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Speaker 1: Welcome to Wellness on MASS. I'm doctor Nicoll Saffhire. Today

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Speaker 1: we are diving into a conversation that intersects two national

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Speaker 1: health emergencies, the opioid epidemic and chronic pain. In twenty

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Speaker 1: twenty four, over eighty thousand Americans lost their lives to

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Speaker 1: drug overdoses. Now, this is a twenty seven percent decline

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Speaker 1: from the previous year, and that's the steepest drop that

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Speaker 1: we've seen in decades. This is absolutely encouraging, but we

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Speaker 1: still have a long ways to go. Overdose remains a

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Speaker 1: leading cause of death in adults among those aged eighteen

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Speaker 1: to forty four now. But I don't want to get

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Speaker 1: into the weeds of the opioid epidemic right now, because

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Speaker 1: that is its own episode in itself, and to be honest,

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Speaker 1: it is more than just one episode. We have to

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Speaker 1: talk about the history of it, where we are now,

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Speaker 1: in the future of it. We're not doing that today.

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Speaker 1: Here's what we're doing today. What's often left out of

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Speaker 1: the conversation is the fact that more than fifty million Americans,

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Speaker 1: roughly one in five adults, are living with chronic pain,

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Speaker 1: and of those that, nearly seventeen million are experiencing high

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Speaker 1: impact chronic pain that actually limits their daily lives. Now,

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Speaker 1: this is not just a personal burden, It's actually a

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Speaker 1: national crisis. I wrote about it in my first book,

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Speaker 1: Make America Healthy Again, which came out in twenty twenty.

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Speaker 1: Chronic pain costs the US economy and estimated five hundred

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Speaker 1: and sixty to six hundred and thirty five billion dollars

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Speaker 1: a year. Now, this is direct medical expenses, but it's

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Speaker 1: also from lost productivity, more than the combined costs of

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Speaker 1: heart disease, cancer, and diabetes. Yet we rarely hear people

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Speaker 1: talking about chronic pain, and I guarantee people listening to

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Speaker 1: this podcast there are some of you who are dealing

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Speaker 1: with it. I'm dealing with it. I've talked to you

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Speaker 1: about the fact that I suffer from an autoimmune disease,

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Speaker 1: and I do everything I possibly can to fight that inflammation,

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Speaker 1: whether it's taking my biological injections, to living a clean lifestyle,

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Speaker 1: to exercising and doing other things that are targeted for

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Speaker 1: decreasing inflammation. What some of you may not know about

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Speaker 1: me is deep During COVID December twenty twenty, I also

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Speaker 1: fell down my stairs. Yeah, that's right, I wasn't doing

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Speaker 1: anything fun. I wasn't dancing or doing anything crazy. I

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Speaker 1: was going down to grab some laundry and I was

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Speaker 1: wearing socks on my wooden stairs, and yep, my foot

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Speaker 1: went out right from under me. I to protect my

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Speaker 1: head because I'm married to a brain surgeon and I've

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Speaker 1: heard total nightmare stories about people falling downstairs and hitting

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Speaker 1: their head. I instinctively threw my arm behind my head

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Speaker 1: and protected my head. The good news is I did

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Speaker 1: not hit my head, but I sacrificed my arm to

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Speaker 1: protect it. By the time I got down to the

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Speaker 1: bottom of the stairs, I knew that something was terribly

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Speaker 1: wrong with my arm. I immediately had to have two

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Speaker 1: surgeries to put the pieces of my arm back together again.

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Speaker 1: But I found myself several months after that second surgery,

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Speaker 1: in still in chronic severe pain. And I found myself

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Speaker 1: I was back at work, I was going back to

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Speaker 1: my daily life, but every evening I was in such

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Speaker 1: severe pain. I was taking motrin to get through the

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Speaker 1: day tile and all, and then I was also taking

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Speaker 1: pain medication in the evening time because I still needed

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Speaker 1: to get on with my life. I have children, we

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Speaker 1: have laundry, I have driving, we have to make dinner,

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Speaker 1: and I needed to get some rest. And I found

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Speaker 1: myself realizing that without taking pain medication at night, I

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Speaker 1: wasn't sure I was going to make it. It was

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Speaker 1: affecting me physically, it was affecting me mentally. So my

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Speaker 1: husband and I decided that I needed to seek the

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Speaker 1: help of a pain specialist, and that pain specialist decided

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Speaker 1: to take me off of the pain medication and he

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Speaker 1: injected my joint with some medications to decrease the inflammation.

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Speaker 1: And it took a few injections, but all of a sudden,

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Speaker 1: I got my life back again. I was able to

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Speaker 1: get through the day without feeling severe pain. I was

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Speaker 1: back to exercising, and I wasn't needing to take any

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Speaker 1: more medication. Now, not everybody is able to go and

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Speaker 1: find a pain medicine doctor. They don't even realize they

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Speaker 1: and some pain medicine doctors will just continue to prescribe

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Speaker 1: opioids and other medications. So how do we balance effective

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Speaker 1: pain relief with responsible prescribing. How do we treat pain

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Speaker 1: without fueling addiction. It was the treatment of pain that

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Speaker 1: got us into this problem of the opioid epidemic. In

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Speaker 1: the first place. To help answer these questions. I'm joined

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Speaker 1: by doctor Paul Lynch, a double board certified pain management physician.

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Speaker 1: He's the founder of multiple national pain clinics and a

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Speaker 1: fierce advocate for safe non opioid alternative. You're listening to

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Speaker 1: Wellness unmass. We'll be right back with more well I

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Speaker 1: am happy to have on my friend, former colleague, doctor

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Speaker 1: Paul Lynch, who has dedicated his career to treating pain.

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Speaker 1: He's also founded us Pain with a clear mission in mind.

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Speaker 1: So Paul, thanks so much for being with us on

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Speaker 1: Wellness Unmasked.

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Speaker 2: Dr Stapfire, thank you so much for having me.

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Speaker 1: Oh, we're going to be formal, Okay, I'll be Doctor Lynch.

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Speaker 1: Take us back to what initially drew you into pain

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Speaker 1: management in the first place.

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Speaker 2: Yeah, if you will allow me, I'll go all the

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Speaker 2: way back to being nine years of age and my

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Speaker 2: dad is a therapist, he's a licensed clinical social worker,

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Speaker 2: and he was on the phone in the kitchen and

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Speaker 2: he called me over to him, and he wrote on

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Speaker 2: a piece of paper to go next door and called

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Speaker 2: nine to one to one, and my dad's patient had

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Speaker 2: called him to say goodbye. He was a therapist, and

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Speaker 2: she said he was the only person that ever listened

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Speaker 2: to her and cared about her. He was the only

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Speaker 2: one that would miss her, and so he kept her

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Speaker 2: on the phone while nine year old Paul ran next door.

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Speaker 2: We called the police and my dad was able to

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Speaker 2: save her life. But I felt like I was part

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Speaker 2: of that, and I said that I've been kind of

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Speaker 2: chasing the dragon to mix our metaphors here today, of

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Speaker 2: saving lives. Since I was nine years old, I always

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Speaker 2: wanted to be like my dad. I wanted to be

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Speaker 2: a psychiatrist, and all the way through school, I majored

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Speaker 2: in psychology. In college, I matched in psychiatry. I'm not

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Speaker 2: sure you even remember this story, or Nicole, we used

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Speaker 2: to talk about it, but I matched in psych I

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Speaker 2: was supposed to go to New York City, right to

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Speaker 2: kind of like you. I was supposed to be in

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Speaker 2: New York for psychiatry. And I was about a month

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Speaker 2: away from graduating and my mother in law was diagnosed

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Speaker 2: with a severe form of cancer. It was pancreatic cancer,

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Speaker 2: which I know you have a lot of experience with

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Speaker 2: in your practice, and it spread to her spine and

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Speaker 2: so she had like seven fractures in her spine and

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Speaker 2: she had a lot of tumor in her belly. The

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Speaker 2: family asked me to help with pain control. I knew

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Speaker 2: nothing about pain as a medical student, right, and so

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Speaker 2: I just started researching and I would talk to the

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Speaker 2: doctors in the hospital and I would use Google, and

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Speaker 2: in the process I realized a couple of things. Once

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Speaker 2: she needed these fractures repaired in her spine, and I

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Speaker 2: learned about a procedure called kyphoplasty, where we could blow

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Speaker 2: up a balloon and restore height to the bones and

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Speaker 2: take away pain. And I read about a procedure called

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Speaker 2: celiat plexus block where we could literally block these nerves

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Speaker 2: that went to her belly. And as I was reading

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Speaker 2: about it, I realized that this was the specialty that

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Speaker 2: I was always supposed to be in, and I didn't

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Speaker 2: know it. You know, I always wanted to treat mental health,

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Speaker 2: growing up watching my dad and wanting to be like him.

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Speaker 2: And then I realized that there was this specialty where

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Speaker 2: I could treat mental health and physical health at the

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Speaker 2: same time, and that was pain. And so I literally

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Speaker 2: dropped out of my psych residency. I had no idea

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Speaker 2: what I was going to do. It was a scary time,

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Speaker 2: but I have a strong faith in God, and I

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Speaker 2: just prayed and I asked God to open the doors.

