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July 9, 2014 dawned hot, dry and cloudless, the New York sidewalks shimmering in the heat. Dr. Cheryl Karcher, a frequent dermatology expert on CNN and shows like “The Doctors,” had no television appearances scheduled that day, but, as always, was camera-ready in her olive green Theory pants and crisp cream blouse.

She said her “I love you/I love you more”s to her children after they and her husband dropped her off at her Park Avenue office, and she was readying a laser for her first patient of the day. There was a knock on the door.

“Cheryl, there are police here,” the receptionist shouted. The staff assumed it was about a former employee. Two weeks earlier, a medical assistant had been fired when it was discovered she had been buying Percocet for the office and stealing it for her drug-dealer boyfriend.

A SWAT team in military garb converged on Dr. Karcher. The receptionist started crying, and the office manager screamed, “Wait, you’ve got the wrong girl.”

It was not about a medical assistant. They did not have the wrong girl.

“Celebrity Doctor Indicted for Illegal Possession of Prescription Meds,” blared The New York Post, which labeled her the “Pill-Popping Celebrity Dermatologist.” The New York Times (which in May had just featured Dr. Karcher in an article discussing a new fat-zapping ultrasound treatment whose pain level could be quelled with Percocet) reported that she was involved in an alleged drug “scheme.”

She was led off in handcuffs and brought to the Police Department’s 19th Precinct. A 50-count indictment, referring to activity that occurred two years earlier, charged criminal possession of a controlled substance, fraud and falsifying business records, and illegal dispersion of narcotics.

Reporters were gathered outside, shouting: “Doctor, did you steal the pills? Doctor, did you sell the pills? Who’d you sell them to? What are you going to tell your patients?” One police officer shielded her face from cameras with her Michael Kors bag.

“You know, after that day, I threw out that outfit, and even that beautiful bag, which had been given to me as a gift. I just couldn’t stand the association,” she says, over tea at an Upper East Side diner (with the unfortunate name Midnight Express).

In her late 50s, Dr. Karcher has the toned body of a lifelong athlete. She wears sheer makeup and sunscreen on her skin, and she touches me frequently as she talks. She is nervous. This is the first time she has discussed her arrest and its consequences publicly. She laughs at the suggestion this has made-for-TV-movie potential.

“Yes, there are a lot of middle-aged actresses who’d like to play a dermatologist taken in by a SWAT team,” she says.

Being accused of illegally selling narcotics is one of the worst things that can happen to a physician. Being labeled a drug addict isn’t much better. And yet two years after the arrest, Dr. Karcher is back and very, very busy, sharing health advice, favorite beauty products and tidbits from her once-again robust social life on her lively Facebook page. (“Summer is in full-on swing and besides the hot days, longer nights and BBQs, it’s also the season where beer and booze seem to be flowing a bit more freely — which means your skin and body are being put through the ringer,” reads one recent entry.)

There was no jail time. Instead of being adjudicated in criminal court, she was turned over to New York’s Judicial Diversion program, without having to plead guilty and thus losing her medical license. She was allowed to attend a rehabilitation program while still seeing patients.

Many have wondered how this was possible. Was Cheryl Karcher’s punishment the kind of sweetheart deal accorded only the most privileged in our society? Or was it an entirely fair outcome, a reflection of society’s changing attitudes toward substance abuse?

Possibly it was both.

What cocaine was to the ’80s, opiates are to the 2010s. Prince’s recent death from a fentanyl overdose has quickly become emblematic of a national scourge: According to the National Institute on Drug Abuse, the number of overdoses from opioids is higher than ever. In a 2014 presentation, the institute reported that the number of prescriptions of opiate medications rose from about 76 million in 1991 to nearly 207 million prescriptions in 2013.

Moreover, some physicians have been responsible not only for overprescribing, but also, in certain high-profile cases, flooding the black market with pills. In March, for example, the Manhattan doctor Moshe Miriashvili was convicted of writing more than 13,000 phony prescriptions to dealers, resulting in the distribution of 1.2 million oxycodone pills and about $2.4 million for himself.

As the addiction specialist Brad Lamm, founder of the Breathe Life Healing Center in Los Angeles, tells me, “I’ve seen more and more doctors fall into the honey trap.”

At our meeting, Dr. Karcher is wearing a sleeveless blouse, and I ask her about a prominent scar on her shoulder. It turns out that over the course of three years, she had five surgeries, including a complete shoulder replacement. Those surgeries, she says, are when her problems began.

At first she took Percocet for pain. Then she took Percocet for fun — “or what I thought was fun,” she says. She had a thriving practice, a relatively new marriage and, at that point in her early 50s, two children younger than five.

“Some people would have wine,” she says. “Me, I would come home and pop two Percocet. And then I’d peel the apples to cook, clean the house, do the laundry, I’d make my phone calls, write my papers. I’d do everything I needed to do. Then I’d crash. Next day, I’d wake up, do it all again.”

