Comfortably Dumb: Drugs in the Trump White House

A closer look at a Pentagon IG report on pharmaceutical mismanagement in FPOTUS's White House Medical Unit

In the fall of 2020, I was a guest on a radio show. This was right after some unidentified flying white object shot out of the nose—or maybe the mouth?—of FPOTUS. By then, we’d all borne witness to Donald Trump behaving lethargically on stage or at a press conference, his pupils saucer-wide, looking for all the world like he was on something. By then, Noel Casler, the “Celebrity Apprentice” talent manager turned stand-up comic, behind-the-scenes tea spiller, and anti-Trump activist, had already told anyone who would listen about Trump’s (alleged) substance abuse problem. Here’s what he told me, on these very pages, in May of 2020:

GO: The drugs are obviously a much bigger deal. Anyone who’s watched him during the last three years—and especially during the pandemic pressers—can see that there are times when his affect is radically different. The press will describe him sometimes as “subdued.” Can you detail what you’ve seen?

NC: He snorts Adderall as his maintenance high. When he gets too wired, this is tempered with benzodiazepines. There’s also a robust use of cocaine and methamphetamine in the Trump orbit, and I’ll leave it at that….NYC is also full of folks with anecdotes of Trump’s drug use. They come up to me and share stories all the time. Look into the Dr. Bornstein stuff if you want to know more, and ask yourself why Trump sent [his bodyguard] Keith Schiller to strong-arm the doctor and steal his medical records, shortly after being elected POTUS.   

So I was on the radio show, and I broached the subject. I spoke carefully. I didn’t make any direct allegations. I didn’t say “Trump is a drug addict!” I cited Noel and that interview, and the many times Trump looked high or otherwise out of it, and all the weird stuff with him desperately trying to hide his medical records—remember when his doctor, under duress, wrote that he was the healthiest president of all time?—and the white chunk that had fallen like a tiny meteor out of his gaping nostril.

Another guest on that radio show was an attorney. She had a big public profile, and she sometimes appeared on the cable news programs. She’s someone I have a lot of respect for, someone I like. As soon as I brought up Trump’s alleged drug use—which, again, I did very carefully, and with good, newsworthy reason—she took great pains to distance herself from the topic. She made it clear that she wanted nothing to do with it. Perhaps, being an attorney, she had her own reasons for wanting to shut it down. But it seemed to me that this was a directive—that she had been warned, likely by some powerful corporate parent-company attorneys, not to go there.

And so we changed the subject. Which was fine. There was plenty to talk about. Besides, what was some crushed-up Adderall compared to serial sexual assault and a negligent pandemic response? The drug abuse allegations were but a tiny white speck on the pile of Bolivian marching powder that was every horrible thing he’d done.

Cut to January 8, 2024. Michael J. Roark, the Pentagon’s deputy inspector general for evaluations, released a report, with the catchy title “The Defense Department Evaluation of the DoD Internal Controls Related to Patient Eligibility and Pharmaceutical Management Within the National Capital Region Executive Medicine Services,” that found problems with how the White House Medical Unit handled its pharmaceuticals during the Trump Administration. A better title might have been “Dr. Feelgood.” Or, maybe, “White House (Don’t Don’t Do It).”

The report came about because of complaints, plural, in 2018, “alleging that a senior military medical officer assigned to the White House Medical Unit engaged in improper medical practices.” The investigation into that individual, who was not named in the report, began in May of that year. The findings, which the press reported on two weeks ago, are worth noting.

First, there was no oversight over the White House Medical Unit. It was Rogue One all up in there:

[T]he White House Medical Unit’s pharmaceutical services included the full scope of pharmacy operations, including storage and inventory, prescribing and dispensing, procurement, and disposal, and was not credentialed by any outside agency…Without oversight from qualified pharmacy staff, the White House Medical Unit’s pharmaceutical management practices may have been subject to prescribing errors and inadequate medication management, increasing the risk to the health and safety of patients treated within the unit.

