WEBVTT - External Exam - Matthew Perry with Addiction Specialist Dr. Bruce Heischober 0:00:04.720 --> 0:00:09.600 Mother Knows Death presents External Exams with Nicole and Jimmy. 0:00:17.239 --> 0:00:20.120 On our first episode of Mother Knows Death, we talked 0:00:20.120 --> 0:00:23.439 about the death of Matthew Perry and this week his 0:00:23.520 --> 0:00:27.600 autopsy report was released, and since he had such a 0:00:27.600 --> 0:00:30.639 big history of addiction, I thought it would be perfect 0:00:30.640 --> 0:00:32.680 to talk to my friend doctor Bruce. 0:00:32.800 --> 0:00:35.680 Hi, doctor Bruce, how are you good to be here? 0:00:35.840 --> 0:00:38.840 Thanks so much for being here today. I first met 0:00:38.880 --> 0:00:42.559 doctor Bruce doing his podcast. Actually, I was on an 0:00:42.560 --> 0:00:45.159 episode of Weekly Infusion. That's when I first met you. 0:00:45.320 --> 0:00:47.559 And then you came to Philly and we went to 0:00:47.600 --> 0:00:49.600 the Motor Museum together. That was fun. 0:00:49.800 --> 0:00:50.760 Wow, was great. 0:00:51.880 --> 0:00:56.400 So let's tell them a little bit about your history. 0:00:56.600 --> 0:01:00.720 You have been an emergency room doctor for a majority 0:01:00.960 --> 0:01:05.800 of your career. And how did you get into addiction? 0:01:06.040 --> 0:01:09.640 How how will not addiction yourself into the specialty of addiction. 0:01:09.760 --> 0:01:11.560 What was it that was intriguing about that? 0:01:11.600 --> 0:01:13.080 I mean, that's a good that's a good statement. How 0:01:13.120 --> 0:01:16.280 to get into addiction addiction medicine, most people are either 0:01:16.319 --> 0:01:19.120 codependents or recovering, So I was in the codependent. I 0:01:19.160 --> 0:01:22.640 got some great codependency stories. But anyway I was I 0:01:22.680 --> 0:01:28.880 did internal Medicine Training residency took boards and immediately during residency. 0:01:29.160 --> 0:01:31.560 This back in the eighties, there are a lot of 0:01:31.640 --> 0:01:34.840 guys that were like gung ho for excitement, moonlighting and 0:01:34.920 --> 0:01:38.720 emergency department. So I was out in Riverside, San Ardanino 0:01:38.880 --> 0:01:41.520 County and there were a group of u sweek moonlight 0:01:41.560 --> 0:01:45.080 at Riverside County Hospital R And then once the I 0:01:45.120 --> 0:01:48.840 finished internal medicine pass boards and then some of the 0:01:48.840 --> 0:01:51.000 people at Loneo and said, hey, let's start an emergency 0:01:51.000 --> 0:01:54.240 medicine training program. And so it's like back then there 0:01:54.240 --> 0:01:56.680 weren't that many residencies it was in. It was sort 0:01:56.720 --> 0:02:02.000 of a new area of sub of specialization. So we 0:02:02.080 --> 0:02:04.600 started the residency program and we had to pick an 0:02:04.680 --> 0:02:07.240 area that to teach, and I thought, well, drug overdose 0:02:07.760 --> 0:02:10.239 and toxicology, that's great interesting stuff. So I went to 0:02:10.280 --> 0:02:12.640 some meetings at UCLA. This is about nineteen eighty five, 0:02:12.760 --> 0:02:15.440 and the first lecture was I don't know if they 0:02:15.440 --> 0:02:17.160 called it sex, drugs and rock and roll, but it 0:02:17.240 --> 0:02:21.079 was a doctor in Addiction Medicine talking about youth culture 0:02:21.440 --> 0:02:25.040 and adolescent addiction. And I was like blown away as 0:02:25.080 --> 0:02:27.400 I came there here about boring drug I mean, you know, 0:02:27.480 --> 0:02:32.480 not boring drug overdose and toxicology. And then this guy's 0:02:32.480 --> 0:02:35.359 talking about you know. You know at that time, the 0:02:35.400 --> 0:02:38.000 Grateful Dead was still touring and they had the docs 0:02:38.040 --> 0:02:40.880 that went with the Grateful Dead, and you know, and 0:02:40.919 --> 0:02:44.920 then you had it was all. It really meld the youth, culture, music, 0:02:44.960 --> 0:02:47.160 all these interesting things together. So I went up at 0:02:47.160 --> 0:02:49.480 the end of the lecture, I said, what is this 0:02:49.520 --> 