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Speaker 1: Mother Knows Death presents External Exams with Nicole and Jimmy.

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Speaker 2: On our first episode of Mother Knows Death, we talked

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Speaker 2: about the death of Matthew Perry and this week his

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Speaker 2: autopsy report was released, and since he had such a

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Speaker 2: big history of addiction, I thought it would be perfect

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Speaker 2: to talk to my friend doctor Bruce.

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Speaker 1: Hi, doctor Bruce, how are you good to be here?

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Speaker 2: Thanks so much for being here today. I first met

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Speaker 2: doctor Bruce doing his podcast. Actually, I was on an

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Speaker 2: episode of Weekly Infusion. That's when I first met you.

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Speaker 2: And then you came to Philly and we went to

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Speaker 2: the Motor Museum together. That was fun.

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Speaker 1: Wow, was great.

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Speaker 2: So let's tell them a little bit about your history.

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Speaker 2: You have been an emergency room doctor for a majority

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Speaker 2: of your career. And how did you get into addiction?

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Speaker 2: How how will not addiction yourself into the specialty of addiction.

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Speaker 2: What was it that was intriguing about that?

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Speaker 1: I mean, that's a good that's a good statement. How

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Speaker 1: to get into addiction addiction medicine, most people are either

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Speaker 1: codependents or recovering, So I was in the codependent. I

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Speaker 1: got some great codependency stories. But anyway I was I

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Speaker 1: did internal Medicine Training residency took boards and immediately during residency.

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Speaker 1: This back in the eighties, there are a lot of

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Speaker 1: guys that were like gung ho for excitement, moonlighting and

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Speaker 1: emergency department. So I was out in Riverside, San Ardanino

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Speaker 1: County and there were a group of u sweek moonlight

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Speaker 1: at Riverside County Hospital R And then once the I

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Speaker 1: finished internal medicine pass boards and then some of the

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Speaker 1: people at Loneo and said, hey, let's start an emergency

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Speaker 1: medicine training program. And so it's like back then there

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Speaker 1: weren't that many residencies it was in. It was sort

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Speaker 1: of a new area of sub of specialization. So we

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Speaker 1: started the residency program and we had to pick an

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Speaker 1: area that to teach, and I thought, well, drug overdose

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Speaker 1: and toxicology, that's great interesting stuff. So I went to

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Speaker 1: some meetings at UCLA. This is about nineteen eighty five,

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Speaker 1: and the first lecture was I don't know if they

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Speaker 1: called it sex, drugs and rock and roll, but it

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Speaker 1: was a doctor in Addiction Medicine talking about youth culture

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Speaker 1: and adolescent addiction. And I was like blown away as

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Speaker 1: I came there here about boring drug I mean, you know,

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Speaker 1: not boring drug overdose and toxicology. And then this guy's

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Speaker 1: talking about you know. You know at that time, the

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Speaker 1: Grateful Dead was still touring and they had the docs

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Speaker 1: that went with the Grateful Dead, and you know, and

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Speaker 1: then you had it was all. It really meld the youth, culture, music,

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Speaker 1: all these interesting things together. So I went up at

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Speaker 1: the end of the lecture, I said, what is this

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Speaker 1: addiction medicine thing? And so I sort of started. I

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Speaker 1: had some training, and I got a position doing addiction,

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Speaker 1: adolescent addiction medicine out Redlins within a year, and I

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Speaker 1: did it alongside of emergency medicine along the way and

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Speaker 1: work with some great people at USC Adolescent Medicine Department

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Speaker 1: and met Drew, doctor Drew. That's why I met him

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Speaker 1: with k Rock and I was sort of his fill

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Speaker 1: in by virtual keeping my mouth shut when he did

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Speaker 1: love line for decades. And that's it and it's still

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Speaker 1: to this day. So I don't do emergency medicine anymore.

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Speaker 1: I quit dury COVID because I'm not a first responder hero.

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Speaker 1: I wasn't a hero. I was a whippie guy. But

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Speaker 1: I'm doing a ton of so I do addiction medicine

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Speaker 1: for a large medical system. I'm still out in Redlands, Riverside,

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Speaker 1: and a lot of what I do is around oh

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Speaker 1: biate addiction use disorder they call it, and chronic pain

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Speaker 1: or both, and use of bubernor feed or sab box

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Speaker 1: on sebuitechs, which sort of segueing back into the webtopsy

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Speaker 1: taxicology report on Matthew Purriy and coincidentally, you know, ketamine

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Speaker 1: is just coming to the UH. It's very popular for

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Speaker 1: treating resistant depression and for chronic pain, and you know,

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Speaker 1: looking at that whole receptor system and addiction, lots of

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Speaker 1: exciting things happening. But since his report, I've gotten some

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Speaker 1: I have a lot of chronic pain patients that are

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Speaker 1: on buporphene, sabasa and Sevitech's transfer UH chronic pain, and

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Speaker 1: they also get treatments with ketamine. And so some very

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Speaker 1: very concerned patients, So like, oh my god, am I

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Speaker 1: gonna die? I'm getting my ketemie fusion. I'm on pupnorphy

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Speaker 1: so and we'll get we'll.

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Speaker 2: Get into that because I have I actually have a

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Speaker 2: lot of questions about that combination and if that's a

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Speaker 2: common thing. But we'll we'll get into that a little

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Speaker 2: in a little bit, but first I wanted to get

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Speaker 2: started with just the basics of addiction because I don't

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Speaker 2: really have anyone in my immediate family that struggles with addiction,

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Speaker 2: and including myself either, so I don't know it on

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Speaker 2: a personal level, so I do have questions about it.

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Speaker 2: I'm a parent. I know you're a parent too, and

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Speaker 2: one of my biggest fears is like one of my

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Speaker 2: kids is going to grow up and fall into one

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Speaker 2: of these addictions. And I guess my first question for

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Speaker 2: you about that is is this something that could happen

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Speaker 2: to anyone? I mean, Matthew Perry said that when he

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Speaker 2: was fourteen he started drinking alcohol, and by eighteen he

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Speaker 2: considered himself like a hardcore alcoholic. Is this something that

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Speaker 2: could happen to anyone or do you think that there's

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Speaker 2: some kind of like predisposing factors that make a person

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Speaker 2: more susceptible to addiction.

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Speaker 1: Yeah, certainly there's biology, right, So first, if your father

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Speaker 1: or mother alcoholic or first degree relative, and then there

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Speaker 1: are issues with exposures. So if somebody starts drinking when

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Speaker 1: they're fourteen, if they get if they have the availability

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Speaker 1: of alcohol or drugs and they start using them, then

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Speaker 1: you you know, then you stop the psychosocial development. You

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Speaker 1: arrest that way, and it's a matter of becoming something

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Speaker 1: that's you know, that's routinely done. So I mean, adolescent's

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Speaker 1: a great thing to talk about because if you have

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Speaker 1: a very structured existence, if you're you know, if your

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Speaker 1: home every evening and your parents are where what you're doing,

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Speaker 1: and they know your friends parents and keep tractiving and

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Speaker 1: you don't have that exposure. But what did it amoss to.

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Speaker 1: There's you know, there's junk science around brain scans, but

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Speaker 1: if you look at people. They did a study where

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Speaker 1: they took and this I'm just sort of generalizing it,

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Speaker 1: but say twenty young adult males and they had a

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Speaker 1: control group who had no first year rol as a

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Speaker 1: were alcoholic, and then a group whose fathers were alcoholic

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Speaker 1: and they were not yet really drinkers, got them all drunk,

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Speaker 1: stuck them in a functional in orife. So we know

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Speaker 1: the area of the brain the lights up with cocaine

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Speaker 1: and her in the reward area in the midbrain. And

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Speaker 1: and it's statistically significant proportion. The first the sons of

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Speaker 1: alcoholics had a lot more activity there. So I mean

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Speaker 1: it's you know, it's sort of a gross representation of

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Speaker 1: the biologic nature of it. But if I don't, you know,

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Speaker 1: you can both be sitting having a couple of beers

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Speaker 1: or whatever age and and what do you ask the

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Speaker 1: other guy? Well, what does it feel like to you?

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Speaker 1: And so you know, one way is to look at

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Speaker 1: what part of the brain, you know, amount of dopamine release,

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Speaker 1: sorta tallerant neurotransmitters, activity in the rewards center. So we

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Speaker 1: know that there's a different of there's a different reaction

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Speaker 1: or activity from alcohol. So the fourteen year old like

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Speaker 1: Matthew Perry, I don't know, is you know, And again,

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Speaker 1: if there's a childhood trauma, if there's sexual abuse, physical

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Speaker 1: abuse pre adolescence, that's another risk. There's a bunch these

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Speaker 1: different riskpects. So there's no one one addiction, there's no

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Speaker 1: one addiction gene, but certainly the biology is there. And

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Speaker 1: then if you figure, you know, I've had patients to

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Speaker 1: say the first time I got drunk as a teenager,

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Speaker 1: I knew that's what I'm you know, it was just

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Speaker 1: like I never felt normal until that point, and I

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Speaker 1: immediately and is often going after whatever substance it is,

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Speaker 1: So that's a breaking and then it go ahead. So

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Speaker 1: that's a very roundabout way partially answering your question.

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Speaker 2: Well, my question is, especially talking about that particular study,

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Speaker 2: do you think that there could be some aspect of

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Speaker 2: it not being biology but just nature, just just being

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Speaker 2: around a dad. You saw your dad drink their whole life,

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Speaker 2: and maybe some sort of center lights up in your

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Speaker 2: brain because it makes you think of like a positive

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Speaker 2: experience when you were a child or something.

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Speaker 1: Right, so you know there's conditioning, and certainly that would

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Speaker 1: and then a dad that drinks with a certain effect

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Speaker 1: or is you know, is the a binge drinker and

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Speaker 1: abusive intermittently or is he a daily drinker and abusive

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Speaker 1: every day or neglectful. It's so complex, but we know

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Speaker 1: the you know, in the and then again what about

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Speaker 1: bonding the first couple of years, attachment theory, So these

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Speaker 1: things all come into play, and there's no doubt separating

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Speaker 1: them is difficult. But you're right, there's the there's pair

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Speaker 1: of parental modeling, and then there's the genetics there and

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Speaker 1: then there's the exposure. Pretty complicated, right, So do.

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Speaker 2: You feel as if any drugs I mean, I sound

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Speaker 2: like a commercial from the eighties when I was growing up.

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Speaker 2: But do you feel that there's like gateway drugs, cigarettes, alcohol,

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Speaker 2: or anything that starts a child because you have children

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Speaker 2: that eventually turn into one of these addicts. Is there

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Speaker 2: some kind of like predisposing thing that you might see

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Speaker 2: prior to an addiction starting.

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Speaker 1: You know, again, it's that mood alterar effect. And obviously

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Speaker 1: anybody that gets cocaine or heroin or methamphetamine and depends

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Speaker 1: how much, but I mean get you're going to get

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Speaker 1: that immediate rush and the euphoria, and once that part

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Speaker 1: of the brain, the lizard I called the lizard brain,

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Speaker 1: recognizes that, then you know, is it going to be

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Speaker 1: available the next week, is it going to be a

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Speaker 1: year later? Because adolescence is a time when you you know,

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Speaker 1: there's there's no rehabilitation if you haven't abilitated, if you

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Speaker 1: haven't had the normal development that occurs. So the exposure

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Speaker 1: piece of it again is if if a kid's is

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Speaker 1: there a gateway drug? I say, whatever? Drugs like for me,

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Speaker 1: I tried pop when I was fifteen. I hate it.

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Speaker 1: It's like just and you know, it was not something

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Speaker 1: I was going to get addicted to. But you get

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Speaker 1: a kid with the biology where they get more you know, dopamiricus,

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Speaker 1: whatever it is that causes there's some euphoria there. That's

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Speaker 1: going to be a gateway drug. So to me, it's

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Speaker 1: at that age if you start having reward and euphoria

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Speaker 1: from something that cut it's like if you if you

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Speaker 1: just like with with sel, what's the problem with smartphones,

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Speaker 1: what's the problem with online gambling? Is that immediate dopamine rush,

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Speaker 1: whether it's you know, and kids watching what's the average

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Speaker 1: agent for a kid watches porn in North America eight

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Speaker 1: years old?

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Speaker 2: That is that real?

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Speaker 1: Yeah, I believe that's right, And I'm sure, I'm sure

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Speaker 1: you know, I'm sort of generalizing a lot of stuff.

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Speaker 1: But the bottom line is the more immediate the responses

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Speaker 1: to a stimulus where you get dopamine, you know whatever

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Speaker 1: dopamine make release of you know, these pleasure neurotransmitters, the

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Speaker 1: and if a kid doesn't have uh, you know, they

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Speaker 1: haven't built up any defenses, they haven't learned to, you know,

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Speaker 1: fend for themselves in difficult situations. You know that that

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Speaker 1: growth the process of the three stages of adolescents early

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Speaker 1: adolescens mid late. If they can't get through that, they

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Speaker 1: you know, the student, the earlier they start, that's sort

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Speaker 1: of where your psychosocial development arrests. So it gets very complicated.

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Speaker 1: It's like a dysfunctional home, a using parent, pre adolescent abuse. No.

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Speaker 1: I mean a lot of therapists will say, well, how

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Speaker 1: is you know what what went on during your mother's

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Speaker 1: pregnancy with you? You know, was was it a veray?

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Speaker 1: Was there a lot of stress? Was there high cortisol?

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Speaker 1: All kinds of ways of looking at it to put

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Speaker 1: you at risk. So but to me, I you know

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Speaker 1: what's the worst drug. It's the one that the kid

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Speaker 1: starts using in this day and age, I worry about poisoning. Right,

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Speaker 1: It's like fentanyl, car fentelso, feneral, whatever these things are

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Speaker 1: out there, these are there's this whole other uh, their

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Speaker 1: expanse of risk that comes from just being exposed one

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Speaker 1: time in dying. So that that's the you know with

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Speaker 1: my kids they're a little older now, but even even

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Speaker 1: in their twenties, I say, look, it's one dose. You know,

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Speaker 1: you go to a party and somebody says, hey try

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Speaker 1: this pill or you know pot there's disagreement. You know

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Speaker 1: that whether there's ventanyl in pot but definitely in cocaine,

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Speaker 1: definitely any any pill you get, the x annex, the norcos,

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Speaker 1: the the oxycons. These these people there, whether they're cartels

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Speaker 1: or whoever's selling drugs, they have pill presses that make

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Speaker 1: identical pills to the pharmaceutical but they throw fentanyl in there.

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Speaker 1: So that's the one thing with that I don't think

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Speaker 1: we thought about as much prior to this whole fentanyl

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Speaker 1: scourge is poisoning. And so how many kids they go

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Speaker 1: to a party and friend says, hey, try this, you know,

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Speaker 1: it's like they're dead.

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Speaker 2: Well, I think that's why I'm so scared because I

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Speaker 2: was that kid, right like I've done. I did all

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Speaker 2: that stuff when I was a teenager, and never like

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Speaker 2: my older daughter she is, she's just a very she

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Speaker 2: listens like if you say, don't try jougs because you

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Speaker 2: can get you can get killed and stuff. She she

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Speaker 2: listened to that. But I was that kid that was like,

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Speaker 2: that ain't gonna happen to me. That's what's that's what's scary.

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Speaker 2: Because you hear about this all the time on the

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Speaker 2: news and stuff. Parents just so distraw obviously because their

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Speaker 2: kid wasn't even doing drugs really, just like trying something

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Speaker 2: and they just died taking it once. It's so scary.

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Speaker 1: Yep. My friend of mine is mom. She passed away.

