1 00:00:03,720 --> 00:00:06,560 Speaker 1: Welcome to Wellness Unmass. I'm doctor Nicole Saffire and we 2 00:00:06,640 --> 00:00:09,920 Speaker 1: have a really good guest joining us today. Today we 3 00:00:09,960 --> 00:00:13,119 Speaker 1: are talking about sensonyl, not about a political issue, but 4 00:00:13,160 --> 00:00:15,560 Speaker 1: as a public health emergency and what we need to 5 00:00:15,560 --> 00:00:18,600 Speaker 1: do about it. This synthetic opioid is now the leading 6 00:00:18,640 --> 00:00:23,720 Speaker 1: cause of death for Americans ages eighteen forty five, killing quietly, quickly, 7 00:00:24,000 --> 00:00:28,040 Speaker 1: and indiscriminately. Just a small dose the size of a 8 00:00:28,080 --> 00:00:31,440 Speaker 1: few grains of salt can be fatal. This isn't just 9 00:00:31,520 --> 00:00:36,080 Speaker 1: about addiction. It's about poisoned supply chains, failed policies, and 10 00:00:36,120 --> 00:00:40,800 Speaker 1: the urgent need for accountability, prevention, and real solutions. So 11 00:00:41,080 --> 00:00:44,239 Speaker 1: let's unmask the spental crisis and dive right in well 12 00:00:44,280 --> 00:00:47,239 Speaker 1: with the President's war on drugs. Right now, there is 13 00:00:47,280 --> 00:00:50,279 Speaker 1: nobody better to be joining us on Wellness Unmass than 14 00:00:50,360 --> 00:00:55,160 Speaker 1: doctor Stephn Lloyd, Internal medicine and addiction medicine physician, President 15 00:00:55,200 --> 00:00:58,240 Speaker 1: of the Tennessee Medical Board. And he has many more 16 00:00:58,280 --> 00:01:01,400 Speaker 1: titles which I'll leave to hand to tell you all about. 17 00:01:01,440 --> 00:01:03,600 Speaker 1: But Steven, thank you so much for joining us today. 18 00:01:03,800 --> 00:01:04,919 Speaker 2: Thanks for having me Nicole. 19 00:01:05,520 --> 00:01:08,200 Speaker 1: So I mean big news out of the White House obviously, 20 00:01:08,240 --> 00:01:10,839 Speaker 1: President Trump has had a war on drugs, but he's 21 00:01:10,920 --> 00:01:14,240 Speaker 1: now declaring fentanyl to be a weapon of mass destruction. 22 00:01:14,520 --> 00:01:15,560 Speaker 1: What's your thoughts on that. 23 00:01:16,240 --> 00:01:18,280 Speaker 2: Well, you know, I'm not sure what all that entails, 24 00:01:18,319 --> 00:01:21,800 Speaker 2: but from an awareness standpoint thing, Nicole, I'm all for it. 25 00:01:22,760 --> 00:01:24,960 Speaker 2: You know, we know that we're losing about two hundred 26 00:01:24,959 --> 00:01:27,759 Speaker 2: and twenty Americans today to drug overdoses, and the large 27 00:01:27,760 --> 00:01:30,640 Speaker 2: percentage of those are fentanyl. And so you know, if 28 00:01:30,680 --> 00:01:32,559 Speaker 2: you look at two hundred and twenty people a day dying, 29 00:01:32,600 --> 00:01:35,160 Speaker 2: that's a seven thirty seven crashing and killing everybody on 30 00:01:35,160 --> 00:01:38,120 Speaker 2: board every day of the year. And so anytime that 31 00:01:38,200 --> 00:01:40,600 Speaker 2: you know, you can raise awareness about that, then I'm 32 00:01:40,640 --> 00:01:42,480 Speaker 2: all for it. I think it's the right move. I 33 00:01:42,520 --> 00:01:44,720 Speaker 2: don't know what some of the ramifications of that are. 34 00:01:44,720 --> 00:01:47,480 Speaker 2: From a military standpoint or a border control standpoint, that's 35 00:01:47,520 --> 00:01:50,000 Speaker 2: not my area of expertise, but I am certainly in 36 00:01:50,040 --> 00:01:53,320 Speaker 2: favor of because interdiction efforts do help us keeping daily 37 00:01:53,360 --> 00:01:54,560 Speaker 2: drugs out of the United States. 38 00:01:55,520 --> 00:01:57,720 Speaker 1: Yeah, I mean, you know, you make an interesting point. 39 00:01:57,760 --> 00:02:02,000 Speaker 1: So as physicians, we think of drugs as a medical condition. 40 00:02:02,240 --> 00:02:05,680 Speaker 1: It's a physical health issue, but also a mental health issue. 41 00:02:05,760 --> 00:02:09,480 Speaker 1: From a physician's perspective, How do you actually feel about 42 00:02:09,480 --> 00:02:12,800 Speaker 1: it turning into kind of a criminal justice crisis. 43 00:02:13,560 --> 00:02:15,600 Speaker 2: Well, you know, that's the part that always worries me, 44 00:02:15,680 --> 00:02:18,320 Speaker 2: Nicole r. You hang the weapon of mass destruction thing 45 00:02:18,360 --> 00:02:20,080 Speaker 2: on there, and then people who are addicted to it 46 00:02:20,120 --> 00:02:22,519 Speaker 2: get tied into that. And as you know, stigma is 47 00:02:22,560 --> 00:02:24,359 Speaker 2: the biggest thing we have to overcome when we're trying 48 00:02:24,400 --> 00:02:26,720 Speaker 2: to help people with any type of substance use disorder. 49 00:02:26,960 --> 00:02:29,560 Speaker 2: So I do get worried about that. At the same time, 50 00:02:29,600 --> 00:02:32,800 Speaker 2: our partnerships with law enforcement and criminal justice system are key. 51 00:02:33,000 --> 00:02:35,119 Speaker 2: We're not going to move the needle on the opioid 52 00:02:35,120 --> 00:02:37,640 Speaker 2: crisis in the United States until we address this in 53 00:02:37,639 --> 00:02:40,040 Speaker 2: our caarcial setting. I mean, it's just a fact. There's 54 00:02:40,040 --> 00:02:42,200 Speaker 2: so many, you know, so many people in there, and 55 00:02:42,280 --> 00:02:45,560 Speaker 2: so I think there's pluses and minuses to it, But overall, 56 00:02:45,600 --> 00:02:48,120 Speaker 2: I'm glad that he's done it. So it certainly puts 57 00:02:48,120 --> 00:02:51,000 Speaker 2: it on the radar, and if our president thinks it's 58 00:02:51,080 --> 00:02:54,800 Speaker 2: that important, it certainly raises the level of awareness in 59 00:02:54,840 --> 00:02:58,080 Speaker 2: the everyday Americans lives. Except for the people who aren't 60 00:02:58,080 --> 00:02:59,919 Speaker 2: going to like anything the President Trump does. 61 00:03:00,400 --> 00:03:02,799 Speaker 1: Well, there are definitely a handful of them. Right, it 62 00:03:02,880 --> 00:03:05,320 Speaker 1: doesn't matter what he does. He could cure cancer and 63 00:03:05,440 --> 00:03:09,720 Speaker 1: they criticize him somehow, right. You know, President Trump obviously 64 00:03:09,800 --> 00:03:14,120 Speaker 1: has emphasized border security and targeting these cartels, and you know, 65 00:03:14,240 --> 00:03:17,560 Speaker 1: from a medical standpoint, you know, I think about it, 66 00:03:17,600 --> 00:03:22,680 Speaker 1: and the reality is disrupting supply is going to eventually 67 00:03:22,720 --> 00:03:25,840 Speaker 1: have to trickle down to a reduction in overdose deaths, 68 00:03:25,919 --> 00:03:27,480 Speaker 1: don't you think, yes. 69 00:03:27,280 --> 00:03:29,120 Speaker 2: Ma'am, I mean, yes, Nicole. You know, it's one of 70 00:03:29,200 --> 00:03:30,960 Speaker 2: the things that kills me. You know, I hear this. 71 00:03:31,080 --> 00:03:33,400 Speaker 2: The war on drugs has been a failure, right, And 72 00:03:33,440 --> 00:03:36,760 Speaker 2: from a strictly drug using standpoint, I guess it has been, 73 00:03:37,200 --> 00:03:40,480 Speaker 2: But it hasn't been a failure across the board. I mean, 74 00:03:40,520 --> 00:03:42,600 Speaker 2: we have stopped a lot of dangerous drugs from entering 75 00:03:42,640 --> 00:03:45,400 Speaker 2: the United States. That's a good thing, right, If nothing else, 76 00:03:45,440 --> 00:03:47,600 Speaker 2: it drives up the price of what's here, and it 77 00:03:47,640 --> 00:03:50,600 Speaker 2: makes it harder for people to access, right. And so 78 00:03:51,760 --> 00:03:54,480 Speaker 2: I don't buy into those arguments. Our partnerships with law 79 00:03:54,560 --> 00:03:58,200 Speaker 2: enforcement criminal justice are key. They're absolutely key to us 80 00:03:58,240 --> 00:04:00,360 Speaker 2: coming out on the other side of this, And so 81 00:04:00,400 --> 00:04:03,000 Speaker 2: I don't buy those arguments that interdiction efforts don't matter, 82 00:04:03,040 --> 00:04:05,080 Speaker 2: because I think they do, and I think it does 83 00:04:05,120 --> 00:04:07,120 Speaker 2: trickle down. As a matter of fact, I think you're 84 00:04:07,160 --> 00:04:09,440 Speaker 2: seeing it right now. You know, look in the United 85 00:04:09,480 --> 00:04:11,680 Speaker 2: States right now. You know our drug overdose deaths are 86 00:04:11,680 --> 00:04:14,680 Speaker 2: going down. In state of West Virginia. They're down over 87 00:04:14,720 --> 00:04:18,000 Speaker 2: forty percent year over year, and I think interdiction efforts 88 00:04:18,000 --> 00:04:19,440 Speaker 2: have something to do with that. Now, is it one 89 00:04:19,480 --> 00:04:22,599 Speaker 2: hundred percent, No, But is it a portion of it? Absolutely? 