0:02:53.680 addiction medicine thing? And so I sort of started. I 0:02:53.680 --> 0:02:57.880 had some training, and I got a position doing addiction, 0:02:58.400 --> 0:03:03.560 adolescent addiction medicine out Redlins within a year, and I 0:03:03.680 --> 0:03:06.880 did it alongside of emergency medicine along the way and 0:03:07.000 --> 0:03:10.560 work with some great people at USC Adolescent Medicine Department 0:03:11.160 --> 0:03:13.679 and met Drew, doctor Drew. That's why I met him 0:03:13.680 --> 0:03:16.800 with k Rock and I was sort of his fill 0:03:16.880 --> 0:03:19.640 in by virtual keeping my mouth shut when he did 0:03:19.760 --> 0:03:24.760 love line for decades. And that's it and it's still 0:03:24.800 --> 0:03:27.040 to this day. So I don't do emergency medicine anymore. 0:03:27.040 --> 0:03:29.840 I quit dury COVID because I'm not a first responder hero. 0:03:29.919 --> 0:03:33.160 I wasn't a hero. I was a whippie guy. But 0:03:33.280 --> 0:03:37.120 I'm doing a ton of so I do addiction medicine 0:03:37.160 --> 0:03:41.720 for a large medical system. I'm still out in Redlands, Riverside, 0:03:41.800 --> 0:03:44.200 and a lot of what I do is around oh 0:03:44.240 --> 0:03:49.120 biate addiction use disorder they call it, and chronic pain 0:03:49.920 --> 0:03:53.040 or both, and use of bubernor feed or sab box 0:03:53.080 --> 0:03:57.760 on sebuitechs, which sort of segueing back into the webtopsy 0:03:57.840 --> 0:04:02.960 taxicology report on Matthew Purriy and coincidentally, you know, ketamine 0:04:03.080 --> 0:04:07.040 is just coming to the UH. It's very popular for 0:04:07.240 --> 0:04:11.520 treating resistant depression and for chronic pain, and you know, 0:04:11.640 --> 0:04:15.280 looking at that whole receptor system and addiction, lots of 0:04:15.320 --> 0:04:19.480 exciting things happening. But since his report, I've gotten some 0:04:19.800 --> 0:04:21.400 I have a lot of chronic pain patients that are 0:04:21.400 --> 0:04:26.279 on buporphene, sabasa and Sevitech's transfer UH chronic pain, and 0:04:26.520 --> 0:04:29.960 they also get treatments with ketamine. And so some very 0:04:30.560 --> 0:04:33.000 very concerned patients, So like, oh my god, am I 0:04:33.040 --> 0:04:36.320 gonna die? I'm getting my ketemie fusion. I'm on pupnorphy 0:04:37.680 --> 0:04:40.159 so and we'll get we'll. 0:04:39.960 --> 0:04:42.919 Get into that because I have I actually have a 0:04:42.960 --> 0:04:47.479 lot of questions about that combination and if that's a 0:04:47.520 --> 0:04:49.800 common thing. But we'll we'll get into that a little 0:04:50.520 --> 0:04:53.520 in a little bit, but first I wanted to get 0:04:53.640 --> 0:04:58.120 started with just the basics of addiction because I don't 0:04:58.160 --> 0:05:02.600 really have anyone in my immediate family that struggles with addiction, 0:05:03.520 --> 0:05:06.200 and including myself either, so I don't know it on 0:05:06.240 --> 0:05:09.400 a personal level, so I do have questions about it. 0:05:09.880 --> 0:05:12.080 I'm a parent. I know you're a parent too, and 0:05:12.520 --> 0:05:14.920 one of my biggest fears is like one of my 0:05:15.040 --> 0:05:17.880 kids is going to grow up and fall into one 0:05:17.920 --> 0:05:21.520 of these addictions. And I guess my first question for 0:05:21.560 --> 0:05:25.520 you about that is is this something that could happen 0:05:25.760 --> 0:05:29.440 to anyone? I mean, Matthew Perry said that when he 0:05:29.480 --> 0:05:33.240 was fourteen he started drinking alcohol, and by eighteen he 0:05:33.360 --> 0:05:37.440 considered himself like a hardcore alcoholic. Is this something that 0:05:37.480 --> 0:05:39.520 could happen to anyone or do you think that there's 0:05:39.520 --> 0:05:43.880 some kind of like predisposing factors that make a person 0:05:44.000 --> 0:05:45.839 more susceptible to addiction. 