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Speaker 1: She was like one hundred and one. But there was

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Speaker 1: a delay of putting your plaque up or something. So

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Speaker 1: they were at it wherever, you know, the cemetery of

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Speaker 1: the Morchwark and they were at the marketing person's desk

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Speaker 1: for something. But she said they had some sort of

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Speaker 1: a video and it would show a picture for a

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Speaker 1: few seconds and then the next one of these are

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Speaker 1: people that had passed away. And she's a she's a

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Speaker 1: nurse and her sister was had a substance issue. So

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Speaker 1: she was very, uh, you know, curious about all these

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Speaker 1: young people that she saw. And they were sitting there

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Speaker 1: for half an hour, she said, just constantly, and she said,

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Speaker 1: you know, it seems like a lot of these people

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Speaker 1: you have that have come through here or buried here

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Speaker 1: are young. And they said, there's she said, it's just

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Speaker 1: unbelievable how many young people come in with you know, drug,

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Speaker 1: fentmol overdose herself whatever. It's just but I hate, you know, pot.

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Speaker 1: I'm pot is just it's it's no longer pot I mean,

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Speaker 1: cannabis today is so potent, and it's there's so much

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Speaker 1: disregard for it, and that's so what's you know, there's

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Speaker 1: it's different now that it was when when it's you know,

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Speaker 1: the eighties, things started to change when the cannabis, you know,

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Speaker 1: all these strains that are and then the wax ninety

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Speaker 1: percent THC. It's just a different it's a different actor

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Speaker 1: and affixed brain development.

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Speaker 2: It. Oh. I had a situation with with edible weed

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Speaker 2: that I I have never and I've tried some things

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Speaker 2: in my life when I was younger and then I haven't.

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Speaker 2: I haven't done anything since the nineties and except weed.

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Speaker 2: And I took an edible weed too much of it,

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Speaker 2: I guess, and I was like tripping, like I was

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Speaker 2: on acid or something. It was insane. I thought that

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Speaker 2: I was poisoned. It was. It was the most surreal

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Speaker 2: experience and I'll never do it again. Obviously scared the

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Speaker 2: shit out of me.

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Speaker 1: Yeah, well, you know, it's definitely it's definitely a different

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Speaker 1: scenario than what was it. In the John Lennon's Harmless

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Speaker 1: Giggle that he talked about pot it was like point

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Speaker 1: five percent THC and you compare that to who knows

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Speaker 1: how much THAC is and somebody l you just don't

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Speaker 1: really know what you're getting.

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Speaker 2: But oh yeah it was I was I was like hallucinating.

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Speaker 2: It was terrible. I didn't even know that we could

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Speaker 2: do that to you.

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Speaker 1: Yeah, it's technically a hallucinogen. Yeah, and it's one of

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Speaker 1: those things when when kids start doing that, when they're

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Speaker 1: thirteen or fourteen, it's you know, the future is not

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Speaker 1: very bright if you're smoking that kind of the view

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Speaker 1: use that kind of pot every day.

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Speaker 2: Right, So yeah, it's definitely can't be good for your brain.

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Speaker 2: So you you deal with all different kinds of addictions,

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Speaker 2: but you you really you specialize in the opioid addictions.

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Speaker 2: How as far as percentages of your patients go. Is

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Speaker 2: that the most frequently used drug that people tend to

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Speaker 2: abuse nowadays?

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Speaker 1: Well, you know it's still in high school, it's still alcohol, cannabis, right,

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Speaker 1: pot and alcohol is still still almost common. Cocaines made

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Speaker 1: a resurgence ketamine abuse, you know, specil k there's you know,

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Speaker 1: it just depends in the age group. And you're getting

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Speaker 1: so much more news worthy stories about fentanyl again the overdoses,

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Speaker 1: the poisoning. But we see most in the hospital system

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Speaker 1: I am. We're seeing mostly adults. And the question I

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Speaker 1: have it's like, it seems like there's just much disregard

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Speaker 1: for alcohol and cannabis products in teenagers. I know, you know,

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Speaker 1: a few decades ago, I was seeing a lot of

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Speaker 1: kids coming in for alcohol and pot problems, and I

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Speaker 1: don't know if they're graduating more rapidly to the you know,

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Speaker 1: to methamphetamy and cocaine. But I just I don't see

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Speaker 1: the referrals in our large medical system. So I'm seeing

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Speaker 1: tons of adults and still you know, the older adults

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Speaker 1: a lot of alcohol and the you know, a lot

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Speaker 1: of opiate patience. See, part of it is retention and treatment.

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Speaker 1: So there's an opia called bupin orphis the box on

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Speaker 1: Seviitex's ub solved, various names for it, and it's used

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Speaker 1: you give it on a daily basis to alleviate craving.

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Speaker 1: And those patients stay with you, so we see them

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Speaker 1: every month every two months for refills and and they're

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Speaker 1: retained in the program. So you know, with other drugs,

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Speaker 1: generally you get them into treatment, they start working a program,

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Speaker 1: you know, and you don't continue to follow them, so

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Speaker 1: you build up a lot of the opiate patients. It's

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Speaker 1: it's much longer term.

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Speaker 2: So a patient would come to you that was either

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Speaker 2: addicted to pills or even heroin, and the part of

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Speaker 2: their treatment is for you to give them this drug

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Speaker 2: that's kind of is it to kind of like wean

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Speaker 2: them down off of it.

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Speaker 1: So bupernorphine is an opiate, and it was discovered in

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Speaker 1: the sixties and trial. It's semisynthetic. It's derived from debane,

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Speaker 1: which is part of something come out coming out of

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Speaker 1: poppy plant, and it was trialed in the seventies. It

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Speaker 1: was released in like seventy nine or eighty over here

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Speaker 1: for pain. It was another pain opiate. They did didn't

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Speaker 1: really know what opiate's where opiates went in the central

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Speaker 1: nervous system. They didn't discover the first opiate receptor until

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Speaker 1: I nineteen seventy six, and then it was like, oh,

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Speaker 1: this elop it's work. They'd bind to this receptor I

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Speaker 1: think was the MWe receptor was the first one. And

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Speaker 1: then in the eighties and nineties, much more understanding of

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Speaker 1: different opiates worked more different parts of the brain, and

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Speaker 1: this one buper and orphine. They noticed it had much

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Speaker 1: less activity in this in the cent the brain, mid brain,

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Speaker 1: minimal binding in the respiratory center. The you know, all opiates,

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Speaker 1: it's not really talked about much, but opiate suppressed the

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Speaker 1: immune system. They decrease the hypothalamic pituitary axis that makes

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Speaker 1: like testosterone. They decrease testosterone. And those are big things

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Speaker 1: immune suppression, respiratory depression. And it turned out the buper

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Speaker 1: and orphine had minimal like is a sole agent. If

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Speaker 1: I if you put an ib in my arm and

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Speaker 1: gave me more than the maximum dose, I wouldn't stop reading,

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Speaker 1: which is crazy for an opiate. If you add alcohol

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Speaker 1: or you know, a value or something, it's a different story,

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Speaker 1: but it's it's basically it's much safer. So they said,

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Speaker 1: and if you have an opiate addict and they commit

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Speaker 1: to treatment, you know, you could offer a method all

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Speaker 1: which is a potent opia. They have to go to

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Speaker 1: a clinic ticket every day to alleviate craving. They said,

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Speaker 1: why don't we release this dupern urphene in a higher dose.

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Speaker 1: Four practitioners in their office can dispense it, and ideally

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Speaker 1: you have the patient go to you know, night twelve

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Speaker 1: step meetings, they have a therapist, you follow them every

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Speaker 1: The recommendation at first was you see them every two

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Speaker 1: weeks and every four weeks, but it was to alleviate

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Speaker 1: craving and it didn't go to the rewards center. So

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Speaker 1: this has been out twenty plus, about twenty one years,

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Speaker 1: and it's it was very controversial at first because what

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Speaker 1: people in the recovery field would say is duper and

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Speaker 1: orphiene suboxol subtexts, subs. You're giving an opiate for an opiate,

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Speaker 1: you're not really clean and sober. And there's a lot

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Speaker 1: of argument, how can you tell me that if you're

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Speaker 1: giving an opiate to someone, they're not getting high on it.

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Speaker 1: But a lot of studies were done and it and

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Speaker 1: they determine the retention and treatment. There's huge difference in

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Speaker 1: retention and treatment and the you know, the the overdose debts.

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Speaker 1: So basically right now, the standard of care is like

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Speaker 1: one to three years on syboxa rebup and ORP or

384
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Speaker 1: more when the patient's carefully monitored. And it's that's so

385
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Speaker 1: an addiction medicine. When you're treating opiate addiction, can you

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Speaker 1: take this it's a sublingual form. It's a it's a

387
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Speaker 1: film or a tablet put under your tongue and could

388
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Speaker 1: you take that and inject it and get high? Well,

389
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Speaker 1: you can get high injecting ben a drill. I've had

390
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Speaker 1: patients that snorted prozac. I mean, certainly it's an opiate

391
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Speaker 1: and if you misuse it, Uh, there are issues, but

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Speaker 1: it has it really is revolutionized. And the reason is

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Speaker 1: again I'm still totally totally behind. I tell my patients

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Speaker 1: it's almost a requirement you have to go to work

395
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Speaker 1: a program. You need to address issues in therapy depending

396
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Speaker 1: on the patient, but definitely twelve step is a foundation.

397
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Speaker 1: But what this type of thing buprien orphin does is

398
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Speaker 1: when once somebody has an opiate addiction, then what we

399
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Speaker 1: find is the the the mid brain, the part of

400
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Speaker 1: the brain that tells you to breathe when you and

401
00:23:30,960 --> 00:23:33,280
Speaker 1: tells you to heat when you're hungry, drink when you're thirsty,

402
00:23:33,440 --> 00:23:38,639
Speaker 1: the emotional areas, the messages when they once you have

403
00:23:38,880 --> 00:23:42,640
Speaker 1: programmed those areas to get the opiate when they don't

404
00:23:42,640 --> 00:23:44,840
Speaker 1: get and when you stop the messages up to the

405
00:23:44,840 --> 00:23:47,920
Speaker 1: cortex and you can you could look at brain activity

406
00:23:47,920 --> 00:23:50,439
Speaker 1: on a functional MRI, and you can see when someone's

407
00:23:50,440 --> 00:23:54,119
Speaker 1: in withdrawal, what's happening is there's a tremendous powd of

408
00:23:54,400 --> 00:23:57,439
Speaker 1: nerve firing up to the cortex basically, which is what

409
00:23:57,440 --> 00:24:01,240
Speaker 1: withdrawal is. It's the anxiety. It's you know, besides the

410
00:24:01,240 --> 00:24:05,760
Speaker 1: the opiate withdrawal where you have diarrhea and vomiting and

411
00:24:05,880 --> 00:24:09,320
Speaker 1: abdominal physical symptoms. But you know when people say they

412
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Speaker 1: don't have a choice, well, certainly everyone has a choice,

413
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Speaker 1: but there's so much intense activity from it's almost like

414
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Speaker 1: when some they've done studies look at dopamine levels and

415
00:24:20,320 --> 00:24:25,359
Speaker 1: people that are detoxing from methem fatamine cocaine, and they've

416
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Speaker 1: compared to people that are starving or are water super

417
00:24:29,640 --> 00:24:33,800
Speaker 1: water deprived, and their dopamine levels are actually lower when

418
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Speaker 1: they're when they stop or run a methamphatamine or coke

419
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Speaker 1: or opiate. So what is the drive to get water

420
00:24:40,359 --> 00:24:43,320
Speaker 1: when you're water deprived or food when you're food deprived?

421
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Speaker 1: I mean it over it's it sort of supersedes all

422
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Speaker 1: other anything else you want to do. And that's the

423
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Speaker 1: impetus or the stimulation from the mid brain up to

424
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Speaker 1: the core tex the executive function area when some So

425
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Speaker 1: it's not an excuse, but it's an explanation when some

426
00:25:00,080 --> 00:25:03,000
Speaker 1: one becomes addicted and they use larger and larger amounts.

427
00:25:03,000 --> 00:25:06,800
Speaker 1: When they stop, they're almost like a decorticated animal. That

428
00:25:07,000 --> 00:25:10,600
Speaker 1: executive functionary is not making the choices. So that's the

429
00:25:10,640 --> 00:25:14,080
Speaker 1: beauty of bu periorphy for me, is it allows the individual.

430
00:25:14,560 --> 00:25:17,840
Speaker 1: It sort of shuts off that you know, lizard brain

431
00:25:17,960 --> 00:25:21,560
Speaker 1: overdrive to get the substance, and the person needs to

432
00:25:21,600 --> 00:25:24,240
Speaker 1: take steps to maintain sobriety and they need to work

433
00:25:24,280 --> 00:25:27,840
Speaker 1: a program and replace the time and energy they're spending

434
00:25:27,880 --> 00:25:32,200
Speaker 1: getting the substance and being loaded with other activities. And

435
00:25:32,960 --> 00:25:36,560
Speaker 1: but that's I think today it's pretty pretty well. It's

436
00:25:36,680 --> 00:25:38,760
Speaker 1: even in the twelve step community. It's much more accepted

437
00:25:39,000 --> 00:25:43,040
Speaker 1: using bupern orphine for for opiate addiction. So and that's

438
00:25:43,080 --> 00:25:45,040
Speaker 1: where you know, the I didn't treat Matthew Perry. And

439
00:25:45,080 --> 00:25:48,600
Speaker 1: you're not supposed to diagnose or be the doctor for

440
00:25:48,720 --> 00:25:52,919
Speaker 1: people dead or alive. But you know, I've gotten calls

441
00:25:52,960 --> 00:25:55,399
Speaker 1: from patients that are you know, they're on bupernorphine. They

442
00:25:55,400 --> 00:25:59,679
Speaker 1: had there was pupernorphine and the guys forensics and then

443
00:25:59,720 --> 00:26:02,720
Speaker 1: the care atamine and you know, I'm not sure what

444
00:26:02,760 --> 00:26:03,560
Speaker 1: else was in there body.

445
00:26:03,600 --> 00:26:07,000
Speaker 2: Well you were saying that with with withdrawal, there's physiological

446
00:26:07,040 --> 00:26:11,600
Speaker 2: symptoms as well as you have these depression, anxiety and

447
00:26:11,640 --> 00:26:15,320
Speaker 2: things like that. So he apparently he was given the

448
00:26:15,400 --> 00:26:20,560
Speaker 2: ketamine treatments because he was having like severe anxiety. And

449
00:26:20,800 --> 00:26:24,800
Speaker 2: is that is that something common that would be given

450
00:26:24,880 --> 00:26:29,600
Speaker 2: to these types of patients is additional kademine treatments.

451
00:26:29,720 --> 00:26:35,520
Speaker 1: Uh so, I okay, So ketamine is It's not controversial.

452
00:26:35,600 --> 00:26:38,239
Speaker 1: It's just there's a feeling that it's you know, like

453
00:26:38,280 --> 00:26:46,280
Speaker 1: for anxiety my understanding and the way our medical organization

454
00:26:46,400 --> 00:26:48,880
Speaker 1: does it. I mean for treatment resistant depression when nothing

455
00:26:48,920 --> 00:26:52,680
Speaker 1: else has worked. They've even been studied with somebody is

456
00:26:53,480 --> 00:26:59,720
Speaker 1: suicidal giving the ketamine infusion and again and then also

457
00:26:59,760 --> 00:27:04,879
Speaker 1: for on pain patients, right, And there's the anxiety thing.