90 00:04:23,279 --> 00:04:25,640 Speaker 1: So, Now, what do you think the role like narcan 91 00:04:25,760 --> 00:04:26,400 Speaker 1: has played in that. 92 00:04:27,160 --> 00:04:29,680 Speaker 2: I think it's been a big, huge role, right. I mean, 93 00:04:30,160 --> 00:04:32,800 Speaker 2: if I was in the decision making position to be 94 00:04:32,839 --> 00:04:35,240 Speaker 2: able to address this on a national scale, you know, 95 00:04:35,320 --> 00:04:36,960 Speaker 2: the first thing I would do is blanket the United 96 00:04:37,000 --> 00:04:40,040 Speaker 2: States with narcan or overdose reversal drugs. Because you and 97 00:04:40,160 --> 00:04:42,160 Speaker 2: I are physicians, right, and I don't know about you. 98 00:04:42,160 --> 00:04:45,600 Speaker 2: I mean, I think you're an anaesthesiologist or a radiologist 99 00:04:45,680 --> 00:04:47,880 Speaker 2: or mediologist. Right. You haven't figured out how to treat 100 00:04:47,920 --> 00:04:51,200 Speaker 2: dead people. Nicoleon neither, and so so we have to 101 00:04:51,240 --> 00:04:53,920 Speaker 2: keep people alive. And so the easiest thing to do 102 00:04:54,040 --> 00:04:56,640 Speaker 2: right off the bat is blanket the country with narkann. 103 00:04:56,680 --> 00:04:58,920 Speaker 2: But but you know, then you just have people coming 104 00:04:58,960 --> 00:05:01,279 Speaker 2: in and out of systems go right back. So you 105 00:05:01,320 --> 00:05:03,520 Speaker 2: do have to have that intervention where you actually direct 106 00:05:03,520 --> 00:05:06,040 Speaker 2: people towards treatment, and that would be you know, step 107 00:05:06,080 --> 00:05:07,800 Speaker 2: two of the process. But I think it's key. I 108 00:05:07,880 --> 00:05:10,520 Speaker 2: think overdose reversal drugs have played a big role in this. 109 00:05:11,279 --> 00:05:13,800 Speaker 1: Yeah, but I mean the overdose reversal drugs are for 110 00:05:13,839 --> 00:05:16,239 Speaker 1: the FENNOYL and the drugs that are currently in the system. 111 00:05:16,360 --> 00:05:19,919 Speaker 1: President Trump's working to try and decrease that supply. But 112 00:05:20,080 --> 00:05:22,200 Speaker 1: I'm you know, I still look at our system and 113 00:05:22,360 --> 00:05:25,039 Speaker 1: you know, just to bring a little current events to 114 00:05:25,120 --> 00:05:30,640 Speaker 1: the conversation, I mean what happened just in California with 115 00:05:29,920 --> 00:05:34,159 Speaker 1: the Reiner family. You know, they have a son who 116 00:05:34,440 --> 00:05:38,240 Speaker 1: since his mid adolescence has been in and out of rehabs. 117 00:05:38,240 --> 00:05:41,000 Speaker 1: I think by the age of twenty two, he had 118 00:05:41,040 --> 00:05:46,240 Speaker 1: been in rehab like eighteen times for polysubstance abuse, and 119 00:05:46,279 --> 00:05:49,000 Speaker 1: now he's been arrested for murdering his parents. I mean, 120 00:05:49,480 --> 00:05:53,080 Speaker 1: at what point do you say if if one of 121 00:05:53,120 --> 00:05:57,600 Speaker 1: the most privileged children in our country, I mean, I 122 00:05:57,640 --> 00:05:59,720 Speaker 1: would say he's privileged, he obviously was born into a 123 00:05:59,760 --> 00:06:02,640 Speaker 1: house privilege. If one of the most privileged children in 124 00:06:02,680 --> 00:06:07,120 Speaker 1: this country has failed these multiple rounds of rehab. Like, 125 00:06:07,400 --> 00:06:08,719 Speaker 1: is it a system problem? 126 00:06:09,240 --> 00:06:11,600 Speaker 2: Oh, NICOLEE is for sure a system problem. I mean, 127 00:06:11,600 --> 00:06:13,160 Speaker 2: it's why I'm on here with you. It is a 128 00:06:13,200 --> 00:06:16,040 Speaker 2: system problem. I mean, any other medical condition that we 129 00:06:16,080 --> 00:06:19,880 Speaker 2: put that we treated somebody for, you know, and we're unsuccessful. 130 00:06:19,880 --> 00:06:21,400 Speaker 2: We have a we have a second you know, we 131 00:06:21,440 --> 00:06:24,840 Speaker 2: have a second line treatment option, right, and a third 132 00:06:25,200 --> 00:06:27,880 Speaker 2: and a fourth line and a combination of things. Addiction 133 00:06:28,000 --> 00:06:30,240 Speaker 2: treatments basically not changed the United States in the last 134 00:06:30,240 --> 00:06:32,840 Speaker 2: one hundred years outside of some medications. But they don't 135 00:06:32,839 --> 00:06:35,880 Speaker 2: get people into recovery. They quell cravings. They're important for 136 00:06:35,960 --> 00:06:38,400 Speaker 2: keeping people alive. But Nicole, we got to change our 137 00:06:38,400 --> 00:06:41,359 Speaker 2: fundamental system. You know. I was always I was told 138 00:06:41,600 --> 00:06:43,159 Speaker 2: I don't know if you know about my past, but 139 00:06:43,160 --> 00:06:47,719 Speaker 2: but I'm recovering from opioid and benzo diazepine addiction for 140 00:06:47,760 --> 00:06:50,279 Speaker 2: twenty one years. As a young doctor, I got addicted, 141 00:06:50,680 --> 00:06:52,880 Speaker 2: and I stepped into a system of care for doctors 142 00:06:52,920 --> 00:06:56,200 Speaker 2: that is very good addressing those underlying drivers of addiction. 143 00:06:56,480 --> 00:06:58,760 Speaker 2: And I've got no idea what happened in the Rhiner family. 144 00:06:58,800 --> 00:07:01,599 Speaker 2: And I have no insight into it. However, from my 145 00:07:01,720 --> 00:07:03,840 Speaker 2: point of view, and I look at this and I see, 146 00:07:03,960 --> 00:07:07,200 Speaker 2: you know, young Nick's issues. I wonder, were you just 147 00:07:07,240 --> 00:07:09,400 Speaker 2: addressing the drug use or were you trying to get 148 00:07:09,400 --> 00:07:12,120 Speaker 2: at some of the underlying drivers that was pushing Nick 149 00:07:12,160 --> 00:07:14,040 Speaker 2: in that direction? And then a lot of times it's 150 00:07:14,120 --> 00:07:17,120 Speaker 2: untreated mental health issues. And so the system of care 151 00:07:17,160 --> 00:07:19,840 Speaker 2: that we have today is not meeting the standard. The 152 00:07:19,920 --> 00:07:23,760 Speaker 2: average person with addiction issues takes eight years to get 153 00:07:23,800 --> 00:07:26,000 Speaker 2: one year of sobriety, and in that time they go 154 00:07:26,040 --> 00:07:28,720 Speaker 2: to five different treatment programs. I mean, come on, the cole, 155 00:07:28,800 --> 00:07:31,200 Speaker 2: there's something wrong with that system. 156 00:07:31,360 --> 00:07:32,520 Speaker 1: So what do you think it is? 157 00:07:33,240 --> 00:07:36,480 Speaker 2: Well, I think it's if you're a hammer, everything's a nail. Right. 