Top US judge had delusions during detox, FBI files reveal

by Ed Pilkington, New York
Saturday January 6, 2007
The Guardian

William Rehnquist, the late head of the US supreme court, was so addicted to sedatives that when he stopped taking the drugs he had hallucinations that the CIA was plotting against him, newly released FBI records reveal.

The papers, running to 1,561 pages, are the product of an FBI investigation into Rehnquist’s drug dependency which is revealed to be much more serious than previously known. They show that he went into detox having been prescribed sedatives shortly before he was appointed by President Richard Nixon onto the supreme court 10 years previously.

The papers show that he withdrew from the drugs during a week at the George Washington University hospital in 1981, and suffered paranoid delusions.

One doctor said Rehnquist complained that the designs on the curtains were moving and that he heard voices outside his hospital room in which CIA operatives plotted against him. The judge was found in the lobby of the hospital in his pyjamas trying to escape.

It was already known that Rehnquist was dependant on Placidyl, a sedative he was prescribed for back pain and which is addictive. But the extent of his dependency is only now apparent, with the papers revealing that by the time of his detox he was on nightly doses of 1,500mg, three times the norm.

During the course of 33 years on the court Rehnquist came to represent the increasingly conservative face of US justice. When he took his seat in January 1972 the court was largely liberal in complexion, and remained so during the 1970s and 1980s until President Reagan managed to transform its composition. He nominated Rehnquist to the top judicial post of chief justice of the supreme court in 1986, a job which Rehnquist held until his death in September 2005.

The chief justice was controversial, having supported the segregation of southern schools in a legal memo written in 1952 and having been accused of attempting to prevent black and Hispanic people registering to vote while acting as a Republican election volunteer in Arizona in the 1960s. He also opposed abortion and was in favour of allowing religion to have a greater presence in public life.

The papers also show that Republican administrations asked the FBI to investigate witnesses they feared would be hostile to Rehnquist during his confirmation battles. In the run-up to his confirmation as chief justice in 1986 John Bolton, who recently stood down as US ambassador to the UN, delivered witnesses’ names to the FBI, telling the agency he “would accept responsibility should concerns be raised about the role of the FBI”.

Mr Bolton defended the action to the Washington Post yesterday, saying there was no political motive behind it as the request for FBI involvement originally came from the Democrats.

Newsweek weighs in…
By Peg Tyre
Newsweek

Jan. 6, 2007 – As more details about the late Supreme Court Chief Justice William Rehnquist’s battle with prescription medication have emerged, they have focused new attention on how doctors prescribe and monitor people who take potentially addictive drugs.

Declassified documents released by the FBI this week paint a picture of an esteemed and learned man who nonetheless fell prey to a long-term debilitating habit while he was a Supreme Court justice during the 1970s. In 1981, five years before he became chief justice, Rehnquist was admitted to George Washington University Hospital for a month in order to be weaned off prescription drugs. During his hospital stay, according to the documents, Rehnquist experienced paranoid delusions and tried, at one point, to escape from the hospital in his pajamas. Shortly before he underwent the treatment his family described him as having a longstanding problem with “slurred speech.”

And no wonder. The FBI reports that Rehnquist was already taking the powerful hypnotic ethchlorvynol—marketed as Placidyl—to treat insomnia when, in 1972, he came under the care of a Capitol Hill doctor (whose name was redacted from the report). Subsequently, Rehnquist’s dose of the powerful drug as much as tripled to 1,500 milligrams per day. He began taking a pill before retiring and a pill if he woke once or twice during the night. At the same time, the jurist was also taking Darvon, a narcotic, and Tylenol 3, prescribed by another physician to treat chronic back pain.

Back then, prescription drug abuse was nowhere near the problem it is today. There are simply more drugs available now, says Dr. Nora D. Volkow, executive director for the National Institute of Drug Abuse, and physicians often lack the training to properly administer them. “Doctors don’t know how to evaluate patients and they don’t know how to get honest responses from them about their drug use,” she says. Although increased public awareness has helped—former First Lady Betty Ford famously opened her clinic in 1982—for the most part, says Volkow, patients often mistakenly assume that if a doctor is prescribing a drug then “they can’t get addicted.” According to the U.S. government’s 2004 National Survey on Drug Use and Health, the most recent study available, 6 million people—some 2.5 percent of the population over the age of 12—have abused prescription drugs.

Physical dependence is not always a sign of addiction. Dependence indicates that an individual has been exposed to a drug at high enough doses for long enough to develop a tolerance for it. Addiction is a neurobiological syndrome that can include physical dependence, but is characterized by craving, loss of control and compulsive use—even when the users knows it is causing them harm. Addiction is typically treated with behavioral intervention, drug treatment in the case of methadone, or a combination. Although it is not clear if Rehnquist’s drug problem affected his judgment, doctors who treated him told the FBI that toxicity from Placidyl might result in blurred vision, slurred speech and difficulty in moving.

In the FBI report, the doctor who helped Rehnquist get off drugs said the justice’s family blamed the prescribing physician and the pharmacist and suggested that they were intimidated by high-ranking government officials. Dr. Russell Portenoy, chairman of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York, says Mrs. Natalie C. Rehnquist may have been right. With an estimated 70 million Americans in chronic pain, Portenoy believes that every kind of doctor—including primary care physicians—should know how to identify patients who may have addictive tendencies and intervene if they think their patient has developed a problem. Warning signs? When patients up the dosage rates without medical supervision, experience cravings or get prescriptions from a variety of physicians (a practice known as doctor shopping.)

But Portenoy knows it’s not easy—especially with a VIP. “I have some sympathy for the doctor” who was treating him, he says. “The doctor realizes that an esteemed scholar, a person of high personal wealth or a head of a major corporation has been engaging in significantly problematic drug-related behavior,” such as Rehnquist exhibited. “The reality is, it can be difficult for a physician to handle.” Unfortunately, what was true 30 years ago is still true today.