458
00:27:04,960 --> 00:27:09,400
Speaker 1: I don't. I don't give ketamine there. I do work

459
00:27:09,440 --> 00:27:10,880
Speaker 1: with a lot. The other thing I do. I work

460
00:27:10,920 --> 00:27:15,720
Speaker 1: with pain patients that are on opiates and their primary

461
00:27:15,720 --> 00:27:19,320
Speaker 1: care wants them all for decrease whatever. And there's a

462
00:27:19,359 --> 00:27:21,840
Speaker 1: bupert arphie the subox and is a higher dose for

463
00:27:22,040 --> 00:27:24,560
Speaker 1: bupert arfine sort of first line if somebody needs a

464
00:27:24,640 --> 00:27:26,879
Speaker 1: daily opiate. So I think he was on it for

465
00:27:26,960 --> 00:27:32,440
Speaker 1: pain and addiction, but using it for anxiety. I don't

466
00:27:32,480 --> 00:27:36,760
Speaker 1: really understand that that's a bona fide indication. Triguer is

467
00:27:36,840 --> 00:27:41,800
Speaker 1: a resistant depression and chronic pain are pretty established, certain

468
00:27:41,840 --> 00:27:45,000
Speaker 1: kinds of chronic pain. But but in his case there's

469
00:27:45,480 --> 00:27:50,320
Speaker 1: first of all, the the infusions that are given for

470
00:27:50,480 --> 00:27:54,840
Speaker 1: pain and depression and the amounts that were found in

471
00:27:54,880 --> 00:27:57,960
Speaker 1: this nothing to do with he had huge amounts in

472
00:27:58,000 --> 00:28:00,960
Speaker 1: his system, like a week after his last his last

473
00:28:01,000 --> 00:28:05,359
Speaker 1: Kenemy infusion, so those infusions are much lower dose. I

474
00:28:05,359 --> 00:28:08,160
Speaker 1: think he had pulls in his stomach. There was abuse.

475
00:28:08,240 --> 00:28:13,360
Speaker 1: So the problem with addicts if you find that something

476
00:28:14,000 --> 00:28:16,080
Speaker 1: seems to feel good and work at a low dose,

477
00:28:16,160 --> 00:28:18,520
Speaker 1: then why not take ten times more. That's sort of,

478
00:28:18,560 --> 00:28:20,800
Speaker 1: you know, the problem get into. I don't know all

479
00:28:20,840 --> 00:28:24,760
Speaker 1: the details there, but the use of ketamine certainly, I

480
00:28:24,840 --> 00:28:27,240
Speaker 1: used to be a doctor of raves and they'd have

481
00:28:27,760 --> 00:28:31,320
Speaker 1: a tent and specifically people ken of means much safer.

482
00:28:32,200 --> 00:28:36,840
Speaker 1: It doesn't affect a respiratory drive that much. You know,

483
00:28:37,280 --> 00:28:41,160
Speaker 1: when you first give the injection, it can bump up

484
00:28:41,200 --> 00:28:44,040
Speaker 1: your blood pressure. There they are various issues, but as

485
00:28:44,040 --> 00:28:46,800
Speaker 1: far as you're breathing, it's it's not a respiratory depressant

486
00:28:46,880 --> 00:28:50,240
Speaker 1: like other like things like opiates. But when you mix

487
00:28:50,280 --> 00:28:52,480
Speaker 1: it with you know, even though like I said, you

488
00:28:52,520 --> 00:28:55,000
Speaker 1: put ourphans in opiate, it's it's quite safe in terms

489
00:28:55,000 --> 00:28:57,440
Speaker 1: of respiratory depression. But when you start he I think

490
00:28:57,440 --> 00:29:00,840
Speaker 1: he had some benzos like out of Banner Clowd opinion

491
00:29:00,840 --> 00:29:02,640
Speaker 1: your system when you put other when you mix these

492
00:29:02,640 --> 00:29:05,920
Speaker 1: things together, and then his ketemy was very high dose,

493
00:29:06,000 --> 00:29:08,680
Speaker 1: then you that's when you get into real promise whether

494
00:29:08,840 --> 00:29:11,880
Speaker 1: he had cornary artery disease. When you use a lot

495
00:29:11,920 --> 00:29:14,640
Speaker 1: of ketamine, you can you can spike the blood pressure,

496
00:29:14,760 --> 00:29:19,400
Speaker 1: even get an a rhythmia. I mean, I Ketemine is

497
00:29:19,400 --> 00:29:22,080
Speaker 1: a great thing for setting bones. It's a short acting thing.

498
00:29:22,160 --> 00:29:26,680
Speaker 1: But I know when I in er days, you'd have

499
00:29:26,720 --> 00:29:29,360
Speaker 1: somebody on a cardiac monitor and O two censor you'd

500
00:29:29,360 --> 00:29:31,120
Speaker 1: have you know, I mean, it was like a critical

501
00:29:31,200 --> 00:29:32,840
Speaker 1: care bad they were in it.

502
00:29:33,120 --> 00:29:35,400
Speaker 2: And so that's when you would give it. When like

503
00:29:35,640 --> 00:29:37,920
Speaker 2: if someone came in with a broken bone and you

504
00:29:37,960 --> 00:29:40,640
Speaker 2: were trying to put it like something that you had

505
00:29:40,640 --> 00:29:42,640
Speaker 2: to put them in an extreme amount of pain just

506
00:29:42,680 --> 00:29:45,280
Speaker 2: to get them to like not be paying attention.

507
00:29:45,960 --> 00:29:49,520
Speaker 1: Yeah, propafall, milk, milk obamnesia, you know, the white stuff

508
00:29:49,640 --> 00:29:53,640
Speaker 1: like those are much safer and kennemine. You know. The

509
00:29:53,800 --> 00:29:57,640
Speaker 1: residency training program was on in the nineties. I think

510
00:29:57,680 --> 00:30:01,200
Speaker 1: we're the first. I was just part of the faculty group,

511
00:30:01,240 --> 00:30:04,800
Speaker 1: but we were probably one of the first people to

512
00:30:04,960 --> 00:30:07,719
Speaker 1: use it. It wasn't being used until the nineties and

513
00:30:07,760 --> 00:30:11,520
Speaker 1: we started using it for the first study trial we

514
00:30:11,600 --> 00:30:14,680
Speaker 1: did was for pediatric anesthesi in the emergency far because

515
00:30:14,680 --> 00:30:18,240
Speaker 1: it's you know that the immersion phenomenon where you know,

516
00:30:18,320 --> 00:30:20,800
Speaker 1: adults get it and they when they're coming out of it,

517
00:30:20,880 --> 00:30:24,480
Speaker 1: they they have nightmares and they have to be sedated

518
00:30:24,560 --> 00:30:30,320
Speaker 1: and stuff. Kids don't really have that Sowhach and basically

519
00:30:30,400 --> 00:30:34,040
Speaker 1: there's some secretion issues. Initially it's a very safe anesthetic, okay,

520
00:30:34,080 --> 00:30:38,200
Speaker 1: but the anesthetic dose is much higher, you know what

521
00:30:38,280 --> 00:30:41,680
Speaker 1: you're using for for depression and stuff like that. It's like,

522
00:30:41,800 --> 00:30:44,080
Speaker 1: I don't know, half milligram per kilogram and then for

523
00:30:44,320 --> 00:30:48,320
Speaker 1: IV and then for uh, you know, for the dissociative

524
00:30:48,360 --> 00:30:51,080
Speaker 1: state you're up. You know, I don't know, two to

525
00:30:51,160 --> 00:30:54,000
Speaker 1: four milligrams for killing. It's it's a much higher dose IV.

526
00:30:54,800 --> 00:30:58,040
Speaker 2: So when he was going to get infusions, obviously you

527
00:30:58,080 --> 00:31:01,440
Speaker 2: weren't treating him. But if he was to get this

528
00:31:01,560 --> 00:31:05,680
Speaker 2: like therapeutic low dose, would he feel high at all

529
00:31:05,680 --> 00:31:09,160
Speaker 2: from that? Or that it's so low you wouldn't really

530
00:31:09,240 --> 00:31:10,160
Speaker 2: even notice.

531
00:31:10,520 --> 00:31:13,200
Speaker 1: No, it's mood altering. And I've talked to some patients

532
00:31:13,280 --> 00:31:15,520
Speaker 1: like the way it feels. Others are very uncomfortable. They

533
00:31:15,560 --> 00:31:18,000
Speaker 1: don't like the way it feels feel they don't like

534
00:31:18,000 --> 00:31:22,560
Speaker 1: the way it feels at all. And again, you know

535
00:31:22,840 --> 00:31:26,400
Speaker 1: k holing. It was sort of a rave alternative drug,

536
00:31:26,440 --> 00:31:29,120
Speaker 1: you know with m d M A raves and people

537
00:31:29,120 --> 00:31:33,320
Speaker 1: would snort it and take it in pills, but those

538
00:31:33,360 --> 00:31:36,400
Speaker 1: were usually much higher doses, and it was it's sort

539
00:31:36,440 --> 00:31:42,240
Speaker 1: of like when you think of you know, PCP, like dissociative,

540
00:31:42,320 --> 00:31:46,520
Speaker 1: so you don't feel connected to your body. You could

541
00:31:46,560 --> 00:31:48,280
Speaker 1: do anything to the body and you don't feel it

542
00:31:48,360 --> 00:31:51,960
Speaker 1: because it dissociates your brain from the body. So it's

543
00:31:51,960 --> 00:31:57,120
Speaker 1: that kind of ketamine PCP very similar. So when but

544
00:31:57,200 --> 00:32:01,080
Speaker 1: what I'm saying, yeah, and I had a I have

545
00:32:01,320 --> 00:32:04,480
Speaker 1: some very bright patients and I have some very down

546
00:32:04,520 --> 00:32:06,880
Speaker 1: the line into the road with chronic pain patients and

547
00:32:07,640 --> 00:32:09,600
Speaker 1: they have a lot of questions and I won those

548
00:32:09,640 --> 00:32:12,280
Speaker 1: considering amputation and you have a very sort of a

549
00:32:12,360 --> 00:32:18,320
Speaker 1: rare cup CRPS complex regional pain syndrome. And he's looking

550
00:32:18,400 --> 00:32:21,600
Speaker 1: into everything possible, but you know he's concerned with academy.

551
00:32:21,600 --> 00:32:22,720
Speaker 1: He goes, you know, I don't want to get a

552
00:32:22,760 --> 00:32:24,320
Speaker 1: lot of people say I don't want to get addicted,

553
00:32:24,520 --> 00:32:28,160
Speaker 1: and you know, if it feels good, am I going

554
00:32:28,240 --> 00:32:30,200
Speaker 1: to want to do it? Or there's the way it's

555
00:32:30,240 --> 00:32:33,440
Speaker 1: given medically? You know, it's certainly a possibility, and if

556
00:32:33,600 --> 00:32:36,640
Speaker 1: someone has an addiction history, it's not something you know,

557
00:32:36,760 --> 00:32:38,160
Speaker 1: you have to be very careful with it.

558
00:32:39,000 --> 00:32:41,560
Speaker 2: Yeah, that's what I was wondering, like why if someone

559
00:32:41,600 --> 00:32:43,360
Speaker 2: has such a strong I mean, he had such a

560
00:32:43,400 --> 00:32:48,400
Speaker 2: strong history of alcohol addiction and then the opioid abuse

561
00:32:48,520 --> 00:32:51,160
Speaker 2: that why would you Why would you give them a

562
00:32:51,240 --> 00:32:56,080
Speaker 2: medication that's known to be abused. I guess that was

563
00:32:56,120 --> 00:32:57,240
Speaker 2: one of my questions.

564
00:32:57,320 --> 00:33:00,719
Speaker 1: But you know, I may be ignorant. I don't know.

565
00:33:01,200 --> 00:33:03,440
Speaker 1: I really don't know why they were giving it was

566
00:33:03,480 --> 00:33:06,000
Speaker 1: it was he in such a state with his depression

567
00:33:06,400 --> 00:33:08,680
Speaker 1: that it was considered sort of a last resort. Was

568
00:33:08,720 --> 00:33:11,120
Speaker 1: it for some chronic I think, I know, I assume

569
00:33:11,120 --> 00:33:15,960
Speaker 1: you had chronic pain issues, and yeah, I mean it

570
00:33:16,000 --> 00:33:17,840
Speaker 1: would be a considerate, it would be something to take

571
00:33:17,920 --> 00:33:18,840
Speaker 1: into consideration.

572
00:33:19,360 --> 00:33:22,840
Speaker 2: So his assistance said it was for a for depression

573
00:33:22,880 --> 00:33:25,280
Speaker 2: and anxiety. But yeah, I mean he you know, he

574
00:33:25,360 --> 00:33:29,480
Speaker 2: had multiple surgeries because he had val obstruction from the

575
00:33:29,640 --> 00:33:33,040
Speaker 2: chronic constipation from the opioid abuse he had. He had

576
00:33:33,160 --> 00:33:38,440
Speaker 2: a back injury, yeah, he had. He had multiple surgical adhesions.

577
00:33:38,480 --> 00:33:43,440
Speaker 2: He was probably in pain for sure, so but that

578
00:33:43,600 --> 00:33:46,280
Speaker 2: wasn't reported as to why he was taking it. But

579
00:33:47,240 --> 00:33:50,320
Speaker 2: you also see this thing with with celebrities and famous

580
00:33:50,320 --> 00:33:54,120
Speaker 2: people that they get this VIP treatment that normal patients

581
00:33:54,160 --> 00:33:54,640
Speaker 2: don't get.

582
00:33:55,640 --> 00:34:01,560
Speaker 1: Yeah. Absolutely, well, I was wondering that too. Right, There

583
00:34:01,680 --> 00:34:05,640
Speaker 1: was a guy knew that was hired to be with

584
00:34:05,720 --> 00:34:13,040
Speaker 1: a certain very famous rock musician and he would stay

585
00:34:13,080 --> 00:34:17,840
Speaker 1: with the guy at the guy's place, and you know,

586
00:34:18,440 --> 00:34:21,279
Speaker 1: they have so much power and money. The guy would

587
00:34:21,320 --> 00:34:24,399
Speaker 1: get and this was back in the nineties, but these

588
00:34:24,400 --> 00:34:27,960
Speaker 1: FedEx boxes would come with demroll in them and stuff,

589
00:34:27,960 --> 00:34:31,520
Speaker 1: and the guy eventually, you know, died. But my friend

590
00:34:31,840 --> 00:34:35,360
Speaker 1: was very high powered interventional. He did interventions, and he

591
00:34:35,440 --> 00:34:38,600
Speaker 1: worked with you know, Fortune five hundred companies and you know,

592
00:34:38,680 --> 00:34:44,200
Speaker 1: various behaviors people on the board that developed drug or

593
00:34:44,360 --> 00:34:49,040
Speaker 1: porn or gambling addictions, and you know, but he couldn't

594
00:34:49,080 --> 00:34:51,480
Speaker 1: do anything because this guy, you know, the the hangers

595
00:34:51,520 --> 00:34:57,040
Speaker 1: on and the you know, the gophers, and it undermines

596
00:34:57,640 --> 00:35:00,880
Speaker 1: and undermines their ability to get treatment to stay sober.

597
00:35:00,920 --> 00:35:10,960
Speaker 2: So this episode is brought to you by The Grosser Room.