158 00:07:36,840 --> 00:07:38,960 Speaker 2: You know, you come in, you have this problem. This 159 00:07:39,000 --> 00:07:41,600 Speaker 2: is what we treat you. You're unsuccessful at it, you 160 00:07:41,720 --> 00:07:43,600 Speaker 2: go back out, You come back in, and we hit 161 00:07:43,680 --> 00:07:45,240 Speaker 2: you with the same thing that you came back in 162 00:07:45,320 --> 00:07:48,000 Speaker 2: with the first time. Right. I learned early on in 163 00:07:48,000 --> 00:07:50,560 Speaker 2: recovery that the definition of insanity is doing the same 164 00:07:50,560 --> 00:07:53,040 Speaker 2: thing over and over expecting a different result. That's what 165 00:07:53,120 --> 00:07:54,920 Speaker 2: we do in addiction treatment. We do it all the time, 166 00:07:54,960 --> 00:07:57,080 Speaker 2: and we do it every day. And then when people 167 00:07:57,120 --> 00:07:59,640 Speaker 2: are unsuccessful we kick them out. I mean, what if 168 00:07:59,640 --> 00:08:01,440 Speaker 2: we treat hard failure that way. You know, the day 169 00:08:01,480 --> 00:08:03,920 Speaker 2: after Christmas when Papal was loaded up on country ham 170 00:08:03,920 --> 00:08:06,680 Speaker 2: and salt, it gets fluid overload and fills these lungs up. 171 00:08:06,680 --> 00:08:09,440 Speaker 2: If we treated him like we do people with addiction, 172 00:08:09,480 --> 00:08:10,560 Speaker 2: we'd kick him out of the er. 173 00:08:11,400 --> 00:08:14,760 Speaker 1: That's actually really interesting comparison. You're right, because all the 174 00:08:14,800 --> 00:08:18,960 Speaker 1: time we have either non adherence to medications, non compliance 175 00:08:19,000 --> 00:08:22,040 Speaker 1: with diets and recommendations, and yet we treat them just 176 00:08:22,040 --> 00:08:24,520 Speaker 1: the same. We just give them more diuretics, we up 177 00:08:24,520 --> 00:08:27,200 Speaker 1: their medications, and we just move on. But when it 178 00:08:27,240 --> 00:08:31,040 Speaker 1: comes to addiction medicine, they lose their privilege for certain things, 179 00:08:31,080 --> 00:08:33,679 Speaker 1: they get kicked out of rehabs. That's really interesting. So 180 00:08:33,760 --> 00:08:36,839 Speaker 1: that stigma is still there despite how much talk there 181 00:08:36,920 --> 00:08:38,680 Speaker 1: is about getting rid of stigma. 182 00:08:39,040 --> 00:08:41,880 Speaker 2: It's the biggest roadblock we have. Nicole. People are always 183 00:08:41,880 --> 00:08:43,600 Speaker 2: asking me, Steve, if you know, if you had pixie 184 00:08:43,679 --> 00:08:46,200 Speaker 2: dust and you could wave it, you know, spread a 185 00:08:46,280 --> 00:08:49,000 Speaker 2: pixie dust, and you'd have one thing in this whole system, 186 00:08:49,280 --> 00:08:51,360 Speaker 2: what would you want? And the thing that I want 187 00:08:51,520 --> 00:08:54,480 Speaker 2: doesn't cost any money, right, it's just a change in attitude. 188 00:08:54,880 --> 00:08:57,120 Speaker 2: And you know, the attitude of which I was approached 189 00:08:57,120 --> 00:08:59,280 Speaker 2: back in two thousand and four when I found recovery. 190 00:08:59,679 --> 00:09:01,480 Speaker 2: You know, they didn't tell me it was okay. They 191 00:09:01,520 --> 00:09:03,880 Speaker 2: didn't tell me that, you know that, you know, what 192 00:09:03,920 --> 00:09:06,480 Speaker 2: I've done was great. They did tell me that there's 193 00:09:06,520 --> 00:09:08,560 Speaker 2: an avenue here for help, and if you choose to help, 194 00:09:08,760 --> 00:09:11,000 Speaker 2: if you choose to follow it, then then we're going 195 00:09:11,080 --> 00:09:12,599 Speaker 2: to be beside you the whole way. We're going to 196 00:09:12,640 --> 00:09:14,640 Speaker 2: support you, and we're going to help you in your 197 00:09:14,720 --> 00:09:17,080 Speaker 2: job as you were in your medicine and and so 198 00:09:17,280 --> 00:09:19,160 Speaker 2: you know, those are the type of things that really 199 00:09:19,200 --> 00:09:22,439 Speaker 2: helped me going forward. Most people don't have access to that. 200 00:09:22,720 --> 00:09:24,600 Speaker 2: Most people, when they come into the system, this is 201 00:09:24,640 --> 00:09:26,319 Speaker 2: your last chance. If you mess up, we're going to 202 00:09:26,440 --> 00:09:29,000 Speaker 2: kick you out. And it's this tough love approach. And 203 00:09:29,040 --> 00:09:31,160 Speaker 2: I'm not above tough love, but I can tell you, 204 00:09:31,200 --> 00:09:33,480 Speaker 2: for the most part, it doesn't work. And so we 205 00:09:33,800 --> 00:09:35,880 Speaker 2: absolutely have to change our system. And the thing that 206 00:09:35,920 --> 00:09:38,080 Speaker 2: we can do first of all is change our attitudes 207 00:09:38,080 --> 00:09:39,760 Speaker 2: about addiction and the stigma around it. 208 00:09:40,880 --> 00:09:43,000 Speaker 1: You know, one thing, you know, to bring in a 209 00:09:43,000 --> 00:09:45,040 Speaker 1: little bit of health policy and I'm not sure how 210 00:09:45,080 --> 00:09:47,400 Speaker 1: familiar you are with it. The one thing that came out, 211 00:09:47,600 --> 00:09:49,960 Speaker 1: so the Affordable Care Act, I'm not I'm not going 212 00:09:50,000 --> 00:09:51,560 Speaker 1: to ask you your opinion on it. We don't need 213 00:09:51,600 --> 00:09:55,160 Speaker 1: to go there. But I have always been not a 214 00:09:55,280 --> 00:09:57,680 Speaker 1: huge fan of it. I think there were some good, 215 00:09:57,840 --> 00:10:01,880 Speaker 1: good impetus behind it, but the way I'm not a fan. 216 00:10:01,960 --> 00:10:03,760 Speaker 1: Let me put it that way, got it? You know, 217 00:10:03,800 --> 00:10:06,560 Speaker 1: I think there are significantly more consequences than benefits to it. 218 00:10:06,640 --> 00:10:08,800 Speaker 1: But one thing that did come out with the Affordable 219 00:10:08,840 --> 00:10:12,720 Speaker 1: Care Act was that addiction treatment was deemed one of 220 00:10:12,720 --> 00:10:17,240 Speaker 1: those essential health benefits, and they classified substance use disorder 221 00:10:17,320 --> 00:10:20,439 Speaker 1: treatment and mental health care. You know that insurance plans 222 00:10:20,480 --> 00:10:25,000 Speaker 1: must cover them detact, detox, impatient rehab, outpatient treatment, medication 223 00:10:25,160 --> 00:10:29,800 Speaker 1: assistant treatment. While we also we obviously saw improved in access, 224 00:10:30,000 --> 00:10:34,840 Speaker 1: the quality and the continuity didn't necessarily improve in itself. Like, 225 00:10:34,920 --> 00:10:35,760 Speaker 1: what do you make of that? 226 00:10:36,040 --> 00:10:37,600 Speaker 2: Well, I think I think we have to work on 227 00:10:37,640 --> 00:10:39,480 Speaker 2: the things that you just talked about the quality and 228 00:10:39,520 --> 00:10:42,560 Speaker 2: the continuity, and are we using evidence based approaches to 229 00:10:42,600 --> 00:10:45,360 Speaker 2: treat addiction. I mean that's you know, from a system standpoint, 230 00:10:45,440 --> 00:10:47,360 Speaker 2: you have to do that. But I'm in your corner 231 00:10:47,360 --> 00:10:50,240 Speaker 2: with the Affordable Care Act, you know, and it was actually, 232 00:10:50,320 --> 00:10:52,840 Speaker 2: you know, I think it was well Stone Diminici Act 233 00:10:52,840 --> 00:10:55,480 Speaker 2: of what two thousand and eight or somewhere, the Parity Act. 234 00:10:55,760 --> 00:10:58,079 Speaker 2: They said insurance companies have to cover substance use like 235 00:10:58,120 --> 00:11:00,800 Speaker 2: they cover everything else. And there's ever been any teeth 236 00:11:00,840 --> 00:11:04,040 Speaker 2: in that, and it's really never happened. And so I 237 00:11:04,080 --> 00:11:05,600 Speaker 2: think that, you know, we have to We've got some 238 00:11:05,640 --> 00:11:07,559 Speaker 2: systems problems we got to look at from a coverage 239 00:11:07,559 --> 00:11:10,360 Speaker 2: standpoint here to give people access to care. You know, 240 00:11:10,360 --> 00:11:12,680 Speaker 2: if you break your leg, I mean there's certain things 241 00:11:12,720 --> 00:11:14,120 Speaker 2: you go through when you break your leg, right, you 242 00:11:14,160 --> 00:11:16,000 Speaker 2: see an orthopedis they set your leg, they put you 243 00:11:16,040 --> 00:11:18,559 Speaker 2: in the cast. Your insurance come. You know, your insurance 244 00:11:18,559 --> 00:11:20,320 Speaker 2: pays for the majority of that. You pay your cope 245 00:11:20,320 --> 00:11:22,720 Speaker 2: in deductible. I mean, you have access to care for 246 00:11:22,800 --> 00:11:25,880 Speaker 2: that broken leg. If you