How fentanyl turned an ER doctor into an addict

Dr. Darryl Gebien had a young family and a rewarding career. A fentanyl addiction left him broke, near death and destined for prison.

Dr. Darryl Gebien was still passed out on the living room couch when they started pounding on his front door at 7 a.m. on a cold January Monday. The dogs were going nuts and he remembers worrying that the barking would wake his wife, Katie, and three young kids sleeping upstairs. Peeking out the window, he could see the police cars and the black uniformed drug squad officers. One had a battering ram in his hands. Gebien, an emergency room physician in Barrie, Ont., knew why they were there. He opened the door and met his fate, standing in the hall in his underwear.

Two-and-half months earlier, on Nov. 3, 2014—the day after his 44th birthday—he had arrived for the morning shift at the Royal Victoria Hospital and discovered his 14-year medical career had come to an abrupt end. The chief of staff and head of the emergency department were waiting in the corridor to inform him that a local pharmacist had tipped them off about the prescription Gebien had written himself for a dozen 75-microgram fentanyl patches, forging the signature of a fellow doctor. They led him to a meeting with a staff psychiatrist who was tasked with making sure he wasn’t going to kill himself. It was the first time Gebien admitted to anyone else that he was an addict—deep in the grip of a painkiller 20 times stronger than heroin and up to 100 times more potent than morphine. “I was scared s–tless, yet at the same time, part of me went, ‘Thank God,’ ” he says. “It was a feeling of relief.”

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The police visited him at home later that morning, but let him drive himself down to the station to be booked and have his fingerprints and mugshot taken. Soon afterwards, Gebien checked into a private drug treatment centre in Guelph and began his detox hell. By mid-December, he was officially clean and back in the house to celebrate Christmas with Katie and the kids. Within a week, he had scratched out a prescription on an old pad in someone else’s name and was using again.

He didn’t give much thought to getting caught. During the eight months that he had been smoking fentanyl, cutting up patches and inhaling the sweet and noxious plastic fumes, it was all about the drug, not the consequences. “Everything was centred around getting high and avoiding getting sick,” says Gebien. The agreed statement of facts entered into the court record would eventually show that he obtained 445 patches of varying doses via 46 prescriptions to himself and 10 other people.

Gebien had always tried to ration his intake, using his medical knowledge to avoid overdosing. But in the early days of 2015, he made a mistake. It was just after breakfast when Katie went looking and found him in the basement shower stall, pale and mostly dead, with pieces of patch and charred tinfoil scattered around. Her screams and shaking started him breathing again. “What I remember is the look of fear on her face,” he says. Still, it took him another week to get the courage and quit again, this time cold turkey.

Related: Inside Canada’s opiate crisis

Rock bottom was the kids’ tears that Monday, Jan. 19, 2015, when the Barrie cops cuffed him and his wife and put them in separate squad cars. Gebien was ultimately charged with 144 counts of forgery and trafficking in a controlled substance. Katie faced 31 charges for aiding and abetting his addiction.

In the two years that he has been free on $80,000 bail, required to have his surety, his 82-year-old father, Morty, a former travelling salesman, at his side whenever he leaves their Toronto apartment, a lot has changed. He has lost his house, the car and the boat, and declared personal bankruptcy. Katie filed for divorce and moved the children to her home province of New Brunswick. Gebien’s mother died. And although he still holds out some faint hope, it seems unlikely he will ever be allowed to practise medicine again. He says he never smoked while at work in the ER, wearing patches instead to get through his shift, but acknowledges that there was often “a level” of impairment. “It’s really damning, but it’s true,” he says. “How do I apologize to a whole city?”

Sharing his full story is a start: making an effort to explain how someone trained to recognize and fix the medical problems of strangers couldn’t diagnose or heal himself. Gebien knew all about the dangers of fentanyl yet that didn’t stop him from becoming an addict and destroying his life. And the health care system he worked in seemed unable to halt or help him.

He’s been drug-free since his second arrest, but his recovery is still under way. On Dec. 12, 2016, Gebien pleaded guilty to one all-encompassing charge of forgery and another of trafficking. Sentencing will take place on Feb. 17.

It’s not a good time to be standing in front of a judge making such admissions. The abuse of fentanyl—both the prescription and illicit versions—is now a full-fledged health crisis in Canada. By the end of November, British Columbia alone had experienced a record-shattering 755 opiate overdose deaths in 2016, with 60 per cent of them attributed to this specific painkiller. Nearly 200 Albertans died from the drug between last January and October. In Ontario, where 700 people overdosed and died in 2015 (the latest figures available) fentanyl was the leading cause. Dr. Darryl Gebien is coming to grips with the idea that he’s going to jail: Perhaps for a long time. The Crown wants to send him away for the next eight years.