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Speaker 2: And I won't tell you the rest of the story now,

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Speaker 2: but I got into surgery in New York and then

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Speaker 2: I did anesthesiology at NYU and became a pain doctor.

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Speaker 1: I mean, isn't that interesting that you learned early on

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Speaker 1: in the career, because usually it's not until you've been

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Speaker 1: in practice five, ten, even twenty years that you see

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Speaker 1: how intimately connected physical health and mental health really are.

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Speaker 1: But pain is the forefront of that connection, because chronic

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Speaker 1: pain is one of the most debilitating things and affecting

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Speaker 1: mental health so much. And obviously you have now dedicated

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Speaker 1: your professional life to treating acute pain but also chronic pain.

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Speaker 2: Well, that's exactly right. And I think that for better

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Speaker 2: or for worse, God gave me these experiences and I

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Speaker 2: learned from them. You know. I like to talk about

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Speaker 2: justifying the suffering. You know, the suffering that my mother

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Speaker 2: in law went through was vast, and what my wife

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Speaker 2: went through and seeing that, but I feel like out

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Speaker 2: of that there was a silver lining that, you know,

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Speaker 2: I think I learned what true suffering is, and it's

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Speaker 2: not just physical suffering, but it's mental suffering. And I

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Speaker 2: think I probably I learned the mental suffering part for

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Speaker 2: the first fifteen years of you know, believing I was

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Speaker 2: going to be a psychiatrist, and then I learned the

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Speaker 2: physical suffering probably over the last fifteen or twenty years.

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Speaker 2: And the thing that I really want to talk about

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Speaker 2: today is that there's there's a third part of it,

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Speaker 2: which is, yes, you can treat the physical suffering, and

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Speaker 2: yes you can treat the mental suffering. And as a country,

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Speaker 2: we're getting a little bit better at talking about mental suffering,

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Speaker 2: but we're really bad when it comes to addiction.

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Speaker 1: Well, well, let's talk about that, because when our quest

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Speaker 1: to focus on pain, we thought we had the magic pill,

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Speaker 1: the opioids, I mean, right, which you know, decades ago

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Speaker 1: when they first came to the market. All of a sudden,

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Speaker 1: we were finally seeing something that was helping people with

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Speaker 1: their pain. And now we're still in the middle of

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Speaker 1: an opioid epidemic. You've obviously been very vocal about non

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Speaker 1: opioid interventions.

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Speaker 3: But in your view, let's go back a little bit.

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Speaker 1: How do you think we ended up in this opioid

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Speaker 1: epidemic in the first place. You know, what did the

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Speaker 1: medical community do, right?

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Speaker 2: Well, I think it actually comes from the good side

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Speaker 2: of us. The positive side of being a physician is

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Speaker 2: you want to help your patients. When I saw my

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Speaker 2: mother in law suffering in the hospital, dying in pain,

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Speaker 2: of course I wanted to give her opioids. She was

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Speaker 2: dying with cancer. We wanted to take away that pain.

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Speaker 2: And people came along, you know, multiple times over the

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Speaker 2: last hundreds of years, saying that there was a new

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Speaker 2: opioid that's not addictive, right, Like, I'm not sure if

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Speaker 2: you know this or if your viewers do, But when

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Speaker 2: they released Heroin. It came out in about the eighteen eighties. Morphine,

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Speaker 2: we were learning was very addictive. We started using morphine

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Speaker 2: a lot during the Civil War, and by the eighteen

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Speaker 2: eighties we had, you know, thousands of people that were

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Speaker 2: addicted to morphine. So they released Heroin. The same people

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Speaker 2: that make bear aspirin made Heroin, and they said it's

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Speaker 2: just like morphine, but without the addiction. That was the advertising,

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Speaker 2: and of course we found out that heroin is very addictive,

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Speaker 2: and then we thought the same thing was shocking, right,

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Speaker 2: And then we thought the same thing about oxycoda and

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Speaker 2: the same thing about fyking in. And we went through

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Speaker 2: this period in the nineties where the entire healthcare system

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Speaker 2: came together and basically said, we can treat people with

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Speaker 2: opioids and they're not going to get addicted. And it

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Speaker 2: was a slippery slope, but it accelerated by the time

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Speaker 2: I went to medical school in nineteen ninety eight. I

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Speaker 2: had a lecture on a Monday, and the pharmacology teacher

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Speaker 2: said that opioids are a perfect molecule that won't damage

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Speaker 2: one cell in the human body if used at the

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Speaker 2: right doses. That's what they told me in nineteen ninety eight.

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Speaker 2: And the next day I went to a lecture in

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Speaker 2: behavioral health and they brought in a heroin addict to

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Speaker 2: talk to us. And he said he brought the pharmacy,

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Speaker 2: sat down the floor, set off the alarm, and knew

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Speaker 2: that he could get away, but he chose to shoot

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Speaker 2: up one last time because the opio was more powerful

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Speaker 2: to him than anything, including his family and his God.

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Speaker 2: He said that to us, and I said, how could

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Speaker 2: this reconcile with the lecture that we got yesterday? And

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Speaker 2: this was nineteen ninety eight. And so we went through

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Speaker 2: about a twenty year period, call it nineteen ninety five

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Speaker 2: to about twenty thirteen, where we basically told people that

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Speaker 2: these meds were safe, and they are safe when used

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Speaker 2: in the operating room by nanastesiologists, they're safe when used

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Speaker 2: at the end of life for someone who has cancer.

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Speaker 2: They're not safe for people that just have low back pain.

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Speaker 2: And that doesn't mean we don't use it. There are

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Speaker 2: some patients I say low back pain. I had patients

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Speaker 2: that you know were blown up in Iraq and had

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Speaker 2: shratton on their spine and were paralyzed. And there is

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Speaker 2: true suffering that we see every day in our pain clinics.

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Speaker 2: What we need to be very careful about is putting

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Speaker 2: someone who doesn't need to be on opioids on opioids,

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Speaker 2: because the addiction problem really is real.

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Speaker 1: Well, so what I mean there are still many people

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Speaker 1: who are addicted. What are your thoughts on subox owne,

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Speaker 1: you know, widely used for opioid addiction treatment. You know,

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Speaker 1: what are your thoughts on some of those medications?

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Speaker 2: Yeah, So my goal with US pain Care is I

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Speaker 2: want to save a million lives, And people say, how

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Speaker 2: are you going to save a million? Lives, and the

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Speaker 2: answer is to do what I talked about earlier. I

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Speaker 2: call it try diagnosis for these patients that have mental

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Speaker 2: health issues, in mental suffering, they have physical suffering, but

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Speaker 2: they also become addicted to the very pills that we're

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Speaker 2: giving them to treat their physical suffering. Sometimes they get

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Speaker 2: addicted to the pills that we give them to treat

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Speaker 2: their mental suffering. I listened to one of your podcasts

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Speaker 2: earlier this month on anxiety and ADHD, and like you

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Speaker 2: talk about these medications, there's the flip side of it,

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Speaker 2: which is we always are battling the side effects, which

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Speaker 2: sometimes could be dependents and addiction. So for me, the

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Speaker 2: way that I save a million lives is number one

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Speaker 2: is we have to get really big market share, which

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Speaker 2: I'm working on going into all fifty states and working

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Speaker 2: with some of the best doctors around the country. But

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Speaker 2: once we have market share, I want to influence, if

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Speaker 2: not change, the standard of care that if someone becomes

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Speaker 2: addicted to the pills that we're giving them right now,

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Speaker 2: what we do is we kick them out of our clinics.

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Speaker 2: I'm an anesthesiologist, I'm not an addictionologist, and so someone

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Speaker 2: would come in I would write them percoset because they

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Speaker 2: just had knee surgery. At week two or three, they're

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Speaker 2: still hurting. Let's say I keep writing it. At six weeks,

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Speaker 2: Let's say it becomes clear they're totally addicted to the METS.

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Speaker 2: What most doctors will do is just cut them off

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Speaker 2: the pills and kick them out or send them to

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Speaker 2: an addiction psychiatrist, which typically takes about ninety days to

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Speaker 2: get in to see, and a lot of the people

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Speaker 2: are out of network, you can't afford it. My goal

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Speaker 2: is to train antestesiologists across the country and physical medicine

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Speaker 2: rehab docs and neurologists or radiologists or whoever I'm working with,

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Speaker 2: that if that person becomes dependent, you just treat it

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Speaker 2: like a side effect. You don't act like it's a

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Speaker 2: big deal. And the treatment is subox you know, you

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Speaker 2: asked about suboxone. If you take someone who has opioid

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Speaker 2: use disorder, not just someone that's been on for four

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Speaker 2: six weeks, that's not a great example. What about someone

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Speaker 2: that's been on for four or six years and they're

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Speaker 2: taking ten pills a day, and they're going to the street,

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Speaker 2: and maybe they're getting fentanyl, which is widely available now

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Speaker 2: in every city. If you put that person who's opioid

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Speaker 2: use disorder on suboxone, you reduce their death rate by

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Speaker 2: fifty percent.

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Speaker 1: And so, how does suboxone work for people who don't

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Speaker 1: really know what it is? Peope, you have heard a

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Speaker 1: lot about in the loxo, but not necessarily suboxide.

