“Josh, my problem is that guys like Dr. Solbern give guys like you prescription drugs like they’re handing out candy"

Josh wasn’t the first kid I’d seen living on the edge of addiction and substance abuse disguised as benign psych meds. He was a young man from a frum home in Lakewood who had clearly taken a few detours in life and didn’t seem to be particularly interested in getting back on the straight and narrow at the current time.

It was hard to tell at first glance, though. He still pretty much looked the part of an American yeshivah guy in Israel, although I certainly couldn’t vouch for how much time he actually spent — if any — in the beis medrash.

Just because there weren’t any visible tattoos or track marks on his arms didn’t mean he didn’t have his share of war stories. Josh was a tough kid, and to him, I was just another doctor who could get him his next fix.

“Yeah, I take a bit of Xanax and Adderall a few times a day,” he told me right off the bat, which was the first red flag.

But I wanted to judge him favorably, and having seen my share of guys like Josh, it was pretty clear that he’d probably grown up as little “Shia” in a standard family, had an upsherin, a Chumash party, a bar mitzvah, and had made a siyum or two just like the other kids in the neighborhood. But somewhere along the line, something traumatic had happened and he’d veered off the tracks and into office after office looking for that elusive comfort and release.

And here, he’d made his way to my office, which I felt was a sign that perhaps I could help him to find sobriety, or at least let him know I wouldn’t give him a stack of abusable medications just because he had shown up with the audacity to ask.

“Let’s start from the beginning,” I suggested amicably. “Where are you from, how do you keep yourself busy, what’s your date of birth? You know, the kind of stuff doctors like to know when they meet new patients.”

But Josh wasn’t particularly interested in having me taking a thorough history or even discussing himself.

He made it clear, “Ugg, I gotta do this again?! Listen, I just need a refill for my Xanax and my Adderall. I take three Xanax three times a day and five Adderall twice a day. I already paid you and I’m busy today, so let’s just move along.”

Wow, this kid wasn’t even attempting to play the drug-seeking-patient and the crooked-doctor game. He’d asked for enough Xanax to put a rhinoceros to sleep and enough Adderall to keep a hippo wired for a week.

“I hear you Josh,” I said sincerely, “but I wouldn’t be much of a psychiatrist if I just wrote you a few prescriptions and sent you on your merry way. After all, I’m not a drug dealer where you can hand me a fist full of cash and I’ll hand you a little baggie filled with whatever you’re after. Maybe we want to start from the beginning to see if I can be helpful in a different way?”

But Josh was in no mood for what he perceived to be psychobabble and stepped up the ante. “Listen, Dr. Freedman, the only reason I’m here is because Dr. Solbern is on vacation and isn’t taking clients this week. He’s been a doctor since before you were born, so don’t pretend like you’re some kind of tzaddik — just refill the meds he gave me.”

Josh tossed two empty boxes at me in a moment of aggravated chutzpah and I caught what happened to be packages of Xanax — an easily abusable benzodiazepine medication that acts on the brain and nervous system for a calming effect, and Adderall — a stimulant medication that boosts concentration. To my great surprise, there was a stamp on the box with Josh’s name, date of birth, and even instructions to take the very dosages he’d asked me for.

Josh was true to his word that these had been prescribed to him by Dr. Solbern, but that didn’t make me any more comfortable with the situation. The whole thing screamed of substance abuse — aside from the fact that he was taking one medication to speed you up and a second one to slow you down. And that was even before I knew that Dr. Solbern was involved.

In fact, I might have been less suspicious of Josh if he had never mentioned the psychiatrist who was notoriously known as “The Candyman.”

I tried to engage Josh in a discussion to better understand what he was really looking for, what was driving his addiction, or even to see if he would play the angry-patient-who-ends-up-working-with-the-caring-physician game with me. But he wasn’t going to stick around for long enough to engage in a meaningful discussion about what I imagined was a serious substance-abuse problem.

“Solbern just gives me scripts, Doc,” he said openly. “From the first time I met Solbern, he didn’t have any issues with these pills. So what’s your problem?”

It was clear that we weren’t going to make any big therapeutic breakthroughs when Josh pulled out a cigarette and prepared to light it in my office, so I figured I’d be honest. “Josh, my problem is that guys like Dr. Solbern give guys like you prescription drugs like they’re handing out candy. Truth is, we’ve got another 40 minutes to talk if you’re interested, and I’d love to hear about how this whole thing started — but my guess is that you’re outa here, off to find another Dr. Solbern instead of hearing how I might actually be able to help you.”

“You mind if I smoke here, Doc?”

“Yes.”

“Then I’m out. And just so you know, Solbern is a lot cooler than you are even though he’s a lot older,” he said as he made for the door.

“Good luck, Josh,” I said while he was still within earshot. “And just so you know, he’s not cooler than I am. I’m an ex-Navy Seal who once took down a Mexican drug cartel single-handedly with nothing more than a switchblade and a 12-foot rope.”

“Nah… really?” Josh asked as he casually turned his head around.

“No. But I have a mind to take down Solbern and make sure he doesn’t perpetuate the problem of prescription-drug abuse among young kids here in Hashem’s holiest of lands.”

Josh was out the door and was unlikely to be seen again. Dr. Solbern would likely return from vacation soon, and in the meantime Josh would probably find his fix via a friend with a similar substance-abuse problem.

But I couldn’t let it rest. Josh was one of half-a-dozen kids I’d seen over the past year who’d been given boxes of stimulants, benzos, and opiates by Dr. Solbern for no apparent reason beyond their request and cash payments. I’d called the fellow once or twice to try and discuss my concerns regarding the high doses and large numbers of refills he’d regularly give young men and women, but, gracious and friendly as he was, there was no one to talk to.

It was time to handle this the old-fashioned way.

To be continued…

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman, whose new book Off the Couch has just been released in collaboration with Menucha Publishers, can be found learning Torah in the Old City or hiking the hills around Jerusalem.           Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com

(Originally featured in Mishpacha, Issue 848)