Speaker 1: Mother Knows Death presents External Exams with Nicole and Jimmy.
Speaker 2: On our first episode of Mother Knows Death, we talked
Speaker 2: about the death of Matthew Perry and this week his
Speaker 2: autopsy report was released, and since he had such a
Speaker 2: big history of addiction, I thought it would be perfect
Speaker 2: to talk to my friend doctor Bruce.
Speaker 1: Hi, doctor Bruce, how are you good to be here?
Speaker 2: Thanks so much for being here today. I first met
Speaker 2: doctor Bruce doing his podcast. Actually, I was on an
Speaker 2: episode of Weekly Infusion. That's when I first met you.
Speaker 2: And then you came to Philly and we went to
Speaker 2: the Motor Museum together. That was fun.
Speaker 1: Wow, was great.
Speaker 2: So let's tell them a little bit about your history.
Speaker 2: You have been an emergency room doctor for a majority
Speaker 2: of your career. And how did you get into addiction?
Speaker 2: How how will not addiction yourself into the specialty of addiction.
Speaker 2: What was it that was intriguing about that?
Speaker 1: I mean, that's a good that's a good statement. How
Speaker 1: to get into addiction addiction medicine, most people are either
Speaker 1: codependents or recovering, So I was in the codependent. I
Speaker 1: got some great codependency stories. But anyway I was I
Speaker 1: did internal Medicine Training residency took boards and immediately during residency.
Speaker 1: This back in the eighties, there are a lot of
Speaker 1: guys that were like gung ho for excitement, moonlighting and
Speaker 1: emergency department. So I was out in Riverside, San Ardanino
Speaker 1: County and there were a group of u sweek moonlight
Speaker 1: at Riverside County Hospital R And then once the I
Speaker 1: finished internal medicine pass boards and then some of the
Speaker 1: people at Loneo and said, hey, let's start an emergency
Speaker 1: medicine training program. And so it's like back then there
Speaker 1: weren't that many residencies it was in. It was sort
Speaker 1: of a new area of sub of specialization. So we
Speaker 1: started the residency program and we had to pick an
Speaker 1: area that to teach, and I thought, well, drug overdose
Speaker 1: and toxicology, that's great interesting stuff. So I went to
Speaker 1: some meetings at UCLA. This is about nineteen eighty five,
Speaker 1: and the first lecture was I don't know if they
Speaker 1: called it sex, drugs and rock and roll, but it
Speaker 1: was a doctor in Addiction Medicine talking about youth culture
Speaker 1: and adolescent addiction. And I was like blown away as
Speaker 1: I came there here about boring drug I mean, you know,
Speaker 1: not boring drug overdose and toxicology. And then this guy's
Speaker 1: talking about you know. You know at that time, the
Speaker 1: Grateful Dead was still touring and they had the docs
Speaker 1: that went with the Grateful Dead, and you know, and
Speaker 1: then you had it was all. It really meld the youth, culture, music,
Speaker 1: all these interesting things together. So I went up at
Speaker 1: the end of the lecture, I said, what is this
Speaker 1: addiction medicine thing? And so I sort of started. I
Speaker 1: had some training, and I got a position doing addiction,
Speaker 1: adolescent addiction medicine out Redlins within a year, and I
Speaker 1: did it alongside of emergency medicine along the way and
Speaker 1: work with some great people at USC Adolescent Medicine Department
Speaker 1: and met Drew, doctor Drew. That's why I met him
Speaker 1: with k Rock and I was sort of his fill
Speaker 1: in by virtual keeping my mouth shut when he did
Speaker 1: love line for decades. And that's it and it's still
Speaker 1: to this day. So I don't do emergency medicine anymore.
Speaker 1: I quit dury COVID because I'm not a first responder hero.
Speaker 1: I wasn't a hero. I was a whippie guy. But
Speaker 1: I'm doing a ton of so I do addiction medicine
Speaker 1: for a large medical system. I'm still out in Redlands, Riverside,
Speaker 1: and a lot of what I do is around oh
Speaker 1: biate addiction use disorder they call it, and chronic pain
Speaker 1: or both, and use of bubernor feed or sab box
Speaker 1: on sebuitechs, which sort of segueing back into the webtopsy
Speaker 1: taxicology report on Matthew Purriy and coincidentally, you know, ketamine
Speaker 1: is just coming to the UH. It's very popular for
Speaker 1: treating resistant depression and for chronic pain, and you know,
Speaker 1: looking at that whole receptor system and addiction, lots of
Speaker 1: exciting things happening. But since his report, I've gotten some
Speaker 1: I have a lot of chronic pain patients that are
Speaker 1: on buporphene, sabasa and Sevitech's transfer UH chronic pain, and
Speaker 1: they also get treatments with ketamine. And so some very
Speaker 1: very concerned patients, So like, oh my god, am I
Speaker 1: gonna die? I'm getting my ketemie fusion. I'm on pupnorphy
Speaker 1: so and we'll get we'll.
Speaker 2: Get into that because I have I actually have a
Speaker 2: lot of questions about that combination and if that's a
Speaker 2: common thing. But we'll we'll get into that a little
Speaker 2: in a little bit, but first I wanted to get
Speaker 2: started with just the basics of addiction because I don't
Speaker 2: really have anyone in my immediate family that struggles with addiction,
Speaker 2: and including myself either, so I don't know it on
Speaker 2: a personal level, so I do have questions about it.
Speaker 2: I'm a parent. I know you're a parent too, and
Speaker 2: one of my biggest fears is like one of my
Speaker 2: kids is going to grow up and fall into one
Speaker 2: of these addictions. And I guess my first question for
Speaker 2: you about that is is this something that could happen
Speaker 2: to anyone? I mean, Matthew Perry said that when he
Speaker 2: was fourteen he started drinking alcohol, and by eighteen he
Speaker 2: considered himself like a hardcore alcoholic. Is this something that
Speaker 2: could happen to anyone or do you think that there's
Speaker 2: some kind of like predisposing factors that make a person
Speaker 2: more susceptible to addiction.
Speaker 1: Yeah, certainly there's biology, right, So first, if your father
Speaker 1: or mother alcoholic or first degree relative, and then there
Speaker 1: are issues with exposures. So if somebody starts drinking when
Speaker 1: they're fourteen, if they get if they have the availability
Speaker 1: of alcohol or drugs and they start using them, then
Speaker 1: you you know, then you stop the psychosocial development. You
Speaker 1: arrest that way, and it's a matter of becoming something
Speaker 1: that's you know, that's routinely done. So I mean, adolescent's
Speaker 1: a great thing to talk about because if you have
Speaker 1: a very structured existence, if you're you know, if your
Speaker 1: home every evening and your parents are where what you're doing,
Speaker 1: and they know your friends parents and keep tractiving and
Speaker 1: you don't have that exposure. But what did it amoss to.
Speaker 1: There's you know, there's junk science around brain scans, but
Speaker 1: if you look at people. They did a study where
Speaker 1: they took and this I'm just sort of generalizing it,
Speaker 1: but say twenty young adult males and they had a
Speaker 1: control group who had no first year rol as a
Speaker 1: were alcoholic, and then a group whose fathers were alcoholic
Speaker 1: and they were not yet really drinkers, got them all drunk,
Speaker 1: stuck them in a functional in orife. So we know
Speaker 1: the area of the brain the lights up with cocaine
Speaker 1: and her in the reward area in the midbrain. And
Speaker 1: and it's statistically significant proportion. The first the sons of
Speaker 1: alcoholics had a lot more activity there. So I mean
Speaker 1: it's you know, it's sort of a gross representation of
Speaker 1: the biologic nature of it. But if I don't, you know,
Speaker 1: you can both be sitting having a couple of beers
Speaker 1: or whatever age and and what do you ask the
Speaker 1: other guy? Well, what does it feel like to you?
Speaker 1: And so you know, one way is to look at
Speaker 1: what part of the brain, you know, amount of dopamine release,
Speaker 1: sorta tallerant neurotransmitters, activity in the rewards center. So we
Speaker 1: know that there's a different of there's a different reaction
Speaker 1: or activity from alcohol. So the fourteen year old like
Speaker 1: Matthew Perry, I don't know, is you know, And again,
Speaker 1: if there's a childhood trauma, if there's sexual abuse, physical
Speaker 1: abuse pre adolescence, that's another risk. There's a bunch these
Speaker 1: different riskpects. So there's no one one addiction, there's no
Speaker 1: one addiction gene, but certainly the biology is there. And
Speaker 1: then if you figure, you know, I've had patients to
Speaker 1: say the first time I got drunk as a teenager,
Speaker 1: I knew that's what I'm you know, it was just
Speaker 1: like I never felt normal until that point, and I
Speaker 1: immediately and is often going after whatever substance it is,
Speaker 1: So that's a breaking and then it go ahead. So
Speaker 1: that's a very roundabout way partially answering your question.
Speaker 2: Well, my question is, especially talking about that particular study,
Speaker 2: do you think that there could be some aspect of
Speaker 2: it not being biology but just nature, just just being
Speaker 2: around a dad. You saw your dad drink their whole life,
Speaker 2: and maybe some sort of center lights up in your
Speaker 2: brain because it makes you think of like a positive
Speaker 2: experience when you were a child or something.
Speaker 1: Right, so you know there's conditioning, and certainly that would
Speaker 1: and then a dad that drinks with a certain effect
Speaker 1: or is you know, is the a binge drinker and
Speaker 1: abusive intermittently or is he a daily drinker and abusive
Speaker 1: every day or neglectful. It's so complex, but we know
Speaker 1: the you know, in the and then again what about
Speaker 1: bonding the first couple of years, attachment theory, So these
Speaker 1: things all come into play, and there's no doubt separating
Speaker 1: them is difficult. But you're right, there's the there's pair
Speaker 1: of parental modeling, and then there's the genetics there and
Speaker 1: then there's the exposure. Pretty complicated, right, So do.