598
00:35:11,480 --> 00:35:14,680
Speaker 2: If you love this podcast and you love my Instagram account,

599
00:35:14,840 --> 00:35:17,719
Speaker 2: you will love the Grosser Room. Every week we have

600
00:35:17,920 --> 00:35:22,279
Speaker 2: lots of cases of articles discussing celebrity deaths and high

601
00:35:22,280 --> 00:35:25,879
Speaker 2: profile deaths. And since we are going on our fourth year,

602
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Speaker 2: you have thousands of photos, videos and articles to catch

603
00:35:29,280 --> 00:35:36,680
Speaker 2: up on. Treat yourself this holiday season to gross do

604
00:35:36,719 --> 00:35:40,520
Speaker 2: you think that because at the time of his death,

605
00:35:40,719 --> 00:35:44,040
Speaker 2: people were in his life seemed to be a little

606
00:35:44,080 --> 00:35:46,640
Speaker 2: bit shocked about it because it seems as if he

607
00:35:46,960 --> 00:35:51,080
Speaker 2: had been sober for like nineteen months. Do you think

608
00:35:52,640 --> 00:35:56,759
Speaker 2: My question is, why start a new drug instead of

609
00:35:56,840 --> 00:36:00,279
Speaker 2: just going back to the one that you knew? Is

610
00:36:00,320 --> 00:36:04,080
Speaker 2: it because of like shame and embarrassment to say, oh,

611
00:36:04,120 --> 00:36:06,720
Speaker 2: I'm not sober anymore. Or did he think maybe because

612
00:36:06,760 --> 00:36:09,960
Speaker 2: he was allowed to get that treatment that it wasn't

613
00:36:10,239 --> 00:36:13,359
Speaker 2: it wasn't bad. He just was taken a little bit more.

614
00:36:14,040 --> 00:36:16,719
Speaker 1: I mean it could be a number of things. He

615
00:36:16,760 --> 00:36:19,960
Speaker 1: may exactly considered himself to still be clean and sober.

616
00:36:20,000 --> 00:36:23,480
Speaker 1: I'm doing it. I'm taped. It really helped my depression.

617
00:36:23,760 --> 00:36:25,800
Speaker 1: I'm going to treat myself. I don't you know, I

618
00:36:25,800 --> 00:36:28,520
Speaker 1: don't know. Was he getting high? Sounded like he was.

619
00:36:29,040 --> 00:36:32,359
Speaker 1: You know, he had quite a bit in a system.

620
00:36:32,880 --> 00:36:37,040
Speaker 1: And there's look asked anybody that struggled with an addiction

621
00:36:37,320 --> 00:36:40,719
Speaker 1: and what what was there? You know, they sort about

622
00:36:40,719 --> 00:36:44,600
Speaker 1: stinking thinking right, It's like, what was how did you rationalize?

623
00:36:45,800 --> 00:36:47,680
Speaker 1: You know? Was it just e fit? I'm going to

624
00:36:48,080 --> 00:36:50,719
Speaker 1: go get loaded or maybe I can get loaded and

625
00:36:50,719 --> 00:36:53,080
Speaker 1: nobody will know because it's ketamine and I've already on it.

626
00:36:53,120 --> 00:36:58,680
Speaker 1: I mean there's a who knows? And was it? Did

627
00:36:58,680 --> 00:37:00,400
Speaker 1: he have a heart attack? I mean, was that or not?

628
00:37:00,560 --> 00:37:03,799
Speaker 1: In any arrhythmia? And he's you know, in the in

629
00:37:03,880 --> 00:37:06,359
Speaker 1: the hot tub. You're in the hot tub and you're

630
00:37:06,560 --> 00:37:10,680
Speaker 1: you know, you're getting dehydra I mean, there's all all

631
00:37:10,719 --> 00:37:11,600
Speaker 1: the speculations.

632
00:37:11,600 --> 00:37:14,879
Speaker 3: So yeah, I mean he had did you I don't

633
00:37:14,880 --> 00:37:18,040
Speaker 3: know if you you saw the report, but he had

634
00:37:18,400 --> 00:37:23,240
Speaker 3: he had emphysema, right, I mean, pretty extensive emphysema, spoke

635
00:37:23,280 --> 00:37:25,480
Speaker 3: two packs of cigarettes a day, which you know.

636
00:37:25,480 --> 00:37:27,839
Speaker 2: Nobody ever wants to talk about how bad cigarettes are

637
00:37:28,560 --> 00:37:30,319
Speaker 2: on the body. But there was that, and then he

638
00:37:30,400 --> 00:37:33,880
Speaker 2: had uh in his lad he had fifty to seventy

639
00:37:33,920 --> 00:37:42,399
Speaker 2: percent focal occlusion, which yeah, exactly, you're just I mean,

640
00:37:42,440 --> 00:37:44,279
Speaker 2: he didn't have any fibrosis in the heart, so it

641
00:37:44,320 --> 00:37:46,400
Speaker 2: didn't look like he had a heart attack as the

642
00:37:46,520 --> 00:37:48,839
Speaker 2: immediate cause of death, but he was going to have

643
00:37:48,880 --> 00:37:53,319
Speaker 2: one soon basically, right. But but yeah, I think that

644
00:37:53,600 --> 00:37:56,360
Speaker 2: he took the jougs and passed out, and then he

645
00:37:56,440 --> 00:38:00,200
Speaker 2: had some signs that he drowned underwater, was take making

646
00:38:00,280 --> 00:38:02,880
Speaker 2: some breaths underwater. So there was a little bit of

647
00:38:03,560 --> 00:38:05,080
Speaker 2: not a lot though, there was a little bit of

648
00:38:05,080 --> 00:38:08,840
Speaker 2: pulmonary edema with some foam, and he had in the

649
00:38:08,880 --> 00:38:13,080
Speaker 2: petres bone some hemorrhage too, so they concluded that that

650
00:38:13,239 --> 00:38:15,200
Speaker 2: was a contributing factor to his death.

651
00:38:16,719 --> 00:38:19,279
Speaker 1: Tell me about the Petro's bawn thing, so.

652
00:38:19,440 --> 00:38:23,040
Speaker 2: You can see hemorrhage in that bone in drowning cases,

653
00:38:23,080 --> 00:38:25,840
Speaker 2: but it's not like if you see it, that doesn't

654
00:38:25,840 --> 00:38:29,120
Speaker 2: mean the person drowned, but that along with other gross findings,

655
00:38:29,160 --> 00:38:34,239
Speaker 2: could indicate that he drowned. But he didn't have like

656
00:38:34,320 --> 00:38:37,399
Speaker 2: typically if a person just primarily drowned, you would see

657
00:38:37,440 --> 00:38:40,719
Speaker 2: a lot of foam in the airway because of their

658
00:38:40,800 --> 00:38:45,600
Speaker 2: last breaths. But he was probably already his respiratory rate

659
00:38:45,680 --> 00:38:48,120
Speaker 2: was probably already so low when he went into the water,

660
00:38:48,320 --> 00:38:51,640
Speaker 2: so that's why there wasn't that much of it. And

661
00:38:51,760 --> 00:38:55,880
Speaker 2: obviously he had super high levels in his blood that

662
00:38:55,960 --> 00:38:58,799
Speaker 2: you would see in a patient that was under anesthesia,

663
00:38:59,800 --> 00:39:02,839
Speaker 2: and in his stomach contents as well, they found they

664
00:39:02,880 --> 00:39:06,160
Speaker 2: found remnants of it, so which means that he took it,

665
00:39:06,560 --> 00:39:09,560
Speaker 2: you know, shortly before his death, a high dose of it.

666
00:39:09,920 --> 00:39:13,720
Speaker 1: Right and you get that sort of that adrenaline blood

667
00:39:13,760 --> 00:39:15,920
Speaker 1: pressure spike, and that's when you're gonna get your a

668
00:39:16,040 --> 00:39:17,960
Speaker 1: rhythmy is and you know you don't have to have

669
00:39:18,000 --> 00:39:20,640
Speaker 1: a heart attack for as you know that that'll do

670
00:39:20,719 --> 00:39:24,879
Speaker 1: you in real really quickly too. So but is.

671
00:39:24,880 --> 00:39:29,520
Speaker 2: Ketamine treatment is that FDA approved right now too? For

672
00:39:29,640 --> 00:39:32,960
Speaker 2: other than anesthesia like these it's all Flabel.

673
00:39:33,440 --> 00:39:36,640
Speaker 1: It's all flabble proved. Yeah for me for trigger resistant

674
00:39:36,640 --> 00:39:37,560
Speaker 1: depression and pain.

675
00:39:38,160 --> 00:39:40,120
Speaker 2: It just seems like it's like, you know how like

676
00:39:40,160 --> 00:39:42,359
Speaker 2: goes epics in the news right now every day it's

677
00:39:42,440 --> 00:39:44,960
Speaker 2: it's like ketymine is I think Christy Tiagan said she

678
00:39:45,080 --> 00:39:47,239
Speaker 2: did it and one of the housewives or something. It's

679
00:39:47,280 --> 00:39:49,279
Speaker 2: like it's like the all the rage now all the

680
00:39:49,320 --> 00:39:51,720
Speaker 2: celebrities are doing ketymine treatments.

681
00:39:52,200 --> 00:39:56,640
Speaker 1: Oh yeah, it's the ketymine clinics are booming, doing a

682
00:39:56,680 --> 00:40:00,920
Speaker 1: booming business. So the that's the problem with something to

683
00:40:00,920 --> 00:40:04,239
Speaker 1: get strendy, it's you and people with addictions again you

684
00:40:04,280 --> 00:40:06,879
Speaker 1: want to quick fix. And there's also talk about well

685
00:40:08,360 --> 00:40:12,960
Speaker 1: it's just like the ayahuasca circles and that can rapid

686
00:40:13,000 --> 00:40:15,439
Speaker 1: opiate detox where you go in and get an IV

687
00:40:15,600 --> 00:40:18,359
Speaker 1: of Narkian and reverse it and now you're not an

688
00:40:18,360 --> 00:40:22,400
Speaker 1: addict anymore, or ayahuasca circles and uh, you know, you

689
00:40:22,480 --> 00:40:27,560
Speaker 1: get the super loucinogenic experience. And it's I mean generally

690
00:40:27,719 --> 00:40:33,640
Speaker 1: these things occur biologically, genetically over time related to it.

691
00:40:33,520 --> 00:40:36,000
Speaker 1: It takes a long time. Well they don't always take

692
00:40:36,000 --> 00:40:38,399
Speaker 1: a long time to develop an addiction, but usually it's

693
00:40:38,480 --> 00:40:41,440
Speaker 1: it's a complicated, long term process, and recovery is too.

694
00:40:41,480 --> 00:40:43,480
Speaker 1: It's one day at a time, but it's you know,

695
00:40:43,520 --> 00:40:48,120
Speaker 1: you just got to, you know, sit back and listen

696
00:40:48,239 --> 00:40:53,040
Speaker 1: and accept that it's going to take a lot of

697
00:40:53,120 --> 00:40:57,719
Speaker 1: restructuring of your life. It's very doable. Sobriety is you

698
00:40:57,760 --> 00:41:00,440
Speaker 1: know a lot of people fail and they'll relapse. I

699
00:41:00,520 --> 00:41:02,680
Speaker 1: mean this guy, really, what was he in detox sixty

700
00:41:02,719 --> 00:41:04,560
Speaker 1: times or something like that, So that's.

701
00:41:04,360 --> 00:41:06,680
Speaker 2: A yeah, that was one of the questions I was

702
00:41:06,719 --> 00:41:09,440
Speaker 2: going to ask you, is there a point where someone

703
00:41:09,640 --> 00:41:11,759
Speaker 2: I hate to say this, but is there a point

704
00:41:11,760 --> 00:41:16,319
Speaker 2: where someone's brain is like damaged, beyond prepared for them

705
00:41:16,360 --> 00:41:21,000
Speaker 2: to ever kind of have a normal life after struggling

706
00:41:21,040 --> 00:41:22,960
Speaker 2: with an addiction like this. I mean, there was a

707
00:41:23,000 --> 00:41:26,440
Speaker 2: point where he said he was taking fifty five pills

708
00:41:26,480 --> 00:41:30,040
Speaker 2: a day, which is mind blowing to me because I've

709
00:41:30,080 --> 00:41:33,399
Speaker 2: taken one percoset and like thrown up all night.

710
00:41:34,600 --> 00:41:36,560
Speaker 1: Right. But so again, I had a patient and I

711
00:41:36,600 --> 00:41:38,120
Speaker 1: know this is the case. He was taking over one

712
00:41:38,160 --> 00:41:42,560
Speaker 1: hundred narcos a day, right, And because I saw there

713
00:41:42,560 --> 00:41:45,120
Speaker 1: was now he was ordering some on the internet. He

714
00:41:45,239 --> 00:41:49,120
Speaker 1: was going to doctors, but he's stole my patient. He's

715
00:41:49,160 --> 00:41:51,000
Speaker 1: on he's been on. You know, he's an older guy.

716
00:41:51,040 --> 00:41:54,239
Speaker 1: He's been on box own for for some years. He

717
00:41:54,280 --> 00:41:58,319
Speaker 1: does have sever c OPD chronic pain. Well you know

718
00:41:58,719 --> 00:42:02,760
Speaker 1: one bars to know is and one bar ridiculo opasy

719
00:42:02,800 --> 00:42:05,480
Speaker 1: blah blah blah. So he's really got paint and he's

720
00:42:05,560 --> 00:42:11,040
Speaker 1: been stable. But if you gradually increase your tile and

721
00:42:11,080 --> 00:42:14,719
Speaker 1: al you know, the tilodol in there is what's going

722
00:42:14,800 --> 00:42:17,239
Speaker 1: to do again. But if you gradually increase your tilool

723
00:42:18,239 --> 00:42:22,000
Speaker 1: and your liver has the ability to you know, produce

724
00:42:22,040 --> 00:42:25,840
Speaker 1: more of the enzymes that metabolize it. Eventually though the kidneys,

725
00:42:25,960 --> 00:42:27,799
Speaker 1: you get to a certain I know, it's like kill

726
00:42:27,880 --> 00:42:30,359
Speaker 1: how many kilograms of the see of benefit have gone

727
00:42:30,400 --> 00:42:33,799
Speaker 1: through your kidneys and then book they're done. But so

728
00:42:34,600 --> 00:42:38,160
Speaker 1: it sounds crazy, but over time people develop a tolerance

729
00:42:38,239 --> 00:42:42,960
Speaker 1: and there you go. So it's it's it's true. I

730
00:42:42,960 --> 00:42:48,040
Speaker 1: mean one, you know, when I've had every everybody's had

731
00:42:48,040 --> 00:42:50,239
Speaker 1: an oracle or a tunnel codeing boy, I'll tell you what.

732
00:42:50,280 --> 00:42:53,320
Speaker 1: That stuff can make a nauseous real quick, and you

733
00:42:53,320 --> 00:42:56,320
Speaker 1: you just but it's like patients I've had there drinking

734
00:42:56,440 --> 00:42:58,160
Speaker 1: you know a couple of liters of bodka a day

735
00:42:58,200 --> 00:43:01,640
Speaker 1: for years and there by all it's not good for them,

736
00:43:01,680 --> 00:43:05,960
Speaker 1: but you know that it occurs over time, it's gradual.

737
00:43:06,040 --> 00:43:11,160
Speaker 2: And when one of these patients that has the opioid

738
00:43:11,160 --> 00:43:13,319
Speaker 2: addiction is used to getting high off of let's say,

739
00:43:13,400 --> 00:43:15,400
Speaker 2: vike it in her percoset, and then they go to

740
00:43:15,520 --> 00:43:19,040
Speaker 2: you and then they get this like subutext drug. Do

741
00:43:19,160 --> 00:43:23,600
Speaker 2: they are you saying that they still kind of feel

742
00:43:23,680 --> 00:43:27,400
Speaker 2: the high, but it doesn't give them that that feeling

743
00:43:27,480 --> 00:43:29,799
Speaker 2: that they need to increase it more and more, which

744
00:43:29,800 --> 00:43:34,320
Speaker 2: would which would lead them to overdose. They still feel

745
00:43:34,400 --> 00:43:35,279
Speaker 2: high right when no.