Growing up, the only thing Gebien ever really wanted to be was a doctor. A stint volunteering at a hospital near his home in Thornhill, Ont., during Grade 13, crystallized the ambition. “The thing that appealed to me was the diverse range of people and problems,” Gebien explains. “That you needed to know a lot about everything.”

After studying at the University of Toronto and McGill, Gebien failed to secure a spot in an Ontario medical school, or his chosen fallbacks in the States. So he signed up for a four-year bachelor of medicine program at the University of Queensland in Brisbane, Australia, graduating in December 2000. Then he completed three years of residency in the ER of a hospital in Grand Rapids, Mich. “There was a lot of gunshots, knife wounds, and blunt trauma from automobile accidents,” says Gebien. “It was a high-pressure job.”

Dr. Darryl Gebien. (Photograph by Jennifer Roberts)

Still, Ontario wouldn’t recognize his blend of British-style medical education and American experience as sufficient to practise at home. So, carrying a $200,000 student debt, Gebien took a job as a cruise ship doctor, then spent two years as physician for an air ambulance service. It wasn’t until 2008 that he finally found a place at a Canadian hospital, in Saint John, N.B.

It was there he met Katie. When he returned to Ontario the next year to take a job in a Richmond Hill emergency room—close to his parents, brother and sister—she soon followed with her toddler daughter from a previous relationship. They moved in together. Their son was born in the fall of 2011, and they got married three months later. A daughter arrived in the fall of 2012.

Katie didn’t like Toronto, and she wasn’t getting along with Gebien’s mother, Gayle, so he found a job at the Royal Victoria and bought a big, lakefront house in Barrie. “I remember thinking to myself: happy wife, happy life,” he says. But the relationship continued to go downhill after the birth of their daughter, and Gebien, who had cut himself off from family, and put an hour’s drive between him and his friends, found himself increasingly isolated. Work was stressful too; he was frustrated by the hospital’s bureaucracy and often found himself at odds with other staff.

His history with drugs was pretty limited: some hash and pot in high school, and a Vicodin that he once ingested at a party in university. He drank—sometimes to excess on weekends—but his only consistent vice was cigarettes. “I said to myself that one bad habit was enough. I recognized that I had an addictive personality,” says Gebien.

In 2008, he injured a thumb playing hockey and was prescribed some Percocet. The next year, a chronic lower back problem flared up while on a trip to Florida and he returned to the ER seeking relief. The doctor asked if he wanted Tylenol 3s or something stronger. “I said, ‘Percocet,’ and that was Pandora’s box opening up.”

The back pain subsided, but Gebien still had the pills. He started using them recreationally, popping one when he got together with friends for a drink. After a while it became more of a daily habit, a reward after a tough day at the hospital. “It took away anxiety and it took away pain,” he says. “I felt the euphoria. I felt optimistic. I thought I was more creative.”

The arguments at home were becoming more frequent and vicious. Gebien would come back from work and nap in his car in the driveway to avoid the tumult inside. “I was present, but I wasn’t,” he says. “I don’t really have any memories of my daughter being born, or the beginning of her life.” In 2013, the father of Katie’s eldest moved to Barrie to be closer to their daughter, adding more stress to an already bad situation. By that fall, Gebien was gobbling eight to 10 Percocets a day. Whenever he ran out, he experienced the symptoms of withdrawal.

Gebien’s mother, who had her own chronic back condition, had been prescribed fentanyl and had used it to control her pain for years. She had once given him a package of the long-acting patches, urging him to try them out if his own lumbar condition became too much to endure. He decided to start wearing one in an effort to wean himself off the Percocet. In hindsight, trying to kick a painkiller addiction by stepping up to an even more powerful opiate was at best, nonsensical. “That’s the addict’s mind,” Gebien says. But he still figured he could fix his own problems.

In the ER, he often saw people in the throes of withdrawal. Doctors and nurses were trained to be sensitive to alcoholics—the DTs can be fatal—but had little time or sympathy for druggies craving a fix. “We were taught all about overdoses, but not addiction,” says Gebien. Now fentanyl was about to provide him a personalized master class.

It didn’t take long before he was wearing more than one patch at a time. Then his need could no longer be satisfied by the slow and steady release of the drug. One night in May 2014, he googled “How to smoke fentanyl.” “I was shocked by how powerful it was,” Gebien recalls. “Ten minutes later, I was craving it again.” The next day, he and Katie went to visit some friends, and he snuck off to the basement bathroom to light up several times over the course of the afternoon.