Speaker 2: You feel as if any drugs I mean, I sound
Speaker 2: like a commercial from the eighties when I was growing up.
Speaker 2: But do you feel that there's like gateway drugs, cigarettes, alcohol,
Speaker 2: or anything that starts a child because you have children
Speaker 2: that eventually turn into one of these addicts. Is there
Speaker 2: some kind of like predisposing thing that you might see
Speaker 2: prior to an addiction starting.
Speaker 1: You know, again, it's that mood alterar effect. And obviously
Speaker 1: anybody that gets cocaine or heroin or methamphetamine and depends
Speaker 1: how much, but I mean get you're going to get
Speaker 1: that immediate rush and the euphoria, and once that part
Speaker 1: of the brain, the lizard I called the lizard brain,
Speaker 1: recognizes that, then you know, is it going to be
Speaker 1: available the next week, is it going to be a
Speaker 1: year later? Because adolescence is a time when you you know,
Speaker 1: there's there's no rehabilitation if you haven't abilitated, if you
Speaker 1: haven't had the normal development that occurs. So the exposure
Speaker 1: piece of it again is if if a kid's is
Speaker 1: there a gateway drug? I say, whatever? Drugs like for me,
Speaker 1: I tried pop when I was fifteen. I hate it.
Speaker 1: It's like just and you know, it was not something
Speaker 1: I was going to get addicted to. But you get
Speaker 1: a kid with the biology where they get more you know, dopamiricus,
Speaker 1: whatever it is that causes there's some euphoria there. That's
Speaker 1: going to be a gateway drug. So to me, it's
Speaker 1: at that age if you start having reward and euphoria
Speaker 1: from something that cut it's like if you if you
Speaker 1: just like with with sel, what's the problem with smartphones,
Speaker 1: what's the problem with online gambling? Is that immediate dopamine rush,
Speaker 1: whether it's you know, and kids watching what's the average
Speaker 1: agent for a kid watches porn in North America eight
Speaker 1: years old?
Speaker 2: That is that real?
Speaker 1: Yeah, I believe that's right, And I'm sure, I'm sure
Speaker 1: you know, I'm sort of generalizing a lot of stuff.
Speaker 1: But the bottom line is the more immediate the responses
Speaker 1: to a stimulus where you get dopamine, you know whatever
Speaker 1: dopamine make release of you know, these pleasure neurotransmitters, the
Speaker 1: and if a kid doesn't have uh, you know, they
Speaker 1: haven't built up any defenses, they haven't learned to, you know,
Speaker 1: fend for themselves in difficult situations. You know that that
Speaker 1: growth the process of the three stages of adolescents early
Speaker 1: adolescens mid late. If they can't get through that, they
Speaker 1: you know, the student, the earlier they start, that's sort
Speaker 1: of where your psychosocial development arrests. So it gets very complicated.
Speaker 1: It's like a dysfunctional home, a using parent, pre adolescent abuse. No.
Speaker 1: I mean a lot of therapists will say, well, how
Speaker 1: is you know what what went on during your mother's
Speaker 1: pregnancy with you? You know, was was it a veray?
Speaker 1: Was there a lot of stress? Was there high cortisol?
Speaker 1: All kinds of ways of looking at it to put
Speaker 1: you at risk. So but to me, I you know
Speaker 1: what's the worst drug. It's the one that the kid
Speaker 1: starts using in this day and age, I worry about poisoning. Right,
Speaker 1: It's like fentanyl, car fentelso, feneral, whatever these things are
Speaker 1: out there, these are there's this whole other uh, their
Speaker 1: expanse of risk that comes from just being exposed one
Speaker 1: time in dying. So that that's the you know with
Speaker 1: my kids they're a little older now, but even even
Speaker 1: in their twenties, I say, look, it's one dose. You know,
Speaker 1: you go to a party and somebody says, hey try
Speaker 1: this pill or you know pot there's disagreement. You know
Speaker 1: that whether there's ventanyl in pot but definitely in cocaine,
Speaker 1: definitely any any pill you get, the x annex, the norcos,
Speaker 1: the the oxycons. These these people there, whether they're cartels
Speaker 1: or whoever's selling drugs, they have pill presses that make
Speaker 1: identical pills to the pharmaceutical but they throw fentanyl in there.
Speaker 1: So that's the one thing with that I don't think
Speaker 1: we thought about as much prior to this whole fentanyl
Speaker 1: scourge is poisoning. And so how many kids they go
Speaker 1: to a party and friend says, hey, try this, you know,
Speaker 1: it's like they're dead.
Speaker 2: Well, I think that's why I'm so scared because I
Speaker 2: was that kid, right like I've done. I did all
Speaker 2: that stuff when I was a teenager, and never like
Speaker 2: my older daughter she is, she's just a very she
Speaker 2: listens like if you say, don't try jougs because you
Speaker 2: can get you can get killed and stuff. She she
Speaker 2: listened to that. But I was that kid that was like,
Speaker 2: that ain't gonna happen to me. That's what's that's what's scary.
Speaker 2: Because you hear about this all the time on the
Speaker 2: news and stuff. Parents just so distraw obviously because their
Speaker 2: kid wasn't even doing drugs really, just like trying something
Speaker 2: and they just died taking it once. It's so scary.
Speaker 1: Yep. My friend of mine is mom. She passed away.
Speaker 1: She was like one hundred and one. But there was
Speaker 1: a delay of putting your plaque up or something. So
Speaker 1: they were at it wherever, you know, the cemetery of
Speaker 1: the Morchwark and they were at the marketing person's desk
Speaker 1: for something. But she said they had some sort of
Speaker 1: a video and it would show a picture for a
Speaker 1: few seconds and then the next one of these are
Speaker 1: people that had passed away. And she's a she's a
Speaker 1: nurse and her sister was had a substance issue. So
Speaker 1: she was very, uh, you know, curious about all these
Speaker 1: young people that she saw. And they were sitting there
Speaker 1: for half an hour, she said, just constantly, and she said,
Speaker 1: you know, it seems like a lot of these people
Speaker 1: you have that have come through here or buried here
Speaker 1: are young. And they said, there's she said, it's just
Speaker 1: unbelievable how many young people come in with you know, drug,
Speaker 1: fentmol overdose herself whatever. It's just but I hate, you know, pot.
Speaker 1: I'm pot is just it's it's no longer pot I mean,
Speaker 1: cannabis today is so potent, and it's there's so much
Speaker 1: disregard for it, and that's so what's you know, there's
Speaker 1: it's different now that it was when when it's you know,
Speaker 1: the eighties, things started to change when the cannabis, you know,
Speaker 1: all these strains that are and then the wax ninety
Speaker 1: percent THC. It's just a different it's a different actor
Speaker 1: and affixed brain development.
Speaker 2: It. Oh. I had a situation with with edible weed
Speaker 2: that I I have never and I've tried some things
Speaker 2: in my life when I was younger and then I haven't.
Speaker 2: I haven't done anything since the nineties and except weed.
Speaker 2: And I took an edible weed too much of it,
Speaker 2: I guess, and I was like tripping, like I was
Speaker 2: on acid or something. It was insane. I thought that
Speaker 2: I was poisoned. It was. It was the most surreal
Speaker 2: experience and I'll never do it again. Obviously scared the
Speaker 2: shit out of me.
Speaker 1: Yeah, well, you know, it's definitely it's definitely a different
Speaker 1: scenario than what was it. In the John Lennon's Harmless
Speaker 1: Giggle that he talked about pot it was like point
Speaker 1: five percent THC and you compare that to who knows
Speaker 1: how much THAC is and somebody l you just don't
Speaker 1: really know what you're getting.
Speaker 2: But oh yeah it was I was I was like hallucinating.
Speaker 2: It was terrible. I didn't even know that we could
Speaker 2: do that to you.
Speaker 1: Yeah, it's technically a hallucinogen. Yeah, and it's one of
Speaker 1: those things when when kids start doing that, when they're
Speaker 1: thirteen or fourteen, it's you know, the future is not
Speaker 1: very bright if you're smoking that kind of the view
Speaker 1: use that kind of pot every day.
Speaker 2: Right, So yeah, it's definitely can't be good for your brain.
Speaker 2: So you you deal with all different kinds of addictions,
Speaker 2: but you you really you specialize in the opioid addictions.
Speaker 2: How as far as percentages of your patients go. Is
Speaker 2: that the most frequently used drug that people tend to
Speaker 2: abuse nowadays?
Speaker 1: Well, you know it's still in high school, it's still alcohol, cannabis, right,
Speaker 1: pot and alcohol is still still almost common. Cocaines made
Speaker 1: a resurgence ketamine abuse, you know, specil k there's you know,
Speaker 1: it just depends in the age group. And you're getting
Speaker 1: so much more news worthy stories about fentanyl again the overdoses,
Speaker 1: the poisoning. But we see most in the hospital system
Speaker 1: I am. We're seeing mostly adults. And the question I
Speaker 1: have it's like, it seems like there's just much disregard
Speaker 1: for alcohol and cannabis products in teenagers. I know, you know,
Speaker 1: a few decades ago, I was seeing a lot of
Speaker 1: kids coming in for alcohol and pot problems, and I
Speaker 1: don't know if they're graduating more rapidly to the you know,
Speaker 1: to methamphetamy and cocaine. But I just I don't see
Speaker 1: the referrals in our large medical system. So I'm seeing
Speaker 1: tons of adults and still you know, the older adults
Speaker 1: a lot of alcohol and the you know, a lot
Speaker 1: of opiate patience. See, part of it is retention and treatment.
Speaker 1: So there's an opia called bupin orphis the box on
Speaker 1: Seviitex's ub solved, various names for it, and it's used
Speaker 1: you give it on a daily basis to alleviate craving.