0:05:46.520 --> 0:05:50.799 Yeah, certainly there's biology, right, So first, if your father 0:05:50.960 --> 0:05:55.960 or mother alcoholic or first degree relative, and then there 0:05:56.080 --> 0:06:02.360 are issues with exposures. So if somebody starts drinking when 0:06:02.360 --> 0:06:05.640 they're fourteen, if they get if they have the availability 0:06:05.640 --> 0:06:08.480 of alcohol or drugs and they start using them, then 0:06:08.839 --> 0:06:12.279 you you know, then you stop the psychosocial development. You 0:06:12.680 --> 0:06:17.279 arrest that way, and it's a matter of becoming something 0:06:17.440 --> 0:06:20.919 that's you know, that's routinely done. So I mean, adolescent's 0:06:20.920 --> 0:06:23.680 a great thing to talk about because if you have 0:06:24.320 --> 0:06:27.960 a very structured existence, if you're you know, if your 0:06:28.279 --> 0:06:31.400 home every evening and your parents are where what you're doing, 0:06:31.400 --> 0:06:34.800 and they know your friends parents and keep tractiving and 0:06:34.839 --> 0:06:38.200 you don't have that exposure. But what did it amoss to. 0:06:38.440 --> 0:06:41.359 There's you know, there's junk science around brain scans, but 0:06:42.960 --> 0:06:46.800 if you look at people. They did a study where 0:06:46.839 --> 0:06:49.520 they took and this I'm just sort of generalizing it, 0:06:49.560 --> 0:06:53.240 but say twenty young adult males and they had a 0:06:53.240 --> 0:06:55.080 control group who had no first year rol as a 0:06:55.080 --> 0:06:58.720 were alcoholic, and then a group whose fathers were alcoholic 0:06:58.760 --> 0:07:01.880 and they were not yet really drinkers, got them all drunk, 0:07:01.920 --> 0:07:03.560 stuck them in a functional in orife. So we know 0:07:03.640 --> 0:07:05.440 the area of the brain the lights up with cocaine 0:07:05.480 --> 0:07:08.440 and her in the reward area in the midbrain. And 0:07:08.440 --> 0:07:14.640 and it's statistically significant proportion. The first the sons of 0:07:14.640 --> 0:07:16.960 alcoholics had a lot more activity there. So I mean 0:07:16.960 --> 0:07:20.480 it's you know, it's sort of a gross representation of 0:07:20.600 --> 0:07:24.920 the biologic nature of it. But if I don't, you know, 0:07:24.760 --> 0:07:27.400 you can both be sitting having a couple of beers 0:07:27.480 --> 0:07:29.760 or whatever age and and what do you ask the 0:07:29.760 --> 0:07:31.280 other guy? Well, what does it feel like to you? 0:07:31.520 --> 0:07:34.440 And so you know, one way is to look at 0:07:34.440 --> 0:07:37.560 what part of the brain, you know, amount of dopamine release, 0:07:37.760 --> 0:07:41.520 sorta tallerant neurotransmitters, activity in the rewards center. So we 0:07:41.600 --> 0:07:47.080 know that there's a different of there's a different reaction 0:07:47.600 --> 0:07:50.960 or activity from alcohol. So the fourteen year old like 0:07:51.000 --> 0:07:53.600 Matthew Perry, I don't know, is you know, And again, 0:07:53.680 --> 0:07:56.920 if there's a childhood trauma, if there's sexual abuse, physical 0:07:56.960 --> 0:08:00.240 abuse pre adolescence, that's another risk. There's a bunch these 0:08:00.280 --> 0:08:04.760 different riskpects. So there's no one one addiction, there's no 0:08:04.840 --> 0:08:08.200 one addiction gene, but certainly the biology is there. And 0:08:08.240 --> 0:08:11.160 then if you figure, you know, I've had patients to 0:08:11.160 --> 0:08:13.160 say the first time I got drunk as a teenager, 0:08:13.320 --> 0:08:14.920 I knew that's what I'm you know, it was just 0:08:14.960 --> 0:08:17.600 like I never felt normal until that point, and I 0:08:17.600 --> 0:08:21.160 immediately and is often going after whatever substance it is, 0:08:21.480 --> 0:08:25.400 So that's a breaking and then it go ahead. So 0:08:25.480 --> 0:08:28.320 that's a very roundabout way partially answering your question. 0:08:28.720 --> 0:08:32.960 Well, my question is, especially talking about that particular study, 0:08:33.040 --> 0:08:35.080 do you think that there could be some aspect of 0:08:36.240 --> 0:08:40.400 it not being biology but just nature, just just being 0:08:40.480 --> 0:08:44.840 around a dad. You saw your dad drink their whole life, 0:08:45.200 --> 0:08:48.160 and maybe some sort of center lights up in your 0:08:48.200 --> 0:08:51.199 brain because it makes you think of like a positive 0:08:53.000 --> 0:08:55.640 experience when you were a child or something. 