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Speaker 2: Sure. No, it's a great question. And I know your

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Speaker 2: viewers probably can't see me, but I'm going to use

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Speaker 2: my hand to demonstrate. So there's like a receptor in

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Speaker 2: your brain called a MEW receptor. And if someone's taking fentanyl,

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Speaker 2: let's just use fentone example, because it's the drug that's

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Speaker 2: killing so many people, eighty thousand dead from fentanyl in

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Speaker 2: twenty twenty three. So fentanel comes along and it sticks

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Speaker 2: in the receptor and it's a perfect fit. It fits

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Speaker 2: perfectly in the MEW receptor. We call that an agonist

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Speaker 2: it agoni, or it stimulates the receptor and you get

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Speaker 2: pain relief. Sometimes you get euphoria, and you can get

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Speaker 2: respiratory depression where you stop breathing. You also get other

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Speaker 2: things like itching and constipation and stuff that no one

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Speaker 2: cares about. But it's thinkinting perfectly inside this receptor. If

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Speaker 2: someone overdoses, you can give them narcan or in the lozone,

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Speaker 2: which a lot of people have heard about. I worked

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Speaker 2: with the White House sit between twenty fourteen and sixteen

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Speaker 2: to get education out there about how we can use

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Speaker 2: narcan throughout the country. This wasn't a thing like even

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Speaker 2: ten or fifteen years ago. But now we have narcan

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Speaker 2: in the back of every ambulance. We have it widely available,

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Speaker 2: and we know that it saves lives. And so where

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Speaker 2: you have that fentanyl stuck in that me receptor, narcan

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Speaker 2: comes along. It's called an antagonist, and it's stronger than

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Speaker 2: the fentanyl is, so it kicks it off. And now

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Speaker 2: I'm putting my hand kind of partially in the receptor.

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Speaker 2: The narcan only partially stimulates the receptor, so and I'm

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Speaker 2: not saying that well, I'm sorry, it completely blocks the

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Speaker 2: receptor and it kicks off the fentanyl. And so if

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Speaker 2: you look at suboxone, there's actually two molecules in it.

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Speaker 2: One is bupernorphine, which is called an agonist antagonist, and

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Speaker 2: so it partially agonizes the receptor. So if you give

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Speaker 2: it to a patient who has severe pain, they will

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Speaker 2: get some pain relief, which is a nice benefit of suboxone.

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Speaker 2: Not as much as fentanyl, but it might work sixty

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Speaker 2: percent as well, or even seventy percent. But here's where

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Speaker 2: it gets interesting. It also blocks the receptor, so we

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Speaker 2: call it an agonist antagonist. It will partially bind to

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Speaker 2: the receptor, but it blocks it. And here's the part

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Speaker 2: that most people don't know. It is seventy times stronger

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Speaker 2: than fentanyl seven zero. And so when people are afraid

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Speaker 2: of like this fentanyl crisis, I tell them, listen, I'm

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Speaker 2: not afraid of fensanel. We literally need more suboxone or

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Speaker 2: more bupernorphine, because it's like Godzilla is bupernorphine and fentanyl

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Speaker 2: is this little baby bunny at a molecular level when

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Speaker 2: you're talking about how it stimulates that receptor. And so

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Speaker 2: what we do with suboxone is we combine these two

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Speaker 2: molecules bupernorphine, which will partially agonize the receptor and block it.

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Speaker 2: And then narcndis there. And a lot of people don't

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Speaker 2: realize this. The narcan, the naloxone that's part of suboxone,

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Speaker 2: is not even biologically active when you take it sublingually,

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Speaker 2: so you take it under the tongue, it goes into

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Speaker 2: the bloodstream and the buper and orthhene is working. But

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Speaker 2: if you take it and shoot it up, because sometimes

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Speaker 2: when you have opioid use disorder, people start doing ivy drugs.

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Speaker 2: If you try to shoot up the bupernorthene, it keeps

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Speaker 2: you from overdosing because the narcan is released and it

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Speaker 2: blocks the receptor. So it's a brilliant drug and when combined,

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Speaker 2: like I said, it's a fifty percent reduction immortality because

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Speaker 2: it's so much more strong than the opioid.

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Speaker 1: So you're using the sevoxone to treat the chronic pain

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Speaker 1: as a means of someone who has already been addicted

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Speaker 1: to it, or you're starting with savoxone to begin with.

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Speaker 2: So it's kind of a loaded question there. We don't

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Speaker 2: use suboxone typically if it's just pain, we'll use a

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Speaker 2: different a different way to get the buper and orthene

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Speaker 2: into the body. So one's called a bu trans patch.

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Speaker 2: You can just put a patch on and it gives

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Speaker 2: you bruperorphene. It blocks your receptor and it gives you

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Speaker 2: pain relief. But you don't you don't get addicted and

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Speaker 2: you don't ow. It's almost impossible to overdose on bupern

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Speaker 2: orphine unless you combine it with like alcohol or benzodiazepines

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Speaker 2: or other sedative hypnotic agents. So for someone who comes

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Speaker 2: in that just has chronic low back pain, a lot

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Speaker 2: of my community is going towards bupernorphine as a treatment

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Speaker 2: because it's so low risk. But if someone comes in

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Speaker 2: and they have terrible, serious pain and they've become addicted,

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Speaker 2: and they have full on opiud use disorder, this is

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Speaker 2: a very easy diagnosis to make. There's eleven questions in

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Speaker 2: the DSM five they have low, mild, moderate, and severe.

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Speaker 2: And if you take someone like my younger brother, by

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Speaker 2: the way, was a heroin addict, and I can tell

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Speaker 2: you a little bit more about that, you know, maybe later,

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Speaker 2: but he has severe opiod use disorder, and he started

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Speaker 2: helping me tell the story of kind of what he

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Speaker 2: went through. He started on perkos at and then within

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Speaker 2: about ninety days he got addicted to heroin and it

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Speaker 2: lasted about ten years where he was full on severe

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Speaker 2: opiod use disorder. And so for someone like him, he

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Speaker 2: has chronic pain. He had an overdose that was so

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Speaker 2: bad in two thousand and six that he spent about

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Speaker 2: ninety days in the ICU. We had about twenty six surgeries.

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Speaker 2: He was paralyzed from the waist down. It was terrible,

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Speaker 2: Nicole and when he came out, yeah, took us back.

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Speaker 3: For those who don't know the story.

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Speaker 1: So what most people don't understand is they think of, well,

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Speaker 1: we take pergose, maybe wisdom teeth got taken out.

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Speaker 3: They had the ACL from a ski injury.

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Speaker 1: Most people can't comprehend how you can go from just

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Speaker 1: taking post procedural opioids to getting heroin on the street.

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Speaker 1: Like they can't fathom that that happens to everyday people.

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Speaker 2: Yeah, so thank you Boyd's. You know, the data shows

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Speaker 2: that if you smoke even one cigarette when you're in

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Speaker 2: junior high or high school or as an adult, sixty five

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Speaker 2: percent of people will get addicted for at least a

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Speaker 2: short period of time. Think that's crazy, right, sixty five percent.

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Speaker 2: It actually happened to me. My brother took me and

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Speaker 2: we smoked a cigarette when I was nine years old

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Speaker 2: behind a train station, and I smoke for a week.

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Speaker 2: Every time every chance I got, I'd sneak away and

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Speaker 2: go smoke with my brother. Other smoke for almost ten years.

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Speaker 2: He got addicted as a child and smoke all the

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Speaker 2: way up through college, and then he finally stopped. If

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Speaker 2: you look at the lifetime prevalence of smoke in the

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Speaker 2: United States, I think it's not about fifteen or twenty percent.

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Speaker 2: Those people are addicted. They can't stop right and so alcoholism,

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Speaker 2: it's about seventeen to twenty percent of Americans will get

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Speaker 2: addicted to alcohol at some point during their life. So

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Speaker 2: if you take just those same numbers and said seventeen

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Speaker 2: to twenty percent of people who take percoset might get addicted,

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Speaker 2: that's probably not too far off the reality. There's some

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Speaker 2: data showing it's as low as four percent or ten percent.

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Speaker 2: There's some data showing as high as forty but I

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Speaker 2: think the numbers somewhere between ten and twenty percent. Of

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Speaker 2: people are like my brother. They take the percoset and

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Speaker 2: they love the way it makes them feel. Listening to

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Speaker 2: your podcasts and stuff, you're very into mental health and

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Speaker 2: you understand depression and anxiety. You take an opioid for

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Speaker 2: the right person or the wrong person, it might make

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Speaker 2: them feel calm for the first time in their life.

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Speaker 2: It might make them feel pleasure when it stimulates that

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Speaker 2: receptor that I talked about, it releases endorphins, right, and

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Speaker 2: so this person finally feels good and they feel pain

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Speaker 2: and they feel happy, and then they take a bigger

430
00:21:02,960 --> 00:21:05,560
Speaker 2: dose and a bigger dose and a bigger dose over time,

431
00:21:05,760 --> 00:21:07,800
Speaker 2: and before you know it, someone becomes addicted.

432
00:21:08,920 --> 00:21:11,880
Speaker 1: But then how does that transform to going and getting heroin?

433
00:21:12,000 --> 00:21:13,720
Speaker 1: Why you know they shop around.

434
00:21:13,520 --> 00:21:16,159
Speaker 3: To the doctors or I want to know how to

435
00:21:16,160 --> 00:21:16,800
Speaker 3: go get heroin?