Speaker 1: And those patients stay with you, so we see them
Speaker 1: every month every two months for refills and and they're
Speaker 1: retained in the program. So you know, with other drugs,
Speaker 1: generally you get them into treatment, they start working a program,
Speaker 1: you know, and you don't continue to follow them, so
Speaker 1: you build up a lot of the opiate patients. It's
Speaker 1: it's much longer term.
Speaker 2: So a patient would come to you that was either
Speaker 2: addicted to pills or even heroin, and the part of
Speaker 2: their treatment is for you to give them this drug
Speaker 2: that's kind of is it to kind of like wean
Speaker 2: them down off of it.
Speaker 1: So bupernorphine is an opiate, and it was discovered in
Speaker 1: the sixties and trial. It's semisynthetic. It's derived from debane,
Speaker 1: which is part of something come out coming out of
Speaker 1: poppy plant, and it was trialed in the seventies. It
Speaker 1: was released in like seventy nine or eighty over here
Speaker 1: for pain. It was another pain opiate. They did didn't
Speaker 1: really know what opiate's where opiates went in the central
Speaker 1: nervous system. They didn't discover the first opiate receptor until
Speaker 1: I nineteen seventy six, and then it was like, oh,
Speaker 1: this elop it's work. They'd bind to this receptor I
Speaker 1: think was the MWe receptor was the first one. And
Speaker 1: then in the eighties and nineties, much more understanding of
Speaker 1: different opiates worked more different parts of the brain, and
Speaker 1: this one buper and orphine. They noticed it had much
Speaker 1: less activity in this in the cent the brain, mid brain,
Speaker 1: minimal binding in the respiratory center. The you know, all opiates,
Speaker 1: it's not really talked about much, but opiate suppressed the
Speaker 1: immune system. They decrease the hypothalamic pituitary axis that makes
Speaker 1: like testosterone. They decrease testosterone. And those are big things
Speaker 1: immune suppression, respiratory depression. And it turned out the buper
Speaker 1: and orphine had minimal like is a sole agent. If
Speaker 1: I if you put an ib in my arm and
Speaker 1: gave me more than the maximum dose, I wouldn't stop reading,
Speaker 1: which is crazy for an opiate. If you add alcohol
Speaker 1: or you know, a value or something, it's a different story,
Speaker 1: but it's it's basically it's much safer. So they said,
Speaker 1: and if you have an opiate addict and they commit
Speaker 1: to treatment, you know, you could offer a method all
Speaker 1: which is a potent opia. They have to go to
Speaker 1: a clinic ticket every day to alleviate craving. They said,
Speaker 1: why don't we release this dupern urphene in a higher dose.
Speaker 1: Four practitioners in their office can dispense it, and ideally
Speaker 1: you have the patient go to you know, night twelve
Speaker 1: step meetings, they have a therapist, you follow them every
Speaker 1: The recommendation at first was you see them every two
Speaker 1: weeks and every four weeks, but it was to alleviate
Speaker 1: craving and it didn't go to the rewards center. So
Speaker 1: this has been out twenty plus, about twenty one years,
Speaker 1: and it's it was very controversial at first because what
Speaker 1: people in the recovery field would say is duper and
Speaker 1: orphiene suboxol subtexts, subs. You're giving an opiate for an opiate,
Speaker 1: you're not really clean and sober. And there's a lot
Speaker 1: of argument, how can you tell me that if you're
Speaker 1: giving an opiate to someone, they're not getting high on it.
Speaker 1: But a lot of studies were done and it and
Speaker 1: they determine the retention and treatment. There's huge difference in
Speaker 1: retention and treatment and the you know, the the overdose debts.
Speaker 1: So basically right now, the standard of care is like
Speaker 1: one to three years on syboxa rebup and ORP or
Speaker 1: more when the patient's carefully monitored. And it's that's so
Speaker 1: an addiction medicine. When you're treating opiate addiction, can you
Speaker 1: take this it's a sublingual form. It's a it's a
Speaker 1: film or a tablet put under your tongue and could
Speaker 1: you take that and inject it and get high? Well,
Speaker 1: you can get high injecting ben a drill. I've had
Speaker 1: patients that snorted prozac. I mean, certainly it's an opiate
Speaker 1: and if you misuse it, Uh, there are issues, but
Speaker 1: it has it really is revolutionized. And the reason is
Speaker 1: again I'm still totally totally behind. I tell my patients
Speaker 1: it's almost a requirement you have to go to work
Speaker 1: a program. You need to address issues in therapy depending
Speaker 1: on the patient, but definitely twelve step is a foundation.
Speaker 1: But what this type of thing buprien orphin does is
Speaker 1: when once somebody has an opiate addiction, then what we
Speaker 1: find is the the the mid brain, the part of
Speaker 1: the brain that tells you to breathe when you and
Speaker 1: tells you to heat when you're hungry, drink when you're thirsty,
Speaker 1: the emotional areas, the messages when they once you have
Speaker 1: programmed those areas to get the opiate when they don't
Speaker 1: get and when you stop the messages up to the
Speaker 1: cortex and you can you could look at brain activity
Speaker 1: on a functional MRI, and you can see when someone's
Speaker 1: in withdrawal, what's happening is there's a tremendous powd of
Speaker 1: nerve firing up to the cortex basically, which is what
Speaker 1: withdrawal is. It's the anxiety. It's you know, besides the
Speaker 1: the opiate withdrawal where you have diarrhea and vomiting and
Speaker 1: abdominal physical symptoms. But you know when people say they
Speaker 1: don't have a choice, well, certainly everyone has a choice,
Speaker 1: but there's so much intense activity from it's almost like
Speaker 1: when some they've done studies look at dopamine levels and
Speaker 1: people that are detoxing from methem fatamine cocaine, and they've
Speaker 1: compared to people that are starving or are water super
Speaker 1: water deprived, and their dopamine levels are actually lower when
Speaker 1: they're when they stop or run a methamphatamine or coke
Speaker 1: or opiate. So what is the drive to get water
Speaker 1: when you're water deprived or food when you're food deprived?
Speaker 1: I mean it over it's it sort of supersedes all
Speaker 1: other anything else you want to do. And that's the
Speaker 1: impetus or the stimulation from the mid brain up to
Speaker 1: the core tex the executive function area when some So
Speaker 1: it's not an excuse, but it's an explanation when some
Speaker 1: one becomes addicted and they use larger and larger amounts.
Speaker 1: When they stop, they're almost like a decorticated animal. That
Speaker 1: executive functionary is not making the choices. So that's the
Speaker 1: beauty of bu periorphy for me, is it allows the individual.
Speaker 1: It sort of shuts off that you know, lizard brain
Speaker 1: overdrive to get the substance, and the person needs to
Speaker 1: take steps to maintain sobriety and they need to work
Speaker 1: a program and replace the time and energy they're spending
Speaker 1: getting the substance and being loaded with other activities. And
Speaker 1: but that's I think today it's pretty pretty well. It's
Speaker 1: even in the twelve step community. It's much more accepted
Speaker 1: using bupern orphine for for opiate addiction. So and that's
Speaker 1: where you know, the I didn't treat Matthew Perry. And
Speaker 1: you're not supposed to diagnose or be the doctor for
Speaker 1: people dead or alive. But you know, I've gotten calls
Speaker 1: from patients that are you know, they're on bupernorphine. They
Speaker 1: had there was pupernorphine and the guys forensics and then
Speaker 1: the care atamine and you know, I'm not sure what
Speaker 1: else was in there body.
Speaker 2: Well you were saying that with with withdrawal, there's physiological
Speaker 2: symptoms as well as you have these depression, anxiety and
Speaker 2: things like that. So he apparently he was given the
Speaker 2: ketamine treatments because he was having like severe anxiety. And
Speaker 2: is that is that something common that would be given
Speaker 2: to these types of patients is additional kademine treatments.
Speaker 1: Uh so, I okay, So ketamine is It's not controversial.
Speaker 1: It's just there's a feeling that it's you know, like
Speaker 1: for anxiety my understanding and the way our medical organization
Speaker 1: does it. I mean for treatment resistant depression when nothing
Speaker 1: else has worked. They've even been studied with somebody is
Speaker 1: suicidal giving the ketamine infusion and again and then also
Speaker 1: for on pain patients, right, And there's the anxiety thing.
Speaker 1: I don't. I don't give ketamine there. I do work
Speaker 1: with a lot. The other thing I do. I work
Speaker 1: with pain patients that are on opiates and their primary
Speaker 1: care wants them all for decrease whatever. And there's a
Speaker 1: bupert arphie the subox and is a higher dose for
Speaker 1: bupert arfine sort of first line if somebody needs a
Speaker 1: daily opiate. So I think he was on it for
Speaker 1: pain and addiction, but using it for anxiety. I don't
Speaker 1: really understand that that's a bona fide indication. Triguer is
Speaker 1: a resistant depression and chronic pain are pretty established, certain
Speaker 1: kinds of chronic pain. But but in his case there's
Speaker 1: first of all, the the infusions that are given for
Speaker 1: pain and depression and the amounts that were found in
Speaker 1: this nothing to do with he had huge amounts in
Speaker 1: his system, like a week after his last his last
Speaker 1: Kenemy infusion, so those infusions are much lower dose. I
Speaker 1: think he had pulls in his stomach. There was abuse.
Speaker 1: So the problem with addicts if you find that something
Speaker 1: seems to feel good and work at a low dose,
Speaker 1: then why not take ten times more. That's sort of,
Speaker 1: you know, the problem get into. I don't know all
Speaker 1: the details there, but the use of ketamine certainly, I
Speaker 1: used to be a doctor of raves and they'd have
Speaker 1: a tent and specifically people ken of means much safer.
