A physician's struggle to close Pandora's box

Lynne Cohen

CMAJ 1999;160:1412

© 1999 Lynne Cohen

"I had just finished 3 tortuous, 18-hour days in residency training at the National Defence Medical Centre and I needed 4 good hours of sleep before I started another long day. So I took, for the first time in my life, something external to help me fall asleep. I had no idea of the Pandora's box I was opening."

Dr. Dan Sweet: "I hate this disease."

The 34-year-old husband, father and physician had no idea how the next 10 years would play out: daily chemical dependency, a near-death experience in 1989, months of difficult treatment in Toronto and at home, relapse, more treatment in Atlanta and the loss of his job as chief of anesthesiology at the Cornwall General Hospital in Eastern Ontario. And, finally, recovery and renewal, both as a man and as a physician.

Today, after being clear of narcotics for 8 years, he practises exclusively as an addiction specialist. Certified by the American Society of Addiction Medicine, he has 8 employees and 2000 active patients. His addiction clinic in Ottawa offers a complete range of medical and counselling services.

Sweet, the eldest of 6 children, has lived in or near Ottawa since his family moved from Alberta after he completed Grade 6. "I grew up in an RCMP family," he explains. "All my brothers became policemen. There was no active use of drugs or alcohol in my home, but there was a certain rigidity and emotional distance."

Sweet initially spent 3 years with the Canadian Armed Forces, but left for private practice in 1986. For a time after his first experiment with self-medication, the University of Ottawa graduate had little trouble controlling his urge to inject leftover narcotics — usually wastage from dosages given to his patients.

Then in 1987, he was prescribed some Tylenol 3s for pain in his neck. "I was told to come back if I needed more. I was too busy, so I thought, 'Tylenol 3s, morphine, not much difference. I can provide it. After all, I am a doctor, I know what is best.' "

That is when the loss of control really started. And as time went on, the relentless obsession became overpowering. "It was a funny thing," he notes. "I would say [to myself] I am going to quit, I am going to quit. Monday would come and I would fight and fight not to use. Finally, in the middle of Monday afternoon, I was back to doing it.

By 1989, as chief of anesthesia at the Cornwall General, acquiring the drugs he needed had become pretty easy. Responsible for ordering quantities of medicines, he simply requested extra.

He knew the behaviour had to stop but he had no idea how to go about it. "I was filled with terror, horrified that someone was going to find out and turn me in, and I would be arrested and [the news] would be all over the papers. So I was living with enormous fear."

With his concentration declining and his wife pregnant with their third child, Sweet finally made a near-fatal error: he replaced the wrong drug in an opiate syringe. "You end up substituting whatever clear liquid is available," he explains matter-of-factly. "This time it was a muscle relaxant, but I thought it was my [fentanyl]."

The near-death experience propelled him into seeking treatment. Over the next few years, Sweet stumbled several times on his way to complete abstinence and full recovery. His brother's terminal illness ignited intense grief, superhuman work hours and relapse, the final event before he was sent to Atlanta for 7 months. "My fourth child was born without my presence," he recalls. The pain is obvious.

Now, at age 43, Sweet is doing exactly what he believes is his mission in life: using his medical expertise to treat people suffering the way he did. "I do this because I hate this disease," he says. "I hate what it does to families. I also know there is proper and effective treatment. The more we succeed with people with this disease, the more they become advocates for [adequate] resources and government funding."

Send a letter to the editor Envoyez une lettre à la rédaction