746
00:43:35,400 --> 00:43:39,440
Speaker 1: No, no no. So so basically you're supposed to be

747
00:43:39,560 --> 00:43:42,799
Speaker 1: off about any opiate for twenty at least twenty four

748
00:43:42,800 --> 00:43:45,480
Speaker 1: hours when you start upern No. Orpheny's a box subject.

749
00:43:45,600 --> 00:43:48,799
Speaker 1: Why is that because even though it doesn't people say,

750
00:43:48,800 --> 00:43:52,319
Speaker 1: well it's a partial stimuli or powerful agonist, it's it

751
00:43:52,520 --> 00:43:56,520
Speaker 1: just works differently attaching to the opia receptors. So but

752
00:43:56,640 --> 00:44:00,560
Speaker 1: it's it like has the most attraction of any opiates.

753
00:44:00,640 --> 00:44:04,520
Speaker 1: So if I've been taking four or ten to orco

754
00:44:04,600 --> 00:44:07,719
Speaker 1: a day, whatever, and I put some box on subutext

755
00:44:07,800 --> 00:44:11,839
Speaker 1: under my tongue it's going to displace all the percocet

756
00:44:11,960 --> 00:44:16,400
Speaker 1: or oxycodone or hydro codone. And even though you're attaching

757
00:44:16,440 --> 00:44:19,680
Speaker 1: to the receptor, the opiate receptor, it stimulates it differently,

758
00:44:19,760 --> 00:44:22,120
Speaker 1: so your body perceives it as withdrawal and gets super

759
00:44:22,160 --> 00:44:29,160
Speaker 1: sick a withdrawal. And the other situation. If you stop

760
00:44:29,239 --> 00:44:31,440
Speaker 1: somebody's opiate's for twenty four hours, they're going to be

761
00:44:31,440 --> 00:44:33,520
Speaker 1: in withdrawal and then you give them the upper from

762
00:44:33,520 --> 00:44:36,560
Speaker 1: the subject text sub box or whatever, and within minutes

763
00:44:36,800 --> 00:44:41,920
Speaker 1: they withdrawal abates. So it it's it's sort of you know,

764
00:44:42,000 --> 00:44:45,879
Speaker 1: it's not intuitive at explaining, and it's like, so it's

765
00:44:45,920 --> 00:44:48,080
Speaker 1: a partial agonist or is it a block you're oh,

766
00:44:48,080 --> 00:44:51,120
Speaker 1: it's a blocker. Well, it attaches the receptor, but it

767
00:44:51,960 --> 00:44:55,000
Speaker 1: you know, it starts withdrawal, but you can treat withdrawal,

768
00:44:55,040 --> 00:44:56,640
Speaker 1: you know what I'm saying. It can be a little confusing,

769
00:44:56,719 --> 00:45:02,120
Speaker 1: but it's uh, you know, it's an opiate. It has

770
00:45:02,160 --> 00:45:04,360
Speaker 1: a high high affinity for the recept or, so it

771
00:45:04,400 --> 00:45:07,160
Speaker 1: will displace any other opiate and when it does so,

772
00:45:07,440 --> 00:45:09,879
Speaker 1: then your body feels like it's in withdrawal even though

773
00:45:09,880 --> 00:45:13,080
Speaker 1: it's it's attaching. But if you wait for somebody to

774
00:45:13,120 --> 00:45:14,719
Speaker 1: be and withdrawal and you give it to them. It

775
00:45:14,760 --> 00:45:23,880
Speaker 1: will resolve the withdrawal within minutes. So the lesson so

776
00:45:24,080 --> 00:45:26,759
Speaker 1: I said, people can inject it, Okay, Like I said,

777
00:45:26,840 --> 00:45:30,200
Speaker 1: when you start injecting things, it's not like taking it properly.

778
00:45:30,320 --> 00:45:32,840
Speaker 1: So the art. You know, I've heard all the arguments against,

779
00:45:32,840 --> 00:45:34,880
Speaker 1: oh it's an opiate, you're you know, you're not sober,

780
00:45:35,000 --> 00:45:38,839
Speaker 1: you're not clean when you're using. But if you take

781
00:45:38,880 --> 00:45:41,239
Speaker 1: it properly, now they say one to two percent of

782
00:45:41,280 --> 00:45:46,080
Speaker 1: people will say, uh, oh it makes me relax, it

783
00:45:46,120 --> 00:45:49,000
Speaker 1: gives me energy. So those are people that you probably

784
00:45:49,000 --> 00:45:50,920
Speaker 1: don't want to use the box on or up an

785
00:45:50,960 --> 00:45:54,520
Speaker 1: orphine and recovery. So it's it's one of those things.

786
00:45:54,520 --> 00:45:56,200
Speaker 1: It's just like some people will take I mean it's

787
00:45:56,239 --> 00:45:59,200
Speaker 1: not a great analogy, but some people will say, yeah,

788
00:45:59,200 --> 00:46:01,759
Speaker 1: I took you know, I took motoring and I got

789
00:46:01,760 --> 00:46:04,799
Speaker 1: a mood alterary effect. So a variety of things can

790
00:46:05,040 --> 00:46:07,279
Speaker 1: give you a mood alterary effect, and some people get

791
00:46:07,400 --> 00:46:11,839
Speaker 1: very attached to it. So but it's very rare. It's

792
00:46:11,920 --> 00:46:14,800
Speaker 1: very rare that you know, buprin orphine. I've had patients

793
00:46:14,840 --> 00:46:17,520
Speaker 1: take double you know there they try to get high

794
00:46:17,560 --> 00:46:20,120
Speaker 1: on it. They'll take the maximum thirty two milligrams a day,

795
00:46:20,120 --> 00:46:23,319
Speaker 1: they'll get the prescription take sixty four milligrams a day.

796
00:46:23,320 --> 00:46:26,680
Speaker 1: And I mean, I've had that happen and you can't

797
00:46:26,680 --> 00:46:28,960
Speaker 1: give them an early refill and they commit, and I say, well,

798
00:46:29,080 --> 00:46:31,279
Speaker 1: so what did you feel? Well, it didn't work. I

799
00:46:31,320 --> 00:46:33,440
Speaker 1: didn't get high, and you know, it was a waste

800
00:46:33,480 --> 00:46:35,920
Speaker 1: of time and I'll never do it again. Whatever. So

801
00:46:36,040 --> 00:46:39,080
Speaker 1: it's and it's again the binding characters. We're in the

802
00:46:39,440 --> 00:46:43,080
Speaker 1: you know, the ventral tegmental area whatever, the midbrain reward areas.

803
00:46:43,120 --> 00:46:44,680
Speaker 1: It has very little activity there.

804
00:46:44,760 --> 00:46:49,920
Speaker 2: So if so if a person like myself took that drug,

805
00:46:50,280 --> 00:46:53,360
Speaker 2: what would would would I feel anything?

806
00:46:53,640 --> 00:46:56,279
Speaker 1: Or probably? Well, okay, it is an opiate. So if

807
00:46:56,280 --> 00:46:58,879
Speaker 1: you're opiate naive, and it depends on the dose you took,

808
00:46:58,920 --> 00:47:01,400
Speaker 1: it's just like if you eject did it? I said,

809
00:47:01,800 --> 00:47:04,680
Speaker 1: if I injected into myself, would stop my breathing? No,

810
00:47:05,200 --> 00:47:07,520
Speaker 1: if it was a sole agent. Now, if I had

811
00:47:07,560 --> 00:47:10,239
Speaker 1: a few beers and you inject the dose, but if

812
00:47:10,239 --> 00:47:13,560
Speaker 1: you if you took eight milligrams, I mean we start

813
00:47:13,760 --> 00:47:16,799
Speaker 1: somebody that's in withdrawal, will give them two four milligrams

814
00:47:17,440 --> 00:47:21,040
Speaker 1: under the time. And if if I just did that

815
00:47:21,120 --> 00:47:24,480
Speaker 1: right now, I probably initially I get you four. Okay.

816
00:47:24,480 --> 00:47:26,840
Speaker 1: I've had patients tell me there were big pot smokers.

817
00:47:27,600 --> 00:47:29,600
Speaker 1: They had a bunch of THC in their system. They

818
00:47:29,640 --> 00:47:33,839
Speaker 1: came in for induction and and afterwards to say, you know, doc,

819
00:47:33,920 --> 00:47:36,480
Speaker 1: that stuff I did get a you know when I

820
00:47:36,520 --> 00:47:38,880
Speaker 1: had the UH when I was using pot. And again,

821
00:47:39,800 --> 00:47:42,239
Speaker 1: you have patients that you get them off the fantinel

822
00:47:42,680 --> 00:47:45,920
Speaker 1: and and you know you're you're working with them and

823
00:47:45,960 --> 00:47:48,719
Speaker 1: there and you drive testament. It comes back for THAC.

824
00:47:49,719 --> 00:47:52,160
Speaker 1: You don't want patients to We're sort of harm reduction.

825
00:47:52,239 --> 00:47:54,040
Speaker 1: That's my philosophy. I mean, I don't want to smoke

826
00:47:54,040 --> 00:47:55,759
Speaker 1: a plot. But IVE had patients tell me if I'm

827
00:47:55,800 --> 00:47:58,680
Speaker 1: smoking some potent pot and I'm taking subox and I

828
00:47:58,800 --> 00:48:02,000
Speaker 1: do get a buzz, and that's not good. So but

829
00:48:02,120 --> 00:48:05,000
Speaker 1: it's just in and of itself. Ninety eight percent of

830
00:48:05,040 --> 00:48:07,280
Speaker 1: people do not get a mood alterary effect when taken

831
00:48:07,320 --> 00:48:09,000
Speaker 1: within the DOSA drains. It's proved.

832
00:48:09,880 --> 00:48:14,440
Speaker 2: Now, does this drug help with pain? Oh yeah, yeah,

833
00:48:15,280 --> 00:48:18,520
Speaker 2: so why so my obvious question is then if this

834
00:48:18,760 --> 00:48:23,759
Speaker 2: is safer, why isn't this drug that is?

835
00:48:24,320 --> 00:48:28,880
Speaker 1: That is a great question, and I for my uh so,

836
00:48:29,000 --> 00:48:35,640
Speaker 1: here's what happens now. The pain physiology and the you know,

837
00:48:35,719 --> 00:48:41,560
Speaker 1: pain fibers and pathways and different types of pain are

838
00:48:41,680 --> 00:48:44,319
Speaker 1: really really much better understood now than they were even

839
00:48:44,400 --> 00:48:47,600
Speaker 1: you know, five ten years ago, right, and super a

840
00:48:47,600 --> 00:48:51,920
Speaker 1: lot of complexities there. It turns out the uprenorphine, you know,

841
00:48:52,040 --> 00:48:54,480
Speaker 1: if you if you have pain in your foot or

842
00:48:54,520 --> 00:48:56,640
Speaker 1: your back or your hand, the fibers go to your

843
00:48:56,640 --> 00:48:58,960
Speaker 1: spinal cord. The dorsal in the back of your spinal

844
00:48:59,000 --> 00:49:02,839
Speaker 1: cord has transmission nerve centers and sends the signal up.

845
00:49:02,880 --> 00:49:07,399
Speaker 1: So buprenorphine blocks pain more in the spinal cord, right

846
00:49:07,800 --> 00:49:10,080
Speaker 1: much not so much up in the brain. Sort of

847
00:49:10,080 --> 00:49:13,360
Speaker 1: a crude way of explaining it, and that doesn't have

848
00:49:13,360 --> 00:49:16,920
Speaker 1: as much activity the respiratory center. But it's so currently

849
00:49:17,440 --> 00:49:21,200
Speaker 1: according to the medical literature, if someone needs a daily

850
00:49:21,600 --> 00:49:26,680
Speaker 1: opiate chronically for bonafide pain, whether or not they have

851
00:49:26,719 --> 00:49:30,400
Speaker 1: an addiction history, then the first line medications be pan orphine.

852
00:49:30,640 --> 00:49:35,200
Speaker 1: Why isn't Why isn't that done? I I was talking

853
00:49:35,239 --> 00:49:39,760
Speaker 1: to somebody today. I've talked to people at other academic centers.

854
00:49:39,800 --> 00:49:43,399
Speaker 1: I was talking to somebody at a ivyly programmed back

855
00:49:43,480 --> 00:49:46,960
Speaker 1: East today for about an hour, and we we share

856
00:49:47,000 --> 00:49:50,160
Speaker 1: the same frustration. It's if it's first line, if it's

857
00:49:50,160 --> 00:49:52,920
Speaker 1: a first of all safety, first hipocratic codes, right, So

858
00:49:53,960 --> 00:49:57,480
Speaker 1: I don't I've been paying medicine in my facility, large

859
00:49:58,080 --> 00:50:01,759
Speaker 1: organization on Wednesday. Third, I'm not a pain doctor. I

860
00:50:01,960 --> 00:50:05,319
Speaker 1: just get referred paying doctors say hey, can you see uh,

861
00:50:05,480 --> 00:50:09,000
Speaker 1: you know, mister Smith, he's been on one hundred milligrams

862
00:50:09,000 --> 00:50:11,560
Speaker 1: of morphine and forty and oracle for twenty years and

863
00:50:11,600 --> 00:50:16,680
Speaker 1: we've tapered him now the pain's unbearable, or you know,

864
00:50:17,040 --> 00:50:19,600
Speaker 1: we need to detox this for whatever it is. I

865
00:50:19,960 --> 00:50:22,680
Speaker 1: just get patients that are already on opiates and it's

866
00:50:22,719 --> 00:50:25,279
Speaker 1: buper and orphan is safer opiate? Yes, So what the

867
00:50:25,320 --> 00:50:29,440
Speaker 1: literature says, it's we're not starting people on opiates for

868
00:50:29,560 --> 00:50:32,279
Speaker 1: chronic pain. Not a good not a good medication for

869
00:50:32,360 --> 00:50:35,520
Speaker 1: chronic paint, right, But if someone's already on it, it's like,

870
00:50:36,239 --> 00:50:39,280
Speaker 1: why not if it's safer, why not at least try

871
00:50:39,320 --> 00:50:42,360
Speaker 1: to switch them and then either tape them off the

872
00:50:42,880 --> 00:50:45,560
Speaker 1: orphine or you know, if they do need a chronic

873
00:50:45,600 --> 00:50:50,759
Speaker 1: alpiate use puper arpi. But there's a lot of a

874
00:50:50,760 --> 00:50:52,800
Speaker 1: lot of paint specialists that are boards. Now I'm not

875
00:50:52,840 --> 00:50:55,040
Speaker 1: a board certified paint specialist, so I get into it

876
00:50:55,080 --> 00:50:56,200
Speaker 1: with some of these guys.

877
00:50:56,560 --> 00:50:56,680
Speaker 2: Uh.

878
00:50:56,840 --> 00:51:00,279
Speaker 1: It's then one of the reasons is because it's the

879
00:51:00,320 --> 00:51:02,200
Speaker 1: first thing if you say viewper orphane people, I don't

880
00:51:02,200 --> 00:51:03,879
Speaker 1: know what that is, but the average person has heard

881
00:51:03,920 --> 00:51:06,719
Speaker 1: of the box on right sub attexts. But well, that's

882
00:51:06,760 --> 00:51:10,080
Speaker 1: an it's an opiate for for addicts, right, Well, it's

883
00:51:10,120 --> 00:51:13,480
Speaker 1: it's a big pronorphine. That's the opiate. Well, well an opiate.

884
00:51:13,480 --> 00:51:15,719
Speaker 1: It's an opiate, and that's for addicts. And if you're

885
00:51:15,760 --> 00:51:18,880
Speaker 1: given that to pain patients, then yeah, you're a quack.

886
00:51:19,239 --> 00:51:22,160
Speaker 1: I mean, I've gotten called it. I d you know.