Speaker 1: It doesn't affect a respiratory drive that much. You know,
Speaker 1: when you first give the injection, it can bump up
Speaker 1: your blood pressure. There they are various issues, but as
Speaker 1: far as you're breathing, it's it's not a respiratory depressant
Speaker 1: like other like things like opiates. But when you mix
Speaker 1: it with you know, even though like I said, you
Speaker 1: put ourphans in opiate, it's it's quite safe in terms
Speaker 1: of respiratory depression. But when you start he I think
Speaker 1: he had some benzos like out of Banner Clowd opinion
Speaker 1: your system when you put other when you mix these
Speaker 1: things together, and then his ketemy was very high dose,
Speaker 1: then you that's when you get into real promise whether
Speaker 1: he had cornary artery disease. When you use a lot
Speaker 1: of ketamine, you can you can spike the blood pressure,
Speaker 1: even get an a rhythmia. I mean, I Ketemine is
Speaker 1: a great thing for setting bones. It's a short acting thing.
Speaker 1: But I know when I in er days, you'd have
Speaker 1: somebody on a cardiac monitor and O two censor you'd
Speaker 1: have you know, I mean, it was like a critical
Speaker 1: care bad they were in it.
Speaker 2: And so that's when you would give it. When like
Speaker 2: if someone came in with a broken bone and you
Speaker 2: were trying to put it like something that you had
Speaker 2: to put them in an extreme amount of pain just
Speaker 2: to get them to like not be paying attention.
Speaker 1: Yeah, propafall, milk, milk obamnesia, you know, the white stuff
Speaker 1: like those are much safer and kennemine. You know. The
Speaker 1: residency training program was on in the nineties. I think
Speaker 1: we're the first. I was just part of the faculty group,
Speaker 1: but we were probably one of the first people to
Speaker 1: use it. It wasn't being used until the nineties and
Speaker 1: we started using it for the first study trial we
Speaker 1: did was for pediatric anesthesi in the emergency far because
Speaker 1: it's you know that the immersion phenomenon where you know,
Speaker 1: adults get it and they when they're coming out of it,
Speaker 1: they they have nightmares and they have to be sedated
Speaker 1: and stuff. Kids don't really have that Sowhach and basically
Speaker 1: there's some secretion issues. Initially it's a very safe anesthetic, okay,
Speaker 1: but the anesthetic dose is much higher, you know what
Speaker 1: you're using for for depression and stuff like that. It's like,
Speaker 1: I don't know, half milligram per kilogram and then for
Speaker 1: IV and then for uh, you know, for the dissociative
Speaker 1: state you're up. You know, I don't know, two to
Speaker 1: four milligrams for killing. It's it's a much higher dose IV.
Speaker 2: So when he was going to get infusions, obviously you
Speaker 2: weren't treating him. But if he was to get this
Speaker 2: like therapeutic low dose, would he feel high at all
Speaker 2: from that? Or that it's so low you wouldn't really
Speaker 2: even notice.
Speaker 1: No, it's mood altering. And I've talked to some patients
Speaker 1: like the way it feels. Others are very uncomfortable. They
Speaker 1: don't like the way it feels feel they don't like
Speaker 1: the way it feels at all. And again, you know
Speaker 1: k holing. It was sort of a rave alternative drug,
Speaker 1: you know with m d M A raves and people
Speaker 1: would snort it and take it in pills, but those
Speaker 1: were usually much higher doses, and it was it's sort
Speaker 1: of like when you think of you know, PCP, like dissociative,
Speaker 1: so you don't feel connected to your body. You could
Speaker 1: do anything to the body and you don't feel it
Speaker 1: because it dissociates your brain from the body. So it's
Speaker 1: that kind of ketamine PCP very similar. So when but
Speaker 1: what I'm saying, yeah, and I had a I have
Speaker 1: some very bright patients and I have some very down
Speaker 1: the line into the road with chronic pain patients and
Speaker 1: they have a lot of questions and I won those
Speaker 1: considering amputation and you have a very sort of a
Speaker 1: rare cup CRPS complex regional pain syndrome. And he's looking
Speaker 1: into everything possible, but you know he's concerned with academy.
Speaker 1: He goes, you know, I don't want to get a
Speaker 1: lot of people say I don't want to get addicted,
Speaker 1: and you know, if it feels good, am I going
Speaker 1: to want to do it? Or there's the way it's
Speaker 1: given medically? You know, it's certainly a possibility, and if
Speaker 1: someone has an addiction history, it's not something you know,
Speaker 1: you have to be very careful with it.
Speaker 2: Yeah, that's what I was wondering, like why if someone
Speaker 2: has such a strong I mean, he had such a
Speaker 2: strong history of alcohol addiction and then the opioid abuse
Speaker 2: that why would you Why would you give them a
Speaker 2: medication that's known to be abused. I guess that was
Speaker 2: one of my questions.
Speaker 1: But you know, I may be ignorant. I don't know.
Speaker 1: I really don't know why they were giving it was
Speaker 1: it was he in such a state with his depression
Speaker 1: that it was considered sort of a last resort. Was
Speaker 1: it for some chronic I think, I know, I assume
Speaker 1: you had chronic pain issues, and yeah, I mean it
Speaker 1: would be a considerate, it would be something to take
Speaker 1: into consideration.
Speaker 2: So his assistance said it was for a for depression
Speaker 2: and anxiety. But yeah, I mean he you know, he
Speaker 2: had multiple surgeries because he had val obstruction from the
Speaker 2: chronic constipation from the opioid abuse he had. He had
Speaker 2: a back injury, yeah, he had. He had multiple surgical adhesions.
Speaker 2: He was probably in pain for sure, so but that
Speaker 2: wasn't reported as to why he was taking it. But
Speaker 2: you also see this thing with with celebrities and famous
Speaker 2: people that they get this VIP treatment that normal patients
Speaker 2: don't get.
Speaker 1: Yeah. Absolutely, well, I was wondering that too. Right, There
Speaker 1: was a guy knew that was hired to be with
Speaker 1: a certain very famous rock musician and he would stay
Speaker 1: with the guy at the guy's place, and you know,
Speaker 1: they have so much power and money. The guy would
Speaker 1: get and this was back in the nineties, but these
Speaker 1: FedEx boxes would come with demroll in them and stuff,
Speaker 1: and the guy eventually, you know, died. But my friend
Speaker 1: was very high powered interventional. He did interventions, and he
Speaker 1: worked with you know, Fortune five hundred companies and you know,
Speaker 1: various behaviors people on the board that developed drug or
Speaker 1: porn or gambling addictions, and you know, but he couldn't
Speaker 1: do anything because this guy, you know, the the hangers
Speaker 1: on and the you know, the gophers, and it undermines
Speaker 1: and undermines their ability to get treatment to stay sober.
Speaker 2: So this episode is brought to you by The Grosser Room.
Speaker 2: If you love this podcast and you love my Instagram account,
Speaker 2: you will love the Grosser Room. Every week we have
Speaker 2: lots of cases of articles discussing celebrity deaths and high
Speaker 2: profile deaths. And since we are going on our fourth year,
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Speaker 2: you think that because at the time of his death,
Speaker 2: people were in his life seemed to be a little
Speaker 2: bit shocked about it because it seems as if he
Speaker 2: had been sober for like nineteen months. Do you think
Speaker 2: My question is, why start a new drug instead of
Speaker 2: just going back to the one that you knew? Is
Speaker 2: it because of like shame and embarrassment to say, oh,
Speaker 2: I'm not sober anymore. Or did he think maybe because
Speaker 2: he was allowed to get that treatment that it wasn't
Speaker 2: it wasn't bad. He just was taken a little bit more.
Speaker 1: I mean it could be a number of things. He
Speaker 1: may exactly considered himself to still be clean and sober.
Speaker 1: I'm doing it. I'm taped. It really helped my depression.
Speaker 1: I'm going to treat myself. I don't you know, I
Speaker 1: don't know. Was he getting high? Sounded like he was.
Speaker 1: You know, he had quite a bit in a system.
Speaker 1: And there's look asked anybody that struggled with an addiction
Speaker 1: and what what was there? You know, they sort about
Speaker 1: stinking thinking right, It's like, what was how did you rationalize?
Speaker 1: You know? Was it just e fit? I'm going to
Speaker 1: go get loaded or maybe I can get loaded and
Speaker 1: nobody will know because it's ketamine and I've already on it.
Speaker 1: I mean there's a who knows? And was it? Did
Speaker 1: he have a heart attack? I mean, was that or not?
Speaker 1: In any arrhythmia? And he's you know, in the in
Speaker 1: the hot tub. You're in the hot tub and you're
Speaker 1: you know, you're getting dehydra I mean, there's all all
Speaker 1: the speculations.
Speaker 3: So yeah, I mean he had did you I don't
Speaker 3: know if you you saw the report, but he had
Speaker 3: he had emphysema, right, I mean, pretty extensive emphysema, spoke
Speaker 3: two packs of cigarettes a day, which you know.
Speaker 2: Nobody ever wants to talk about how bad cigarettes are
Speaker 2: on the body. But there was that, and then he
Speaker 2: had uh in his lad he had fifty to seventy
Speaker 2: percent focal occlusion, which yeah, exactly, you're just I mean,
Speaker 2: he didn't have any fibrosis in the heart, so it
Speaker 2: didn't look like he had a heart attack as the
Speaker 2: immediate cause of death, but he was going to have
Speaker 2: one soon basically, right. But but yeah, I think that
Speaker 2: he took the jougs and passed out, and then he
Speaker 2: had some signs that he drowned underwater, was take making
Speaker 2: some breaths underwater. So there was a little bit of
Speaker 2: not a lot though, there was a little bit of
Speaker 2: pulmonary edema with some foam, and he had in the
Speaker 2: petres bone some hemorrhage too, so they concluded that that
Speaker 2: was a contributing factor to his death.