0:08:55.880 --> 0:09:00.440 Right, so you know there's conditioning, and certainly that would 0:09:00.800 --> 0:09:03.840 and then a dad that drinks with a certain effect 0:09:04.160 --> 0:09:07.160 or is you know, is the a binge drinker and 0:09:08.120 --> 0:09:11.320 abusive intermittently or is he a daily drinker and abusive 0:09:11.360 --> 0:09:14.480 every day or neglectful. It's so complex, but we know 0:09:14.559 --> 0:09:16.600 the you know, in the and then again what about 0:09:16.880 --> 0:09:20.520 bonding the first couple of years, attachment theory, So these 0:09:20.559 --> 0:09:26.920 things all come into play, and there's no doubt separating 0:09:26.960 --> 0:09:31.959 them is difficult. But you're right, there's the there's pair 0:09:32.000 --> 0:09:36.000 of parental modeling, and then there's the genetics there and 0:09:36.000 --> 0:09:40.680 then there's the exposure. Pretty complicated, right, So do. 0:09:40.600 --> 0:09:45.040 You feel as if any drugs I mean, I sound 0:09:45.080 --> 0:09:47.960 like a commercial from the eighties when I was growing up. 0:09:48.000 --> 0:09:53.120 But do you feel that there's like gateway drugs, cigarettes, alcohol, 0:09:53.280 --> 0:09:58.120 or anything that starts a child because you have children 0:09:58.320 --> 0:10:01.120 that eventually turn into one of these addicts. Is there 0:10:01.160 --> 0:10:04.480 some kind of like predisposing thing that you might see 0:10:04.520 --> 0:10:07.520 prior to an addiction starting. 0:10:09.040 --> 0:10:13.480 You know, again, it's that mood alterar effect. And obviously 0:10:13.520 --> 0:10:17.960 anybody that gets cocaine or heroin or methamphetamine and depends 0:10:18.000 --> 0:10:19.720 how much, but I mean get you're going to get 0:10:19.720 --> 0:10:24.720 that immediate rush and the euphoria, and once that part 0:10:24.720 --> 0:10:27.360 of the brain, the lizard I called the lizard brain, 0:10:28.400 --> 0:10:31.920 recognizes that, then you know, is it going to be 0:10:31.960 --> 0:10:33.640 available the next week, is it going to be a 0:10:33.760 --> 0:10:37.520 year later? Because adolescence is a time when you you know, 0:10:37.559 --> 0:10:41.000 there's there's no rehabilitation if you haven't abilitated, if you 0:10:41.040 --> 0:10:45.119 haven't had the normal development that occurs. So the exposure 0:10:45.160 --> 0:10:49.800 piece of it again is if if a kid's is 0:10:49.840 --> 0:10:52.960 there a gateway drug? I say, whatever? Drugs like for me, 0:10:53.080 --> 0:10:55.040 I tried pop when I was fifteen. I hate it. 0:10:55.040 --> 0:11:00.120 It's like just and you know, it was not something 0:11:00.120 --> 0:11:02.000 I was going to get addicted to. But you get 0:11:02.000 --> 0:11:06.239 a kid with the biology where they get more you know, dopamiricus, 0:11:06.320 --> 0:11:09.920 whatever it is that causes there's some euphoria there. That's 0:11:09.960 --> 0:11:11.840 going to be a gateway drug. So to me, it's 0:11:12.160 --> 0:11:15.640 at that age if you start having reward and euphoria 0:11:15.800 --> 0:11:18.760 from something that cut it's like if you if you 0:11:20.200 --> 0:11:23.199 just like with with sel, what's the problem with smartphones, 0:11:23.240 --> 0:11:28.160 what's the problem with online gambling? Is that immediate dopamine rush, 0:11:28.160 --> 0:11:31.320 whether it's you know, and kids watching what's the average 0:11:31.320 --> 0:11:33.839 agent for a kid watches porn in North America eight 0:11:33.920 --> 0:11:34.319 years old? 0:11:35.600 --> 0:11:36.680 That is that real? 0:11:37.520 --> 0:11:42.280 Yeah, I believe that's right, And I'm sure, I'm sure 0:11:42.320 --> 0:11:44.240 you know, I'm sort of generalizing a lot of stuff. 