This went on for several years, she says. By 2012 Dr. Karcher knew she had a serious problem. She wanted help, but in addition to being addicted, she was ashamed. She didn’t want to go to the New York Health Committee for Physician Health, a program funded by the American Medical Association to identify and treat doctors with mental health or drug problems, she says, “because I didn’t want anybody to find out.”

Nobody wants to admit defeat or weakness; but only doctors (and airline pilots) thought to have drug problems have such rigorous drug-testing programs, according to Terrance M. Bedient, the director of the Committee for Physician Health. Some lose their livelihoods temporarily, some permanently.

At first Dr. Karcher told her husband, Duncan Karcher, she was addicted, but he didn’t quite believe her. “He works in risk management, he’s obsessive-compulsive about playing by the rules, but he just didn’t understand,” she says, because he didn’t see her behaving oddly. It took a while for him to realize that Superwoman needed a fix.

She tried to quit. Repeatedly. She failed. “I tried so hard to do it myself,” she says. “I could cry when I think about it.”

Dr. Karcher couldn’t quite describe what it was like to go cold turkey, so I asked a friend who is a physician and is in the throes of quitting opiates, and who agreed to talk only if I did not name him. It’s not just body aches and flulike symptoms.

“It’s the feeling that life is pointless, that there will never be joy again,” he told me. “What’s worse is that it erases any memory of joy or even of the simple quotidian pleasures of everyday life.” When my friend had written this to me in an email, he had stopped taking the methadone. A week later he was back on it and planning to spend a week by himself, leaving his friends and family “because it is simply too horrible being around me” during withdrawal.

“This is a chronic, progressive and fatal disease,” Dr. Karcher tells me. “I have a friend of mine whose husband used to be an addict and she said, ‘Cheryl, I really believe it would have been easier for him to kill himself than to get sober.’”

Not that Dr. Karcher always felt sympathy for addicts. Far from it. “I really felt they were lowlifes,” she says. “Like, ‘What is wrong with you, just don’t drink that glass of wine’ or whatever. A lot of doctors feel this way.”

Growing up in Florida in a middle-class home that looked perfect on the outside but in reality was cold and tense, Cheryl was the family goody-two-shoes: great grades, great athlete and certainly no drugs, even though she went to the University of Florida (which has been ranked as one of the Top 10 Party Schools by The Princeton Review).

“I was afraid I’d ruin my brain cells,” she says. “Everyone was out at the movies. I was studying.” She was published in The New England Journal of Medicine (an article on vitamin E and the way it permeates the skin) even before she was in medical school. “A lot of stuff in my life has taken dedication,” she says. “This isn’t about being undisciplined. I have a load of self-control.”

Enough, in fact, that when the SWAT team descended, Dr. Karcher had already been drug free for about a year and a half (a detail not reported in the articles about her arrest).

Around the end of 2012, with her habit out of control, she sought treatment with Dr. Kenneth Rosenberg, an addiction psychiatrist in Manhattan. She insisted he drug test her every week. She also joined Caduceus, a 12-step-based recovery program for people in health care. (The name refers to the staff entwined with two snakes that is a symbol of the medical profession.) While she was struggling, she still regularly appeared in many outlets, including T: The New York Times Style Magazine.

Soon she was chairing weekly sessions of the group, and was the contact person for frightened newbies. It became, she says, “my secret life.”

“Cheryl was at every meeting, and I’ve been going four years,” says Reggie, a physician and an acquaintance of Dr. Karcher’s who agreed to talk if he was allowed to maintain the anonymity provided in the recovery group. He treated his bipolar disorder with a variety of drugs, and had been hospitalized for attempted suicide. “The thing about addicts, and particularly those of us in medicine, is that we think we’re somehow unique,” Reggie says. “We are not unique, except maybe in our access to medication.”

Still, when she was arrested, Dr. Karcher was not 100 percent surprised. She always had a feeling this day might come. After all, even though she had not sold drugs, which eventually the narcotics office acknowledged, she had an office worker who did. “Of course they thought I sold,” Dr. Karcher says. “If I’d been them, I would have thought so, too.”

Besides, even without the selling, hers was not a victimless crime. It was a form of identity theft. Citing privacy laws and the fact that the case is sealed, the New York City Office of the Special Narcotics Prosecutor would not put me in touch with the five people whose names Dr. Karcher mined for her own prescriptions.

But with the change in the prescribing laws that require physicians to check a patient’s controlled-substance records, these five people may have to explain to their future doctors why they were taking large quantities of Percocet (and Ambien and Adderall); they could be denied medications they actually need.