By early summer, Gebien was carrying a cut-up patch, a lighter, the hollow tube from a pen and a charred piece of tinfoil everywhere he went, reaching into his pocket to touch them and reassure himself many times an hour. Still, he told himself that he had the power to quit whenever he wanted. He took a week’s vacation and made an attempt to kick fentanyl on his own, failing after just a couple of days.

Gebien’s recollections of that summer are hazy, and his timelines sometimes jumbled. The agreed statement of facts shows that he began forging prescriptions under the names of two emergency room colleagues at the end of July. He’d already been writing false scripts to Katie for almost a year, initially getting her to pick up and hand over the fentanyl, and then later collecting the drugs himself, supposedly on her behalf. And he had come to a similar arrangement with her ex-spouse. (Both were arrested along with Gebien in January 2015, but the charges against them have since been dropped.)

His increasing need made him more and more reckless. Gebien started approaching acquaintances and even total strangers—a contractor who did some renovations on his home, a Barrie cabbie and his girlfriend—and asking them to front his prescriptions for fentanyl, sharing some of the patches as payment, or throwing in Percocets. The statement of facts says that there is “no evidence that Dr. Gebien sold or otherwise distributed the fentanyl for financial gain,” but notes that some of his partners were also opiate addicts. It is unclear whether they used the drugs themselves or sold them on. At his lowest depths, Gebien even made use of his authority in the ER to obtain fentanyl, cajoling a nurse and two assistants at the hospital to fill prescriptions that he’d written and return the patches to him.

Gebien’s mother had been prescribed fentanyl for back pain; she suggested her son try it. (Darryl Gebien)

An addict is by necessity a dissembler, but it wasn’t hard to figure out that something was very wrong with Gebien. He had no appetite and had lost more than 30 lb. In his mid-forties, his pallor was sickly and his skin was breaking out with acne. His muscles cramped constantly—especially in his hands. His mother, Gayle, who had always known him better than anyone, figured out what was going on. That summer, when she and Morty were visiting the house in Barrie, she confronted him. “We were sitting in the backyard, and she said, ‘You know, your son is an addict,’ ” Morty recalls. “I cried like a baby.” Gebien has no recollection.

In mid-October, Gebien’s boss in the emergency ward ushered him into a meeting with the chief of staff. They wanted to know if everything was all right and raised the subject of addiction. “They asked if there was a problem that they needed to know about.” Gebien denied that there was an issue. He was given a pamphlet that outlined the Royal Victoria’s employee assistance program and remained on the ER schedule. Gebien’s mother later told him that she had called the hospital that week and blown the whistle about his drug problem.

Doctors and other health care facility operators in Ontario are obliged under provincial law and the ethical code of the College of Physicians and Surgeons to report any colleague whom they have “reasonable grounds” to believe might be incompetent or incapacitated. The Royal Victoria did so, but only after the police became involved.

The hospital declined Maclean’s request for an interview, and responded selectively to a list of written questions. A statement attributed to Chris Tebbutt, the facility’s vice-president of academic and medical affairs, confirmed that RVH conducted an internal chart review and ordered an independent third-party audit of the records of patients Gebien had treated over a two-year period: “None of which identified any adverse impact on patients.” What the Royal Victoria learned from the whole affair, or whether they have actually made any changes to policies or procedures because of it, remains a mystery. “We take this situation very seriously as we hold our staff and physicians to the highest standard of accountability, trust and ethics,” it concluded in a statement. “We are unwavering in that expectation and have zero tolerance for any criminal activity, breaches of our Code of Conduct or the standards set out by professionals’ governing body.”

Royal Victoria Regional Health Centre in Barrie. (Photograph by Nick Iwanyshyn)

One thing is clear, however: the Barrie Police had no inkling of what Gebien was up to until the pharmacist tweaked to his forged prescription in early November. In retrospect, Gebien figures he was ready to be caught. “I was spiritually dead. Intellectually dead. I had no energy. I was completely drained,” he says. Standing in the drugstore that Sunday afternoon, he couldn’t even bring himself to make the effort to sweet talk the clerk to make sure that the druggist wouldn’t call to verify the prescription. And for the first time, he had misread the hospital schedule, using the name of a colleague who was actually on-duty in the ER.

The detox in Guelph was worse than anything he could have imagined. Gebien pulls out a notebook that he used to record the sensations—at the behest of a counsellor—so that he would never forget them. “A Jupiter Eye thunderstorm in my head,” he reads. There were sweats, chills, blurred vision, weakness, shortness of breath, nightmares, intense fear. Anything that rubbed against his skin was torture. “It was the ying and the yang: the opposite of the good feeling of being high,” he says. Twelve hours in, he began devising a plan to kill himself. The doctors eventually gave in to his begging and handed him a Valium to take the edge off. As bad as it was, he was back using a little more than a month later. The three weeks he spent in jail after his January arrest came as a relief: he was finally locked away from all his problems.