0:11:44.280 --> 0:11:48.560 But the bottom line is the more immediate the responses 0:11:48.679 --> 0:11:51.440 to a stimulus where you get dopamine, you know whatever 0:11:51.559 --> 0:11:58.040 dopamine make release of you know, these pleasure neurotransmitters, the 0:11:58.120 --> 0:12:02.160 and if a kid doesn't have uh, you know, they 0:12:02.200 --> 0:12:05.120 haven't built up any defenses, they haven't learned to, you know, 0:12:05.200 --> 0:12:08.840 fend for themselves in difficult situations. You know that that 0:12:08.960 --> 0:12:11.520 growth the process of the three stages of adolescents early 0:12:11.559 --> 0:12:14.560 adolescens mid late. If they can't get through that, they 0:12:15.360 --> 0:12:19.480 you know, the student, the earlier they start, that's sort 0:12:19.480 --> 0:12:23.439 of where your psychosocial development arrests. So it gets very complicated. 0:12:23.440 --> 0:12:31.000 It's like a dysfunctional home, a using parent, pre adolescent abuse. No. 0:12:31.160 --> 0:12:32.839 I mean a lot of therapists will say, well, how 0:12:32.920 --> 0:12:34.800 is you know what what went on during your mother's 0:12:34.800 --> 0:12:37.360 pregnancy with you? You know, was was it a veray? 0:12:37.640 --> 0:12:39.679 Was there a lot of stress? Was there high cortisol? 0:12:40.000 --> 0:12:42.200 All kinds of ways of looking at it to put 0:12:42.200 --> 0:12:46.440 you at risk. So but to me, I you know 0:12:46.480 --> 0:12:48.400 what's the worst drug. It's the one that the kid 0:12:48.480 --> 0:12:52.520 starts using in this day and age, I worry about poisoning. Right, 0:12:52.600 --> 0:12:56.040 It's like fentanyl, car fentelso, feneral, whatever these things are 0:12:56.080 --> 0:13:00.199 out there, these are there's this whole other uh, their 0:13:00.240 --> 0:13:03.880 expanse of risk that comes from just being exposed one 0:13:03.920 --> 0:13:07.439 time in dying. So that that's the you know with 0:13:07.520 --> 0:13:09.840 my kids they're a little older now, but even even 0:13:09.880 --> 0:13:13.400 in their twenties, I say, look, it's one dose. You know, 0:13:13.440 --> 0:13:15.560 you go to a party and somebody says, hey try 0:13:15.600 --> 0:13:20.000 this pill or you know pot there's disagreement. You know 0:13:20.040 --> 0:13:23.160 that whether there's ventanyl in pot but definitely in cocaine, 0:13:23.720 --> 0:13:30.160 definitely any any pill you get, the x annex, the norcos, 0:13:30.320 --> 0:13:36.280 the the oxycons. These these people there, whether they're cartels 0:13:36.400 --> 0:13:40.320 or whoever's selling drugs, they have pill presses that make 0:13:40.400 --> 0:13:43.760 identical pills to the pharmaceutical but they throw fentanyl in there. 0:13:43.800 --> 0:13:46.160 So that's the one thing with that I don't think 0:13:46.160 --> 0:13:49.640 we thought about as much prior to this whole fentanyl 0:13:49.960 --> 0:13:53.760 scourge is poisoning. And so how many kids they go 0:13:53.840 --> 0:13:57.560 to a party and friend says, hey, try this, you know, 0:13:57.800 --> 0:14:00.239 it's like they're dead. 0:14:00.520 --> 0:14:02.440 Well, I think that's why I'm so scared because I 0:14:02.559 --> 0:14:05.439 was that kid, right like I've done. I did all 0:14:05.440 --> 0:14:07.960 that stuff when I was a teenager, and never like 0:14:08.040 --> 0:14:11.560 my older daughter she is, she's just a very she 0:14:11.760 --> 0:14:15.280 listens like if you say, don't try jougs because you 0:14:15.320 --> 0:14:17.640 can get you can get killed and stuff. She she 0:14:17.800 --> 0:14:19.880 listened to that. But I was that kid that was like, 0:14:19.960 --> 0:14:22.960 that ain't gonna happen to me. That's what's that's what's scary. 0:14:23.080 --> 0:14:26.040 Because you hear about this all the time on the 0:14:26.080 --> 0:14:30.680 news and stuff. Parents just so distraw obviously because their 0:14:30.760 --> 0:14:33.640 kid wasn't even doing drugs really, just like trying something 0:14:33.640 --> 0:14:36.080 and they just died taking it once. It's so scary. 