Speaker 1: Tell me about the Petro's bawn thing, so.
Speaker 2: You can see hemorrhage in that bone in drowning cases,
Speaker 2: but it's not like if you see it, that doesn't
Speaker 2: mean the person drowned, but that along with other gross findings,
Speaker 2: could indicate that he drowned. But he didn't have like
Speaker 2: typically if a person just primarily drowned, you would see
Speaker 2: a lot of foam in the airway because of their
Speaker 2: last breaths. But he was probably already his respiratory rate
Speaker 2: was probably already so low when he went into the water,
Speaker 2: so that's why there wasn't that much of it. And
Speaker 2: obviously he had super high levels in his blood that
Speaker 2: you would see in a patient that was under anesthesia,
Speaker 2: and in his stomach contents as well, they found they
Speaker 2: found remnants of it, so which means that he took it,
Speaker 2: you know, shortly before his death, a high dose of it.
Speaker 1: Right and you get that sort of that adrenaline blood
Speaker 1: pressure spike, and that's when you're gonna get your a
Speaker 1: rhythmy is and you know you don't have to have
Speaker 1: a heart attack for as you know that that'll do
Speaker 1: you in real really quickly too. So but is.
Speaker 2: Ketamine treatment is that FDA approved right now too? For
Speaker 2: other than anesthesia like these it's all Flabel.
Speaker 1: It's all flabble proved. Yeah for me for trigger resistant
Speaker 1: depression and pain.
Speaker 2: It just seems like it's like, you know how like
Speaker 2: goes epics in the news right now every day it's
Speaker 2: it's like ketymine is I think Christy Tiagan said she
Speaker 2: did it and one of the housewives or something. It's
Speaker 2: like it's like the all the rage now all the
Speaker 2: celebrities are doing ketymine treatments.
Speaker 1: Oh yeah, it's the ketymine clinics are booming, doing a
Speaker 1: booming business. So the that's the problem with something to
Speaker 1: get strendy, it's you and people with addictions again you
Speaker 1: want to quick fix. And there's also talk about well
Speaker 1: it's just like the ayahuasca circles and that can rapid
Speaker 1: opiate detox where you go in and get an IV
Speaker 1: of Narkian and reverse it and now you're not an
Speaker 1: addict anymore, or ayahuasca circles and uh, you know, you
Speaker 1: get the super loucinogenic experience. And it's I mean generally
Speaker 1: these things occur biologically, genetically over time related to it.
Speaker 1: It takes a long time. Well they don't always take
Speaker 1: a long time to develop an addiction, but usually it's
Speaker 1: it's a complicated, long term process, and recovery is too.
Speaker 1: It's one day at a time, but it's you know,
Speaker 1: you just got to, you know, sit back and listen
Speaker 1: and accept that it's going to take a lot of
Speaker 1: restructuring of your life. It's very doable. Sobriety is you
Speaker 1: know a lot of people fail and they'll relapse. I
Speaker 1: mean this guy, really, what was he in detox sixty
Speaker 1: times or something like that, So that's.
Speaker 2: A yeah, that was one of the questions I was
Speaker 2: going to ask you, is there a point where someone
Speaker 2: I hate to say this, but is there a point
Speaker 2: where someone's brain is like damaged, beyond prepared for them
Speaker 2: to ever kind of have a normal life after struggling
Speaker 2: with an addiction like this. I mean, there was a
Speaker 2: point where he said he was taking fifty five pills
Speaker 2: a day, which is mind blowing to me because I've
Speaker 2: taken one percoset and like thrown up all night.
Speaker 1: Right. But so again, I had a patient and I
Speaker 1: know this is the case. He was taking over one
Speaker 1: hundred narcos a day, right, And because I saw there
Speaker 1: was now he was ordering some on the internet. He
Speaker 1: was going to doctors, but he's stole my patient. He's
Speaker 1: on he's been on. You know, he's an older guy.
Speaker 1: He's been on box own for for some years. He
Speaker 1: does have sever c OPD chronic pain. Well you know
Speaker 1: one bars to know is and one bar ridiculo opasy
Speaker 1: blah blah blah. So he's really got paint and he's
Speaker 1: been stable. But if you gradually increase your tile and
Speaker 1: al you know, the tilodol in there is what's going
Speaker 1: to do again. But if you gradually increase your tilool
Speaker 1: and your liver has the ability to you know, produce
Speaker 1: more of the enzymes that metabolize it. Eventually though the kidneys,
Speaker 1: you get to a certain I know, it's like kill
Speaker 1: how many kilograms of the see of benefit have gone
Speaker 1: through your kidneys and then book they're done. But so
Speaker 1: it sounds crazy, but over time people develop a tolerance
Speaker 1: and there you go. So it's it's it's true. I
Speaker 1: mean one, you know, when I've had every everybody's had
Speaker 1: an oracle or a tunnel codeing boy, I'll tell you what.
Speaker 1: That stuff can make a nauseous real quick, and you
Speaker 1: you just but it's like patients I've had there drinking
Speaker 1: you know a couple of liters of bodka a day
Speaker 1: for years and there by all it's not good for them,
Speaker 1: but you know that it occurs over time, it's gradual.
Speaker 2: And when one of these patients that has the opioid
Speaker 2: addiction is used to getting high off of let's say,
Speaker 2: vike it in her percoset, and then they go to
Speaker 2: you and then they get this like subutext drug. Do
Speaker 2: they are you saying that they still kind of feel
Speaker 2: the high, but it doesn't give them that that feeling
Speaker 2: that they need to increase it more and more, which
Speaker 2: would which would lead them to overdose. They still feel
Speaker 2: high right when no.
Speaker 1: No, no no. So so basically you're supposed to be
Speaker 1: off about any opiate for twenty at least twenty four
Speaker 1: hours when you start upern No. Orpheny's a box subject.
Speaker 1: Why is that because even though it doesn't people say,
Speaker 1: well it's a partial stimuli or powerful agonist, it's it
Speaker 1: just works differently attaching to the opia receptors. So but
Speaker 1: it's it like has the most attraction of any opiates.
Speaker 1: So if I've been taking four or ten to orco
Speaker 1: a day, whatever, and I put some box on subutext
Speaker 1: under my tongue it's going to displace all the percocet
Speaker 1: or oxycodone or hydro codone. And even though you're attaching
Speaker 1: to the receptor, the opiate receptor, it stimulates it differently,
Speaker 1: so your body perceives it as withdrawal and gets super
Speaker 1: sick a withdrawal. And the other situation. If you stop
Speaker 1: somebody's opiate's for twenty four hours, they're going to be
Speaker 1: in withdrawal and then you give them the upper from
Speaker 1: the subject text sub box or whatever, and within minutes
Speaker 1: they withdrawal abates. So it it's it's sort of you know,
Speaker 1: it's not intuitive at explaining, and it's like, so it's
Speaker 1: a partial agonist or is it a block you're oh,
Speaker 1: it's a blocker. Well, it attaches the receptor, but it
Speaker 1: you know, it starts withdrawal, but you can treat withdrawal,
Speaker 1: you know what I'm saying. It can be a little confusing,
Speaker 1: but it's uh, you know, it's an opiate. It has
Speaker 1: a high high affinity for the recept or, so it
Speaker 1: will displace any other opiate and when it does so,
Speaker 1: then your body feels like it's in withdrawal even though
Speaker 1: it's it's attaching. But if you wait for somebody to
Speaker 1: be and withdrawal and you give it to them. It
Speaker 1: will resolve the withdrawal within minutes. So the lesson so
Speaker 1: I said, people can inject it, Okay, Like I said,
Speaker 1: when you start injecting things, it's not like taking it properly.
Speaker 1: So the art. You know, I've heard all the arguments against,
Speaker 1: oh it's an opiate, you're you know, you're not sober,
Speaker 1: you're not clean when you're using. But if you take
Speaker 1: it properly, now they say one to two percent of
Speaker 1: people will say, uh, oh it makes me relax, it
Speaker 1: gives me energy. So those are people that you probably
Speaker 1: don't want to use the box on or up an
Speaker 1: orphine and recovery. So it's it's one of those things.
Speaker 1: It's just like some people will take I mean it's
Speaker 1: not a great analogy, but some people will say, yeah,
Speaker 1: I took you know, I took motoring and I got
Speaker 1: a mood alterary effect. So a variety of things can
Speaker 1: give you a mood alterary effect, and some people get
Speaker 1: very attached to it. So but it's very rare. It's
Speaker 1: very rare that you know, buprin orphine. I've had patients
Speaker 1: take double you know there they try to get high
Speaker 1: on it. They'll take the maximum thirty two milligrams a day,
Speaker 1: they'll get the prescription take sixty four milligrams a day.
Speaker 1: And I mean, I've had that happen and you can't
Speaker 1: give them an early refill and they commit, and I say, well,
Speaker 1: so what did you feel? Well, it didn't work. I
Speaker 1: didn't get high, and you know, it was a waste
Speaker 1: of time and I'll never do it again. Whatever. So
Speaker 1: it's and it's again the binding characters. We're in the
Speaker 1: you know, the ventral tegmental area whatever, the midbrain reward areas.
Speaker 1: It has very little activity there.
Speaker 2: So if so if a person like myself took that drug,
Speaker 2: what would would would I feel anything?
Speaker 1: Or probably? Well, okay, it is an opiate. So if
Speaker 1: you're opiate naive, and it depends on the dose you took,
Speaker 1: it's just like if you eject did it? I said,
Speaker 1: if I injected into myself, would stop my breathing? No,
Speaker 1: if it was a sole agent. Now, if I had
Speaker 1: a few beers and you inject the dose, but if
Speaker 1: you if you took eight milligrams, I mean we start
Speaker 1: somebody that's in withdrawal, will give them two four milligrams
Speaker 1: under the time. And if if I just did that
Speaker 1: right now, I probably initially I get you four. Okay.
