This is a fine memoir of a Canadian family physician’s personal experience of opioid addiction—in his case, Demerol—well before “the opioid epidemic” of recent years. It’s informative, brutally honest, and often unsettling—including as it does fairly graphic descriptions of the using of opioids and their effects on the body; in the final pages, it’s also very moving. Drugs, Lies & Docs is not only about Dr. Michael Kaufmann’s substance use disorder, but also about the Ontario Medical Association’s Physician Health Program (PHP). After completing long-term addiction recovery work, Kaufmann became its founding director in 1995 and remained in that position for 22 years until his retirement in 2017. The PHP offers assistance to physicians “at risk of, or suffering from substance use disorders, and/or mental health disorders through prompt intervention, referral to treatment, monitoring and advocacy.”

At the time Kaufmann himself was in crisis, a concerned family physician colleague “referred” him to the PHP’s precursor, known as “DOC” (Doctors on Chemicals). Well, it wasn’t a referral exactly; it was an ultimatum. If Kaufmann, who everyone knew was seriously addicted and heading for a catastrophe, did not phone the DOC program by 3 pm that day, the colleague (who was going to check up on him with DOC personnel at 3:10) would phone Ontario’s provincial physician regulatory body and report him.

Kaufmann effectively intermixes his own story with complementary, logically sequenced segments of a standard presentation he frequently delivered to medical students. In that lecture, the doctor considers the kind of people who typically enter medical school, usually excellent students with a desire to help others. Some of those individuals don’t fare so well down the road. He refers to a 30-year New England Journal of Medicine study comparing a group of medical students to students in other non-medical professions. Over time, those in the physician group were more likely to have poor marriages, use drugs and alcohol regularly, and require psychological counselling. The authors of the study went on to note that “these observations correlated quite closely to poor childhood nurturing experiences in the physician group compared to the non-physicians” and speculated that “some who chose medicine may have done so unconsciously, seeking to help others because they needed to help themselves.” Kaufmann appears to be one of them.

The medical profession, the author notes, is not kind to its own wounded. The wounding starts in medical school. He writes that if you take young people with aptitude and intelligence who lack awareness of their vulnerability and psychological needs, submit them to continuous stress, and then add alcohol or drugs, you have a recipe for trouble. Prospective physicians quickly learn that asking for assistance is a sign of weakness. They develop the “pernicious skill” of making sure their outsides look fine when they don’t feel fine inside. Some never shake the sense of being imposters. In his position as director of the Physician Health Program, Kaufmann would become aware that many physicians do not have personal family doctors and often resort to self-treatment and self-prescribing. Work conditions are not conducive to health. Burnout is high and can lead to physical and psychiatric illness, including drug and alcohol problems.

Through his presentations to medical students, Kaufmann hoped not only to make them aware of their own vulnerabilities as they progressed through their training and career, but also to urge them to intervene, with the support of the PHP, when they noticed a colleague struggling. Statistics collected by the program have shown that action really can save the lives of troubled doctors (and by extension protect their patients from harm). In later chapters of his book, Kaufmann addresses intervention, treatment, monitoring, Twelve Step and other support programs, as well as the matter of a physician’s returning to work.

An estimated ten percent of doctors have a drinking or drug problem, which is pretty much in line with substance use disorder prevalence in the general population. Alcohol is the substance most frequently abused by physicians, with opioids a close second at 30 to 40 percent of cases. Other drugs—including cannabis and cocaine—make up the other few percent. The medical speciality that is over represented in the Physician Health Program is, not surprisingly, anesthesiology. Anesthetists not only have easy access to drugs, but they are also the group most likely to begin by self-injecting.

Unfortunately Kaufmann’s discussion of addiction, now officially known as “substance use disorder”, is based on on the out-of-date American Psychological Association’s DSM IV-TR (Diagnostic and Statistical Manual, 4th Edition Text Revision) which dates back to 2000, and not the DSM V-TR, which has been in use since 2022. I found some of the material about the spectrum of substance use disorders a bit muddy. From my own research, I see that these disorders are now characterized in the DSM as mild, moderate, or severe. A consistently key concept, however, is dependence. In more severe forms of substance use disorder (what we commonly refer to as “addiction”) a person’s body has made a physical adaptation to a drug or alcohol. The individual requires that substance to function both biologically and psychologically, and the withdrawal symptoms he experiences when deprived of it compel him to seek and use the substance again.

The memoir component of the book begins with Kaufmann’s childhood in Montreal. He was the first son (of three) born to young, emotionally immature secular Jewish parents, whose marriage quickly became dysfunctional. Admittedly atheistic in adulthood, Kaufman nevertheless laments the lack of any sort of spiritual anchor or guidelines in his early life. His was not a warm, loving home into which the children could invite friends. Kaufmann’s father had a variety of jobs—from textile factory worker to lawn maintenance—never hanging on to one for more than a few years. A frustrated, angry, and volatile man, he belted Kaufmann’s younger brothers while mostly leaving Michael, an overachieving student, alone. The boy understood his main role in life was to help his mother feel better: “relieve her depression, loneliness, and gnawing insatiability.” On top of this, addiction ran in the family: his mother regularly used opioids for her frequent migraines and his maternal grandmother was an alcoholic, who died prematurely after mixing alcohol and sedatives and lethally scalding herself in the bath. A genetic predisposition and the dysfunctional dynamics of his family of origin no doubt increased his susceptibility to substance abuse and addiction.