0:14:37.200 --> 0:14:39.960 Yep. My friend of mine is mom. She passed away. 0:14:40.000 --> 0:14:42.720 She was like one hundred and one. But there was 0:14:42.760 --> 0:14:44.960 a delay of putting your plaque up or something. So 0:14:45.000 --> 0:14:48.800 they were at it wherever, you know, the cemetery of 0:14:48.800 --> 0:14:52.280 the Morchwark and they were at the marketing person's desk 0:14:52.320 --> 0:14:54.320 for something. But she said they had some sort of 0:14:54.320 --> 0:14:56.920 a video and it would show a picture for a 0:14:57.000 --> 0:14:58.760 few seconds and then the next one of these are 0:14:58.800 --> 0:15:02.240 people that had passed away. And she's a she's a 0:15:02.320 --> 0:15:06.200 nurse and her sister was had a substance issue. So 0:15:06.240 --> 0:15:09.480 she was very, uh, you know, curious about all these 0:15:09.520 --> 0:15:11.800 young people that she saw. And they were sitting there 0:15:11.840 --> 0:15:14.520 for half an hour, she said, just constantly, and she said, 0:15:14.680 --> 0:15:17.520 you know, it seems like a lot of these people 0:15:17.600 --> 0:15:20.720 you have that have come through here or buried here 0:15:20.840 --> 0:15:23.920 are young. And they said, there's she said, it's just 0:15:24.800 --> 0:15:28.800 unbelievable how many young people come in with you know, drug, 0:15:28.840 --> 0:15:32.440 fentmol overdose herself whatever. It's just but I hate, you know, pot. 0:15:33.200 --> 0:15:36.680 I'm pot is just it's it's no longer pot I mean, 0:15:36.680 --> 0:15:39.920 cannabis today is so potent, and it's there's so much 0:15:39.960 --> 0:15:45.760 disregard for it, and that's so what's you know, there's 0:15:45.920 --> 0:15:48.680 it's different now that it was when when it's you know, 0:15:48.720 --> 0:15:51.320 the eighties, things started to change when the cannabis, you know, 0:15:51.360 --> 0:15:54.440 all these strains that are and then the wax ninety 0:15:54.440 --> 0:15:58.240 percent THC. It's just a different it's a different actor 0:15:58.320 --> 0:15:59.920 and affixed brain development. 0:16:00.120 --> 0:16:04.040 It. Oh. I had a situation with with edible weed 0:16:04.200 --> 0:16:06.960 that I I have never and I've tried some things 0:16:06.960 --> 0:16:09.640 in my life when I was younger and then I haven't. 0:16:09.840 --> 0:16:12.880 I haven't done anything since the nineties and except weed. 0:16:13.360 --> 0:16:15.680 And I took an edible weed too much of it, 0:16:15.720 --> 0:16:18.840 I guess, and I was like tripping, like I was 0:16:18.880 --> 0:16:21.360 on acid or something. It was insane. I thought that 0:16:21.480 --> 0:16:24.080 I was poisoned. It was. It was the most surreal 0:16:24.120 --> 0:16:28.160 experience and I'll never do it again. Obviously scared the 0:16:28.160 --> 0:16:28.800 shit out of me. 0:16:30.440 --> 0:16:36.720 Yeah, well, you know, it's definitely it's definitely a different 0:16:36.760 --> 0:16:39.960 scenario than what was it. In the John Lennon's Harmless 0:16:39.960 --> 0:16:41.840 Giggle that he talked about pot it was like point 0:16:41.840 --> 0:16:45.800 five percent THC and you compare that to who knows 0:16:45.800 --> 0:16:47.800 how much THAC is and somebody l you just don't 0:16:47.800 --> 0:16:49.000 really know what you're getting. 0:16:49.040 --> 0:16:52.600 But oh yeah it was I was I was like hallucinating. 0:16:52.640 --> 0:16:55.720 It was terrible. I didn't even know that we could 0:16:55.800 --> 0:16:56.520 do that to you. 0:16:56.800 --> 0:17:01.720 Yeah, it's technically a hallucinogen. Yeah, and it's one of 0:17:01.760 --> 0:17:05.280 those things when when kids start doing that, when they're 0:17:05.359 --> 0:17:11.359 thirteen or fourteen, it's you know, the future is not 0:17:11.560 --> 0:17:14.280 very bright if you're smoking that kind of the view 0:17:14.320 --> 0:17:15.760 use that kind of pot every day. 0:17:15.680 --> 0:17:18.760 Right, So yeah, it's definitely can't be good for your brain. 0:17:19.200 --> 0:17:22.440 So you you deal with all different kinds of addictions, 0:17:22.480 --> 0:17:26.640 but you you really you specialize in the opioid addictions. 0:17:26.720 --> 0:17:30.760 How as far as percentages of your patients go. Is 0:17:30.800 --> 0:17:34.679 that the most frequently used drug that people tend to 0:17:34.760 --> 0:17:37.240 abuse nowadays? 