Speaker 1: I've had patients tell me there were big pot smokers.
Speaker 1: They had a bunch of THC in their system. They
Speaker 1: came in for induction and and afterwards to say, you know, doc,
Speaker 1: that stuff I did get a you know when I
Speaker 1: had the UH when I was using pot. And again,
Speaker 1: you have patients that you get them off the fantinel
Speaker 1: and and you know you're you're working with them and
Speaker 1: there and you drive testament. It comes back for THAC.
Speaker 1: You don't want patients to We're sort of harm reduction.
Speaker 1: That's my philosophy. I mean, I don't want to smoke
Speaker 1: a plot. But IVE had patients tell me if I'm
Speaker 1: smoking some potent pot and I'm taking subox and I
Speaker 1: do get a buzz, and that's not good. So but
Speaker 1: it's just in and of itself. Ninety eight percent of
Speaker 1: people do not get a mood alterary effect when taken
Speaker 1: within the DOSA drains. It's proved.
Speaker 2: Now, does this drug help with pain? Oh yeah, yeah,
Speaker 2: so why so my obvious question is then if this
Speaker 2: is safer, why isn't this drug that is?
Speaker 1: That is a great question, and I for my uh so,
Speaker 1: here's what happens now. The pain physiology and the you know,
Speaker 1: pain fibers and pathways and different types of pain are
Speaker 1: really really much better understood now than they were even
Speaker 1: you know, five ten years ago, right, and super a
Speaker 1: lot of complexities there. It turns out the uprenorphine, you know,
Speaker 1: if you if you have pain in your foot or
Speaker 1: your back or your hand, the fibers go to your
Speaker 1: spinal cord. The dorsal in the back of your spinal
Speaker 1: cord has transmission nerve centers and sends the signal up.
Speaker 1: So buprenorphine blocks pain more in the spinal cord, right
Speaker 1: much not so much up in the brain. Sort of
Speaker 1: a crude way of explaining it, and that doesn't have
Speaker 1: as much activity the respiratory center. But it's so currently
Speaker 1: according to the medical literature, if someone needs a daily
Speaker 1: opiate chronically for bonafide pain, whether or not they have
Speaker 1: an addiction history, then the first line medications be pan orphine.
Speaker 1: Why isn't Why isn't that done? I I was talking
Speaker 1: to somebody today. I've talked to people at other academic centers.
Speaker 1: I was talking to somebody at a ivyly programmed back
Speaker 1: East today for about an hour, and we we share
Speaker 1: the same frustration. It's if it's first line, if it's
Speaker 1: a first of all safety, first hipocratic codes, right, So
Speaker 1: I don't I've been paying medicine in my facility, large
Speaker 1: organization on Wednesday. Third, I'm not a pain doctor. I
Speaker 1: just get referred paying doctors say hey, can you see uh,
Speaker 1: you know, mister Smith, he's been on one hundred milligrams
Speaker 1: of morphine and forty and oracle for twenty years and
Speaker 1: we've tapered him now the pain's unbearable, or you know,
Speaker 1: we need to detox this for whatever it is. I
Speaker 1: just get patients that are already on opiates and it's
Speaker 1: buper and orphan is safer opiate? Yes, So what the
Speaker 1: literature says, it's we're not starting people on opiates for
Speaker 1: chronic pain. Not a good not a good medication for
Speaker 1: chronic paint, right, But if someone's already on it, it's like,
Speaker 1: why not if it's safer, why not at least try
Speaker 1: to switch them and then either tape them off the
Speaker 1: orphine or you know, if they do need a chronic
Speaker 1: alpiate use puper arpi. But there's a lot of a
Speaker 1: lot of paint specialists that are boards. Now I'm not
Speaker 1: a board certified paint specialist, so I get into it
Speaker 1: with some of these guys.
Speaker 2: Uh.
Speaker 1: It's then one of the reasons is because it's the
Speaker 1: first thing if you say viewper orphane people, I don't
Speaker 1: know what that is, but the average person has heard
Speaker 1: of the box on right sub attexts. But well, that's
Speaker 1: an it's an opiate for for addicts, right, Well, it's
Speaker 1: it's a big pronorphine. That's the opiate. Well, well an opiate.
Speaker 1: It's an opiate, and that's for addicts. And if you're
Speaker 1: given that to pain patients, then yeah, you're a quack.
Speaker 1: I mean, I've gotten called it. I d you know.
Speaker 1: I've got probably one hundred and fifty patients that I'm
Speaker 1: with the paining physicians. I'm not going out recruiting people.
Speaker 1: I don't I don't start it in rare cases. There's
Speaker 1: a low dose view transpatch. If the primary care for
Speaker 1: paining physicians says I think this patient does need an opiate,
Speaker 1: then you know I will work with them. But I'm
Speaker 1: not out there starting paying patients on it. But anybody
Speaker 1: who's listening to this, if you are on it, if
Speaker 1: you're on dorac or you're on morphine, it's just you know,
Speaker 1: if there's a if there's a dangerous or there's a
Speaker 1: like I use the example if I talk to doctor
Speaker 1: and they say, if you have a patient on anodor
Speaker 1: on it's it's a great medication, cardiac medication for certain rhythmis,
Speaker 1: but it is rough, rough to manage, sort of toxic,
Speaker 1: you know, not toxic. But so what I tell them
Speaker 1: if they're a safer anti arrhythmic came out and it
Speaker 1: was documented just the physiology of it, the pharmacology of it.
Speaker 1: It's safer, does the same thing. And five years from now,
Speaker 1: you still had them on amiodoro. What would your defense be.
Speaker 1: There's no defense, so.
Speaker 2: Ill just like a stigma of the drug. Basically exactly
Speaker 2: so right.
Speaker 1: And so I was talking to somebody at one of
Speaker 1: these university programs because I was I was in fear
Speaker 1: of losing my job because they said, you're an addiction
Speaker 1: medicine doctor, why do you have forty people on this
Speaker 1: for chronic pain? And I said, well, they were sent
Speaker 1: to me. They were on morphine, fentanyl, whatever, and they
Speaker 1: told me to detoxible, you know. And this when this
Speaker 1: stuff came out in the higher does form of the
Speaker 1: sabbox armount in two thousand and two, a lot of
Speaker 1: us got And it wasn't just to me, obviously, it
Speaker 1: was a lot of anybody that did addiction medicine and
Speaker 1: worked in a medical system. You know, I work with
Speaker 1: an integrated pain program, so we have psychiatry addiction, clinical pharmacy,
Speaker 1: physical medicine, psychiatry addiction about world. So they'll say you're
Speaker 1: the one you this pay. We don't want this patient
Speaker 1: on the opiates. Can you tape or detox them? But
Speaker 1: a lot of the patients would say to me, to
Speaker 1: other doctors working in pain clinics, hey that buw pernorphine
Speaker 1: stuff work great for my pain. I could think straight,
Speaker 1: I could function again, and I didn't feel like I
Speaker 1: was taking anything. So when you switch people about, you know,
Speaker 1: there's a are a great article in the doc is uh,
Speaker 1: you know, published a lot. He says, a third or
Speaker 1: third the third of people on chronic alpiates that need
Speaker 1: to be on on or felt a need to be
Speaker 1: on something that strong for pain. A third of them,
Speaker 1: it's life changing to put them on to be port orphy.
Speaker 1: A third it's you know, it's okay, may not be
Speaker 1: as well received. And a third issues. It's an opiate
Speaker 1: nause at dizziness, you're tired before it helps the pain.
Speaker 1: So you know, I'm a therapeutic nihilist. I think get
Speaker 1: the less meds the better. But if you're gonna then again,
Speaker 1: I just work with paying positions and we try and
Speaker 1: get people off the opiates. But if they're you know,
Speaker 1: there's a lot of people committing suicide too, because the
Speaker 1: six seven years ago does CDC said get people at
Speaker 1: ninety or less mmy morphine milligramma clobeland So one milligram
Speaker 1: of oxy conton I mean boxy code on is like
Speaker 1: one and a half a morphine. One a hydrocode on
Speaker 1: or an oorco's like one a morphine. Want to dilaud
Speaker 1: it is like four morphine. So you calculate what your
Speaker 1: equivalent in morphine milligrams is and if they're over ninety,
Speaker 1: oh got a taper. Well what if they were? You know,
Speaker 1: I had a layers one hundred and forty miligrams of
Speaker 1: morphine for twenty years she's seventy years old. And suddenly
Speaker 1: the doctor's like, I don't lose my license. I gotta
Speaker 1: get you blow a ninety. No talk about risk benefits.
Speaker 1: So in the literature it does. It says, look definitely
Speaker 1: over fifty mm e fifty miligram's equivalent of morphine, the
Speaker 1: risk of respiratory depression is you know, there's a higher
Speaker 1: death rate, So you certainly not only want to get
Speaker 1: him blown ninety, but under fifty. And opiates are not
Speaker 1: a great chronic pain medication. But in the in the interim,
Speaker 1: if they need to be on an opiate, or if
Speaker 1: they're on one and you want to get them off it,
Speaker 1: why not switch to something safer. So that so that's
Speaker 1: my my arm. It's not for everybody, but it's you
Speaker 1: hit it on the head. But there's there's a stigma.
Speaker 1: And one Ivy League ACTA the mission who I contacted
Speaker 1: because I was like, I'm gonna get fired for what
Speaker 1: I'm doing, but I think I'm doing the right thing.
Speaker 1: He said, you know, he said, I said, why is this?
Speaker 1: And this is probably six seven years ago. I was
Speaker 1: talking to this guy and he said, well, look at
Speaker 1: the money. The big form of puts into viupern orphine.