And there was one thing Dr. Karcher did, she says, that was unforgivable: She got her nanny — a woman who was not a United States citizen and could hardly say no to her — to pick up prescriptions written in the nanny’s name and hand over the medication to her. “She was a part of our family, and I never saw her again after the arrest,” Dr. Karcher says. “I go to bed many nights wishing I could apologize.”

The post-arrest fallout was swift. Dr. Karcher had worked at Sadick Dermatology, a tony practice owned by Dr. Neil Sadick, with offices on Park Avenue, West 15th Street and on Long Island, and had to leave until her case was decided.

She also lost her lucrative consulting contract with Avon and was devastated when, within a week, two dermatologists she considered good friends tried to take the job. One other consulting gig remained: She is the dermatologist with the Miss Universe Organization, recently sold by Donald Trump.

“When I saw what happened with her, my theory was that someone was trying to get publicity,” says Paula Shugart, the president of the organization. “I mean, why would there be media at the courthouse if someone hadn’t alerted them?”

Why stick by Dr. Karcher? “First of all, We had a Miss USA who went to rehab in 2006, and Cheryl stood behind us,” Ms. Shugart says. “Second, not to sound too clichéd, but we are an organization run by women that supports women, and standing up and doing what’s right. This was a no-brainer for us.”

The most painful memory of that time came when Dr. Karcher realized the effect on her children. Her daughter was too young to read the newspapers, and so would have been unaware were it not for the talk among friends’ parents and older siblings.

“Soon after the arrest I was picking my daughter up from this little parade, and I heard her say, ‘Where’s my mommy?’” Dr. Karcher says. “And I started to say, ‘I’m here, honey,’ when the little girl standing next to her said, ‘She’s probably in jail.’ And my daughter just lost it, crying and crying. Totally inconsolable.”

A few weeks after the arrest, the initial shock wore off. Word got out to patients and colleagues that Dr. Karcher was not the person in her office who had been selling drugs for money but indeed had had a drug problem herself. That’s when empathy began to kick in.

“She’s so good, so professional,” says Dr. Doris Day, a fellow dermatologist who considers Dr. Karcher a good friend. “I felt guilty, like I had let her down because I never noticed anything was wrong.”

Wendy Lewis, a plastic surgery consultant who has run physician practices, says: “She’s someone I would never hesitate to recommend. She’s not a salesperson, not greedy, not dishonest. You never heard an unkind word about her from other doctors, in the field where unkind words are the norm.”

But if they really liked her personally, they were still wary professionally. After her arrest, referrals, a large part of any dermatologist’s business, dried up. Too risky to them, they said.

But with patients she already had, there was an enormous outpouring of support. “You have to understand, she took care of some of the most high-profile people in the city, in publishing and fashion,” Dr. Neil Sadick says. “And they loved her.”

“When I heard about this, the first thing I did was write a letter to the judge,” says Ronna Lichtenberg, a business strategist and author who had been a patient for several years. “I have a lot of complex medical conditions, and often with doctors you have to choose between technical competence and bedside manner. With Cheryl, I didn’t have to choose.”

Was writing these prescriptions stupid? Of course, Ms. Lichtenberg says, and patients gossiped about it. “Maybe with another doctor, the end result would be different,” she says. “But it doesn’t surprise me that everyone I know is back. People have one question when something like this comes up: Are we safe? And the answer is yes.”

“I don’t think there is such a thing as a victimless crime, but this was about her personal pain,” says Marie Komisar, the executive director of the National Association of Women Judges, who considers Dr. Karcher both her doctor and friend.

“I can tell you this: This is not a woman who’s cavalier about drugs,” Ms. Komisar says. “A few years ago, I called Cheryl to try and prescribe some medication for my daughter, who has terrible migraines. We live in Washington, D.C. And it was a weekend. Cheryl was very apologetic, but wouldn’t do it. She had never examined my daughter, and she was worried she could make something worse. I didn’t want to go to the E.R., but we did, and I totally respected that decision.”

“I went to her for all the usual cosmetic things, but this was different,” says Dee Dee Ricks, a hedge fund consultant and cancer-patient advocate who documented her battle with breast cancer in the HBO special “The Education of Dee Dee Ricks.”

Ms. Ricks had a blister on her toe that wouldn’t go away. Another dermatologist had told her it was probably nothing, but if it didn’t heal in a few weeks she should come in and have it examined again. Ms. Ricks ignored it. Then one day, she was seeing Dr. Karcher for a Botox session and mentioned the blister.

“Cheryl looked at it, and I saw all the color drain out of her face,” Ms. Ricks says. “‘Let’s biopsy this right now,’ Cheryl said. It turned out to be Stage 3 melanoma.” Ms. Ricks lost her toe, but says “Cheryl saved my life.”

In March 2015, Justice Richard M. Weinberg of the New York State Supreme Court ruled on Dr. Karcher’s case: She could enter a drug-treatment program without pleading guilty to the charges (which would have forced her to lose her license). “The consequences to this doctor if I make her plea to the counts of indictment would be exceptional circumstances that could destroy her career and destroy her life with no redeeming value,” Justice Weinberg said.