436
00:21:17,480 --> 00:21:21,040
Speaker 2: Sure, So I'm gonna answer that through the story of

437
00:21:21,080 --> 00:21:23,920
Speaker 2: my brother. So interestingly, the story I told you about

438
00:21:23,920 --> 00:21:26,119
Speaker 2: my mother in law that was in the spring summer

439
00:21:26,119 --> 00:21:28,600
Speaker 2: of two thousand and two. I had what I call

440
00:21:28,640 --> 00:21:30,760
Speaker 2: about a three or four month honeymoon period with the

441
00:21:30,760 --> 00:21:33,520
Speaker 2: pain space where I was like, these procedures are great,

442
00:21:33,560 --> 00:21:36,840
Speaker 2: these drugs are great, these opioids help people. I mean

443
00:21:36,880 --> 00:21:38,919
Speaker 2: I was a little suspicious because, like I said, I

444
00:21:38,960 --> 00:21:41,879
Speaker 2: saw the guy in medical school telling me rob the

445
00:21:41,880 --> 00:21:44,400
Speaker 2: pharmacy to get opiates. I was a little bit suspicious.

446
00:21:44,440 --> 00:21:47,760
Speaker 2: And my dad ironically was a drug and alcohol counselor

447
00:21:47,880 --> 00:21:49,560
Speaker 2: at the time, and so I didn't know a little

448
00:21:49,600 --> 00:21:51,640
Speaker 2: bit about drugs. But I had like this four month

449
00:21:51,680 --> 00:21:54,200
Speaker 2: honeymoon period in New York City, and this was kind

450
00:21:54,240 --> 00:21:56,359
Speaker 2: of like ground zero writing a bunch of opioids. You know,

451
00:21:56,359 --> 00:21:58,400
Speaker 2: I worked under a guy named Russell Portnoy at Beth

452
00:21:58,440 --> 00:22:01,560
Speaker 2: Israel Hospital who was of some of this. My brother

453
00:22:02,400 --> 00:22:06,280
Speaker 2: hurt his back and in Oklahoma, where you know where

454
00:22:06,320 --> 00:22:08,159
Speaker 2: I was going to medical school, he went to a

455
00:22:08,160 --> 00:22:10,960
Speaker 2: doctor in the game percocet and immediately took away my

456
00:22:11,040 --> 00:22:13,600
Speaker 2: brother's pain. But my brother had, you know, a long

457
00:22:13,720 --> 00:22:17,640
Speaker 2: history of probably you know, mental health issues as well,

458
00:22:17,640 --> 00:22:21,480
Speaker 2: including depression, anxiety, on other things, and so I think

459
00:22:21,520 --> 00:22:24,720
Speaker 2: for him he felt he felt good for the first time.

460
00:22:25,160 --> 00:22:27,600
Speaker 2: But what happens is you get tolerance, right, and so

461
00:22:27,640 --> 00:22:30,240
Speaker 2: you're a doctor, you understand this. But for your users,

462
00:22:30,240 --> 00:22:33,600
Speaker 2: what tolerance means is that receptor that I talked about,

463
00:22:34,280 --> 00:22:36,480
Speaker 2: Once it gets filled with a percocet, your brain makes

464
00:22:36,520 --> 00:22:38,520
Speaker 2: two more and now you have three receptors, and so

465
00:22:38,560 --> 00:22:39,800
Speaker 2: you go back to the doctor and say I need

466
00:22:39,800 --> 00:22:41,680
Speaker 2: a bigger dose. So they give you a bigger dose,

467
00:22:41,880 --> 00:22:44,359
Speaker 2: and then you get six receptors, and then ten and

468
00:22:44,359 --> 00:22:46,320
Speaker 2: then one hundred. And they've done lots of research on this,

469
00:22:46,600 --> 00:22:49,680
Speaker 2: but it's called opioid hyper algesia where they actually start

470
00:22:49,720 --> 00:22:53,000
Speaker 2: having worse pain because they have more receptors. And so

471
00:22:53,040 --> 00:22:54,760
Speaker 2: you get to the point where the doctor says, no,

472
00:22:55,040 --> 00:22:57,600
Speaker 2: you can't have anymore. This is crazy. You can't take

473
00:22:57,680 --> 00:23:00,560
Speaker 2: twenty oxycode on a day. And if you've ever had

474
00:23:00,600 --> 00:23:02,320
Speaker 2: like you know, if you ever go out drinking with friends,

475
00:23:02,320 --> 00:23:03,920
Speaker 2: you might have that one guy that can drink twenty

476
00:23:04,000 --> 00:23:06,560
Speaker 2: drinks and it just doesn't affect them. That person will

477
00:23:06,560 --> 00:23:08,640
Speaker 2: get cut off by the doctors say I can't give

478
00:23:08,680 --> 00:23:11,480
Speaker 2: you twenty oxy cotos today, and then they go to

479
00:23:11,520 --> 00:23:14,919
Speaker 2: the street and you you start buying pills, and then

480
00:23:14,960 --> 00:23:16,679
Speaker 2: the pills aren't enough and someone's like, hey, I can

481
00:23:16,680 --> 00:23:17,960
Speaker 2: give you heroin. You can shoot it up and you

482
00:23:17,960 --> 00:23:20,160
Speaker 2: feel better immediately, and you slip into it. And that's

483
00:23:20,200 --> 00:23:23,200
Speaker 2: exactly what happens in the old days. When I first

484
00:23:23,200 --> 00:23:26,440
Speaker 2: started looking at this data, when my brother first overdosed

485
00:23:26,440 --> 00:23:29,160
Speaker 2: in my bathroom, there was about five hundred thousand Americans

486
00:23:29,160 --> 00:23:33,439
Speaker 2: that were addicted to heroin. Today it's nine million that

487
00:23:33,480 --> 00:23:37,320
Speaker 2: are addicted to fentanyl or opioids or pills. Nine million.

488
00:23:37,400 --> 00:23:38,919
Speaker 2: This has all happened during my career.

489
00:23:39,480 --> 00:23:40,640
Speaker 3: Well, so you keep.

490
00:23:40,440 --> 00:23:43,439
Speaker 1: Bringing up fentanyl because there is a relationship between you know,

491
00:23:43,520 --> 00:23:48,080
Speaker 1: medical opioid dependents, but also fentanyl, and the new FBI director,

492
00:23:48,160 --> 00:23:50,280
Speaker 1: Cash Forttel, has said that it is going to be

493
00:23:50,280 --> 00:23:53,080
Speaker 1: a priority to him to get the fentanyl off our

494
00:23:53,119 --> 00:23:56,159
Speaker 1: streets because it's being imported in from other countries and

495
00:23:56,200 --> 00:23:58,680
Speaker 1: he's working on this very hard. What kind of impact

496
00:23:58,720 --> 00:24:00,679
Speaker 1: do you think that we'll actually have of on the

497
00:24:00,680 --> 00:24:03,720
Speaker 1: opioid crisis that we are seeing here in the United States.

498
00:24:04,320 --> 00:24:06,359
Speaker 2: Well, I think it's I think it's very important. I

499
00:24:06,400 --> 00:24:09,280
Speaker 2: think that Fentanel I like to teach this to people.

500
00:24:09,359 --> 00:24:12,000
Speaker 2: We have two separate epidemics going on at the same time,

501
00:24:12,240 --> 00:24:14,720
Speaker 2: and it's almost like a ven diagram where they overlap

502
00:24:14,760 --> 00:24:17,760
Speaker 2: a little bit. There is an opioid prescribing epidemic. There

503
00:24:17,760 --> 00:24:19,960
Speaker 2: has been an epidemic in the way we've prescribed since

504
00:24:20,040 --> 00:24:22,919
Speaker 2: nineteen ninety five. Probably we've got better at it, but

505
00:24:23,000 --> 00:24:25,159
Speaker 2: we continue to write more opioids than any other country

506
00:24:25,160 --> 00:24:27,040
Speaker 2: in the world, and we have an epidemic of people

507
00:24:27,040 --> 00:24:29,439
Speaker 2: becoming dependent on the very pills we're writing, which is

508
00:24:29,440 --> 00:24:31,840
Speaker 2: a big part of my campaign to educate pain doctors

509
00:24:32,160 --> 00:24:35,439
Speaker 2: use less pills and if you get someone who's addicted,

510
00:24:35,480 --> 00:24:37,280
Speaker 2: you treat their addiction. Like that's how I make an

511
00:24:37,280 --> 00:24:39,879
Speaker 2: impact in my space. In the fentanyl space, it's a

512
00:24:39,880 --> 00:24:44,040
Speaker 2: totally different epidemic. You have a molecule that is micrograms, right,

513
00:24:44,119 --> 00:24:46,399
Speaker 2: not milligrams. Like when we had our cocaine crisis in

514
00:24:46,440 --> 00:24:48,679
Speaker 2: the eighties. You remember you'd watched the shows with Pablo

515
00:24:48,840 --> 00:24:52,440
Speaker 2: Escobar and they were shipping in plane loads of cocaine,

516
00:24:52,520 --> 00:24:54,240
Speaker 2: and like you could see the plane coming and you

517
00:24:54,280 --> 00:24:56,359
Speaker 2: know it's got cocaine, and it was actually very easy