Speaker 1: Where is it. It's like ninety nine percent for use
Speaker 1: for addictions, And he said, unfortunately a lot of doctors
Speaker 1: get their information from drug detailed people or you know,
Speaker 1: you watch TV. Well, there's not much subox on being
Speaker 1: advertised on TV, but just the information out there disseminated
Speaker 1: to doctors that they hear about buper or FI, they're
Speaker 1: in about subox owner and get I get referrals. Can
Speaker 1: you talk to mister Jones about subox on And I'll go, no,
Speaker 1: I can talk to him about BUEPERI ORFI.
Speaker 2: Yeah, so you just basically have to rebrand it. We'll
Speaker 2: then contact them and say like, let's call it something
Speaker 2: else and it's.
Speaker 1: It's off label FDA approved subbox on sebutexts for chronic paint. Right.
Speaker 1: And the problem is in this country, the higher dose
Speaker 1: forums are subox on subutex. So like medic here, DHHS
Speaker 1: put out a a sort of a pain management bulletin.
Speaker 1: I think it was twenty seventeen or eighteen or twenty
Speaker 1: nineteen September, but basically they then a flow diagram and
Speaker 1: they say said, well and this is dj HSS and
Speaker 1: then the VA and Department of Defense in January. But
Speaker 1: basically their guidelines where if somebody needs to be on
Speaker 1: an opiate, you know, try and get them off the opiate. Ope.
Speaker 1: It's not great, it's really not good for chronic paint.
Speaker 1: But go with bupern orphy if to either detox them
Speaker 1: or if you choose to maintain them at an opiate.
Speaker 1: Medicare does not pay for the higher dose forums. So
Speaker 1: you have somebody that's sixty six years old, you've gotten
Speaker 1: them off their their you know, fentanyl patch and their
Speaker 1: oraco and then they go to fill the prescription and
Speaker 1: the farms. He goes, oh, you got Medicare Part D.
Speaker 1: You have to have an addiction diagnosis for us to
Speaker 1: pay for your box or cyber detext it's and.
Speaker 2: They just want people to die so they don't have
Speaker 2: to pay for them anymore.
Speaker 1: That's well the theory the government.
Speaker 2: Yeah, that's a whole other, a whole other episode.
Speaker 1: Bruce, Yeah, get Burger, get Kennedy on here. I'm sure
Speaker 1: that guy's got some mark.
Speaker 2: Interesting.
Speaker 1: You need a contrary and you need a shit stir.
Speaker 2: But yeah, I mean that would be that would be
Speaker 2: fun actually to hear that. But I think that. I mean,
Speaker 2: I'm one of these people that are just like, yeah,
Speaker 2: there's the whole entire time you're talking about this, I'm like,
Speaker 2: there's there's absolutely no reason except these barriers of and
Speaker 2: it has to do with money being made, right, Like
Speaker 2: that's how I look.
Speaker 1: Well, I'm telling you, I guarantee you. I don't know
Speaker 1: how many people you have listening with this thing, theirs
Speaker 1: or his drop, but you will get just a shipload
Speaker 1: of that doctor doesn't know what he's talking about, or
Speaker 1: he's he's a shoal for the drug companies. That's the
Speaker 1: worst you know, I have had. If you go to
Speaker 1: drugs dot com, I mean there's a billion pages, but
Speaker 1: there's one there that says your paring should not be
Speaker 1: used for pain. It's a terrible paint drug. So when
Speaker 1: I get a referral, you know from the pain doctors,
Speaker 1: probably off three or four to more Wednesday, and I
Speaker 1: spent and you know, my organization's great. They give me
Speaker 1: an hour to talk to them, and then I will
Speaker 1: spend an hour and I don't know what I'm getting.
Speaker 1: Some of them are fit to be tied if had
Speaker 1: theopia tapered. Others are I don't know who you are.
Speaker 1: I don't know what this medication you're talking to me
Speaker 1: about is. And I'm like, I don't know if I
Speaker 1: canna get you know, punched in the face or yelled at.
Speaker 1: But I say, well, you know there's They say, well,
Speaker 1: they said you're talking to be about the box on it,
Speaker 1: and and I'll say, I want your family, anybody has
Speaker 1: your nose in your medical business, I'll talk to you
Speaker 1: about this medication, but I explain what I tried my best,
Speaker 1: like we were talking about today, how it's different, how
Speaker 1: it's better if you're not on any oopiah blah blah blah,
Speaker 1: and and I've had family members and then else I
Speaker 1: won't prescribe it until a week later. I'll say, I
Speaker 1: want to meet with you again in the family, bring questions.
Speaker 1: And it's it's really a shame. It's there's so much
Speaker 1: misinformation and you know, people that are suffering and paint
Speaker 1: I'll tell you what, Yeah, it's it's really one of
Speaker 1: the most underserved communities of patients in medicine. I mean,
Speaker 1: you know, because it's so frustrating for doctors adding what
Speaker 1: do you do with these people? You know, you can't
Speaker 1: give them hope it's They have something called the Beer's
Speaker 1: List b E E R S. I think it's a
Speaker 1: doctor beers. It's kind of your drinking beer and it's
Speaker 1: been around since the nineties. The beers List for medications
Speaker 1: you shouldn't get people over sixty five. Yeah, there's antibiotics
Speaker 1: on there. It's muscle relas, smooth muscle relaxes. Oh, it's
Speaker 1: it's it's really the hands of pain physicians are are
Speaker 1: more and more time. That's why things like ketamine infusions.
Speaker 1: You know you're able to do that. You know you're
Speaker 1: not sending them home with it. Well in some cases
Speaker 1: they have, but that's available to anyway. I'm rambling.
Speaker 2: No, this is really this is really good information because
Speaker 2: I think that a lot even I just did a
Speaker 2: post on on my website, The grocer Room, about Matthew
Speaker 2: Perry's death, like more just a dissection of the of
Speaker 2: the autopsy report, and a couple of people had made
Speaker 2: comments under there that they are chronic pain patients and
Speaker 2: they took they were taking uh a hydro codone every day,
Speaker 2: like the one woman had said that she was taking
Speaker 2: three a day, And that kind of surprised me because
Speaker 2: I think it's it's almost a perfect drug that it
Speaker 2: could have the effect of the opioid but not make
Speaker 2: a person addicted as addicted to it maybe and high
Speaker 2: and able to function. I don't I don't see why
Speaker 2: you wouldn't go with that like sabutext or so yeah,
Speaker 2: right right, I.
Speaker 1: It's interesting. Yeah, yeah, I've had I've had pain. Special
Speaker 1: to say, well, they can only use for pain if
Speaker 1: they have an addiction. They can only use it for pain.
Speaker 1: If they don't have an addiction, they can It's just.
Speaker 2: Okay, yes, it's it's it's really weird that they that
Speaker 2: they would want the patient to take the other one
Speaker 2: that could potentially give them addiction. You don't want to
Speaker 2: wait till a person gets the addiction. Maybe you want
Speaker 2: to prevent them from getting it.
Speaker 1: The other one is kreatim. You've heard of kreatum, right, No,
Speaker 1: I've never heard of that.
Speaker 2: What's that?
Speaker 1: Kreatim? I you know, I mean we've been seeing that
Speaker 1: for years and years. So Creative is a it's sold
Speaker 1: as a tea or a powder or a pill, and
Speaker 1: it's derived from a plant that's similar related to the
Speaker 1: coffee plant, and it is a it's sort of like tramatol.
Speaker 1: It's it binds the opia receptor, the merror receptor, but
Speaker 1: it also has NSRI activity, norp an effertser antonin reuptake
Speaker 1: like effects or or symbalta. So you know, tramadol is
Speaker 1: an interesting opiate. And if you take towards trama you
Speaker 1: have a seizure. Right, Why is that? Well, it's because
Speaker 1: it's like you know, effects or is a NORP an
Speaker 1: efforts ser atona reuptake inhibitor. So you take a bunch
Speaker 1: of effects or and you get too much adrenaline your brain,
Speaker 1: you have a seizure. So this this creative stuff, you know.
Speaker 1: I mean it's available in head shops and a variety
Speaker 1: of places. It's still legal, but it's new receptor opiate.
Speaker 1: It has opiate activity and n sri I activity. So
Speaker 1: it's considered by a lot of people to be an herb.
Speaker 1: It's herbal, it's safe, and it's oh we see, we're
Speaker 1: seeing more and more of it in terms of it's
Speaker 1: it's like an over the counter tram It all basically, oh.
Speaker 2: My, go as far as the opiate, and this is
Speaker 2: something you could just get at like a place that
Speaker 2: sells vitamins, or something.
Speaker 1: Unfortunately, Yeah, you go, you go to the places at Selly,
Speaker 1: the bonds and the and the vapes, and yeah, but
Speaker 1: it's it's an opiate. It's bad. It's bad news. And
Speaker 1: then it's perceived as it's sort of like, well, it's
Speaker 1: Eastern medicine. You know, you you doctors are prescribing all
Speaker 1: these other things, and it's it's not dangerous. But I've
Speaker 1: had you know it. Then I had a patient spending
Speaker 1: fifteen thousand bucks a month for his creative. You get tolerance,
Speaker 1: you get into into major, and then when you stop,
Speaker 1: you get antidepressant withdrawal, right, because it's it's got just
Speaker 1: as much activity as taking effects or some ball to
Speaker 1: those kind of those kind of prestique the NSRI thing,
Speaker 1: so creat them. That's the other obiit that that we're seeing.
Speaker 2: I can't wait to look into that more.
Speaker 1: That's really krri ato nver don't.
Speaker 2: We're not trying to push it. We're trying to tell
Speaker 2: you not to do it. It's not good, all right,
Speaker 2: So to wrap this up, all right, go ahead.
Speaker 1: So the last thing is, so do an adolescent addiction medicine.