After making bail, Gebien had no money left for private treatment. So the former one-percenter found himself a place in a downtown Toronto centre that usually deals with addicts living on the streets. His recovery was inching along but he still felt emotionally and physically fragile. In August 2015, he went back into another in-patient program run by a non-profit foundation in Woodbridge, north of Toronto. The marriage to Katie was irreparably broken, but Gebien was slowly pulling his life back together. The house in Barrie was being sold, and he was ready to move on—even as he came to the realization his next fixed address was likely to be prison.

The panicked call from his father came on Nov. 2, his 45th birthday, and a year to the day that the pharmacist had knocked over the first domino. By the time he completed the half-hour trip to his parents’ condo in North York, the police and paramedics had arrived and Gayle had been declared dead. Morty had found her cold and breathless in bed. Gayle’s back pain had worsened as she dealt with the stress of her son’s legal woes and looked after the closing on the sale of his house. She had gone to bed that night wearing three 50-mcg patches—three to six times her normal dosage. The toxicology report would eventually confirm what the family feared: the cause of death was a fentanyl overdose. “I’m positive she didn’t do it on purpose,” Gebien says, choking back the tears. “It’s so ironic. She was so worried about me. It really feels like my ultimate punishment.”

When he knelt down to kiss her goodbye, he saw a pill lying on the floor beneath her bed. It was a Valium. Gebien stared at it for a moment, but he knew what he needed to do. He picked it up and gave it to one of the cops.

A few days before he was to appear in provincial court in Barrie to enter his guilty plea, Gebien posted a message on Facebook asking his friends to come and join him and fill the room with love and optimism. Only three showed up: a woman with whom he writes music, a Toronto hockey buddy, and a young man he met during his post-arrest weeks in jail in nearby Penetanguishene.

Being back in Barrie made him almost as nervous as the circumstances. In the hours he had to wait until all was ready to go before the judge, Gebien paced and fidgeted, and excused himself frequently to venture out into the snow for a smoke. Two years on, he finds it harder and harder to recognize the man that he was in Barrie, and to reconcile the things that he did. “It’s an oh-my-God sensation,” he says. “I can’t believe I was doing it. It’s almost like a different person.”

Gebien has started sharing his experiences with others in recovery, pleased to be helping others to heal, even if it’s not as a physician. And he’s been giving PowerPoint talks to health professionals about the dangers of fentanyl and destigmatizing addiction. He’d like to become an advocate for those struggling with drug problems. “Maybe politicians will listen to me because of the M.D. after my name,” he says.

Gebien also started a small business that sells and installs flooring for apartment balconies. Last summer, he and Morty had a job on Georgian Bay. On the way back home, they stopped at the Royal Victoria and Gebien revisited the ER for the first time since his arrest. One of the doctors whose signature he had forged was on duty. Gebien apologized and they shared a moment. It was cathartic, he says.

As his health improves, his energy and passions have returned. Gebien’s playing hockey again. He’s been composing music on the piano and guitar. One song, “The Air I Breathe,” is about his late mother. “You held me in your arms / We laughed while broken down / Felt the music heal and mend our aching bones,” it goes.

The plea was entered in a large and mostly empty courtroom over the lunch hour. As Gebien stood before the justice, Morty sat on a spectators’ bench quietly weeping. Afterwards, Gebien texted his soon-to-be ex-wife to let her know that it was almost over.

The judges in Barrie have been tough on fentanyl traffickers. In 2014, a medical secretary who pleaded guilty to 46 counts of forging prescriptions was sentenced to nine years in jail, as was her boyfriend/co-conspirator. The dealer to whom they supplied some 900 patches got 10 years this past October.

Gebien feels like he’s already been sufficiently punished. “I made mistakes. I made horrible decisions and I live with that,” he says. “I’ve thought about it every day and night for the last two years.” But he recognizes that a lengthy prison term is almost inevitable. Now he’s grappling with the question of whether or not he wants his kids to come and visit him while he’s behind bars.

That morning back in January 2015, when the police pounded on his door, the arresting officer had warned him that his life was about to change. It has, in almost every imaginable way. Darryl Gebien wishes that he never heard of fentanyl, and that his profession took the power of the drugs they prescribed much more seriously. But he recognizes that there only one person to blame. “This whole story doesn’t end until I forgive myself,” he says.