have addiction, right, which can 247 00:11:25,960 --> 00:11:28,800 Speaker 2: kill you much quicker than a broken leg. A lot 248 00:11:28,840 --> 00:11:31,040 Speaker 2: of people don't even have access to the care that's 249 00:11:31,040 --> 00:11:32,760 Speaker 2: going to help them, and they wind up in the 250 00:11:32,760 --> 00:11:35,320 Speaker 2: criminal justice system. And the weird thing, n Cole is 251 00:11:35,320 --> 00:11:37,439 Speaker 2: that they get the help once they get into criminal 252 00:11:37,520 --> 00:11:39,079 Speaker 2: justice system. How messed up is that? 253 00:11:40,120 --> 00:11:42,040 Speaker 1: I mean it is. And that's an interesting concept in 254 00:11:42,080 --> 00:11:44,800 Speaker 1: itself because going back and forth on whether you should 255 00:11:44,840 --> 00:11:48,600 Speaker 1: criminalize drug use or not. You know, my thing with 256 00:11:48,640 --> 00:11:52,560 Speaker 1: the Affordable Care Act was the ACA expanded coverage for 257 00:11:52,600 --> 00:11:56,440 Speaker 1: addiction treatment. And therefore, I know it saves lives in 258 00:11:56,520 --> 00:11:58,520 Speaker 1: terms of making sure there's a lot of those medication 259 00:11:58,600 --> 00:12:02,920 Speaker 1: assistant treatments, but it obviously created a bloated, bureaucratic system 260 00:12:03,360 --> 00:12:08,480 Speaker 1: that prioritizes access over outcomes. And so we may be 261 00:12:08,559 --> 00:12:11,120 Speaker 1: treating addiction more often now, but I wouldn't say that 262 00:12:11,160 --> 00:12:13,960 Speaker 1: we're treating it better. Yes, we have more medications, but 263 00:12:14,040 --> 00:12:16,520 Speaker 1: that's not a result of the ACA. They only care 264 00:12:16,559 --> 00:12:18,800 Speaker 1: about the metrics. They care about the number, saying, well, 265 00:12:18,840 --> 00:12:21,560 Speaker 1: this many people went to rehab. Okay, well how many 266 00:12:21,600 --> 00:12:22,560 Speaker 1: people are now sober? 267 00:12:22,720 --> 00:12:25,320 Speaker 2: So it's so beautiful. I couldn't have said it better. 268 00:12:25,400 --> 00:12:27,800 Speaker 2: I mean, this is this is my soapbox. If I 269 00:12:27,880 --> 00:12:31,959 Speaker 2: have it, I could I could care less about the metrics, right, 270 00:12:32,040 --> 00:12:33,920 Speaker 2: I know those things are important. Right, you've got to 271 00:12:33,920 --> 00:12:35,600 Speaker 2: see somebody in this amount of time, and you've got 272 00:12:35,640 --> 00:12:37,240 Speaker 2: to do an ASI on this, and those are things 273 00:12:37,280 --> 00:12:40,480 Speaker 2: are all Nicole. What I care about is outcomes. Outcomes 274 00:12:40,480 --> 00:12:42,560 Speaker 2: are the only thing that matters. You know, in our 275 00:12:42,600 --> 00:12:45,040 Speaker 2: current system, if you're getting federal or state dollars in 276 00:12:45,040 --> 00:12:46,920 Speaker 2: a lot of our treatment programs, you get the money 277 00:12:46,920 --> 00:12:48,439 Speaker 2: you got this year, and then next year, if you 278 00:12:48,480 --> 00:12:50,880 Speaker 2: spend all your money this year, then you get you know, 279 00:12:51,000 --> 00:12:53,440 Speaker 2: five percent or ten percent more, whatever the budget says. 280 00:12:53,520 --> 00:12:55,200 Speaker 2: I don't care about that. I want to know what 281 00:12:55,240 --> 00:12:58,680 Speaker 2: your outcomes were. How many people went from having no job, 282 00:12:58,800 --> 00:13:01,480 Speaker 2: you know, living on the street, to being in recovery, 283 00:13:01,520 --> 00:13:03,760 Speaker 2: having a job, paying into the tax base, getting their 284 00:13:03,800 --> 00:13:06,080 Speaker 2: family back, getting their kid. That's what I care about, 285 00:13:06,360 --> 00:13:09,560 Speaker 2: right recovery. When are we going to start looking at outcomes? 286 00:13:09,559 --> 00:13:12,040 Speaker 2: Because outcomes are the only thing that matters. And I 287 00:13:12,080 --> 00:13:14,319 Speaker 2: think that we have to take the third party approach here, 288 00:13:14,400 --> 00:13:17,400 Speaker 2: bring them to the table and incentivize people for those outcomes. 289 00:13:17,400 --> 00:13:19,480 Speaker 2: And I think there's a way to do that. But Nicole, 290 00:13:19,480 --> 00:13:21,400 Speaker 2: it it's the only thing that matters, or the outcome. 291 00:13:21,720 --> 00:13:22,640 Speaker 2: Nothing else matters. 292 00:13:22,960 --> 00:13:25,520 Speaker 1: You're listening to wellness and mass, We'll be right back 293 00:13:25,600 --> 00:13:32,000 Speaker 1: with more well so. I mean you're not just talking 294 00:13:32,000 --> 00:13:34,800 Speaker 1: the talk, you're walking the walk. One you lived it. 295 00:13:35,280 --> 00:13:39,680 Speaker 1: You're a professional, but you are chairman of something called 296 00:13:39,720 --> 00:13:41,439 Speaker 1: Reach United. Tell us a little bit about. 297 00:13:41,280 --> 00:13:43,960 Speaker 2: That, So Reach you on. It is a nonprofit that 298 00:13:44,160 --> 00:13:47,040 Speaker 2: started with some other folks to raise awareness about how 299 00:13:47,040 --> 00:13:50,280 Speaker 2: the opioid debatement money is being spent. I was actually 300 00:13:50,360 --> 00:13:53,760 Speaker 2: one of the expert witnesses in the cases that you 301 00:13:53,760 --> 00:13:56,559 Speaker 2: know secured about fifty five to sixty big dollars for 302 00:13:56,840 --> 00:13:57,400 Speaker 2: the United States. 303 00:13:57,520 --> 00:13:59,559 Speaker 1: Hold on. So I know what that is because I 304 00:13:59,600 --> 00:14:01,959 Speaker 1: was a part of a lot of the conversations in 305 00:14:02,000 --> 00:14:05,480 Speaker 1: here in New Jersey and Jack Chiarelli had he won, 306 00:14:05,760 --> 00:14:07,960 Speaker 1: like he had a strong plan as to what to 307 00:14:08,000 --> 00:14:10,520 Speaker 1: do with that. But some of our listeners may not 308 00:14:10,800 --> 00:14:12,880 Speaker 1: know what that is, so break it down. 309 00:14:13,240 --> 00:14:17,000 Speaker 2: So multiple states sued industry for the opioid crisis, not 310 00:14:17,040 --> 00:14:21,560 Speaker 2: only Purdue Pharma, but the other manufacturers, distributors, macass and 311 00:14:21,600 --> 00:14:24,720 Speaker 2: Cardinal Health, a mayor source Bergen, and then pharmacy change 312 00:14:24,760 --> 00:14:27,360 Speaker 2: like Walgreens, Walmart and and Kroger some of you know 313 00:14:27,400 --> 00:14:31,960 Speaker 2: some of the big pharmacy change. And so when that happened, 314 00:14:32,360 --> 00:14:34,640 Speaker 2: the federal court system took those cases and lumped them 315 00:14:34,680 --> 00:14:37,520 Speaker 2: in all into one of multi district litigation and then 316 00:14:37,760 --> 00:14:40,280 Speaker 2: as a result of that, we won about fifty five 317 00:14:40,320 --> 00:14:44,000 Speaker 2: billion dollars to abate the opioid crisis, and abate basically 318 00:14:44,040 --> 00:14:46,080 Speaker 2: means to make whole. Now, you're not going to be 319 00:14:46,080 --> 00:14:48,320 Speaker 2: able to bring people back from the dead, but the 320 00:14:48,400 --> 00:14:51,200 Speaker 2: money is supposed to be spent by these individual states 321 00:14:51,520 --> 00:14:54,200 Speaker 2: going forward to build a system of care for the 322 00:14:54,280 --> 00:14:57,160 Speaker 2: United States for the next two to three decades. And 323 00:14:57,320 --> 00:14:59,800 Speaker 2: that money in a lot of places. Now some places 324 00:14:59,800 --> 00:15:02,240 Speaker 2: it's it's going well, but in other places it's sitting 325 00:15:02,240 --> 00:15:05,680 Speaker 2: in bank accounts, the process is not transparent, and in 326 00:15:05,720 --> 00:15:07,920 Speaker 2: some places it's being used for things that aren't related 327 00:15:07,920 --> 00:15:10,400 Speaker 2: to opio debatement. And so that's the whole reason we 328 00:15:10,400 --> 00:15:12,880 Speaker 2: started reaching out. It was to shine a light on that, 329 00:15:13,200 --> 