexible, individualized approach to recovery. This is particularly important for physicians. At the end of the day, our goal is to save lives and help people return to helping others. A more realistic and compassionate approach to recovery greatly improves the chances of achieving that goal. 

CHPR: Thank you for your time, Dr. Grinspoon.