The New York Post described the judge as “star-struck,” and many saw the ruling as too lenient. Dr. Karcher is a pretty blond physician at the top of her game, with a lot of well-to-do clients. Would she have gotten this consideration if she weren’t a person of means, or nonwhite, or both?

Dr. Karcher is well aware of the advantages of her position and race: “I was mistaken for a lawyer on more than one occasion.” But at the same time, she thinks in her case her treatment had less to do with privilege and more to do with the fact that New York State is very much ahead of the curve in treatment of addicts who are not otherwise engaged in criminal behavior.

“I saw people with less privilege, less education, treated the same way I was,” she says. “The judge in my case understood addiction so well. It’s a disease.”

And that is what many in the addiction field think we should remember: not that Dr. Karcher didn’t have advantages — she did — but that she got the kind of treatment that more substance abusers should get. Physicians in New York State have some of the best outcomes in the country, according to Brad Lamm.

“It’s not that they’re better people or better addicts,” he says. “It’s just that the oversight board gives you more leverage” over their behavior. Mr. Lamm treats a number of physicians at his Breathe Life Healing Center in West Hollywood, Calif., and says that given their access to opiates, he doesn’t want to treat them unless an oversight board is involved. California doesn’t have one like New York’s; Mr. Lamm believes New York City should be the model nationwide.

Dr. Karcher has nothing but praise for the Committee for Physicians Health and the Office of Professional Medical Misconduct, which oversees medical malfeasance. “Somebody has to look out for the public interest,” she says. “You know, when I went up to see them in Albany, they asked, ‘Have you ever been arrested?’ and I was like, ‘Are you kidding me? A SWAT team came to my office!’ and the woman said, ‘I know, but believe it or not I’ve had doctors look me in the eye and say no.’”

Dr. Karcher is unequivocal that doctors who are using should lose their licenses, but there has to be a road back. “Some states are more progressive, more understanding and more educated than others,” she says. “Nobody asks for this disease. Nobody wants to be addicted. But the good news is there’s a way out. And it can really turn a life into one of great gratitude, humility and joy. I wouldn’t trade my life for anyone else’s.”

It’s been a lesson not just in breaking addiction, she says, but in overcoming shame. She had to fight the urge to isolate herself, to disappear from friends and colleagues and wallow.

These days, Dr. Karcher is not only back in the white-on-white office of Dr. Sadick, but she has also opened her own practice, offering “bespoke cosmetic care” in the Fifth Avenue digs of Dr. Virginia Wade, an anesthesiologist for plastic surgeons. It was Dr. Wade who took her in when no one else would. Even Dr. Sadick, her champion, would not let her practice in his office until she was cleared of all charges.

“Her story was so familiar to me,” says Dr. Wade, who points out that there are many addicted people in health care. In anesthesia in particular, she says, “there seems to be a magnet on the door.

“I knew she was desperate. I said: ‘You know what, you don’t get the keys to the office, you’ve had an addiction that is more powerful than your will. I need to let you in every single time, and I need to be there with you.’”

Dr. Wade’s colleagues warned her not to do it, that the liability was too great.

“But everyone deserves another chance,” she says. “And also I would know in about two seconds if her behavior was altered.”

The drug cabinets were locked; the file cabinets, where patient information is kept, were locked. “And Cheryl did everything, everything she needed to do to be acquitted: going through the court system, drug tests, hearings, all of it,” Dr. Wade says. Eventually she got the key to the office.

But the habit of letting Dr. Wade know she is there has not left. “She walks in now, and the first thing she shouts out to me is ‘Honey, I’m home,’” Dr. Wade says.

Dr. Karcher says she will never forget that kindness, nor the fact that it made her do something she wouldn’t have had the courage to do otherwise. “I know this sounds strange, but before this happened I never had the guts to have my own practice,” Dr. Karcher says quietly. “I thought I wouldn’t make it.”

As she excitedly tells me about some of the latest treatments she was offering — the ThermiVa, a laser for bringing back vaginal function; using platelet-rich plasma to encourage hair growth; a new fractional laser called the Halo — I notice she is rubbing her neck a bit.

The next day, it turns out, she was scheduled for another surgery. Her spinal chord was constricted, and she needed small bone grafts inserted to widen the channel. She would not be using opiates for this, or for any other surgery. Nor will she prescribe them anymore. Of procedures like liposuction, after which she once sent her patients home with Percocet, she now says (with a flicker of a smile), “Tylenol’s enough because I’m that good.”

“I am very, very lucky to be where I am today,” Dr. Karcher says. “And also — well, this isn’t true, but colleagues have said it, ‘You’re one tough bitch.’”