00:15:15,440 Speaker 2: to advocate that this money be spent to build this 330 00:15:15,520 --> 00:15:18,240 Speaker 2: system of care for substitutes and mental health that we 331 00:15:18,320 --> 00:15:19,120 Speaker 2: currently do not have. 332 00:15:19,240 --> 00:15:22,560 Speaker 1: Nicole, Yeah, I mean, and you know better than anyone, 333 00:15:22,600 --> 00:15:24,840 Speaker 1: there's a lot of money sitting there and if it's 334 00:15:24,880 --> 00:15:28,160 Speaker 1: not used, it's going to be misappropriated and it may 335 00:15:28,560 --> 00:15:32,200 Speaker 1: go away. So, I mean, it's really been kind of 336 00:15:32,240 --> 00:15:36,000 Speaker 1: like the COVID funds. You know, it's people you know 337 00:15:36,000 --> 00:15:39,760 Speaker 1: who's not good at managing money the government. I'm sorry, 338 00:15:41,440 --> 00:15:42,920 Speaker 1: so well, I mean it's great, So what are some 339 00:15:43,000 --> 00:15:44,760 Speaker 1: of the things that you want to see the money 340 00:15:44,800 --> 00:15:45,360 Speaker 1: being used for. 341 00:15:46,280 --> 00:15:48,120 Speaker 2: You can even go back further than the COVID funds, 342 00:15:48,160 --> 00:15:51,800 Speaker 2: And I know you remember this, the tobacco settlement money. 343 00:15:51,800 --> 00:15:54,160 Speaker 2: I mean, it was huge, and very little of that 344 00:15:54,240 --> 00:15:58,280 Speaker 2: went to prevent kids from taking up tobacco in the 345 00:15:58,320 --> 00:16:01,600 Speaker 2: first place with evidence space programs, and so that's the fear. 346 00:16:02,040 --> 00:16:04,440 Speaker 2: And so I think I think that, you know, we 347 00:16:04,480 --> 00:16:07,560 Speaker 2: need leadership from a national standpoint on this to ask 348 00:16:07,840 --> 00:16:11,800 Speaker 2: mayors and county commissioners across this country how to allocate 349 00:16:11,840 --> 00:16:13,960 Speaker 2: these dollars to build a system of care for people 350 00:16:13,960 --> 00:16:16,960 Speaker 2: with substance use disorder. I believe that solutions are local 351 00:16:17,040 --> 00:16:19,720 Speaker 2: to co I've always believed that. However, this is a 352 00:16:19,840 --> 00:16:22,840 Speaker 2: complex issue, and I think we need leadership from the 353 00:16:22,880 --> 00:16:25,920 Speaker 2: top down in helping these folks work together to build 354 00:16:25,920 --> 00:16:28,239 Speaker 2: a system of care that they need for their communities. 355 00:16:28,720 --> 00:16:31,040 Speaker 2: And this is a community issue. The opposite of addiction 356 00:16:31,160 --> 00:16:34,560 Speaker 2: is not recovery, it's community and relationship. So where is 357 00:16:34,600 --> 00:16:37,600 Speaker 2: the leadership from the top down that's helping form this 358 00:16:37,640 --> 00:16:40,200 Speaker 2: system of care that no matter where you touch the system, 359 00:16:40,440 --> 00:16:42,320 Speaker 2: you get the help that's right for you. And I 360 00:16:42,320 --> 00:16:44,640 Speaker 2: think there's a way to do that. We've got technology, 361 00:16:44,680 --> 00:16:47,480 Speaker 2: We've got tools that we've never had in the past. 362 00:16:47,600 --> 00:16:50,040 Speaker 2: We have a sense of urgency because you know, we're 363 00:16:50,040 --> 00:16:52,680 Speaker 2: losing two hundred twenty Americans a data this, So I 364 00:16:52,720 --> 00:16:55,640 Speaker 2: think the timing is perfect. And we actually have funds, right, 365 00:16:55,680 --> 00:16:58,000 Speaker 2: we have money. We don't have to go to individual 366 00:16:58,080 --> 00:17:01,200 Speaker 2: state legislators and argue for you know, our tax dollars 367 00:17:01,200 --> 00:17:03,440 Speaker 2: to be distributed to this. We have a separate pot 368 00:17:03,440 --> 00:17:05,680 Speaker 2: of money. My fear is is that we're going to 369 00:17:05,720 --> 00:17:06,119 Speaker 2: waste it. 370 00:17:07,440 --> 00:17:09,960 Speaker 1: Well, I mean, I agree with you, because this money 371 00:17:10,359 --> 00:17:14,600 Speaker 1: is supposed to be there's legally restricted to opioid remediation 372 00:17:14,880 --> 00:17:21,080 Speaker 1: like addiction treatments, medication assistant treatments, NARCAN distributions, housing, prevention, education, 373 00:17:21,760 --> 00:17:25,000 Speaker 1: but data tracking and surveillance, which that's an interesting one. 374 00:17:25,160 --> 00:17:26,800 Speaker 1: They're not supposed to be used for like the general 375 00:17:26,840 --> 00:17:30,679 Speaker 1: budgets or pensions or unrelated projects. But it seems like 376 00:17:31,680 --> 00:17:33,800 Speaker 1: sometimes some of it is. But the problem is, as 377 00:17:33,840 --> 00:17:37,080 Speaker 1: you're saying, if there's not a cohesive plan and there's 378 00:17:37,119 --> 00:17:40,200 Speaker 1: not an evidence based formula, that people are looking at 379 00:17:40,240 --> 00:17:42,800 Speaker 1: like we're going to be wasting all of this money 380 00:17:43,480 --> 00:17:46,440 Speaker 1: and this it's really going to be a missed opportunity. 381 00:17:46,560 --> 00:17:49,080 Speaker 1: And so, you know, is this something that you think, 382 00:17:49,440 --> 00:17:52,119 Speaker 1: like President Trump needs to have a task force that 383 00:17:52,160 --> 00:17:54,520 Speaker 1: they're looking at to make sure that Trump that the 384 00:17:54,680 --> 00:17:58,440 Speaker 1: funds are being used. Is there something that on a 385 00:17:58,640 --> 00:18:03,000 Speaker 1: larger scale that they can put out a playbook to say, 386 00:18:03,000 --> 00:18:05,080 Speaker 1: this is what needs to happen, this is what will 387 00:18:05,119 --> 00:18:08,159 Speaker 1: work so that the money's not just sent piecemeal to 388 00:18:08,359 --> 00:18:09,800 Speaker 1: already broken programs. 389 00:18:10,440 --> 00:18:15,040 Speaker 2: You stole my word, nicole, which is a playbook. Yes, 390 00:18:15,480 --> 00:18:18,000 Speaker 2: and we already have that mechanism in place in the 391 00:18:18,000 --> 00:18:21,040 Speaker 2: federal government's bureaucracy, right. I mean, we have the Office 392 00:18:21,080 --> 00:18:25,119 Speaker 2: of National Drug Control Policy, And I get the federal 393 00:18:25,160 --> 00:18:28,200 Speaker 2: government saying that these are community issues and the solutions 394 00:18:28,240 --> 00:18:31,119 Speaker 2: will be local. And for the most part, I agree 395 00:18:31,119 --> 00:18:33,960 Speaker 2: with that. I think this issue is so complex, with 396 00:18:34,119 --> 00:18:37,400 Speaker 2: so many moving parts. It's ripped at the fabric of 397 00:18:37,160 --> 00:18:40,360 Speaker 2: our families in this country. If you look at our 398 00:18:40,359 --> 00:18:42,119 Speaker 2: health care expenditures, and if you will look at this 399 00:18:42,160 --> 00:18:45,600 Speaker 2: from a financial standpoint, health care expenditures, the majority of 400 00:18:45,640 --> 00:18:48,800 Speaker 2: our health care dollars go to treat chronic disease. You 401 00:18:48,920 --> 00:18:53,439 Speaker 2: know that, And the biggest economic burden of any chronic 402 00:18:53,480 --> 00:18:57,879 Speaker 2: disease is actually substitute disorder. It's not diabetes, hypertension, or 403 00:18:57,920 --> 00:19:00,800 Speaker 2: any of these neurologic diseases that wound up being chronic diseases. 