518
00:24:56,400 --> 00:25:00,680
Speaker 2: to fight. In the big picture, fentanel is totally It's

519
00:25:00,680 --> 00:25:03,720
Speaker 2: sold not milligrams, but micrograms. It's very very tiny. You

520
00:25:03,760 --> 00:25:06,400
Speaker 2: can overdose on enough. Fentanyl can sit on the tip

521
00:25:06,440 --> 00:25:09,199
Speaker 2: of a pencil, right, the tip of a pencil can

522
00:25:09,280 --> 00:25:11,639
Speaker 2: kill you. You can sneak it in in diapers and

523
00:25:11,720 --> 00:25:14,280
Speaker 2: dolls and food and whatever you want. It is coming

524
00:25:14,320 --> 00:25:16,840
Speaker 2: across our border. I live in Arizona and we're one

525
00:25:16,880 --> 00:25:19,600
Speaker 2: of the primary access points for fentanyl into our country,

526
00:25:19,880 --> 00:25:23,440
Speaker 2: and so we need to have strong policies on fentanyl,

527
00:25:23,520 --> 00:25:25,640
Speaker 2: whatever that is. And I think that our government can

528
00:25:25,680 --> 00:25:29,080
Speaker 2: make a really big impact by focusing on fentcannel. From

529
00:25:29,119 --> 00:25:31,399
Speaker 2: my perspective as a doctor. The biggest thing I can

530
00:25:31,440 --> 00:25:34,160
Speaker 2: do is educate, like our kids need to know about fencanel.

531
00:25:34,480 --> 00:25:37,080
Speaker 2: Like the good old days of going to a party

532
00:25:37,200 --> 00:25:39,760
Speaker 2: and doing some pills in the seventies or eighties are gone.

533
00:25:40,080 --> 00:25:42,399
Speaker 2: Any pill that you take could kill you one pill

534
00:25:42,560 --> 00:25:45,280
Speaker 2: because they put fentanel in pills, right, and so you

535
00:25:45,320 --> 00:25:47,479
Speaker 2: can literally take it and one pill can kill you.

536
00:25:47,800 --> 00:25:49,720
Speaker 2: And so it's important for us to educate our high

537
00:25:49,720 --> 00:25:53,600
Speaker 2: school students, our college students to have narcan widely available.

538
00:25:53,600 --> 00:25:55,960
Speaker 2: We talked about narcian earlier can reduce and or can

539
00:25:56,160 --> 00:25:59,119
Speaker 2: reverse an overdose. And certainly our federal government needs to

540
00:25:59,160 --> 00:26:03,240
Speaker 2: be looking diplomacy with China and Mexico to cut down

541
00:26:03,280 --> 00:26:06,240
Speaker 2: the distribution of fentchannel across our borders, to go after

542
00:26:06,320 --> 00:26:08,440
Speaker 2: cartels that are selling it. But yes, I think that

543
00:26:10,119 --> 00:26:12,360
Speaker 2: cash betells you to make a big impact with as policies.

544
00:26:12,800 --> 00:26:15,640
Speaker 1: You know, it's interesting you said overdose, and I hear

545
00:26:15,680 --> 00:26:17,280
Speaker 1: a lot of people say, you know, we do talk

546
00:26:17,320 --> 00:26:19,879
Speaker 1: about overdose and when we find people unconscious or when

547
00:26:19,880 --> 00:26:22,480
Speaker 1: they die because they've taken too much of a dose

548
00:26:22,520 --> 00:26:25,720
Speaker 1: of a medication that's caused the respiratory depression and being

549
00:26:25,760 --> 00:26:28,600
Speaker 1: unconscious or even death. But the reality is with a

550
00:26:28,640 --> 00:26:31,320
Speaker 1: lot of these young people who are taking these medications,

551
00:26:31,480 --> 00:26:33,080
Speaker 1: they don't even know that they're spent andel in it,

552
00:26:33,440 --> 00:26:36,480
Speaker 1: so they're not overdosing on it, they're being.

553
00:26:36,320 --> 00:26:38,040
Speaker 3: Poisoned with it, and it's killing them.

554
00:26:38,119 --> 00:26:41,120
Speaker 1: And so I wonder if changing even the verbiage that's

555
00:26:41,240 --> 00:26:44,320
Speaker 1: used to just remind people that these kids who are

556
00:26:44,359 --> 00:26:48,280
Speaker 1: going out and are overdose quote unquote overdosing, they are

557
00:26:48,320 --> 00:26:50,760
Speaker 1: taking something which they don't even realize what it is.

558
00:26:51,160 --> 00:26:52,359
Speaker 3: One they're not asking questions.

559
00:26:52,440 --> 00:26:56,359
Speaker 1: They're taking like unlabeled pills, because that's what people still

560
00:26:56,400 --> 00:26:59,600
Speaker 1: do apparently, and you know, the mindset needs to change.

561
00:27:00,000 --> 00:27:02,040
Speaker 3: But I think it's really interesting with us pain.

562
00:27:02,800 --> 00:27:06,399
Speaker 1: You know, you're talking about how patients shouldn't just be

563
00:27:06,480 --> 00:27:09,760
Speaker 1: cut off, So we're already saying we have an overprescribing

564
00:27:10,119 --> 00:27:13,320
Speaker 1: situation of opioids. It's much better now than it was

565
00:27:13,400 --> 00:27:15,400
Speaker 1: a couple of decades ago, but it's still happening.

566
00:27:15,560 --> 00:27:17,120
Speaker 3: You obviously know more than anyone.

567
00:27:17,440 --> 00:27:21,399
Speaker 1: But the problem is when a physician gets uncomfortable thinking

568
00:27:21,440 --> 00:27:24,360
Speaker 1: someone may be addicted to pain, as you said, they

569
00:27:24,359 --> 00:27:26,400
Speaker 1: get cut off and they get just kind of sent

570
00:27:26,440 --> 00:27:28,640
Speaker 1: out into the world. And do you think that that's

571
00:27:28,680 --> 00:27:31,040
Speaker 1: kind of what pushes them to then go and find

572
00:27:31,359 --> 00:27:34,440
Speaker 1: street level opioids because they can no longer get it,

573
00:27:35,760 --> 00:27:39,080
Speaker 1: you know from a medical professional. And is that perpetuating

574
00:27:39,080 --> 00:27:41,000
Speaker 1: and making this opioid crisis even worse.

575
00:27:41,920 --> 00:27:44,880
Speaker 2: It's very insightful what you're saying. It's one hundred percent true.

576
00:27:44,960 --> 00:27:47,560
Speaker 2: And there's been multiple papers written on this. The CDC

577
00:27:47,680 --> 00:27:50,159
Speaker 2: has acknowledged this. We had guidelines that came out in

578
00:27:50,240 --> 00:27:55,800
Speaker 2: twenty sixteen, and states across the country started making laws

579
00:27:55,800 --> 00:27:57,960
Speaker 2: on how much you could get and started shutting people off,

580
00:27:57,960 --> 00:28:01,560
Speaker 2: and doctors started getting in trouble getting sanctioned, and the

581
00:28:01,600 --> 00:28:03,720
Speaker 2: CDC came out with another report four or five years

582
00:28:03,760 --> 00:28:07,640
Speaker 2: later saying, hey, you guys way overreacted. Is if we're

583
00:28:07,680 --> 00:28:11,879
Speaker 2: not saying that you that you're going to lose their license? Yes, yes,

584
00:28:12,000 --> 00:28:15,000
Speaker 2: it's exactly what happened. And our federal government, I think

585
00:28:15,040 --> 00:28:18,320
Speaker 2: did a bad job of navigating this entire thing. And

586
00:28:18,400 --> 00:28:20,959
Speaker 2: I don't know if your viewers know this, but up

587
00:28:21,040 --> 00:28:23,240
Speaker 2: until a year and a half ago, you had to

588
00:28:23,480 --> 00:28:26,640
Speaker 2: have a special license just to treat addiction. There were

589
00:28:26,680 --> 00:28:30,680
Speaker 2: two million providers, doctors, nurse practitioners, and pas in the country,

590
00:28:30,800 --> 00:28:33,239
Speaker 2: but only fifty thousand people could give you suboxone if

591
00:28:33,240 --> 00:28:35,680
Speaker 2: you got addicted. And I have fought against that for

592
00:28:35,720 --> 00:28:39,080
Speaker 2: ten years, worked with a government, educated everything I could.

593
00:28:39,160 --> 00:28:41,560
Speaker 2: They finally changed that about a year and a half ago,

594
00:28:41,720 --> 00:28:43,560
Speaker 2: and so now every single provider in the United States

595
00:28:43,560 --> 00:28:46,680
Speaker 2: can actually write suboxone. So part of what I'm advocating for,

596
00:28:47,000 --> 00:28:49,120
Speaker 2: I mean, I'm an anesthesiologist. Like when we put someone

597
00:28:49,120 --> 00:28:51,280
Speaker 2: to sleep, we might give them twenty five different drugs.

598
00:28:51,360 --> 00:28:53,160
Speaker 2: We tight trade them off or tight trade them on.

