A lengthy new report from the Department of Defense found that during Trump’s administration, the White House Medical Unit was mishandling dangerous prescription drugs.

The 80-page document released on January 8 detailed inappropriate mishandling of pharmaceuticals and their respective prescribing practices. The investigation into this matter began in 2018 after the Inspector General of the Department of Defense received complaints which included shoddy record keeping, overuse of brand name medications instead of cheaper generic alternatives, mishandling of medications such as one person picking up a prescription for another and so on. 

“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. 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 report said.

Over 120 officials were interviewed during the course of the investigation. Several witnesses gave testimony to the Department of Defense in the course of this investigation, almost all of whom described a very laissez faire environment compared to most pharmacies, or most fast food restaurants for that matter, which have all been under immense pressure from the DEA to crack down on mishandling of controlled substance. Most anyone who has tried to fill a prescription for opioid painkillers or stimulants like Adderall in the last five years can attest to this. 

“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,” one witness told the Department of Defense, while another said that it was common practice to make “go-bags” of drugs like Ambien and Provigil for White House staffers before overseas trips.

In addition to mishandling of medications, the investigation found that taxpayers have been footing the bill for egregious overuse of brand name medications in lieu of their generic alternatives. Between 2017 and 2019, for instance, the White House spent $46,500 for Ambien and $98,000 for Provigil, which are 174 and 55 times more expensive, respectively, than their generic alternatives. Medical services including prescribing of controlled substances were also found to have been administered to ineligible White House staffers, on an average of six to 20 times a week according to the report. 

“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,” the report said. “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,” the report said.

The Department of Defense report concluded that more stringent and robust policies to prevent such issues in the future, which included establishing stricter controls for how controlled substances are prescribed and distributed as well as establishing stricter controls for who is eligible for White House medical care and who is not.

“We recommend that the Director of the Defense Health Agency, in coordination with the White House Medical Unit Director, develop policy and procedures to manage controlled and non‑controlled medications, including, at a minimum, procurement, storage and inventory, prescribing and dispensing, and disposal,” the report said. “We recommend that the Director of the Defense Health Agency, in coordination with the White House Medical Unit Director, establish controls for White House patient eligibility within the Military Health System.”

The complete report from the Inspector General can be found here. 

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As per a new law, the Department of Defense will begin tracking overdoses within the United States military in 2024 and begin to provide naloxone to service members beginning in 2025. 

Military overdose deaths have historically not been systematically tracked until the release of a report by Rolling Stone in 2022 detailing the steep rise in overdose deaths at Fort Bragg, which has since been renamed to Fort Liberty. The report detailed the shocking increase in deaths from fentanyl, counterfeit prescription pills laced with fentanyl and deaths in otherwise healthy young men from causes typically sustained from long-term drug use that were not labeled as overdoses.

In general, Rolling Stone described shoddy record-keeping and experienced a general lack of transparency from the brass at Fort Liberty regarding drug use, drug-related crimes or overdose by military members. Of the 109 deaths that occurred at Fort Liberty between 2020 and 2021, at least 14 soldiers died directly from overdose, though that number is likely higher if you count deaths from drug-related causes, 21 by Rolling Stone’s count, making accidental overdose the leading cause of death at Fort Liberty behind suicide which claimed the lives of 41 soldiers in the same time period. 

After the Rolling Stone report, pressure built on Congress to do something about the issue and Senator Edward Markey (D-Mass.) along with other congressmen began to push the Pentagon for increased transparency. This request led to an admission by the Pentagon that fentanyl-related deaths roughly doubled among military members between 2017 and 2021, much like the rest of the country experienced. According to a Military.com report, 330 service members died from drug overdose between 2017 and 2022, and 15,000 soldiers experienced non-fatal overdoses in the same time frame. 

“Real security means guaranteeing that members of the military and their families can get resources and life-saving treatment necessary to stop the overdose crisis in its tracks,” Senator Markey said in a statement to Military.com.

The law requiring overdose tracking and NARCAN distribution was signed by President Biden in December of 2022 and goes into effect in 2024. According to Military.com, the Department of Defense will be required to submit an annual report on overdose deaths, overdose locations, demographics, whether the service member had previously sought mental health treatment, or if they’d previously been prescribed opioids, benzodiazepines or stimulants.

“It’s really just smart public health,” said Professor Alex Bennett to Military.com. Bennett serves as the director of New York University’s Opioid Overdose Prevention Program. “There’s really a lot of drug naivete amongst military personnel,” Bennett said.

Part of the issue, as is the same with the civilian population, is that fentanyl is often used to make “pressed pills” or fake prescription pills designed to look like pharmaceutical painkillers or benzodiazepines which are often poorly dosed, causing people to unwittingly ingest a lethal dose of fentanyl. The Drug Enforcement Administration has estimated that about 70% of fake prescription pills contain a potentially lethal dose of fentanyl. 

“We’ve been working with a lot of veterans who use substances while they’re in the military. Transparency with data tracking like the kind the military is set to begin doing is a step in the right direction,” Bennett said. “Closing your eyes to drug problems doesn’t solve anything,” Bennett said. “It just makes things worse.”

Carole De Nola, whose 23-year-old child died of an overdose while stationed at Fort Liberty, told Military.com that drug education is especially needed among military members as the new law does not require the military to educate service members on the dangers of fentanyl.

“We should be dealing with this before a service member’s about to overdose,” De Nola said. 

It was not immediately clear how the military would be distributing naloxone, commonly known as NARCAN, which is a life-saving medication that can halt an opioid overdose in its tracks. Many NARCAN distribution programs have been established at the level of local cities and townships but nothing has been established federally, or by military leadership until the new law was passed. The new law requires that naloxone be made available to all troops by the year 2025. The law also requires all the naloxone distributed by tracked, which could discourage some military members from seeking it out. 

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