0:17:38.040 --> 0:17:42.400 Well, you know it's still in high school, it's still alcohol, cannabis, right, 0:17:43.320 --> 0:17:48.600 pot and alcohol is still still almost common. Cocaines made 0:17:48.640 --> 0:17:56.240 a resurgence ketamine abuse, you know, specil k there's you know, 0:17:56.280 --> 0:17:59.280 it just depends in the age group. And you're getting 0:17:59.320 --> 0:18:04.760 so much more news worthy stories about fentanyl again the overdoses, 0:18:04.840 --> 0:18:10.320 the poisoning. But we see most in the hospital system 0:18:10.320 --> 0:18:14.760 I am. We're seeing mostly adults. And the question I 0:18:14.800 --> 0:18:18.480 have it's like, it seems like there's just much disregard 0:18:18.560 --> 0:18:23.800 for alcohol and cannabis products in teenagers. I know, you know, 0:18:23.840 --> 0:18:26.000 a few decades ago, I was seeing a lot of 0:18:26.600 --> 0:18:29.159 kids coming in for alcohol and pot problems, and I 0:18:29.720 --> 0:18:33.520 don't know if they're graduating more rapidly to the you know, 0:18:33.560 --> 0:18:36.960 to methamphetamy and cocaine. But I just I don't see 0:18:36.960 --> 0:18:39.840 the referrals in our large medical system. So I'm seeing 0:18:39.840 --> 0:18:42.879 tons of adults and still you know, the older adults 0:18:42.880 --> 0:18:48.360 a lot of alcohol and the you know, a lot 0:18:48.400 --> 0:18:51.359 of opiate patience. See, part of it is retention and treatment. 0:18:51.480 --> 0:18:54.399 So there's an opia called bupin orphis the box on 0:18:54.440 --> 0:18:58.240 Seviitex's ub solved, various names for it, and it's used 0:18:59.200 --> 0:19:02.280 you give it on a daily basis to alleviate craving. 0:19:02.480 --> 0:19:05.439 And those patients stay with you, so we see them 0:19:05.440 --> 0:19:08.840 every month every two months for refills and and they're 0:19:08.880 --> 0:19:13.040 retained in the program. So you know, with other drugs, 0:19:13.080 --> 0:19:16.240 generally you get them into treatment, they start working a program, 0:19:17.760 --> 0:19:19.760 you know, and you don't continue to follow them, so 0:19:19.840 --> 0:19:21.840 you build up a lot of the opiate patients. It's 0:19:21.920 --> 0:19:24.200 it's much longer term. 0:19:24.720 --> 0:19:27.200 So a patient would come to you that was either 0:19:27.359 --> 0:19:32.080 addicted to pills or even heroin, and the part of 0:19:32.119 --> 0:19:34.600 their treatment is for you to give them this drug 0:19:34.680 --> 0:19:37.160 that's kind of is it to kind of like wean 0:19:37.240 --> 0:19:38.800 them down off of it. 0:19:40.160 --> 0:19:44.760 So bupernorphine is an opiate, and it was discovered in 0:19:44.800 --> 0:19:50.080 the sixties and trial. It's semisynthetic. It's derived from debane, 0:19:50.119 --> 0:19:52.280 which is part of something come out coming out of 0:19:52.320 --> 0:19:55.000 poppy plant, and it was trialed in the seventies. It 0:19:55.119 --> 0:19:57.440 was released in like seventy nine or eighty over here 0:19:57.440 --> 0:20:00.280 for pain. It was another pain opiate. They did didn't 0:20:00.280 --> 0:20:03.760 really know what opiate's where opiates went in the central 0:20:03.800 --> 0:20:06.800 nervous system. They didn't discover the first opiate receptor until 0:20:06.800 --> 0:20:10.040 I nineteen seventy six, and then it was like, oh, 0:20:10.280 --> 0:20:12.600 this elop it's work. They'd bind to this receptor I 0:20:12.600 --> 0:20:14.919 think was the MWe receptor was the first one. And 0:20:14.960 --> 0:20:19.280 then in the eighties and nineties, much more understanding of 0:20:19.800 --> 0:20:24.320 different opiates worked more different parts of the brain, and 0:20:24.440 --> 0:20:27.040 this one buper and orphine. They noticed it had much 0:20:27.119 --> 0:20:31.680 less activity in this in the cent the brain, mid brain, 0:20:32.840 --> 0:20:38.360 minimal binding in the respiratory center. The you know, all opiates, 0:20:38.400 --> 0:20:41.680 it's not really talked about much, but opiate suppressed the 