599
00:28:53,280 --> 00:28:54,960
Speaker 2: We tight trade them off, like we know how to

600
00:28:55,040 --> 00:28:57,320
Speaker 2: use these medications. Someone comes in and they're addicted to

601
00:28:57,360 --> 00:28:59,280
Speaker 2: an opioid, I can help that. I know how to

602
00:28:59,280 --> 00:29:01,000
Speaker 2: get them off with them. One of the things that

603
00:29:01,040 --> 00:29:05,160
Speaker 2: we're teaching is called a suboxone micro induction, where you

604
00:29:05,200 --> 00:29:08,120
Speaker 2: give them four percent of the final dose the very

605
00:29:08,200 --> 00:29:10,080
Speaker 2: day you meet them. I call it treat them when

606
00:29:10,120 --> 00:29:11,920
Speaker 2: you meet them. And so if someone looks at me,

607
00:29:11,960 --> 00:29:14,800
Speaker 2: if you said, hey, doc, I'm I'm addicted to these opioids.

608
00:29:14,800 --> 00:29:16,520
Speaker 2: I feel like I'm out of control. I want some help.

609
00:29:16,800 --> 00:29:19,160
Speaker 2: You could literally stay on your purpose at and I'd say, here,

610
00:29:19,160 --> 00:29:21,480
Speaker 2: you're going to take four percent of your stable dose,

611
00:29:21,520 --> 00:29:24,920
Speaker 2: and that's about zero point five milligrams of suboxone. You

612
00:29:24,920 --> 00:29:26,240
Speaker 2: actually have to cut the strip and it gets a

613
00:29:26,280 --> 00:29:28,800
Speaker 2: little bit complicated. The next day you take eight percent,

614
00:29:29,000 --> 00:29:31,320
Speaker 2: the next day you take twelve. It's not that different

615
00:29:31,360 --> 00:29:33,000
Speaker 2: from me on what I do putting someone to sleep

616
00:29:33,080 --> 00:29:35,680
Speaker 2: or waking them up. I can tytrate on this life

617
00:29:35,680 --> 00:29:39,080
Speaker 2: saving molecule, and once you get to about fifty percent

618
00:29:39,080 --> 00:29:41,120
Speaker 2: of the dose, you can just stop your opioids and

619
00:29:41,160 --> 00:29:44,600
Speaker 2: you're good. I'm encouraging every anesthesiologist in the country. By

620
00:29:44,600 --> 00:29:47,200
Speaker 2: the way, about fifty percent of pain doctors are anesthesiologists

621
00:29:47,280 --> 00:29:48,960
Speaker 2: like me. I'm saying, listen, if you put someone to

622
00:29:49,000 --> 00:29:50,760
Speaker 2: sleep and wake them up, you can put them on

623
00:29:50,800 --> 00:29:53,360
Speaker 2: the suboxone and treat their addiction. And by the way,

624
00:29:53,480 --> 00:29:56,600
Speaker 2: I'm not asking every anesthesiologist and every pain doctor to

625
00:29:56,640 --> 00:29:59,280
Speaker 2: become a full on addiction psychiatrist. I'm asking them to

626
00:29:59,280 --> 00:30:02,880
Speaker 2: stabilize their patient, get him into behavioral health, get them

627
00:30:02,880 --> 00:30:06,239
Speaker 2: into a psychiatrist. But fix the problem. Treat them when

628
00:30:06,280 --> 00:30:06,680
Speaker 2: you meet.

629
00:30:06,560 --> 00:30:08,920
Speaker 1: Them, especially fix the problem that they may have caused

630
00:30:08,960 --> 00:30:09,680
Speaker 1: in the first place.

631
00:30:10,960 --> 00:30:11,440
Speaker 2: Exactly.

632
00:30:11,960 --> 00:30:13,640
Speaker 1: Here's my question, and I'm sure you're going to get

633
00:30:13,640 --> 00:30:16,000
Speaker 1: you get it from critics is are you just replacing

634
00:30:16,040 --> 00:30:17,000
Speaker 1: one addiction for another?

635
00:30:17,040 --> 00:30:18,520
Speaker 3: I mean, are people ever going to get off the

636
00:30:18,560 --> 00:30:19,120
Speaker 3: subox up?

637
00:30:20,000 --> 00:30:21,800
Speaker 2: It's a great question. I'm glad you asked it. So

638
00:30:22,120 --> 00:30:24,840
Speaker 2: when we first realized that methodone could save lives, there

639
00:30:24,840 --> 00:30:28,240
Speaker 2: were methodone clinics in the nineteen seventies. It was massively

640
00:30:28,400 --> 00:30:32,520
Speaker 2: controversial because methodone is a full agonist, right, methodone is

641
00:30:32,560 --> 00:30:35,920
Speaker 2: a very long acting opioid, and especially like the twelve

642
00:30:35,960 --> 00:30:38,440
Speaker 2: Step crowd. I grew up with my dad, who was

643
00:30:38,440 --> 00:30:40,280
Speaker 2: an addiction counsel. I used to go to twelve Step

644
00:30:40,320 --> 00:30:44,680
Speaker 2: meetings and listen and learn, and they were all about abstinence, right.

645
00:30:44,760 --> 00:30:46,680
Speaker 2: It was like God is going to help you your

646
00:30:46,720 --> 00:30:49,800
Speaker 2: higher power, you don't have any substances, and that became

647
00:30:49,920 --> 00:30:53,320
Speaker 2: the standard of care in treating alcoholism. But then they

648
00:30:53,320 --> 00:30:55,600
Speaker 2: had this molecule called methodone. They realized if you showed

649
00:30:55,640 --> 00:30:57,880
Speaker 2: up every day at a clinic, you could take methadone

650
00:30:58,040 --> 00:31:00,000
Speaker 2: once a day and you wouldn't go do street hair.

651
00:31:00,560 --> 00:31:03,360
Speaker 2: And it was very, very controversial, and that continues to

652
00:31:03,360 --> 00:31:05,760
Speaker 2: be fought for years and years and years. When suboxone

653
00:31:05,840 --> 00:31:09,320
Speaker 2: came out, it kind of changed the narrative because suboxone

654
00:31:09,400 --> 00:31:11,480
Speaker 2: is not a pure agonist. It kind of blocks the

655
00:31:11,520 --> 00:31:14,120
Speaker 2: receptor like I talked about, it does stimulate the receptor

656
00:31:14,160 --> 00:31:16,320
Speaker 2: a little bit. It is a scheduled drug, so there's

657
00:31:16,360 --> 00:31:18,480
Speaker 2: a little bit of what you're talking about. But now

658
00:31:18,480 --> 00:31:21,080
Speaker 2: the data started coming out, and the data is that

659
00:31:21,120 --> 00:31:24,160
Speaker 2: if you're on suboxone, there's a fifty percent reduction in

660
00:31:24,240 --> 00:31:27,720
Speaker 2: death rate. There's not another drug that I can think of,

661
00:31:27,720 --> 00:31:30,040
Speaker 2: and I've asked maybe one hundred doctors now I cannot

662
00:31:30,040 --> 00:31:32,240
Speaker 2: think of another drug that has a fifty percent reduction

663
00:31:32,440 --> 00:31:35,680
Speaker 2: in mortality. The chemotherapy drugs aren't even close, right, so

664
00:31:35,720 --> 00:31:38,280
Speaker 2: the heart drugs aren't even close. You're not reducing someone's

665
00:31:38,440 --> 00:31:40,400
Speaker 2: death rate by fifty percent when they have heart failure

666
00:31:40,400 --> 00:31:42,640
Speaker 2: with any drug. And so as we look at the data,

667
00:31:42,800 --> 00:31:45,280
Speaker 2: it is clear that abstinence does not work with opioids.

668
00:31:45,360 --> 00:31:47,600
Speaker 2: If you have severe opid use disorder like my brother,

669
00:31:47,800 --> 00:31:49,400
Speaker 2: he will never come off of this drug. And he

670
00:31:49,440 --> 00:31:51,920
Speaker 2: should never come off of this drug because if he does,

671
00:31:52,320 --> 00:31:55,240
Speaker 2: more than likely he'll be back doing drugs within days,

672
00:31:55,760 --> 00:31:58,400
Speaker 2: if not weeks. And so when I talk to people

673
00:31:58,520 --> 00:32:01,760
Speaker 2: like that, I understand the idea of abstinence. I think

674
00:32:01,800 --> 00:32:05,280
Speaker 2: it works really well with alcoholism. But in the opioid space,

675
00:32:05,280 --> 00:32:07,680
Speaker 2: when you're addicted to opioids, the data is very clear

676
00:32:08,040 --> 00:32:10,760
Speaker 2: if you look at an abstinence group versus a suboxone

677
00:32:10,760 --> 00:32:13,240
Speaker 2: group at five years, if you put someone on suboxone

678
00:32:13,240 --> 00:32:16,000
Speaker 2: and leave them on, eighty percent are not doing drugs.

679
00:32:16,200 --> 00:32:19,080
Speaker 2: The abstinence group is like twenty five percent success. And

680
00:32:19,120 --> 00:32:21,680
Speaker 2: so I lean on the data, which is suboxone save

681
00:32:21,760 --> 00:32:23,400
Speaker 2: lives and it works better than abstinence.