887
00:51:22,520 --> 00:51:25,880
Speaker 1: I've got probably one hundred and fifty patients that I'm

888
00:51:25,920 --> 00:51:28,560
Speaker 1: with the paining physicians. I'm not going out recruiting people.

889
00:51:28,600 --> 00:51:32,359
Speaker 1: I don't I don't start it in rare cases. There's

890
00:51:32,400 --> 00:51:35,440
Speaker 1: a low dose view transpatch. If the primary care for

891
00:51:35,560 --> 00:51:38,640
Speaker 1: paining physicians says I think this patient does need an opiate,

892
00:51:39,520 --> 00:51:42,239
Speaker 1: then you know I will work with them. But I'm

893
00:51:42,280 --> 00:51:45,840
Speaker 1: not out there starting paying patients on it. But anybody

894
00:51:45,880 --> 00:51:48,239
Speaker 1: who's listening to this, if you are on it, if

895
00:51:48,239 --> 00:51:53,360
Speaker 1: you're on dorac or you're on morphine, it's just you know,

896
00:51:53,400 --> 00:51:55,920
Speaker 1: if there's a if there's a dangerous or there's a

897
00:51:56,640 --> 00:51:58,879
Speaker 1: like I use the example if I talk to doctor

898
00:51:58,920 --> 00:52:00,440
Speaker 1: and they say, if you have a patient on anodor

899
00:52:00,520 --> 00:52:03,880
Speaker 1: on it's it's a great medication, cardiac medication for certain rhythmis,

900
00:52:03,920 --> 00:52:09,280
Speaker 1: but it is rough, rough to manage, sort of toxic,

901
00:52:10,600 --> 00:52:14,360
Speaker 1: you know, not toxic. But so what I tell them

902
00:52:14,360 --> 00:52:18,040
Speaker 1: if they're a safer anti arrhythmic came out and it

903
00:52:18,200 --> 00:52:22,120
Speaker 1: was documented just the physiology of it, the pharmacology of it.

904
00:52:22,120 --> 00:52:25,040
Speaker 1: It's safer, does the same thing. And five years from now,

905
00:52:25,080 --> 00:52:27,960
Speaker 1: you still had them on amiodoro. What would your defense be.

906
00:52:28,040 --> 00:52:29,120
Speaker 1: There's no defense, so.

907
00:52:30,880 --> 00:52:34,600
Speaker 2: Ill just like a stigma of the drug. Basically exactly

908
00:52:34,680 --> 00:52:35,640
Speaker 2: so right.

909
00:52:35,719 --> 00:52:37,200
Speaker 1: And so I was talking to somebody at one of

910
00:52:37,239 --> 00:52:40,520
Speaker 1: these university programs because I was I was in fear

911
00:52:40,560 --> 00:52:42,880
Speaker 1: of losing my job because they said, you're an addiction

912
00:52:43,000 --> 00:52:45,239
Speaker 1: medicine doctor, why do you have forty people on this

913
00:52:45,280 --> 00:52:48,040
Speaker 1: for chronic pain? And I said, well, they were sent

914
00:52:48,080 --> 00:52:51,480
Speaker 1: to me. They were on morphine, fentanyl, whatever, and they

915
00:52:51,520 --> 00:52:54,360
Speaker 1: told me to detoxible, you know. And this when this

916
00:52:54,400 --> 00:52:56,000
Speaker 1: stuff came out in the higher does form of the

917
00:52:56,040 --> 00:52:58,759
Speaker 1: sabbox armount in two thousand and two, a lot of

918
00:52:58,800 --> 00:53:00,840
Speaker 1: us got And it wasn't just to me, obviously, it

919
00:53:00,920 --> 00:53:03,200
Speaker 1: was a lot of anybody that did addiction medicine and

920
00:53:03,239 --> 00:53:07,120
Speaker 1: worked in a medical system. You know, I work with

921
00:53:07,160 --> 00:53:11,040
Speaker 1: an integrated pain program, so we have psychiatry addiction, clinical pharmacy,

922
00:53:11,440 --> 00:53:16,640
Speaker 1: physical medicine, psychiatry addiction about world. So they'll say you're

923
00:53:16,680 --> 00:53:19,320
Speaker 1: the one you this pay. We don't want this patient

924
00:53:19,360 --> 00:53:22,040
Speaker 1: on the opiates. Can you tape or detox them? But

925
00:53:22,080 --> 00:53:23,800
Speaker 1: a lot of the patients would say to me, to

926
00:53:23,920 --> 00:53:27,480
Speaker 1: other doctors working in pain clinics, hey that buw pernorphine

927
00:53:27,560 --> 00:53:30,480
Speaker 1: stuff work great for my pain. I could think straight,

928
00:53:30,600 --> 00:53:33,400
Speaker 1: I could function again, and I didn't feel like I

929
00:53:33,440 --> 00:53:36,719
Speaker 1: was taking anything. So when you switch people about, you know,

930
00:53:36,800 --> 00:53:40,600
Speaker 1: there's a are a great article in the doc is uh,

931
00:53:40,960 --> 00:53:43,160
Speaker 1: you know, published a lot. He says, a third or

932
00:53:43,160 --> 00:53:46,680
Speaker 1: third the third of people on chronic alpiates that need

933
00:53:46,719 --> 00:53:49,759
Speaker 1: to be on on or felt a need to be

934
00:53:49,880 --> 00:53:53,440
Speaker 1: on something that strong for pain. A third of them,

935
00:53:53,520 --> 00:53:55,879
Speaker 1: it's life changing to put them on to be port orphy.

936
00:53:56,000 --> 00:53:58,960
Speaker 1: A third it's you know, it's okay, may not be

937
00:53:59,040 --> 00:54:03,000
Speaker 1: as well received. And a third issues. It's an opiate

938
00:54:03,080 --> 00:54:06,000
Speaker 1: nause at dizziness, you're tired before it helps the pain.

939
00:54:07,239 --> 00:54:09,919
Speaker 1: So you know, I'm a therapeutic nihilist. I think get

940
00:54:10,080 --> 00:54:13,759
Speaker 1: the less meds the better. But if you're gonna then again,

941
00:54:13,800 --> 00:54:15,719
Speaker 1: I just work with paying positions and we try and

942
00:54:15,719 --> 00:54:19,840
Speaker 1: get people off the opiates. But if they're you know,

943
00:54:20,719 --> 00:54:23,600
Speaker 1: there's a lot of people committing suicide too, because the

944
00:54:23,920 --> 00:54:27,839
Speaker 1: six seven years ago does CDC said get people at

945
00:54:27,960 --> 00:54:31,960
Speaker 1: ninety or less mmy morphine milligramma clobeland So one milligram

946
00:54:32,000 --> 00:54:34,360
Speaker 1: of oxy conton I mean boxy code on is like

947
00:54:34,400 --> 00:54:36,400
Speaker 1: one and a half a morphine. One a hydrocode on

948
00:54:36,480 --> 00:54:39,160
Speaker 1: or an oorco's like one a morphine. Want to dilaud

949
00:54:39,200 --> 00:54:43,239
Speaker 1: it is like four morphine. So you calculate what your

950
00:54:43,280 --> 00:54:46,480
Speaker 1: equivalent in morphine milligrams is and if they're over ninety,

951
00:54:46,520 --> 00:54:49,800
Speaker 1: oh got a taper. Well what if they were? You know,

952
00:54:49,840 --> 00:54:51,600
Speaker 1: I had a layers one hundred and forty miligrams of

953
00:54:51,640 --> 00:54:55,200
Speaker 1: morphine for twenty years she's seventy years old. And suddenly

954
00:54:55,760 --> 00:54:57,879
Speaker 1: the doctor's like, I don't lose my license. I gotta

955
00:54:57,880 --> 00:55:00,880
Speaker 1: get you blow a ninety. No talk about risk benefits.

956
00:55:00,880 --> 00:55:04,880
Speaker 1: So in the literature it does. It says, look definitely

957
00:55:05,040 --> 00:55:07,960
Speaker 1: over fifty mm e fifty miligram's equivalent of morphine, the

958
00:55:08,160 --> 00:55:11,960
Speaker 1: risk of respiratory depression is you know, there's a higher

959
00:55:12,000 --> 00:55:14,279
Speaker 1: death rate, So you certainly not only want to get

960
00:55:14,320 --> 00:55:17,040
Speaker 1: him blown ninety, but under fifty. And opiates are not

961
00:55:17,080 --> 00:55:21,400
Speaker 1: a great chronic pain medication. But in the in the interim,

962
00:55:21,920 --> 00:55:25,239
Speaker 1: if they need to be on an opiate, or if

963
00:55:25,280 --> 00:55:28,120
Speaker 1: they're on one and you want to get them off it,

964
00:55:28,320 --> 00:55:30,719
Speaker 1: why not switch to something safer. So that so that's

965
00:55:30,760 --> 00:55:35,319
Speaker 1: my my arm. It's not for everybody, but it's you

966
00:55:35,400 --> 00:55:37,560
Speaker 1: hit it on the head. But there's there's a stigma.

967
00:55:38,160 --> 00:55:43,000
Speaker 1: And one Ivy League ACTA the mission who I contacted

968
00:55:43,000 --> 00:55:44,680
Speaker 1: because I was like, I'm gonna get fired for what

969
00:55:44,680 --> 00:55:46,239
Speaker 1: I'm doing, but I think I'm doing the right thing.

970
00:55:46,560 --> 00:55:50,319
Speaker 1: He said, you know, he said, I said, why is this?

971
00:55:50,440 --> 00:55:52,880
Speaker 1: And this is probably six seven years ago. I was

972
00:55:52,880 --> 00:55:54,960
Speaker 1: talking to this guy and he said, well, look at

973
00:55:55,000 --> 00:55:57,720
Speaker 1: the money. The big form of puts into viupern orphine.

974
00:55:57,719 --> 00:56:00,759
Speaker 1: Where is it. It's like ninety nine percent for use

975
00:56:00,800 --> 00:56:03,920
Speaker 1: for addictions, And he said, unfortunately a lot of doctors

976
00:56:03,960 --> 00:56:07,239
Speaker 1: get their information from drug detailed people or you know,

977
00:56:07,680 --> 00:56:09,880
Speaker 1: you watch TV. Well, there's not much subox on being

978
00:56:09,920 --> 00:56:13,759
Speaker 1: advertised on TV, but just the information out there disseminated

979
00:56:13,760 --> 00:56:15,759
Speaker 1: to doctors that they hear about buper or FI, they're

980
00:56:15,800 --> 00:56:18,359
Speaker 1: in about subox owner and get I get referrals. Can

981
00:56:18,400 --> 00:56:21,040
Speaker 1: you talk to mister Jones about subox on And I'll go, no,

982
00:56:21,160 --> 00:56:22,600
Speaker 1: I can talk to him about BUEPERI ORFI.

983
00:56:23,680 --> 00:56:27,799
Speaker 2: Yeah, so you just basically have to rebrand it. We'll

984
00:56:27,840 --> 00:56:30,520
Speaker 2: then contact them and say like, let's call it something

985
00:56:30,520 --> 00:56:31,640
Speaker 2: else and it's.

986
00:56:31,760 --> 00:56:37,640
Speaker 1: It's off label FDA approved subbox on sebutexts for chronic paint. Right.

987
00:56:38,200 --> 00:56:41,520
Speaker 1: And the problem is in this country, the higher dose

988
00:56:41,600 --> 00:56:46,799
Speaker 1: forums are subox on subutex. So like medic here, DHHS

989
00:56:47,000 --> 00:56:51,040
Speaker 1: put out a a sort of a pain management bulletin.

990
00:56:51,360 --> 00:56:55,360
Speaker 1: I think it was twenty seventeen or eighteen or twenty

991
00:56:55,440 --> 00:56:59,719
Speaker 1: nineteen September, but basically they then a flow diagram and

992
00:56:59,719 --> 00:57:02,120
Speaker 1: they say said, well and this is dj HSS and

993
00:57:02,120 --> 00:57:04,799
Speaker 1: then the VA and Department of Defense in January. But

994
00:57:04,880 --> 00:57:07,160
Speaker 1: basically their guidelines where if somebody needs to be on

995
00:57:07,239 --> 00:57:09,520
Speaker 1: an opiate, you know, try and get them off the opiate. Ope.

996
00:57:09,560 --> 00:57:12,560
Speaker 1: It's not great, it's really not good for chronic paint.

997
00:57:12,920 --> 00:57:17,360
Speaker 1: But go with bupern orphy if to either detox them

998
00:57:17,480 --> 00:57:19,600
Speaker 1: or if you choose to maintain them at an opiate.

999
00:57:20,120 --> 00:57:22,920
Speaker 1: Medicare does not pay for the higher dose forums. So

1000
00:57:23,280 --> 00:57:25,920
Speaker 1: you have somebody that's sixty six years old, you've gotten

1001
00:57:25,960 --> 00:57:29,240
Speaker 1: them off their their you know, fentanyl patch and their

1002
00:57:29,360 --> 00:57:32,240
Speaker 1: oraco and then they go to fill the prescription and

1003
00:57:32,320 --> 00:57:34,280
Speaker 1: the farms. He goes, oh, you got Medicare Part D.

1004
00:57:34,440 --> 00:57:36,280
Speaker 1: You have to have an addiction diagnosis for us to

1005
00:57:36,280 --> 00:57:39,280
Speaker 1: pay for your box or cyber detext it's and.

1006
00:57:39,800 --> 00:57:41,720
Speaker 2: They just want people to die so they don't have

1007
00:57:41,760 --> 00:57:42,760
Speaker 2: to pay for them anymore.

1008
00:57:42,800 --> 00:57:45,120
Speaker 1: That's well the theory the government.

1009
00:57:47,000 --> 00:57:50,040
Speaker 2: Yeah, that's a whole other, a whole other episode.

1010
00:57:50,040 --> 00:57:53,960
Speaker 1: Bruce, Yeah, get Burger, get Kennedy on here. I'm sure

1011
00:57:54,000 --> 00:57:55,840
Speaker 1: that guy's got some mark.

1012
00:57:56,440 --> 00:57:56,960
Speaker 2: Interesting.

1013
00:57:57,000 --> 00:57:59,720
Speaker 1: You need a contrary and you need a shit stir.

1014
00:58:00,720 --> 00:58:02,480
Speaker 2: But yeah, I mean that would be that would be

1015
00:58:02,560 --> 00:58:06,520
Speaker 2: fun actually to hear that. But I think that. I mean,

1016
00:58:06,560 --> 00:58:08,480
Speaker 2: I'm one of these people that are just like, yeah,

1017
00:58:08,520 --> 00:58:11,360
Speaker 2: there's the whole entire time you're talking about this, I'm like,

1018
00:58:11,480 --> 00:58:17,360
Speaker 2: there's there's absolutely no reason except these barriers of and

1019
00:58:17,400 --> 00:58:19,800
Speaker 2: it has to do with money being made, right, Like

1020
00:58:20,840 --> 00:58:21,480
Speaker 2: that's how I look.