Speaker 1: You know they'd send you out. They used to send
Speaker 1: me out with this guy that was a character aer
Speaker 1: And I remember they'd send us all kinds of school,
Speaker 1: but I was reading all the prevention literature. It turned
Speaker 1: out kids in especially middle school that got you know,
Speaker 1: when they they'd have the drug record cop come in
Speaker 1: or whatever and they pass around the pod.
Speaker 2: Or their T shirts and everything, right.
Speaker 1: But when they pass around like this is what a
Speaker 1: joint looks like, they had this this thing in a
Speaker 1: box and it said, here's a needle, here's a joint.
Speaker 1: So they found that we kids got information and we're
Speaker 1: they were essentially desensitized, and those lectures there versus not
Speaker 1: getting information, they their drug usage would go up. We
Speaker 1: would put them more at risk because they were desensites, like, oh,
Speaker 1: that's what a joint looks like, Oh that's LUs do
Speaker 1: you exct?
Speaker 2: So yeah, like you're actually teaching them how to use drugs.
Speaker 1: Yeah, it's like, uh, you know, they're they're naturally any
Speaker 1: kind of fear they had was sort of dissolved and
Speaker 1: they're like, oh that doesn't yeah right, all right, Well.
Speaker 2: So if you had My last question for you is
Speaker 2: if you had like a magic wand and you've seen
Speaker 2: all these people addicted to two opioids is something. I mean,
Speaker 2: obviously we might have already talked about this, that we
Speaker 2: have this one drug that you don't think is being
Speaker 2: utilized as well as it should be. But is there
Speaker 2: anything else that's like blatantly obvious that's going on with
Speaker 2: either just the government's response or how we've gotten to
Speaker 2: this point that I feel like it's worse than anything
Speaker 2: I've ever seen. I mean, you know, you're familiar with Philly.
Speaker 2: We have a huge problem here, like huge in Kensington
Speaker 2: Just Street and in Camden to where my husband works.
Speaker 2: Just I go to visit my husband at the firehouse
Speaker 2: and there's just people lyned on the street, standing up,
Speaker 2: nodding off, and it's it's just terrible. How how did
Speaker 2: we get to this point? And how do we go
Speaker 2: away from it?
Speaker 1: Well, I mean, you know, you can get into the
Speaker 1: politics of it, but the permissive Yeah, I was talking
Speaker 1: to there's no there's no fundamental objective truth. It's like
Speaker 1: I was talking to somebody that was in some sort
Speaker 1: of social service thing and I said, well, somebody psychotic
Speaker 1: and they're running down the road naked thinking that their God,
Speaker 1: wouldn't it be better if they were on medication and
Speaker 1: sort of put in some sort of mandatory Well maybe
Speaker 1: they're happier that way. You know. It's like wait a second,
Speaker 1: So the bottom line is homeless. Here's the simple solution, addict.
Speaker 1: Forced treatment of the addiction, or the recognition of the
Speaker 1: metal health addiction. That's what you gotta treat. You give
Speaker 1: them needles, you give them a safe place, you give
Speaker 1: them drugs to use. That's insane. That's effing insane. So
Speaker 1: we know what it takes. We know what's a problem
Speaker 1: with these people. That's not capitalism. I saw some moron
Speaker 1: from San Francisco. It's capital capitalism. They're freaking addicts. They
Speaker 1: have a drug addiction. Ask any addict. The only thing
Speaker 1: that saves of drug court getting locked up, you're decoruicated.
Speaker 1: You know. It's like when you have those frogs and
Speaker 1: you pit them and they still move around. That's what
Speaker 1: these guys are. Once you're addicted, especially math, high potency stuff,
Speaker 1: math and coke and opiates. They they can't choose, and
Speaker 1: then you put them in there, out of the street
Speaker 1: their own try diagnosed. I mean there's psychiatric issues. They
Speaker 1: have health issues. By that, I mean physical issues, but
Speaker 1: psychiatric addiction you can't. You have to step in and
Speaker 1: mandate or give them a chance where they can. So anyway,
Speaker 1: that's that's the bottom line with holelessness. And I don't
Speaker 1: know why you know these arguments that it's it's finance,
Speaker 1: its inequities and financial things. People have psychiatric ANDD or addiction,
Speaker 1: addiction D or psychiatric and you know you don't, you know,
Speaker 1: you can give them all the money in the world,
Speaker 1: all the food. It cracks me up when they distribute
Speaker 1: turkeys at Thanksgiving to the hallless pot relation.
Speaker 2: Yeah, it is crazy. You're you're just like you're you're
Speaker 2: missing the point people. I mean, feels good in the moment,
Speaker 2: you know, yeah.
Speaker 1: Exactly, Yeah, No, I mean, do you have to have compassion?
Speaker 1: But if you know, if you know that if you
Speaker 1: stick their head in a brain scanner, which you can't
Speaker 1: reduce everybody down to a lab animal, but once they've
Speaker 1: been that intense stimulation of their reward center drug reward drug,
Speaker 1: they can't. They can't. It's like somebody that's starving and
Speaker 1: there's food there, are you know, are they going to
Speaker 1: put clothes on or eat the food? Are they going
Speaker 1: to you know what I say, It becomes there. It's
Speaker 1: an existential thing, right They talk about existential crisis, like
Speaker 1: they got to get the drug. They can't make the
Speaker 1: choice themselves. And uh so almost popular if I had
Speaker 1: a magic wand you're to get these people to help
Speaker 1: them they really need and mandated.
Speaker 2: So okay, it's interesting you have like a really different
Speaker 2: because like right now, I just went outside to go
Speaker 2: get my mail and it feels like it's about to snow.
Speaker 2: It's freezing outside here in Philadelphia area, and you guys
Speaker 2: have like this beautiful weather all the time. Michelle told
Speaker 2: us it was like seventy and sunny and ol and
Speaker 2: you have you have people that are are flocking to
Speaker 2: live there, a huge homeless population. We we do too here,
Speaker 2: but not anything like what you guys have. It's just
Speaker 2: different here. But the I don't know if you've seen
Speaker 2: there's there was this one I don't know if it
Speaker 2: was a YouTube or Instagram account that was called Kensington
Speaker 2: Beach and it was this guy that was just going
Speaker 2: and filming all of these people. It looks like the
Speaker 2: zombie apocalypse. It is just it's insane what's going on
Speaker 2: in Philadelphia area right now? And I don't I don't
Speaker 2: necessarily think that that they're that it's a huge homeless situation,
Speaker 2: and I mean there's definitely a lot of it, but
Speaker 2: not anything like we're seeing in California. But the drugs.
Speaker 2: I mean, there's people there that have necrotic legs, wounds,
Speaker 2: open wounds with maggots on them, just on the street
Speaker 2: nodding off. It's just absolutely insane. What's going on there?
Speaker 1: Right? It's like where does compassion?
Speaker 2: Uh?
Speaker 1: What is real compassion for someone? Sometimes?
Speaker 2: You know, yeah, and giving them clean needles is not
Speaker 2: helping them, I mean obviously, like it's just not helping them.
Speaker 1: No, say that's yeah, and certainly they've been maybe they
Speaker 1: were victims of the system at one point. But you
Speaker 1: just talk to people that have been homeless and then
Speaker 1: got sobriety and got mental health care. They're not going
Speaker 1: to be endorsing safe injection places and you know, providing
Speaker 1: providing shelter, let them live in. You know, here's a
Speaker 1: place they can sleep. But you're not treating their addiction
Speaker 1: or their mental health issue. You're really just you know,
Speaker 1: you're contributing to their demise.
Speaker 2: Yeah, and who cares if I mean, who cares if
Speaker 2: they're using clean needles though, because if there if they're
Speaker 2: never going to have a quality of life, Like, what's
Speaker 2: the difference if they get HIV? Really think about that.
Speaker 2: If they're just going to be living like zombies on
Speaker 2: the street, who cares if they get infectious diseases? If
Speaker 2: they're never going to have a good quality of life.
Speaker 2: I mean that the ultimate goal should be for them
Speaker 2: to have a good quality of life.
Speaker 1: Yeah, well, pathologists are seeing stuff they haven't seen in
Speaker 1: one hundred years, right.
Speaker 2: A lot of oh yeah, I'm here in some crazy.
Speaker 1: Yeah, well they didn't. The system caught things early enough.
Speaker 1: But these people are there, you know, they're the diseases
Speaker 1: are It's it's sort of like a fourth World nation
Speaker 1: where things just there's no intervention for it, you know.
Speaker 2: Yeah, it's incredibly sad. Thanks so much for being here
Speaker 2: with us today. This was great. It's very informative because
Speaker 2: this is so outside of my normal realm of knowledge.
Speaker 2: And uh, you taught us a lot. It was really good.
Speaker 1: Oh well great, any any you know, bad feedback you
Speaker 1: get about me, Please don't tell me. I'm very sensitive
Speaker 1: to criticism.
Speaker 2: All right, boys, I'll talk to you later. Thank you
Speaker 2: for listening to mother. Nos Death As a reminder, my
Speaker 2: training is as a pathologist assistant. I have a master's
Speaker 2: level education and specialize in anatomy and pathology education. I
Speaker 2: am not a doctor and I have not diagnosed or
Speaker 2: treated anyone dead or alive without the assistance of a
Speaker 2: licensed medical doctor. This show, my website, and social media
Speaker 2: accounts are designed to educate and inform people based on
Speaker 2: my experience working in pathology, so they can make healthier
Speaker 2: decisions regarding their life and well being. Always remember that
Speaker 2: science is changing every day and the opinions expressed in
Speaker 2: this episode are based on my knowledge of those subjects
Speaker 2: at the time of publication. If you are having a
Speaker 2: medical problem, have a medical question, or having a medical emergency,
Speaker 2: please contact your physician or visit an urgent care center,
Speaker 2: emergency room, or hospital. Please rate, review, and subscribe to
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