682
00:32:23,560 --> 00:32:27,400
Speaker 1: Well, I'm always all about the data. Show me the data. Well,

683
00:32:28,040 --> 00:32:29,880
Speaker 1: I think it's great. I think that you know, we're

684
00:32:29,920 --> 00:32:32,280
Speaker 1: still in the middle of an opioid crisis. I think

685
00:32:32,320 --> 00:32:34,160
Speaker 1: people don't talk about it as much. It's not getting

686
00:32:34,200 --> 00:32:36,800
Speaker 1: as much media attention. But you know, what you're doing

687
00:32:36,800 --> 00:32:40,640
Speaker 1: with us pain is making sure that you know, we're

688
00:32:40,640 --> 00:32:44,480
Speaker 1: trying to stop causing even more problems and potentially helping

689
00:32:44,480 --> 00:32:46,920
Speaker 1: those who are on it and not giving them the stigma,

690
00:32:47,160 --> 00:32:49,920
Speaker 1: and making sure that you're taking their physical and mental

691
00:32:49,960 --> 00:32:50,840
Speaker 1: health into account.

692
00:32:50,840 --> 00:32:53,200
Speaker 3: I think it's great. You know, the world of pain

693
00:32:53,320 --> 00:32:54,520
Speaker 3: is extremely exciting.

694
00:32:54,640 --> 00:32:58,040
Speaker 1: You know, as an interventional and breast radiologist, I love

695
00:32:58,080 --> 00:33:02,560
Speaker 1: the idea of you know nervablys and some non you know,

696
00:33:02,760 --> 00:33:06,000
Speaker 1: medication pain relief items. Do you still talk about some

697
00:33:06,040 --> 00:33:07,560
Speaker 1: of this stuff or do you do this stuff or

698
00:33:07,560 --> 00:33:09,440
Speaker 1: are you kind of just focusing on this right now.

699
00:33:10,520 --> 00:33:16,440
Speaker 2: Well, my goal is to reduce suffering, and I am

700
00:33:16,480 --> 00:33:19,200
Speaker 2: a pain doctor to my core. I love the procedures

701
00:33:19,240 --> 00:33:21,440
Speaker 2: that we do. Like the procedure that my mother in

702
00:33:21,520 --> 00:33:24,680
Speaker 2: law needed, the kyphoplasty. It was so close to my

703
00:33:24,760 --> 00:33:27,080
Speaker 2: heart that you could literally, and like a ten minute procedure,

704
00:33:27,280 --> 00:33:30,160
Speaker 2: take away someone suffering by fixing a fracture. It blew

705
00:33:30,200 --> 00:33:32,360
Speaker 2: me away that was even possible. Like that procedure made

706
00:33:32,360 --> 00:33:35,040
Speaker 2: me want to become a pain doctor. My approach to

707
00:33:35,120 --> 00:33:38,200
Speaker 2: pain is all about holistic care. Though right I think

708
00:33:38,240 --> 00:33:41,240
Speaker 2: that we've gone way too far with interventions, way too

709
00:33:41,280 --> 00:33:44,640
Speaker 2: far with surgery, way too far with pills. And I

710
00:33:44,680 --> 00:33:47,000
Speaker 2: think I think you agree with me. I think it's

711
00:33:47,040 --> 00:33:48,840
Speaker 2: a holistic approach. I think the best thing I can

712
00:33:48,920 --> 00:33:52,840
Speaker 2: do for my patient is to get them mentally healthy

713
00:33:53,000 --> 00:33:55,760
Speaker 2: right to I encourage all my patients to talk to

714
00:33:55,800 --> 00:33:58,080
Speaker 2: a therapist. I talk to a therapist. I want them

715
00:33:58,120 --> 00:34:00,240
Speaker 2: to talk about, you know, what makes them happen, what

716
00:34:00,280 --> 00:34:02,120
Speaker 2: makes them sad? What are their goals. I want them

717
00:34:02,120 --> 00:34:04,960
Speaker 2: to lose weight. I want them to have appropriate diet.

718
00:34:05,160 --> 00:34:06,760
Speaker 2: I want them to look at their supplements and how

719
00:34:06,760 --> 00:34:08,799
Speaker 2: are they doing with vitamins. I want them to do

720
00:34:08,880 --> 00:34:11,359
Speaker 2: physical therapy. If they get addicted, I want to treat

721
00:34:11,360 --> 00:34:14,240
Speaker 2: their addiction. And yes, we have all these crazy cutting

722
00:34:14,320 --> 00:34:17,040
Speaker 2: edge technologies now where we can take away suffering. I

723
00:34:17,200 --> 00:34:19,759
Speaker 2: just what I want us pain care to be is

724
00:34:19,800 --> 00:34:23,040
Speaker 2: that we're not just an interventional based practice. We're not

725
00:34:23,160 --> 00:34:25,479
Speaker 2: just we give you pills. I want us to treat

726
00:34:25,480 --> 00:34:27,600
Speaker 2: the whole person. And I think that's where we really

727
00:34:27,640 --> 00:34:28,640
Speaker 2: will help human suffware.

728
00:34:29,320 --> 00:34:31,240
Speaker 3: So two part question.

729
00:34:31,640 --> 00:34:34,359
Speaker 1: You know what advice would you give to Let's say,

730
00:34:34,480 --> 00:34:36,759
Speaker 1: start with young doctors who want to help people who

731
00:34:36,760 --> 00:34:39,600
Speaker 1: are in pain without feeding into this broken system.

732
00:34:39,960 --> 00:34:42,400
Speaker 2: Yeah, that's great. Number one. If you want to be

733
00:34:42,440 --> 00:34:46,000
Speaker 2: a pain doctor, I suggest that you go to a

734
00:34:46,000 --> 00:34:49,040
Speaker 2: fellowship and you learn these procedures you're talking about, because

735
00:34:49,160 --> 00:34:51,799
Speaker 2: some of these procedures really blow me away, Like it's

736
00:34:52,280 --> 00:34:55,359
Speaker 2: spinal corese stimulation. That data and the research on it

737
00:34:55,400 --> 00:34:57,800
Speaker 2: has gone to the next level. There was a study

738
00:34:57,960 --> 00:35:00,480
Speaker 2: published in jama about two years ago that if you

739
00:35:00,560 --> 00:35:04,960
Speaker 2: have severe painful diabetic neuropathy. Placing a very small electrode

740
00:35:05,320 --> 00:35:08,600
Speaker 2: behind the spinal cord. It sounds crazy, but we can

741
00:35:08,600 --> 00:35:11,839
Speaker 2: place a small little electrode in the epidural space that

742
00:35:11,840 --> 00:35:16,160
Speaker 2: that has ninety percent reduction in pain from diabetic neuropathy,

743
00:35:16,200 --> 00:35:18,400
Speaker 2: and it does it by blocking the pain signals on

744
00:35:18,440 --> 00:35:20,120
Speaker 2: the way to the brain. And so if you want

745
00:35:20,120 --> 00:35:22,000
Speaker 2: to be a pain doctor, I think number one is

746
00:35:22,040 --> 00:35:24,840
Speaker 2: you do a fellowship and you learn these advanced techniques

747
00:35:24,840 --> 00:35:27,240
Speaker 2: that you talked about radio frequency of blation and spinal

748
00:35:27,280 --> 00:35:31,879
Speaker 2: cord stimulation. Number two, I encourage doctors to really become

749
00:35:31,920 --> 00:35:35,080
Speaker 2: a good pharmacologist. Like again, I'm an anesthesiologist. We use

750
00:35:35,160 --> 00:35:38,719
Speaker 2: medications all day. I love the pharmacology of how a

751
00:35:38,760 --> 00:35:41,080
Speaker 2: muscle relaxant works and a neuropathic medicine works, and how

752
00:35:41,120 --> 00:35:44,480
Speaker 2: to interdepressant works, and to really understand those medicines, not

753
00:35:44,600 --> 00:35:47,120
Speaker 2: to lean too heavily on opioids, to look at all

754
00:35:47,120 --> 00:35:50,080
Speaker 2: the other type of medications. And then I really encourage

755
00:35:50,120 --> 00:35:53,800
Speaker 2: doctors to understand mental health. I'm trying to make a

756
00:35:53,840 --> 00:35:55,920
Speaker 2: lot of changes in the system, but one is I

757
00:35:55,960 --> 00:35:59,800
Speaker 2: want all pain physicians to have obligatory training and mental health.

758
00:36:00,000 --> 00:36:03,520
Speaker 2: They need to understand depression and anxiety. Every patient that

759
00:36:03,560 --> 00:36:06,279
Speaker 2: I've ever met who's had pain, you know, for five

760
00:36:06,320 --> 00:36:08,640
Speaker 2: years or ten years, they have some sort of depression

761
00:36:08,719 --> 00:36:11,040
Speaker 2: or anxiety, and we don't focus on that enough. We

762
00:36:11,080 --> 00:36:14,400
Speaker 2: don't focus on the mental health. So for young doctors,

763
00:36:14,440 --> 00:36:16,680
Speaker 2: I just want them to understand a holistic approach which

764
00:36:16,719 --> 00:36:19,319
Speaker 2: includes the procedures and includes the meds, but a lot

765
00:36:19,360 --> 00:36:21,800
Speaker 2: of it is mental health and diet and exercise and

766
00:36:22,080 --> 00:36:22,880
Speaker 2: all the other stuff.