1021
00:58:21,600 --> 00:58:23,920
Speaker 1: Well, I'm telling you, I guarantee you. I don't know

1022
00:58:23,960 --> 00:58:26,560
Speaker 1: how many people you have listening with this thing, theirs

1023
00:58:26,680 --> 00:58:29,960
Speaker 1: or his drop, but you will get just a shipload

1024
00:58:30,040 --> 00:58:32,960
Speaker 1: of that doctor doesn't know what he's talking about, or

1025
00:58:33,000 --> 00:58:36,360
Speaker 1: he's he's a shoal for the drug companies. That's the

1026
00:58:36,440 --> 00:58:40,080
Speaker 1: worst you know, I have had. If you go to

1027
00:58:40,160 --> 00:58:42,760
Speaker 1: drugs dot com, I mean there's a billion pages, but

1028
00:58:42,800 --> 00:58:45,400
Speaker 1: there's one there that says your paring should not be

1029
00:58:45,520 --> 00:58:48,200
Speaker 1: used for pain. It's a terrible paint drug. So when

1030
00:58:48,240 --> 00:58:50,560
Speaker 1: I get a referral, you know from the pain doctors,

1031
00:58:50,560 --> 00:58:54,960
Speaker 1: probably off three or four to more Wednesday, and I

1032
00:58:55,000 --> 00:58:57,720
Speaker 1: spent and you know, my organization's great. They give me

1033
00:58:57,760 --> 00:59:00,480
Speaker 1: an hour to talk to them, and then I will

1034
00:59:00,480 --> 00:59:02,840
Speaker 1: spend an hour and I don't know what I'm getting.

1035
00:59:02,880 --> 00:59:04,440
Speaker 1: Some of them are fit to be tied if had

1036
00:59:04,480 --> 00:59:08,200
Speaker 1: theopia tapered. Others are I don't know who you are.

1037
00:59:08,200 --> 00:59:09,840
Speaker 1: I don't know what this medication you're talking to me

1038
00:59:09,880 --> 00:59:12,680
Speaker 1: about is. And I'm like, I don't know if I

1039
00:59:12,680 --> 00:59:16,200
Speaker 1: canna get you know, punched in the face or yelled at.

1040
00:59:16,560 --> 00:59:19,080
Speaker 1: But I say, well, you know there's They say, well,

1041
00:59:19,120 --> 00:59:20,760
Speaker 1: they said you're talking to be about the box on it,

1042
00:59:20,760 --> 00:59:23,640
Speaker 1: and and I'll say, I want your family, anybody has

1043
00:59:23,640 --> 00:59:25,240
Speaker 1: your nose in your medical business, I'll talk to you

1044
00:59:25,280 --> 00:59:30,680
Speaker 1: about this medication, but I explain what I tried my best,

1045
00:59:30,760 --> 00:59:33,000
Speaker 1: like we were talking about today, how it's different, how

1046
00:59:33,040 --> 00:59:35,760
Speaker 1: it's better if you're not on any oopiah blah blah blah,

1047
00:59:35,800 --> 00:59:38,600
Speaker 1: and and I've had family members and then else I

1048
00:59:38,600 --> 00:59:42,000
Speaker 1: won't prescribe it until a week later. I'll say, I

1049
00:59:42,040 --> 00:59:45,280
Speaker 1: want to meet with you again in the family, bring questions.

1050
00:59:45,880 --> 00:59:49,040
Speaker 1: And it's it's really a shame. It's there's so much

1051
00:59:49,080 --> 00:59:52,919
Speaker 1: misinformation and you know, people that are suffering and paint

1052
00:59:52,960 --> 00:59:55,800
Speaker 1: I'll tell you what, Yeah, it's it's really one of

1053
00:59:55,880 --> 01:00:00,240
Speaker 1: the most underserved communities of patients in medicine. I mean,

1054
01:00:00,440 --> 01:00:03,040
Speaker 1: you know, because it's so frustrating for doctors adding what

1055
01:00:03,040 --> 01:00:04,919
Speaker 1: do you do with these people? You know, you can't

1056
01:00:04,920 --> 01:00:07,400
Speaker 1: give them hope it's They have something called the Beer's

1057
01:00:07,520 --> 01:00:09,120
Speaker 1: List b E E R S. I think it's a

1058
01:00:09,240 --> 01:00:12,240
Speaker 1: doctor beers. It's kind of your drinking beer and it's

1059
01:00:12,240 --> 01:00:14,720
Speaker 1: been around since the nineties. The beers List for medications

1060
01:00:14,720 --> 01:00:18,800
Speaker 1: you shouldn't get people over sixty five. Yeah, there's antibiotics

1061
01:00:18,840 --> 01:00:22,840
Speaker 1: on there. It's muscle relas, smooth muscle relaxes. Oh, it's

1062
01:00:23,560 --> 01:00:27,240
Speaker 1: it's it's really the hands of pain physicians are are

1063
01:00:27,280 --> 01:00:29,919
Speaker 1: more and more time. That's why things like ketamine infusions.

1064
01:00:31,200 --> 01:00:33,680
Speaker 1: You know you're able to do that. You know you're

1065
01:00:33,680 --> 01:00:35,960
Speaker 1: not sending them home with it. Well in some cases

1066
01:00:36,000 --> 01:00:38,640
Speaker 1: they have, but that's available to anyway. I'm rambling.

1067
01:00:40,480 --> 01:00:43,400
Speaker 2: No, this is really this is really good information because

1068
01:00:44,280 --> 01:00:46,520
Speaker 2: I think that a lot even I just did a

1069
01:00:46,560 --> 01:00:49,360
Speaker 2: post on on my website, The grocer Room, about Matthew

1070
01:00:49,360 --> 01:00:53,040
Speaker 2: Perry's death, like more just a dissection of the of

1071
01:00:53,080 --> 01:00:56,160
Speaker 2: the autopsy report, and a couple of people had made

1072
01:00:56,160 --> 01:00:58,840
Speaker 2: comments under there that they are chronic pain patients and

1073
01:00:58,880 --> 01:01:03,439
Speaker 2: they took they were taking uh a hydro codone every day,

1074
01:01:03,560 --> 01:01:06,000
Speaker 2: like the one woman had said that she was taking

1075
01:01:06,520 --> 01:01:10,080
Speaker 2: three a day, And that kind of surprised me because

1076
01:01:10,640 --> 01:01:14,320
Speaker 2: I think it's it's almost a perfect drug that it

1077
01:01:14,400 --> 01:01:16,840
Speaker 2: could have the effect of the opioid but not make

1078
01:01:16,920 --> 01:01:21,520
Speaker 2: a person addicted as addicted to it maybe and high

1079
01:01:21,920 --> 01:01:24,680
Speaker 2: and able to function. I don't I don't see why

1080
01:01:24,720 --> 01:01:29,439
Speaker 2: you wouldn't go with that like sabutext or so yeah,

1081
01:01:29,920 --> 01:01:30,920
Speaker 2: right right, I.

1082
01:01:32,520 --> 01:01:38,120
Speaker 1: It's interesting. Yeah, yeah, I've had I've had pain. Special

1083
01:01:38,200 --> 01:01:40,200
Speaker 1: to say, well, they can only use for pain if

1084
01:01:40,240 --> 01:01:42,960
Speaker 1: they have an addiction. They can only use it for pain.

1085
01:01:43,000 --> 01:01:46,680
Speaker 1: If they don't have an addiction, they can It's just.

1086
01:01:47,520 --> 01:01:51,960
Speaker 2: Okay, yes, it's it's it's really weird that they that

1087
01:01:52,040 --> 01:01:55,040
Speaker 2: they would want the patient to take the other one

1088
01:01:55,080 --> 01:01:57,440
Speaker 2: that could potentially give them addiction. You don't want to

1089
01:01:57,440 --> 01:02:00,280
Speaker 2: wait till a person gets the addiction. Maybe you want

1090
01:02:00,280 --> 01:02:01,880
Speaker 2: to prevent them from getting it.

1091
01:02:03,080 --> 01:02:05,880
Speaker 1: The other one is kreatim. You've heard of kreatum, right, No,

1092
01:02:06,000 --> 01:02:06,800
Speaker 1: I've never heard of that.

1093
01:02:06,840 --> 01:02:07,120
Speaker 2: What's that?

1094
01:02:08,920 --> 01:02:11,400
Speaker 1: Kreatim? I you know, I mean we've been seeing that

1095
01:02:11,440 --> 01:02:15,080
Speaker 1: for years and years. So Creative is a it's sold

1096
01:02:15,080 --> 01:02:17,680
Speaker 1: as a tea or a powder or a pill, and

1097
01:02:17,840 --> 01:02:22,040
Speaker 1: it's derived from a plant that's similar related to the

1098
01:02:22,040 --> 01:02:28,200
Speaker 1: coffee plant, and it is a it's sort of like tramatol.

1099
01:02:28,280 --> 01:02:31,880
Speaker 1: It's it binds the opia receptor, the merror receptor, but

1100
01:02:31,920 --> 01:02:36,600
Speaker 1: it also has NSRI activity, norp an effertser antonin reuptake

1101
01:02:36,720 --> 01:02:40,840
Speaker 1: like effects or or symbalta. So you know, tramadol is

1102
01:02:40,880 --> 01:02:44,440
Speaker 1: an interesting opiate. And if you take towards trama you

1103
01:02:44,480 --> 01:02:46,600
Speaker 1: have a seizure. Right, Why is that? Well, it's because

1104
01:02:47,040 --> 01:02:49,440
Speaker 1: it's like you know, effects or is a NORP an

1105
01:02:49,440 --> 01:02:52,520
Speaker 1: efforts ser atona reuptake inhibitor. So you take a bunch

1106
01:02:52,600 --> 01:02:56,640
Speaker 1: of effects or and you get too much adrenaline your brain,

1107
01:02:56,640 --> 01:02:59,760
Speaker 1: you have a seizure. So this this creative stuff, you know.

1108
01:03:00,600 --> 01:03:05,120
Speaker 1: I mean it's available in head shops and a variety

1109
01:03:05,120 --> 01:03:09,200
Speaker 1: of places. It's still legal, but it's new receptor opiate.

1110
01:03:09,840 --> 01:03:13,160
Speaker 1: It has opiate activity and n sri I activity. So

1111
01:03:13,760 --> 01:03:17,200
Speaker 1: it's considered by a lot of people to be an herb.

1112
01:03:17,320 --> 01:03:21,200
Speaker 1: It's herbal, it's safe, and it's oh we see, we're

1113
01:03:21,240 --> 01:03:23,680
Speaker 1: seeing more and more of it in terms of it's

1114
01:03:24,040 --> 01:03:27,320
Speaker 1: it's like an over the counter tram It all basically, oh.

1115
01:03:27,160 --> 01:03:30,440
Speaker 2: My, go as far as the opiate, and this is

1116
01:03:30,480 --> 01:03:33,000
Speaker 2: something you could just get at like a place that

1117
01:03:33,120 --> 01:03:34,800
Speaker 2: sells vitamins, or something.

1118
01:03:35,400 --> 01:03:38,440
Speaker 1: Unfortunately, Yeah, you go, you go to the places at Selly,

1119
01:03:38,760 --> 01:03:42,760
Speaker 1: the bonds and the and the vapes, and yeah, but

1120
01:03:42,840 --> 01:03:46,200
Speaker 1: it's it's an opiate. It's bad. It's bad news. And

1121
01:03:46,240 --> 01:03:48,920
Speaker 1: then it's perceived as it's sort of like, well, it's

1122
01:03:48,920 --> 01:03:52,280
Speaker 1: Eastern medicine. You know, you you doctors are prescribing all

1123
01:03:52,320 --> 01:03:55,640
Speaker 1: these other things, and it's it's not dangerous. But I've

1124
01:03:55,680 --> 01:04:00,000
Speaker 1: had you know it. Then I had a patient spending

1125
01:04:00,120 --> 01:04:03,400
Speaker 1: fifteen thousand bucks a month for his creative. You get tolerance,

1126
01:04:04,040 --> 01:04:08,120
Speaker 1: you get into into major, and then when you stop,

1127
01:04:08,280 --> 01:04:12,480
Speaker 1: you get antidepressant withdrawal, right, because it's it's got just

1128
01:04:12,520 --> 01:04:14,760
Speaker 1: as much activity as taking effects or some ball to

1129
01:04:14,840 --> 01:04:20,720
Speaker 1: those kind of those kind of prestique the NSRI thing,

1130
01:04:20,880 --> 01:04:25,240
Speaker 1: so creat them. That's the other obiit that that we're seeing.

1131
01:04:25,360 --> 01:04:26,880
Speaker 2: I can't wait to look into that more.

1132
01:04:26,960 --> 01:04:31,480
Speaker 1: That's really krri ato nver don't.

1133
01:04:32,480 --> 01:04:34,200
Speaker 2: We're not trying to push it. We're trying to tell

1134
01:04:34,240 --> 01:04:36,760
Speaker 2: you not to do it. It's not good, all right,

1135
01:04:36,840 --> 01:04:39,200
Speaker 2: So to wrap this up, all right, go ahead.

1136
01:04:39,520 --> 01:04:43,240
Speaker 1: So the last thing is, so do an adolescent addiction medicine.

1137
01:04:43,240 --> 01:04:45,720
Speaker 1: You know they'd send you out. They used to send

1138
01:04:45,720 --> 01:04:47,360
Speaker 1: me out with this guy that was a character aer

1139
01:04:47,840 --> 01:04:50,640
Speaker 1: And I remember they'd send us all kinds of school,

1140
01:04:51,240 --> 01:04:53,840
Speaker 1: but I was reading all the prevention literature. It turned

1141
01:04:53,840 --> 01:04:57,720
Speaker 1: out kids in especially middle school that got you know,

1142
01:04:57,720 --> 01:05:01,520
Speaker 1: when they they'd have the drug record cop come in

1143
01:05:01,600 --> 01:05:03,720
Speaker 1: or whatever and they pass around the pod.

1144
01:05:03,600 --> 01:05:06,480
Speaker 2: Or their T shirts and everything, right.

1145
01:05:06,480 --> 01:05:09,560
Speaker 1: But when they pass around like this is what a

1146
01:05:09,640 --> 01:05:12,040
Speaker 1: joint looks like, they had this this thing in a

1147
01:05:12,080 --> 01:05:14,640
Speaker 1: box and it said, here's a needle, here's a joint.

1148
01:05:15,160 --> 01:05:21,280
Speaker 1: So they found that we kids got information and we're

1149
01:05:21,880 --> 01:05:26,800
Speaker 1: they were essentially desensitized, and those lectures there versus not

1150
01:05:26,920 --> 01:05:30,200
Speaker 1: getting information, they their drug usage would go up. We

1151
01:05:30,200 --> 01:05:32,600
Speaker 1: would put them more at risk because they were desensites, like, oh,

1152
01:05:32,600 --> 01:05:34,400
Speaker 1: that's what a joint looks like, Oh that's LUs do

1153
01:05:34,400 --> 01:05:34,880
Speaker 1: you exct?

1154
01:05:35,480 --> 01:05:38,680
Speaker 2: So yeah, like you're actually teaching them how to use drugs.

1155
01:05:39,560 --> 01:05:42,360
Speaker 1: Yeah, it's like, uh, you know, they're they're naturally any

1156
01:05:42,440 --> 01:05:45,120
Speaker 1: kind of fear they had was sort of dissolved and

1157
01:05:45,120 --> 01:05:50,440
Speaker 1: they're like, oh that doesn't yeah right, all right, Well.

1158
01:05:50,360 --> 01:05:53,120
Speaker 2: So if you had My last question for you is

1159
01:05:53,160 --> 01:05:56,120
Speaker 2: if you had like a magic wand and you've seen

1160
01:05:56,160 --> 01:06:01,320
Speaker 2: all these people addicted to two opioids is something. I mean,

1161
01:06:01,360 --> 01:06:03,760
Speaker 2: obviously we might have already talked about this, that we

1162
01:06:03,880 --> 01:06:07,240
Speaker 2: have this one drug that you don't think is being

1163
01:06:07,440 --> 01:06:11,120
Speaker 2: utilized as well as it should be. But is there

1164
01:06:11,160 --> 01:06:14,880
Speaker 2: anything else that's like blatantly obvious that's going on with

1165
01:06:15,160 --> 01:06:19,560
Speaker 2: either just the government's response or how we've gotten to

1166
01:06:19,640 --> 01:06:23,720
Speaker 2: this point that I feel like it's worse than anything

1167
01:06:23,760 --> 01:06:26,800
Speaker 2: I've ever seen. I mean, you know, you're familiar with Philly.