This led to—you’re not gonna believe it—a chaotic, poorly managed, unsafe Rx situation:

We concluded that all phases of the White House Medical Unit’s pharmacy operations had severe and systemic problems due to the unit’s reliance on ineffective internal controls to ensure compliance with pharmacy safety standards…We found that the White House Medical Unit provided a wide range of health care and pharmaceutical services to ineligible White House staff in violation of Federal law and regulation and DoD policy. Additionally, the White House Medical Unit dispensed prescription medications, including controlled substances, to ineligible White House staff.

Investigators interviewed former employees of the unit, who reported being “unable to act outside of the White House Medical Unit’s historical practices” and “not empowered to deny requests from senior White House Medical Unit leaders.” That sounds like IG-speak for, “That’s a helluva nice medical career you got there; shame if anything happens to it.”

Moreover, the aforementioned White House Medical Unit leaders “directed eligibility practices that did not comply with DoD guidance.” From the sound of it, they handed out prescription drugs like frat house seniors pouring shots of Jim Beam for random freshman pledges. Except it wasn’t Jim Beam. It was Johnny Walker Blue:

Additionally, the White House Medical Unit’s pharmaceutical management practices ineffectively used DoD funds by obtaining brand‑name medications instead of generic equivalents and increased the risk for the diversion of controlled substances…..

The White House Medical Unit routinely requested brand‑name drugs rather than generic equivalents when ordering controlled substances from Walter Reed. For example, over a 3‑year period, the White House Medical Unit spent an estimated $46,500 for brand name Ambien, which is 174 times more expensive than the generic equivalent. Over the same period, the White House Medical Unit also spent an estimated $98,000 for brand name Provigil, which is 55 times more expensive than the generic equivalent.

Ambien is a powerful sedative that knocks you out so you can sleep. If it doesn’t knock you out, it makes you behave strangely while “driving, eating, walking, making phone calls, or having sex” and then not remember anything afterward. Provigil is the opposite. It’s a psychostimulant. It makes you stay awake. It’s used to treat narcolepsy. It’s like a kinder, gentler Adderall. You know—Adderall: the drug Noel Casler told me Trump “snorted” as his “maintenance high.”

Trump’s White House Medical Unit “dispensed non‑emergency controlled medications, such as Ambien and Provigil, without verifying the patient’s identity. The White House Medical Unit also left over‑the‑counter medications in open bins for patient retrieval and use.”

The report says that, basically, the White House Medical Unit operated like a pharmacy, in that it doled out prescription drugs, but not like a pharmacy, in that it was really bad about reporting stuff—especially when it came to Schedule II controlled substances:

During our site visits, we observed White House Medical Unit staff performing tasks customarily associated with those of a pharmacy, such as ordering and storing a variety of prescription and non‑prescription medications and dispensing medications to patients in conventional, amber‑colored pill bottles that were marked “White House Medical Unit” (see Figure 1). Additionally, at the WHCA clinic, we observed a sign that read “Pharmacy” outside a room housing the MedSelect unit.

The internal recordkeeping on this was shit (boldface mine):

The inventory records showed that White House Medical Unit stocked four different types of Schedule II opioid pain medications (fentanyl, hydrocodone, morphine, and oxycodone), as well as medications from Schedules III through V, such as stimulants and sedatives. However, White House Medical Unit kept the records for its Schedule II medications in the EEOB’s inventory binder together with records for all other controlled medications and not maintained separately as required by the CFR….

In our analysis of White House Medical Unit’s inventory records, we concluded that White House Medical Unit’s controlled substance records did not accurately reflect the unit’s procurement, inventory, or disposal of controlled substances.

As shown in the White House Medical Unit Controlled Substance Requisition form (Figure 2) and the White House Medical Unit Controlled Substance Receipt Tracking form (Figure 3), the White House Medical Unit’s hand‑written inventory logs frequently contained errors in the medication counts, illegible text, or crossed out text that was not appropriately annotated, making it hard to accurately track the disposition of controlled substances.

The investigators “could not verify the contents of the controlled substance module” because “staff were unable to open the controlled medication storage drawers and stated that the drawers were empty.” That seems sus, as the kids say.

Trump’s medical team was shall-we-say casual with its recordkeeping:

We concluded that the White House Medical Unit’s internal policy for controlled substance prescriptions was insufficient to meet the DEA requirements for controlled substance prescriptions, omitting the requirements for patient address and practitioner address, branch of Service, and Service identification number….