767
00:36:23,239 --> 00:36:24,880
Speaker 1: And the second part of the question is what about

768
00:36:24,920 --> 00:36:28,560
Speaker 1: for the everyday person, you know, myself, anybody else listening

769
00:36:28,600 --> 00:36:31,200
Speaker 1: who deals with some sort of pain, whether it's a

770
00:36:31,200 --> 00:36:33,640
Speaker 1: cute pain from an injury that just happened, or some

771
00:36:33,680 --> 00:36:36,280
Speaker 1: form of chronic pain, Like, what do you suggest.

772
00:36:35,920 --> 00:36:40,600
Speaker 2: That they do activity? I know it sounds it sounds crazy,

773
00:36:40,640 --> 00:36:43,120
Speaker 2: but when you're hurting, what I want people to do

774
00:36:43,200 --> 00:36:45,640
Speaker 2: is get active. I want them to go to physical

775
00:36:45,680 --> 00:36:50,040
Speaker 2: therapy first, and I want them, within limits to understand

776
00:36:50,200 --> 00:36:52,200
Speaker 2: how bad is the injury and how much can I

777
00:36:52,239 --> 00:36:54,800
Speaker 2: be active range of motion? Right, you hurt your shoulder,

778
00:36:55,320 --> 00:36:57,000
Speaker 2: the best thing you can actually do is start to

779
00:36:57,000 --> 00:36:59,960
Speaker 2: do shoulder exercises and to build up the muscles right

780
00:37:00,239 --> 00:37:05,279
Speaker 2: to get a good doctor. When pain persists beyond two

781
00:37:05,400 --> 00:37:09,120
Speaker 2: or three or four weeks, imaging right, like you're a radiologist.

782
00:37:09,320 --> 00:37:11,440
Speaker 2: I like to do imaging early and often.

783
00:37:11,560 --> 00:37:14,480
Speaker 3: Because sure companies don't always agree with this.

784
00:37:15,360 --> 00:37:18,480
Speaker 2: I agree and I fight them all day long because

785
00:37:18,520 --> 00:37:22,000
Speaker 2: I think that early diagnosis is key and I think,

786
00:37:22,040 --> 00:37:23,719
Speaker 2: you know so, imaging is a big part of it

787
00:37:23,840 --> 00:37:25,439
Speaker 2: when I teach my doctor, and I'd say the same

788
00:37:25,440 --> 00:37:28,320
Speaker 2: thing to my friends, like it's a five finger approach,

789
00:37:28,520 --> 00:37:31,120
Speaker 2: my first finger, my thumb is diagnosis. We have to

790
00:37:31,120 --> 00:37:33,160
Speaker 2: make a good diagnosis and that's usually imaging and a

791
00:37:33,160 --> 00:37:36,680
Speaker 2: good physical exam and sometimes neuro studies. Number two is

792
00:37:36,680 --> 00:37:38,680
Speaker 2: I want to find out what medication is right for you,

793
00:37:38,760 --> 00:37:40,600
Speaker 2: and I'll tell you. As a pain doctor, I always

794
00:37:40,600 --> 00:37:43,240
Speaker 2: start with dietism medication, right, like what are you eating?

795
00:37:43,400 --> 00:37:45,839
Speaker 2: Are you eating vegetables and fruits? And you know your

796
00:37:45,880 --> 00:37:48,759
Speaker 2: gut health and all this. Number three for me is

797
00:37:48,760 --> 00:37:51,319
Speaker 2: is there some sort of physical therapy that I can

798
00:37:51,360 --> 00:37:53,520
Speaker 2: do for you? And that includes massage? Will send people

799
00:37:53,520 --> 00:37:57,640
Speaker 2: for massage, physical therapy, chiropractic care. Number four, I start

800
00:37:57,640 --> 00:38:00,319
Speaker 2: talking about mental health, right, I say, hey, you know,

801
00:38:00,360 --> 00:38:02,640
Speaker 2: are you depressed or you anxious? If my patients say no,

802
00:38:02,680 --> 00:38:04,200
Speaker 2: I'm like, I still want you to talk to someone.

803
00:38:04,280 --> 00:38:06,800
Speaker 2: I think you might actually have I just it's okay,

804
00:38:06,880 --> 00:38:09,520
Speaker 2: Like we want to destigmatize mental health. And then the

805
00:38:09,560 --> 00:38:11,880
Speaker 2: fifth thing is is there some sort of intervention? Is

806
00:38:11,920 --> 00:38:14,000
Speaker 2: there something we can do to change the tissue or

807
00:38:14,239 --> 00:38:16,680
Speaker 2: radio frequency or smile forstem or a surgery? But I

808
00:38:16,719 --> 00:38:18,759
Speaker 2: try to do that. Fifth, I start with the first

809
00:38:18,760 --> 00:38:19,719
Speaker 2: four things.

810
00:38:20,000 --> 00:38:23,080
Speaker 1: Well, doctor Paul Lynch, you are the founder of US

811
00:38:23,120 --> 00:38:25,720
Speaker 1: pain Care. It is a bold endeavor. I am grateful

812
00:38:25,719 --> 00:38:28,960
Speaker 1: that you've included me on your advisory board, and I

813
00:38:29,000 --> 00:38:31,360
Speaker 1: am so excited to see what you do with this.

814
00:38:32,480 --> 00:38:35,400
Speaker 2: I am too, doctor Sapphire, you have been a wonderful

815
00:38:35,400 --> 00:38:37,640
Speaker 2: friend for many, many years. I love the work you do.

816
00:38:37,680 --> 00:38:39,160
Speaker 2: I'm a big fan, and thank you for having me

817
00:38:39,200 --> 00:38:39,640
Speaker 2: on today.

818
00:38:39,800 --> 00:38:40,960
Speaker 3: Thanks for joining us.

819
00:38:41,520 --> 00:38:44,760
Speaker 1: More coming up on Wellness Unmasked with doctor Nicole Sapphire.

820
00:38:48,280 --> 00:38:51,120
Speaker 1: Thank you, doctor Paul Lynch for your insight, your compassion,

821
00:38:51,200 --> 00:38:54,640
Speaker 1: and your relentless pursuit of solutions that heal without harm.

822
00:38:54,800 --> 00:38:57,240
Speaker 1: As we heard today, this is not just about reducing

823
00:38:57,280 --> 00:39:01,080
Speaker 1: overdose deaths. It's about transforming how we understand and treat

824
00:39:01,200 --> 00:39:05,279
Speaker 1: pain in America. Doctor Lynch's goal is nothing short of bold,

825
00:39:05,360 --> 00:39:09,600
Speaker 1: to save one million lives by revolutionizing pain care, expanding

826
00:39:09,640 --> 00:39:14,040
Speaker 1: access to innovative non opioid therapies, and advocating for policy

827
00:39:14,120 --> 00:39:17,640
Speaker 1: change that puts patients first. For me, I am eternally

828
00:39:17,680 --> 00:39:21,040
Speaker 1: grateful for pain physicians like doctor Lynch, who is able

829
00:39:21,040 --> 00:39:23,960
Speaker 1: to get me off pain medications. I wish I could

830
00:39:24,000 --> 00:39:26,560
Speaker 1: say that the trouble with my shoulders in the past,

831
00:39:26,920 --> 00:39:29,719
Speaker 1: but the reality is I will be undergoing a third

832
00:39:29,800 --> 00:39:31,560
Speaker 1: shoulder surgery here in the next.

833
00:39:31,360 --> 00:39:32,120
Speaker 3: Couple of weeks.

834
00:39:32,480 --> 00:39:35,799
Speaker 1: But I already have a pain plan mapped out because

835
00:39:35,840 --> 00:39:38,719
Speaker 1: I do not want to find myself again being reliant

836
00:39:38,760 --> 00:39:41,960
Speaker 1: on pain medications. I will keep you informed as I

837
00:39:42,040 --> 00:39:45,439
Speaker 1: go through this next chapter with this next surgery. I'll

838
00:39:45,520 --> 00:39:48,600
Speaker 1: keep you up to day all along the way. If

839
00:39:48,640 --> 00:39:51,680
Speaker 1: you are someone you know lives with chronic pain, or

840
00:39:51,719 --> 00:39:54,360
Speaker 1: you felt the impact of the opioid epidemic, know that

841
00:39:54,400 --> 00:39:57,200
Speaker 1: there are people like doctor Lynch working every day to

842
00:39:57,280 --> 00:40:00,840
Speaker 1: bring relief, hope, and a better path forward. If you

843
00:40:00,880 --> 00:40:03,120
Speaker 1: are someone you love is living with chronic pain, or

844
00:40:03,120 --> 00:40:05,880
Speaker 1: if you felt the impact of the opioid epidemic, know

845
00:40:05,960 --> 00:40:08,759
Speaker 1: that there still are people like doctor Lynch working every

846
00:40:08,880 --> 00:40:11,920
Speaker 1: day to bring relief, hope, and a better path forward.

847
00:40:12,080 --> 00:40:14,960
Speaker 1: Thanks for listening to Wellness Unmass on America's number one

848
00:40:15,000 --> 00:40:19,200
Speaker 1: podcast network, iHeart. Follow Wellness on Mass with doctor Nicole Sapfire,

849
00:40:19,239 --> 00:40:22,160
Speaker 1: and start listening on the free iHeartRadio app wherever you

850
00:40:22,200 --> 00:40:24,439
Speaker 1: get your podcasts, and we will catch you next time.