404 00:19:01,000 --> 00:19:03,080 Speaker 2: So yes, I do think that there needs to be 405 00:19:03,119 --> 00:19:05,840 Speaker 2: a top down plan. And I'm not a big government guy, 406 00:19:05,880 --> 00:19:07,800 Speaker 2: but I do think that we need leadership from the 407 00:19:07,880 --> 00:19:10,080 Speaker 2: from the top down to help these communities and help 408 00:19:10,119 --> 00:19:12,960 Speaker 2: these individual states formulate a system that's going to stick 409 00:19:13,000 --> 00:19:15,160 Speaker 2: together and get people the help the need. We don't 410 00:19:15,200 --> 00:19:16,880 Speaker 2: get a second bite at this apple on the cole. 411 00:19:18,640 --> 00:19:21,280 Speaker 1: So if part of your playbook, what are some of 412 00:19:21,280 --> 00:19:22,840 Speaker 1: the things that you think needs to be done. 413 00:19:23,040 --> 00:19:24,640 Speaker 2: I think the first one right off the bat, you've 414 00:19:24,640 --> 00:19:27,080 Speaker 2: already covered, which is, you know, nor kin should be 415 00:19:27,280 --> 00:19:30,280 Speaker 2: like you know, it should be in the drinking water. Okay, 416 00:19:30,440 --> 00:19:32,960 Speaker 2: it should be literally everywhere. I mean, you shouldn't be 417 00:19:32,960 --> 00:19:35,560 Speaker 2: able to walk into a restaurant, a school at any level, 418 00:19:35,640 --> 00:19:38,720 Speaker 2: any kind of place where people are in the public, 419 00:19:38,840 --> 00:19:43,239 Speaker 2: athletic venues, you know, orchestras, plays on Broadway, whatever, and 420 00:19:43,320 --> 00:19:46,280 Speaker 2: not see on the wall overdose reversal drugs. I mean, 421 00:19:46,280 --> 00:19:47,919 Speaker 2: that's the first thing you can do to slap a 422 00:19:47,960 --> 00:19:50,000 Speaker 2: band aid on it, right off the bat. And then 423 00:19:50,040 --> 00:19:52,159 Speaker 2: the next thing that needs to happen is building this 424 00:19:52,280 --> 00:19:56,200 Speaker 2: recovery or any system of care that is data driven, right, 425 00:19:56,359 --> 00:20:00,399 Speaker 2: data driven. We have access to medical res records, we 426 00:20:00,400 --> 00:20:03,840 Speaker 2: have access to technology. We have access to now machine learning, 427 00:20:03,920 --> 00:20:06,439 Speaker 2: artificial intelligence. Some of these things I think are going 428 00:20:06,520 --> 00:20:09,439 Speaker 2: to be real tools for us to put together individualized 429 00:20:09,480 --> 00:20:12,240 Speaker 2: treatment plans for the people that we're trying to help. 430 00:20:12,560 --> 00:20:14,320 Speaker 2: And then then last, but not least, you have to 431 00:20:14,359 --> 00:20:17,320 Speaker 2: start looking at things like social determinants of health. A 432 00:20:17,320 --> 00:20:20,119 Speaker 2: lot of these folks have lost everything, and so it 433 00:20:20,160 --> 00:20:23,359 Speaker 2: starts with housing, right and a way to make a living. 434 00:20:23,400 --> 00:20:25,080 Speaker 2: You know, every time I ask my son to help 435 00:20:25,119 --> 00:20:27,520 Speaker 2: me with something on my phone, right, and you know, 436 00:20:27,840 --> 00:20:29,960 Speaker 2: he gives me the old teach a man to fish lecture. 437 00:20:29,960 --> 00:20:32,600 Speaker 2: I'm about tired of hearing that, right, But his point is, 438 00:20:32,720 --> 00:20:33,919 Speaker 2: let me show you how to do it, and the 439 00:20:33,920 --> 00:20:36,040 Speaker 2: next time you won't have to ask me. And so 440 00:20:36,119 --> 00:20:38,560 Speaker 2: I think times that we just hand out money instead 441 00:20:38,560 --> 00:20:41,080 Speaker 2: of helping people, you know, find a way to be 442 00:20:41,080 --> 00:20:43,520 Speaker 2: able to provide for themselves, and I think a lot 443 00:20:43,640 --> 00:20:46,520 Speaker 2: most people want to do that. So so Nicole, those 444 00:20:46,560 --> 00:20:49,000 Speaker 2: would be my strategies. And then the biggest one for 445 00:20:49,080 --> 00:20:52,080 Speaker 2: me is addressing this in the criminal justice population and 446 00:20:52,119 --> 00:20:54,760 Speaker 2: then the CARCO setting. I mean, until we address it 447 00:20:54,800 --> 00:20:56,640 Speaker 2: in that setting, we're not going to move the needle. 448 00:20:56,680 --> 00:20:58,280 Speaker 2: In the United States, numbers are too big. 449 00:20:58,560 --> 00:21:01,560 Speaker 1: So you think that we need more robust programs within 450 00:21:01,760 --> 00:21:03,840 Speaker 1: the like the penal system. 451 00:21:03,960 --> 00:21:06,640 Speaker 2: Absolutely we already had what you what are you doing 452 00:21:06,680 --> 00:21:09,160 Speaker 2: all day long? Right? I mean you know we could 453 00:21:09,160 --> 00:21:11,200 Speaker 2: be using that time to do things that that are 454 00:21:11,200 --> 00:21:12,760 Speaker 2: going to help you when you when you're when you 455 00:21:12,800 --> 00:21:15,240 Speaker 2: get out of that carceral setting. Ninety five percent of 456 00:21:15,280 --> 00:21:17,800 Speaker 2: the people who are incarcerated the United States today will 457 00:21:17,880 --> 00:21:20,560 Speaker 2: walk the street again. That's a fact. And so if 458 00:21:20,560 --> 00:21:22,320 Speaker 2: they're going to walk the street again, I want them healthy. 459 00:21:22,760 --> 00:21:26,640 Speaker 2: And we're missing a golden opportunity and we have leverage, right, 460 00:21:26,840 --> 00:21:28,879 Speaker 2: And I'll get killed by the harm reduction people on this, 461 00:21:28,960 --> 00:21:31,760 Speaker 2: but I don't care, Nicole. When I went to treatment 462 00:21:31,760 --> 00:21:33,720 Speaker 2: as young doc, and you've been through the process right 463 00:21:33,760 --> 00:21:36,680 Speaker 2: medical school residency. I was in my chief resident year 464 00:21:36,680 --> 00:21:39,719 Speaker 2: when when I got addicted, and when they came to 465 00:21:39,760 --> 00:21:42,400 Speaker 2: me and said, Steve, you have a problem, you know, 466 00:21:42,720 --> 00:21:44,879 Speaker 2: and here's what we'd like you to do. Nicole. I 467 00:21:44,880 --> 00:21:48,399 Speaker 2: didn't have my pom poms out cheering, right. I was 468 00:21:48,480 --> 00:21:51,160 Speaker 2: just trying to save my medical license. But they had 469 00:21:51,320 --> 00:21:54,040 Speaker 2: leverage and said here's the process and if you don't 470 00:21:54,040 --> 00:21:56,640 Speaker 2: do this, then we're not going to let you practice medicine. 471 00:21:56,640 --> 00:21:59,200 Speaker 2: That was the leverage and the coll What I got 472 00:21:59,359 --> 00:22:02,679 Speaker 2: was recovery. It changed my life, It changed my profession, 473 00:22:02,760 --> 00:22:04,760 Speaker 2: It changed me as a father, It changed me as 474 00:22:04,760 --> 00:22:07,560 Speaker 2: a husband, It changes me now as a granddad. And 475 00:22:07,960 --> 00:22:10,920 Speaker 2: simply using that leverage that we have to hold people 476 00:22:10,960 --> 00:22:14,359 Speaker 2: into treatment process when they're already there, and I don't 477 00:22:14,400 --> 00:22:16,639 Speaker 2: know why we're not doing it now. We have courts 478 00:22:16,640 --> 00:22:19,399 Speaker 2: around the country that are doing it, drug recovery courts, 479 00:22:19,400 --> 00:22:22,720 Speaker 2: family treatment courts, veterans treatment courts, and I think it's 480 00:22:22,720 --> 00:22:24,919 Speaker 2: a great thing. And I think we need to expand 481 00:22:24,920 --> 00:22:27,119 Speaker 2: the use of that leverage to behind the walls in 482 00:22:27,160 --> 00:22:29,880 Speaker 2: our car stool setting and start the treatment process while 483 00:22:29,880 --> 00:22:32,440 Speaker 2: we still have people, you know, still have the ability 484 00:22:32,480 --> 00:22:34,000 Speaker 2: to direct that while they're incarcerated. 