1168
01:06:27,680 --> 01:06:31,360
Speaker 2: We have a huge problem here, like huge in Kensington

1169
01:06:33,120 --> 01:06:36,040
Speaker 2: Just Street and in Camden to where my husband works.

1170
01:06:36,120 --> 01:06:38,840
Speaker 2: Just I go to visit my husband at the firehouse

1171
01:06:38,840 --> 01:06:42,320
Speaker 2: and there's just people lyned on the street, standing up,

1172
01:06:42,400 --> 01:06:47,439
Speaker 2: nodding off, and it's it's just terrible. How how did

1173
01:06:47,480 --> 01:06:50,200
Speaker 2: we get to this point? And how do we go

1174
01:06:50,680 --> 01:06:51,560
Speaker 2: away from it?

1175
01:06:52,920 --> 01:06:54,480
Speaker 1: Well, I mean, you know, you can get into the

1176
01:06:54,520 --> 01:06:59,760
Speaker 1: politics of it, but the permissive Yeah, I was talking

1177
01:06:59,760 --> 01:07:05,120
Speaker 1: to there's no there's no fundamental objective truth. It's like

1178
01:07:05,200 --> 01:07:07,160
Speaker 1: I was talking to somebody that was in some sort

1179
01:07:07,200 --> 01:07:10,160
Speaker 1: of social service thing and I said, well, somebody psychotic

1180
01:07:10,200 --> 01:07:13,400
Speaker 1: and they're running down the road naked thinking that their God,

1181
01:07:14,080 --> 01:07:16,480
Speaker 1: wouldn't it be better if they were on medication and

1182
01:07:17,040 --> 01:07:20,640
Speaker 1: sort of put in some sort of mandatory Well maybe

1183
01:07:20,640 --> 01:07:23,800
Speaker 1: they're happier that way. You know. It's like wait a second,

1184
01:07:23,920 --> 01:07:28,280
Speaker 1: So the bottom line is homeless. Here's the simple solution, addict.

1185
01:07:29,120 --> 01:07:33,960
Speaker 1: Forced treatment of the addiction, or the recognition of the

1186
01:07:33,600 --> 01:07:38,160
Speaker 1: metal health addiction. That's what you gotta treat. You give

1187
01:07:38,200 --> 01:07:41,080
Speaker 1: them needles, you give them a safe place, you give

1188
01:07:41,120 --> 01:07:44,880
Speaker 1: them drugs to use. That's insane. That's effing insane. So

1189
01:07:44,960 --> 01:07:47,840
Speaker 1: we know what it takes. We know what's a problem

1190
01:07:47,840 --> 01:07:51,160
Speaker 1: with these people. That's not capitalism. I saw some moron

1191
01:07:51,280 --> 01:07:54,840
Speaker 1: from San Francisco. It's capital capitalism. They're freaking addicts. They

1192
01:07:54,840 --> 01:07:56,920
Speaker 1: have a drug addiction. Ask any addict. The only thing

1193
01:07:56,920 --> 01:08:01,840
Speaker 1: that saves of drug court getting locked up, you're decoruicated.

1194
01:08:01,840 --> 01:08:03,280
Speaker 1: You know. It's like when you have those frogs and

1195
01:08:03,280 --> 01:08:05,640
Speaker 1: you pit them and they still move around. That's what

1196
01:08:05,720 --> 01:08:10,080
Speaker 1: these guys are. Once you're addicted, especially math, high potency stuff,

1197
01:08:10,160 --> 01:08:15,120
Speaker 1: math and coke and opiates. They they can't choose, and

1198
01:08:15,160 --> 01:08:16,679
Speaker 1: then you put them in there, out of the street

1199
01:08:17,200 --> 01:08:21,960
Speaker 1: their own try diagnosed. I mean there's psychiatric issues. They

1200
01:08:22,000 --> 01:08:25,559
Speaker 1: have health issues. By that, I mean physical issues, but

1201
01:08:26,120 --> 01:08:30,800
Speaker 1: psychiatric addiction you can't. You have to step in and

1202
01:08:30,920 --> 01:08:34,759
Speaker 1: mandate or give them a chance where they can. So anyway,

1203
01:08:34,840 --> 01:08:38,080
Speaker 1: that's that's the bottom line with holelessness. And I don't

1204
01:08:38,080 --> 01:08:42,559
Speaker 1: know why you know these arguments that it's it's finance,

1205
01:08:42,600 --> 01:08:49,160
Speaker 1: its inequities and financial things. People have psychiatric ANDD or addiction,

1206
01:08:49,760 --> 01:08:53,960
Speaker 1: addiction D or psychiatric and you know you don't, you know,

1207
01:08:54,160 --> 01:08:55,360
Speaker 1: you can give them all the money in the world,

1208
01:08:55,400 --> 01:08:57,360
Speaker 1: all the food. It cracks me up when they distribute

1209
01:08:57,400 --> 01:09:00,320
Speaker 1: turkeys at Thanksgiving to the hallless pot relation.

1210
01:09:01,360 --> 01:09:04,160
Speaker 2: Yeah, it is crazy. You're you're just like you're you're

1211
01:09:04,200 --> 01:09:08,800
Speaker 2: missing the point people. I mean, feels good in the moment,

1212
01:09:09,000 --> 01:09:11,439
Speaker 2: you know, yeah.

1213
01:09:11,320 --> 01:09:14,320
Speaker 1: Exactly, Yeah, No, I mean, do you have to have compassion?

1214
01:09:14,439 --> 01:09:16,400
Speaker 1: But if you know, if you know that if you

1215
01:09:16,439 --> 01:09:18,519
Speaker 1: stick their head in a brain scanner, which you can't

1216
01:09:18,520 --> 01:09:21,880
Speaker 1: reduce everybody down to a lab animal, but once they've

1217
01:09:22,000 --> 01:09:28,040
Speaker 1: been that intense stimulation of their reward center drug reward drug,

1218
01:09:28,280 --> 01:09:32,559
Speaker 1: they can't. They can't. It's like somebody that's starving and

1219
01:09:32,600 --> 01:09:34,439
Speaker 1: there's food there, are you know, are they going to

1220
01:09:34,479 --> 01:09:36,439
Speaker 1: put clothes on or eat the food? Are they going

1221
01:09:36,479 --> 01:09:39,720
Speaker 1: to you know what I say, It becomes there. It's

1222
01:09:39,760 --> 01:09:43,680
Speaker 1: an existential thing, right They talk about existential crisis, like

1223
01:09:44,040 --> 01:09:46,160
Speaker 1: they got to get the drug. They can't make the

1224
01:09:46,280 --> 01:09:50,760
Speaker 1: choice themselves. And uh so almost popular if I had

1225
01:09:50,760 --> 01:09:55,760
Speaker 1: a magic wand you're to get these people to help

1226
01:09:55,800 --> 01:09:58,760
Speaker 1: them they really need and mandated.

1227
01:09:58,960 --> 01:10:02,160
Speaker 2: So okay, it's interesting you have like a really different

1228
01:10:02,200 --> 01:10:05,439
Speaker 2: because like right now, I just went outside to go

1229
01:10:05,479 --> 01:10:08,599
Speaker 2: get my mail and it feels like it's about to snow.

1230
01:10:08,640 --> 01:10:12,759
Speaker 2: It's freezing outside here in Philadelphia area, and you guys

1231
01:10:13,000 --> 01:10:15,680
Speaker 2: have like this beautiful weather all the time. Michelle told

1232
01:10:15,760 --> 01:10:19,240
Speaker 2: us it was like seventy and sunny and ol and

1233
01:10:19,479 --> 01:10:23,120
Speaker 2: you have you have people that are are flocking to

1234
01:10:23,200 --> 01:10:27,479
Speaker 2: live there, a huge homeless population. We we do too here,

1235
01:10:27,560 --> 01:10:30,400
Speaker 2: but not anything like what you guys have. It's just

1236
01:10:30,520 --> 01:10:34,519
Speaker 2: different here. But the I don't know if you've seen

1237
01:10:34,680 --> 01:10:36,840
Speaker 2: there's there was this one I don't know if it

1238
01:10:36,880 --> 01:10:39,480
Speaker 2: was a YouTube or Instagram account that was called Kensington

1239
01:10:39,560 --> 01:10:42,120
Speaker 2: Beach and it was this guy that was just going

1240
01:10:42,120 --> 01:10:46,000
Speaker 2: and filming all of these people. It looks like the

1241
01:10:46,120 --> 01:10:49,920
Speaker 2: zombie apocalypse. It is just it's insane what's going on

1242
01:10:50,080 --> 01:10:54,679
Speaker 2: in Philadelphia area right now? And I don't I don't

1243
01:10:54,720 --> 01:11:00,000
Speaker 2: necessarily think that that they're that it's a huge homeless situation,

1244
01:11:00,120 --> 01:11:02,519
Speaker 2: and I mean there's definitely a lot of it, but

1245
01:11:02,640 --> 01:11:07,680
Speaker 2: not anything like we're seeing in California. But the drugs.

1246
01:11:07,880 --> 01:11:13,479
Speaker 2: I mean, there's people there that have necrotic legs, wounds,

1247
01:11:13,520 --> 01:11:16,240
Speaker 2: open wounds with maggots on them, just on the street

1248
01:11:16,560 --> 01:11:19,639
Speaker 2: nodding off. It's just absolutely insane. What's going on there?

1249
01:11:20,200 --> 01:11:21,920
Speaker 1: Right? It's like where does compassion?

1250
01:11:22,200 --> 01:11:22,320
Speaker 2: Uh?

1251
01:11:23,000 --> 01:11:25,880
Speaker 1: What is real compassion for someone? Sometimes?

1252
01:11:26,200 --> 01:11:28,880
Speaker 2: You know, yeah, and giving them clean needles is not

1253
01:11:29,120 --> 01:11:33,960
Speaker 2: helping them, I mean obviously, like it's just not helping them.

1254
01:11:34,640 --> 01:11:39,400
Speaker 1: No, say that's yeah, and certainly they've been maybe they

1255
01:11:39,400 --> 01:11:43,880
Speaker 1: were victims of the system at one point. But you

1256
01:11:44,000 --> 01:11:46,120
Speaker 1: just talk to people that have been homeless and then

1257
01:11:46,240 --> 01:11:50,200
Speaker 1: got sobriety and got mental health care. They're not going

1258
01:11:50,280 --> 01:11:55,960
Speaker 1: to be endorsing safe injection places and you know, providing

1259
01:11:56,280 --> 01:11:58,840
Speaker 1: providing shelter, let them live in. You know, here's a

1260
01:11:58,840 --> 01:12:01,759
Speaker 1: place they can sleep. But you're not treating their addiction

1261
01:12:01,880 --> 01:12:05,160
Speaker 1: or their mental health issue. You're really just you know,

1262
01:12:05,240 --> 01:12:07,120
Speaker 1: you're contributing to their demise.

1263
01:12:07,439 --> 01:12:09,680
Speaker 2: Yeah, and who cares if I mean, who cares if

1264
01:12:09,680 --> 01:12:12,760
Speaker 2: they're using clean needles though, because if there if they're

1265
01:12:12,800 --> 01:12:14,880
Speaker 2: never going to have a quality of life, Like, what's

1266
01:12:14,920 --> 01:12:19,000
Speaker 2: the difference if they get HIV? Really think about that.

1267
01:12:19,080 --> 01:12:21,640
Speaker 2: If they're just going to be living like zombies on

1268
01:12:21,680 --> 01:12:24,880
Speaker 2: the street, who cares if they get infectious diseases? If

1269
01:12:24,920 --> 01:12:27,640
Speaker 2: they're never going to have a good quality of life.

1270
01:12:27,880 --> 01:12:30,080
Speaker 2: I mean that the ultimate goal should be for them

1271
01:12:30,120 --> 01:12:32,080
Speaker 2: to have a good quality of life.

1272
01:12:32,920 --> 01:12:35,960
Speaker 1: Yeah, well, pathologists are seeing stuff they haven't seen in

1273
01:12:36,000 --> 01:12:37,160
Speaker 1: one hundred years, right.

1274
01:12:37,160 --> 01:12:41,160
Speaker 2: A lot of oh yeah, I'm here in some crazy.

1275
01:12:41,760 --> 01:12:45,360
Speaker 1: Yeah, well they didn't. The system caught things early enough.

1276
01:12:45,360 --> 01:12:47,960
Speaker 1: But these people are there, you know, they're the diseases

1277
01:12:48,120 --> 01:12:52,439
Speaker 1: are It's it's sort of like a fourth World nation

1278
01:12:52,520 --> 01:12:55,479
Speaker 1: where things just there's no intervention for it, you know.

1279
01:12:55,640 --> 01:12:59,639
Speaker 2: Yeah, it's incredibly sad. Thanks so much for being here

1280
01:12:59,680 --> 01:13:03,200
Speaker 2: with us today. This was great. It's very informative because

1281
01:13:03,240 --> 01:13:07,759
Speaker 2: this is so outside of my normal realm of knowledge.

1282
01:13:08,160 --> 01:13:10,920
Speaker 2: And uh, you taught us a lot. It was really good.

1283
01:13:11,000 --> 01:13:15,360
Speaker 1: Oh well great, any any you know, bad feedback you

1284
01:13:15,400 --> 01:13:19,639
Speaker 1: get about me, Please don't tell me. I'm very sensitive

1285
01:13:19,640 --> 01:13:20,560
Speaker 1: to criticism.

1286
01:13:22,160 --> 01:13:29,280
Speaker 2: All right, boys, I'll talk to you later. Thank you

1287
01:13:29,320 --> 01:13:33,000
Speaker 2: for listening to mother. Nos Death As a reminder, my

1288
01:13:33,120 --> 01:13:37,160
Speaker 2: training is as a pathologist assistant. I have a master's

1289
01:13:37,280 --> 01:13:42,320
Speaker 2: level education and specialize in anatomy and pathology education. I

1290
01:13:42,360 --> 01:13:44,559
Speaker 2: am not a doctor and I have not diagnosed or

1291
01:13:44,560 --> 01:13:48,240
Speaker 2: treated anyone dead or alive without the assistance of a

1292
01:13:48,320 --> 01:13:53,719
Speaker 2: licensed medical doctor. This show, my website, and social media

1293
01:13:53,800 --> 01:13:57,040
Speaker 2: accounts are designed to educate and inform people based on

1294
01:13:57,120 --> 01:14:01,519
Speaker 2: my experience working in pathology, so they can make healthier

1295
01:14:01,560 --> 01:14:05,920
Speaker 2: decisions regarding their life and well being. Always remember that

1296
01:14:05,960 --> 01:14:09,000
Speaker 2: science is changing every day and the opinions expressed in

1297
01:14:09,040 --> 01:14:12,080
Speaker 2: this episode are based on my knowledge of those subjects

1298
01:14:12,120 --> 01:14:15,519
Speaker 2: at the time of publication. If you are having a

1299
01:14:15,560 --> 01:14:20,480
Speaker 2: medical problem, have a medical question, or having a medical emergency,

1300
01:14:21,040 --> 01:14:24,439
Speaker 2: please contact your physician or visit an urgent care center,

1301
01:14:24,760 --> 01:14:29,360
Speaker 2: emergency room, or hospital. Please rate, review, and subscribe to

1302
01:14:29,439 --> 01:14:33,800
Speaker 2: Mother Knows Death on Apple, Spotify, YouTube, or anywhere you

1303
01:14:33,840 --> 01:14:45,400
Speaker 2: get podcasts. Thanks