0:20:41.680 --> 0:20:47.560 immune system. They decrease the hypothalamic pituitary axis that makes 0:20:47.680 --> 0:20:52.320 like testosterone. They decrease testosterone. And those are big things 0:20:53.400 --> 0:20:57.840 immune suppression, respiratory depression. And it turned out the buper 0:20:57.840 --> 0:21:01.440 and orphine had minimal like is a sole agent. If 0:21:01.440 --> 0:21:03.200 I if you put an ib in my arm and 0:21:03.280 --> 0:21:06.480 gave me more than the maximum dose, I wouldn't stop reading, 0:21:06.480 --> 0:21:08.880 which is crazy for an opiate. If you add alcohol 0:21:09.080 --> 0:21:11.720 or you know, a value or something, it's a different story, 0:21:11.760 --> 0:21:15.480 but it's it's basically it's much safer. So they said, 0:21:15.480 --> 0:21:18.040 and if you have an opiate addict and they commit 0:21:18.119 --> 0:21:20.000 to treatment, you know, you could offer a method all 0:21:20.000 --> 0:21:21.720 which is a potent opia. They have to go to 0:21:21.760 --> 0:21:24.120 a clinic ticket every day to alleviate craving. They said, 0:21:24.119 --> 0:21:26.720 why don't we release this dupern urphene in a higher dose. 0:21:26.800 --> 0:21:33.320 Four practitioners in their office can dispense it, and ideally 0:21:33.320 --> 0:21:36.000 you have the patient go to you know, night twelve 0:21:36.040 --> 0:21:39.160 step meetings, they have a therapist, you follow them every 0:21:39.840 --> 0:21:41.920 The recommendation at first was you see them every two 0:21:41.920 --> 0:21:44.800 weeks and every four weeks, but it was to alleviate 0:21:44.840 --> 0:21:47.119 craving and it didn't go to the rewards center. So 0:21:47.520 --> 0:21:50.600 this has been out twenty plus, about twenty one years, 0:21:50.640 --> 0:21:53.960 and it's it was very controversial at first because what 0:21:54.200 --> 0:21:56.280 people in the recovery field would say is duper and 0:21:56.359 --> 0:22:00.720 orphiene suboxol subtexts, subs. You're giving an opiate for an opiate, 0:22:00.720 --> 0:22:03.800 you're not really clean and sober. And there's a lot 0:22:03.800 --> 0:22:05.719 of argument, how can you tell me that if you're 0:22:05.760 --> 0:22:09.480 giving an opiate to someone, they're not getting high on it. 0:22:09.520 --> 0:22:11.720 But a lot of studies were done and it and 0:22:11.760 --> 0:22:16.560 they determine the retention and treatment. There's huge difference in 0:22:16.600 --> 0:22:21.440 retention and treatment and the you know, the the overdose debts. 0:22:21.880 --> 0:22:23.959 So basically right now, the standard of care is like 0:22:23.960 --> 0:22:27.000 one to three years on syboxa rebup and ORP or 0:22:27.040 --> 0:22:34.840 more when the patient's carefully monitored. And it's that's so 0:22:34.960 --> 0:22:39.479 an addiction medicine. When you're treating opiate addiction, can you 0:22:39.560 --> 0:22:41.960 take this it's a sublingual form. It's a it's a 0:22:41.960 --> 0:22:45.400 film or a tablet put under your tongue and could 0:22:45.480 --> 0:22:48.360 you take that and inject it and get high? Well, 0:22:48.400 --> 0:22:50.480 you can get high injecting ben a drill. I've had 0:22:50.520 --> 0:22:54.400 patients that snorted prozac. I mean, certainly it's an opiate 0:22:54.440 --> 0:22:57.359 and if you misuse it, Uh, there are issues, but 0:22:57.480 --> 0:23:01.399 it has it really is revolutionized. And the reason is 0:23:01.960 --> 0:23:05.919 again I'm still totally totally behind. I tell my patients 0:23:05.960 --> 0:23:08.080 it's almost a requirement you have to go to work 0:23:08.080 --> 0:23:12.560 a program. You need to address issues in therapy depending 0:23:12.600 --> 0:23:16.160 on the patient, but definitely twelve step is a foundation. 0:23:16.720 --> 0:23:19.360 But what this type of thing buprien orphin does is 0:23:19.680 --> 0:23:24.280 when once somebody has an opiate addiction, then what we 0:23:24.400 --> 0:23:28.560 find is the the the mid brain, the part of 0:23:28.600 --> 0:23:30.919 the brain that tells you to breathe when you and 0:23:30.960 --> 0:23:33.280