485 00:22:34,960 --> 00:22:37,199 Speaker 1: So as someone who's been through it themselves, not just 486 00:22:37,480 --> 00:22:40,359 Speaker 1: on the doctor's side of the room with the patient's 487 00:22:40,359 --> 00:22:43,600 Speaker 1: side of the room. Any went out here listening, who 488 00:22:43,640 --> 00:22:46,080 Speaker 1: may be struggling themselves, or they know someone who is 489 00:22:46,080 --> 00:22:48,560 Speaker 1: struggling with any sort of addiction, What is your advice 490 00:22:48,560 --> 00:22:48,920 Speaker 1: for them? 491 00:22:49,600 --> 00:22:53,399 Speaker 2: Addictions treatable, treatment works, and people recover. That's a fact. 492 00:22:53,480 --> 00:22:56,040 Speaker 2: And so there was a time in my life, Nicole, 493 00:22:56,080 --> 00:22:58,280 Speaker 2: where I had all these things, you know, that worked 494 00:22:58,280 --> 00:23:00,240 Speaker 2: to put on my wall, my medical degree, all the 495 00:23:00,240 --> 00:23:02,960 Speaker 2: stuff that I had won in my academic life, and 496 00:23:03,440 --> 00:23:05,639 Speaker 2: income I never imagined as a little boy growing up 497 00:23:05,640 --> 00:23:08,000 Speaker 2: in Jonesboro, Tennessee. Right, I had all of those things, 498 00:23:08,440 --> 00:23:10,720 Speaker 2: but they didn't matter when I was addicted. The only 499 00:23:10,720 --> 00:23:12,520 Speaker 2: thing that mattered was this thing out here I thought 500 00:23:12,560 --> 00:23:15,320 Speaker 2: I would have to have or I would die. And 501 00:23:15,359 --> 00:23:17,679 Speaker 2: the people that are in that situation right now and 502 00:23:17,760 --> 00:23:20,439 Speaker 2: have cravings for that, and they're willing to sacrifice everything 503 00:23:20,440 --> 00:23:23,000 Speaker 2: that they have for that. I understand that addiction is 504 00:23:23,640 --> 00:23:25,760 Speaker 2: a disorder of the brain. It is about our reward 505 00:23:25,800 --> 00:23:28,280 Speaker 2: system and our frontal lobe which gives us insight and judgment, 506 00:23:28,560 --> 00:23:31,439 Speaker 2: and our effective treatment programs out there to help you 507 00:23:31,520 --> 00:23:34,199 Speaker 2: with the cravings so that you can find long term recovery. 508 00:23:34,240 --> 00:23:35,800 Speaker 2: So the people out there who are struggling, I tell 509 00:23:35,800 --> 00:23:39,600 Speaker 2: you there is hope and don't give up. The problem is, Nicole, 510 00:23:39,800 --> 00:23:41,960 Speaker 2: is that the help that they wind up getting is 511 00:23:41,960 --> 00:23:45,720 Speaker 2: dependent upon where they get sent okay, and they get 512 00:23:45,760 --> 00:23:49,719 Speaker 2: whatever the place that they get sent to provides. And 513 00:23:49,760 --> 00:23:53,679 Speaker 2: that's asinine. Why do we not have individualized treatment plans 514 00:23:53,800 --> 00:23:56,520 Speaker 2: that are built on real data? Right? You know, what 515 00:23:56,600 --> 00:23:58,480 Speaker 2: have you already failed at? What have you not been 516 00:23:58,520 --> 00:24:01,680 Speaker 2: successful at? DNA? What are the markers? What are the 517 00:24:01,760 --> 00:24:03,960 Speaker 2: drugs that are most likely to help you with cravings? 518 00:24:04,160 --> 00:24:06,000 Speaker 2: What are the things you need to do from a 519 00:24:06,040 --> 00:24:09,800 Speaker 2: preventative standpoint, your sleep, your diet. Right, we spend all 520 00:24:09,800 --> 00:24:12,760 Speaker 2: these money in the United States on pharmaceuticals and we 521 00:24:12,840 --> 00:24:15,439 Speaker 2: keep going further down that rat hole instead of talking 522 00:24:15,480 --> 00:24:18,000 Speaker 2: about what we can do from a preventative stand for 523 00:24:18,480 --> 00:24:21,080 Speaker 2: standpoint before this happens in the first place, and we 524 00:24:21,119 --> 00:24:23,439 Speaker 2: have to treat it as a chronic disease. So taking 525 00:24:23,520 --> 00:24:26,600 Speaker 2: all of these factors into consideration, what is the best 526 00:24:26,600 --> 00:24:29,399 Speaker 2: treatment profile for you going forward? It gives you the 527 00:24:29,400 --> 00:24:32,560 Speaker 2: best chance at recovery. And Nicole, we have that we 528 00:24:32,600 --> 00:24:36,080 Speaker 2: actually have the technology and the infrastructure to be able 529 00:24:36,119 --> 00:24:38,720 Speaker 2: to do that when we have access to medical data 530 00:24:38,920 --> 00:24:42,639 Speaker 2: buried within electronic medical records across this country. Sorry, I 531 00:24:42,680 --> 00:24:44,640 Speaker 2: got all the soapbox there for quick, but I feel strung. 532 00:24:44,720 --> 00:24:46,920 Speaker 1: Oh I wanted you on the soapbox. You're the props 533 00:24:46,960 --> 00:24:48,160 Speaker 1: big person to talk about it. 534 00:24:48,240 --> 00:24:51,399 Speaker 2: I get so frustrated because we spend all this money 535 00:24:51,400 --> 00:24:54,280 Speaker 2: on the back end. You know that the pharmaceutical industry 536 00:24:54,359 --> 00:24:57,399 Speaker 2: wants us to be depended on, And it just blows 537 00:24:57,440 --> 00:25:00,399 Speaker 2: me away. I don't understand why we're doing more on 538 00:25:00,440 --> 00:25:03,280 Speaker 2: the front end. It's like sleep. Sleep is a risk 539 00:25:03,359 --> 00:25:06,320 Speaker 2: factor for relapse, Nicole. Right now, I've got a wearable, right, 540 00:25:06,359 --> 00:25:08,480 Speaker 2: I've got this this aura ring thing here. I wear 541 00:25:08,880 --> 00:25:11,040 Speaker 2: and when I wake up in the morning, I can 542 00:25:11,040 --> 00:25:12,680 Speaker 2: see the quality of my sleep. I can see I 543 00:25:12,720 --> 00:25:14,720 Speaker 2: got the bed later later last night, and I should have. 544 00:25:14,840 --> 00:25:17,040 Speaker 2: I'm a little worn down today, right, So I don't 545 00:25:17,080 --> 00:25:19,560 Speaker 2: have my normal energy level because my sleep was disrupted 546 00:25:19,560 --> 00:25:21,399 Speaker 2: because me and my wife watched the TV show that 547 00:25:21,520 --> 00:25:24,600 Speaker 2: upset me. Right, And so now tonight I've got a 548 00:25:24,680 --> 00:25:27,280 Speaker 2: chance to make a correction in that and do better 549 00:25:27,359 --> 00:25:30,240 Speaker 2: with my quality of sleep. Now, am I worried about relapsing? Today. No, 550 00:25:30,280 --> 00:25:32,600 Speaker 2: I'm not right. I've been in recovery twenty one years. 551 00:25:32,720 --> 00:25:34,640 Speaker 2: I know how to handle this stuff, and I've got 552 00:25:34,640 --> 00:25:36,960 Speaker 2: friends in recovery. You can help me if I start 553 00:25:37,000 --> 00:25:39,240 Speaker 2: to struggle. What do you do when you're three days 554 00:25:39,240 --> 00:25:42,520 Speaker 2: out from treatment? Right? And you know what does that 555 00:25:42,560 --> 00:25:45,240 Speaker 2: look like? And so we address it not with the 556 00:25:45,280 --> 00:25:47,600 Speaker 2: things that I'm talking about. We address it with pharmaceuticals 557 00:25:47,720 --> 00:25:49,200 Speaker 2: or oh, you need this sleep eight or let me 558 00:25:49,240 --> 00:25:51,080 Speaker 2: write you this annex to help you go to sleep, 559 00:25:51,119 --> 00:25:53,199 Speaker 2: or this ambient. Well, by the way, those things have 560 00:25:53,240 --> 00:25:57,080 Speaker 2: habit forming potential as well. And now we're giving somebody 561 00:25:57,119 --> 00:26:01,159 Speaker 2: who already has known addiction another sub since that they 562 00:26:01,200 --> 00:26:04,080 Speaker 2: can become dependent on. And it just blows my mind 563 00:26:04,080 --> 00:26:06,600 Speaker 2: that we don't take a different approach looking at some 564 00:26:06,600 --> 00:26:10,080 Speaker 2: preventative things our diet, right, our brain, gut access right, 565 00:26:10,160 --> 00:26:13,119 Speaker 2: these type of things that the data is out there. Wearables, 566 00:26:13,160 --> 00:26:15,600 Speaker 2: the data is out there. We actually know who's at 567 00:26:15,680 --> 00:26:19,160 Speaker 2: risk for relapse two weeks before they actually pick up 568 00:26:19,200 --> 00:26:22,240 Speaker 2: based on things that can be gleaned right out of 569 00:26:22,280 --> 00:26:22,800 Speaker 2: a wearable. 