The author writes that he was given cough syrup with codeine as a child, and he clearly recalls an intramuscular injection of an opioid, likely Demerol, when he was 12 before entering the OR for an emergency appendectomy, but it seems to me that the critical turning point was an ER nurse’s providing him with a small cup of cough syrup when he was a medical student. He was ill with a hacking cough, which the opioid in the syrup suppressed, but which, far more significantly and dangerously for him, also caused him to be suffused with warm euphoria within minutes of consumption. The stress and tension of his training simply melted away. Experiencing that sense of ease and wellbeing once, he needed it again and again and again. In time, as he moved through his residency and then joined a family practice, he would find himself rummaging through the clinic’s drug cabinet (well stocked with samples from drug reps), stealing pills from his palliative care patients, and injecting himself with syringes of Demerol pocketed during his shifts in the local hospital’s ER department. About the latter, the medical record would indicate that the opioids had been administered to patients. In fact, those ailing individuals had been injected with harmless saline solution, while the physician walked off with the potent stuff.

As Kaufmann sees it, addiction is “an irreversible, chronic, life-long condition. It can be managed—but it can’t be cured.” In his own life and in the lives of those who have participated in the Physician Health Program, abstinence from alcohol and all potentially addictive substances is the rule; otherwise cross addictions can and often do occur. If a drug is medically indicated, every safeguard must be taken. Supervision and monitoring are critical.

Kaufmann’s book is well written, organized, and edited. Having said that, I believe it is overly long and would have benefited from a judicious trim. Some childhood scenes could easily have been cut, and I wish the author had omitted the description of the slaughter of animals on his and his wife’s hobby farm. Described in bizarrely jolly terms, it adds nothing to the book (but horror) and has no relevance to Kaufmann’s central themes.

On the positive side, I was impressed by the restrained manner in which he handled his wife’s reaction to the disruption, chaos, and pain his addiction brought to her life. I do not know how she remained with him, and I suspect there is quite a story there. I admit to genuine relief that no children were born into what was obviously, for some time, a terrible situation.

I am glad Dr. Kaufmann shared his compelling story. While it won’t be for everyone, it provides valuable insight into addiction and helps the reader understand the how a healer can heal through ongoing support, community, and daily recovery practice.

I was excited to read this. It’s right up my alley. I love memoirs and work in the medical field and was very interested in learning more about Drs and addiction. Many of the doctors I personally know are plagued with this affliction. I was becoming more and more engrossed until 16% of the way through and I had to abandon ship. I couldn’t stand to read one more word about the slaughtering of his farm animals. I love all farm animals and have a tough time reading about how they are treated and slaughtered. He kept going on and on and on and I finally had had enough and that’s it. I’m done. I am confident the book is excellent beyond that as it started that way but I can’t read another word about those poor animals to find out. I’ll give it 3 stars for what I had already read.

The book didn’t need to be over 400 pages either. Leave some of the animal slaughtering out and save some paper.

Thank you to NetGalley and Dr. Kaufmann for an Advanced Reader's Copy of this title!

"Drugs, Lies, and Docs" is a moving memoir of the author's descent into addiction and the claw-by-claw battle out to the realm recovery, as framed through a presentation to Canadian medical students. Alternating between his chronological path through childhood, medical school, medical practice, and recovery, and his bird's eye view as an addiction specialist in the future, this memoir gently walks the reader through the good, the bad, and the ugly of addiction and recovery, sparing no feelings and making no excuses.

As a medical student, this memoir was especially poignant - medical professionals, and doctors in particular, are held to incredibly high standards personally and professionally, and we are constantly warned at all levels of training about the dangers of addiction and poor mental health (mandatory wellness modules, anyone?). Despite this emphasis I feel like there is still a huge stigma around talking about the warning signs and what to do when you encounter a physician in the throes of illness, and the mindset that would lead someone down this path in the first place. The mental gymnastics around addiction, recovery, and self-worth/self-image as a physician are explored in depth here, and I think could be really helpful for students, trainees, and practitioners to hopefully catch patterns in themselves and others.

This book was an excellent read for anyone, but especially healthcare professionals and those that love them, and for those who have faced or are curious about the cost addiction wrings from our lives. Addiction is complex, disheartening, and aching, but not insurmountable as long as you're willing to reach out your hand.

Thank you to NetGalley and Life to Paper publishing for providing a copy for review. All opinions are my own.

Drugs, lies and docs is Michael Kauffman's deeply personal memoir that takes the reader from a journey into the world of someone struggling with addiction and recovery and how that affects those close to them in their lives; both family and colleagues.

Throughout the memoir, Kauffman does not shy away from exploring and discussing all aspects of addiction and the highs and lows of recovery. From having the strength to walk away from temptation after his drug of choice is prescribed to him, to describing the euphoric feeling he felt when he got a taste of it after years of sobriety. His insight into addiction is profound.

"When we tell our stories, we are not alone. We join - we heal."

I almost feel bad for rating a memoir so honestly raw and vulnerable so low but unfortunately I had some issues.

The memoir is initially framed as a talk he is giving to medical students about addiction in doctors. However, the author seems to often forget about this framing device at multiple instances throughout the book making it feel disjointed and messy. As a result some sections felt like a chore to get through.

My other main issue is some of the language used by the author. Being born in 1953 the author went through medical school in the late 60s and 70s. He makes an observation regarding the differences in his graduating class Vs a modern graduating class in terms of diversity. However, the language used comes across as borderline racist and misogynistic. This isn't something I tolerate in anyone no matter your title.

Eye-opening account of a physician who conquered addiction, and came out the other side to help other doctors recover. Interesting perspective and realization on why it is so common for doctors to have substance use disorders.