We concluded that the White House Medical Unit dispensed non‑emergency controlled medications, such as Ambien and Provigil, without verifying the patient’s identity. The White House Medical Unit senior leaders stated that the White House Medical Unit provided pharmaceutical support for travelers on White House official travel. This included the dispensing of controlled substances, such as Ambien and Provigil.

But for my money, the most compelling sections of the report are the eyewitness testimonies. Below are statements by four of the 60 employees who worked there during the Trump years:

Witness #1: Anything that took place at the White House Clinic was never written down, never recorded. [However,] the only record that you ever had that a patient came in and got any sort of medication would have been if it was a controlled substance that we were required to document for the pharmacy. But if you came in and got any other prescription medication that wasn’t classified as a controlled substance there would be no record that you came in and did anything.

Witness #2: So, traditionally, we would—as part of the duty there in the President’s clinic, we would go ahead and make prepacks of medications. . . . Well, before we would get ready for a big overseas trip, one of our requirements was to go ahead and make packets up for the controlled medications. And those would typically be Ambien or Provigil and typically both, right. So we would normally make these packets of Ambien and Provigil, and a lot of times they’d be in like five tablets in a zip‑lock bag. And so traditionally, too, we would hand these out. . . . But a lot of times the senior staff would come by or their staff representatives . . . would come by the residence clinic to pick it up. And it was very much a, hey, I’m here to pick this up for Ms. X. And the expectation was we just go ahead and pass it out.

Witness #3: Dr. [X] asked if I could hook up this person with some Provigil as a parting gift for leaving the White House. And at the time, the corpsmen and the medics, the enlisted corpsmen and the medics, it was okay for us to dispense Provigil and Ambien without having a provider present. I’m not sure if it was okay as far as, like, what’s medically allowed. But in the unit, it was authorized for us to do that kind of stuff.

And this is the fourth witness, summing up the culture of the White House Medical Unit, which mirrored the culture of the Trump Administration (boldface mine):

[I]n some people’s minds they think they have to change the way they do their medicine because of its an executive world and their not normal patients, but that’s pretty much everything that I’ve been taught against regardless of if it’s the richest man in the world or a man on the street. You treat them the same. And so that didn’t happen at the White House, and we bent knees and we bent the rules to meet this very weird, strange culture that was there, and I think it was really to just impress people. And so I understand it’s almost like the culture of D.C. and politics, and somehow the Medical Unit got sucked up into that culture as well.

There’s more in the report—a lot more. But you get the gist. Trump insiders took advantage of a supine senior medical team to pass around strong prescription drugs, including to individuals who did not work there or were not authorized to use the services provided by the White House Medical Unit. And they did this, at least in part, to show off. Then the inadequately supervised medical team kept inadequate records—assuming it didn’t fudge them entirely.

In the grand scheme of things, I realize, these are minor infractions. Who cares if Trump’s people needed Ambien to sleep on flights to Saudi Arabia or Provigil to stay awake during one of his idiotic MAGA rallies? Next to rape and espionage and fraud, these are jaywalking citations. Furthermore, because the report doesn’t name names, we don’t know if Donald Trump himself was one of the beneficiaries of his medical team’s Rx largesse.

And we probably never will. Already, this story has gone away. Like almost anything related to Trump’s health or medical history or alleged drug use—those crippling bone spurs that kept him out of Vietnam; his goons menacing his doctor and stealing his medical charts; the ridiculous doctor’s statement about his all-time-great health; the concealment of his medical reports despite promises not to; Noel Casler’s allegations of Trump’s substance abuse problems (“I told y’all that mfker was high,” he tweeted when the story broke); the sudden, mysterious Walter Reed visit in 2019; the virulence of Trump’s near-fatal bout with covid-19; even the weird blisters on his fingers earlier this year—the subject seems not to interest the media.

Are journalists reluctant to dig deeper into this subject for fear of Trump reprisal—like my fellow radio show guest appeared to be back in 2020? Or have they become comfortably numb?

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Photo credit: White House Medical Unit Controlled Substance Requisition form from 2019, with image of Trump in the redacted black section.