570 00:26:23,240 --> 00:26:27,040 Speaker 1: Here RFK Junior talking about how he loves wearables. I 571 00:26:27,080 --> 00:26:29,480 Speaker 1: haven't gotten on the bandwagon for wearables. But you know what, 572 00:26:29,520 --> 00:26:32,000 Speaker 1: I'm always behind. My kids don't think I'm very cool. 573 00:26:32,359 --> 00:26:34,320 Speaker 1: And even though I'm a radiologist, I'm not the most 574 00:26:34,320 --> 00:26:35,840 Speaker 1: tech savvy person you've ever met. 575 00:26:36,240 --> 00:26:38,720 Speaker 2: But you are a radiologist, nic Colon. You all spent 576 00:26:38,760 --> 00:26:40,760 Speaker 2: a lot of time in dark rooms, so that could 577 00:26:40,840 --> 00:26:43,000 Speaker 2: mess you up with a wearable. But I get it. 578 00:26:43,040 --> 00:26:46,080 Speaker 1: I get it more coming up on wellness and masks 579 00:26:46,160 --> 00:26:51,960 Speaker 1: with doctor Nicole Sapphire, I like what you're saying. I mean, 580 00:26:52,040 --> 00:26:54,800 Speaker 1: I am for it and for me I talk, you know, 581 00:26:55,320 --> 00:26:59,040 Speaker 1: being a Western doctor, obviously I rely on big pharma, 582 00:26:59,119 --> 00:27:02,040 Speaker 1: but I also very much into If you know anything 583 00:27:02,080 --> 00:27:05,280 Speaker 1: about me, I love natural herbs. I am the one 584 00:27:05,280 --> 00:27:06,920 Speaker 1: who tells you to go outside and sit into a 585 00:27:07,080 --> 00:27:10,320 Speaker 1: vitamin D. You know, I think that everything that you're 586 00:27:10,359 --> 00:27:13,479 Speaker 1: saying makes sense and it should happen. And you'll hear 587 00:27:13,520 --> 00:27:15,440 Speaker 1: a lot of people say, well, we just don't have 588 00:27:15,840 --> 00:27:18,040 Speaker 1: the money, we don't have the support, but the reality 589 00:27:18,160 --> 00:27:22,800 Speaker 1: is we actually do have the money. And you know, again, 590 00:27:22,840 --> 00:27:25,520 Speaker 1: the Affordable Care Act, they just looked at how many 591 00:27:25,560 --> 00:27:29,120 Speaker 1: people had access to addiction care, but they weren't measuring 592 00:27:29,160 --> 00:27:32,680 Speaker 1: the actual outcomes. And same with the opioid settlement money. 593 00:27:33,160 --> 00:27:36,240 Speaker 1: You know, spending isn't a success, the outcomes are. So 594 00:27:36,720 --> 00:27:40,160 Speaker 1: these monies should be judged by live save, not by 595 00:27:40,200 --> 00:27:43,400 Speaker 1: how many programs they get funded. And when you look 596 00:27:43,400 --> 00:27:46,320 Speaker 1: at these rehab centers, you're right, like it should be 597 00:27:46,520 --> 00:27:50,440 Speaker 1: widely available data. You hear President Trump talking about price transparency. 598 00:27:51,000 --> 00:27:56,280 Speaker 1: What about recovery metrics with each rehab center? Like what 599 00:27:56,359 --> 00:27:59,359 Speaker 1: if what if they have bad you know, bad track 600 00:27:59,440 --> 00:28:02,119 Speaker 1: record that they're our patients don't maintain. You know, I 601 00:28:02,160 --> 00:28:03,840 Speaker 1: think this should all be public knowledge. 602 00:28:04,119 --> 00:28:07,160 Speaker 2: Yeah, it's reasonable when you're talking about mortgage in your 603 00:28:07,160 --> 00:28:08,919 Speaker 2: house for the third time to send your kid to 604 00:28:08,960 --> 00:28:12,280 Speaker 2: the same rehab you've already sent them two twice before. Yes, 605 00:28:12,920 --> 00:28:14,920 Speaker 2: and Nicole, I don't want you to hear me wrong. 606 00:28:15,240 --> 00:28:18,440 Speaker 2: I am not antip pharmaceutical on everything. I don't want 607 00:28:18,440 --> 00:28:21,240 Speaker 2: you to hear that wrong. I'm not. Medications are there, 608 00:28:21,320 --> 00:28:23,240 Speaker 2: and they improve our quality of life, and some of 609 00:28:23,280 --> 00:28:25,520 Speaker 2: them you have a mortality benefit. We live longer as 610 00:28:25,520 --> 00:28:28,800 Speaker 2: a result of treating highpertension or whatever. I'm just saying 611 00:28:29,200 --> 00:28:31,359 Speaker 2: that the knee jerk here is as soon as you 612 00:28:31,440 --> 00:28:34,280 Speaker 2: have an issue, it's straight to that without some other 613 00:28:34,359 --> 00:28:36,960 Speaker 2: things that you could do from a preventative standpoint, and 614 00:28:37,000 --> 00:28:39,920 Speaker 2: we start looking at outcomes. You're exactly right, and you 615 00:28:39,960 --> 00:28:42,920 Speaker 2: don't even have to start with punishment. Right, Well, your 616 00:28:42,960 --> 00:28:44,840 Speaker 2: outcomes are bad and we're going to take your money away. 617 00:28:44,960 --> 00:28:47,800 Speaker 2: If my outcomes are bad. As a provider, I'm not 618 00:28:47,920 --> 00:28:49,960 Speaker 2: doing the job that I need to do for my 619 00:28:50,080 --> 00:28:51,920 Speaker 2: patients who are coming to see me. I want to 620 00:28:52,000 --> 00:28:53,800 Speaker 2: know that, and I want to know how I can 621 00:28:53,880 --> 00:28:56,360 Speaker 2: use that data to improve my care plan so that 622 00:28:56,400 --> 00:28:59,600 Speaker 2: they have better long term outcomes. Right, I mean that's 623 00:28:59,680 --> 00:29:02,760 Speaker 2: the reason for it. And so until we start measuring this, 624 00:29:03,160 --> 00:29:06,120 Speaker 2: we don't even know what we're doing, if it's successful 625 00:29:06,160 --> 00:29:08,960 Speaker 2: or not. And more importantly, we don't know what's successful 626 00:29:09,000 --> 00:29:12,080 Speaker 2: for each individual person. We just kind of throw spaghetti 627 00:29:12,160 --> 00:29:13,640 Speaker 2: up against the wall and see what sticks. 628 00:29:13,920 --> 00:29:16,480 Speaker 1: Okay, Well, I think these are all amazing and I'm 629 00:29:16,480 --> 00:29:19,400 Speaker 1: glad to see everything that you're doing. And you know, 630 00:29:19,520 --> 00:29:21,840 Speaker 1: I just I think it's really important that people who 631 00:29:21,840 --> 00:29:24,480 Speaker 1: have been on both sides of the exam table have 632 00:29:24,600 --> 00:29:27,600 Speaker 1: these conversations, and we need to hold people accountable. And 633 00:29:28,040 --> 00:29:31,080 Speaker 1: you know, I can go on my own soapbox and complain, complain, complain, 634 00:29:31,320 --> 00:29:34,960 Speaker 1: all day long, but it takes people like you, working 635 00:29:34,960 --> 00:29:37,320 Speaker 1: outside of the government to really make sure that these 636 00:29:37,320 --> 00:29:40,840 Speaker 1: moneies are being implemented safely. So appreciate all you're doing 637 00:29:40,880 --> 00:29:43,080 Speaker 1: and thank you so much for coming on the podcast today. 638 00:29:43,080 --> 00:29:44,760 Speaker 1: I'd love to have you back on sometime soon. 639 00:29:45,000 --> 00:29:47,040 Speaker 2: You bet I'd be honored. Nicole. Thank you so much 640 00:29:47,040 --> 00:29:48,000 Speaker 2: for shining a lot on it. 641 00:29:48,040 --> 00:29:52,320 Speaker 1: I'm grateful absolutely the functional crisis. It's not abstract. It's 642 00:29:52,360 --> 00:29:54,840 Speaker 1: happening in our homes, in our schools, in our emergency 643 00:29:54,920 --> 00:29:58,400 Speaker 1: rooms every single day, and we cannot normalize this level 644 00:29:58,400 --> 00:30:02,200 Speaker 1: of loss and we can't afford half measures. Real progress 645 00:30:02,280 --> 00:30:06,840 Speaker 1: requires prevention, treatment, enforcement, and definitely accountability, all working together. 646 00:30:07,240 --> 00:30:11,440 Speaker 1: The lives depend on it. We cannot keep celebrating metrics 647 00:30:11,600 --> 00:30:14,280 Speaker 1: like how many people are covered under insurance that have 648 00:30:14,440 --> 00:30:18,920 Speaker 1: addiction benefits. That doesn't matter if people are not getting 649 00:30:18,920 --> 00:30:21,480 Speaker 1: free from their addictions, if they are not getting clean, 650 00:30:21,560 --> 00:30:24,240 Speaker 1: if they are not becoming a productive member of society. 651 00:30:24,520 --> 00:30:27,720 Speaker 1: We have to stop treating the papers and the checkboxes 652 00:30:27,800 --> 00:30:30,200 Speaker 1: and actually look at the people. Thanks so much for 653 00:30:30,240 --> 00:30:33,280 Speaker 1: listening to Wellness on Mass. I'm doctor Nicole Sapphire. Be 654 00:30:33,320 --> 00:30:35,320 Speaker 1: sure to listen to Wellness on Mass with doctor Nicole 655 00:30:35,360 --> 00:30:38,400 Speaker 1: Sapphire on iHeartRadio wherever you get your podcasts, and we 656 00:30:38,440 --> 00:30:40,360 Speaker 1: will see you next time. Happy holidays,