[ 00:00:00 ]Welcome to the Dr. Gabrielle Lyon Show, where cutting-edge science meets innovation and practical application for anybody. If you or someone you love or know or have encountered has suffered with addiction, this podcast episode with Dr. Russell Saraski is for you. This is a critical podcast to raise awareness on addiction, opioid addiction, alcohol addiction, addiction, any of the things that can ruin lives. Please sit down with me with Dr. Russell Saraski.

[ 00:00:39 ] Russell Saraski, thank you so much for coming on the show. I believe that you are going to share with the listeners one of the most powerful messages that we have heard. You know, we talk all about on this podcast health and wellness longevity on this podcast, but I think that there are very few of us who are going to be able to share with the listeners one of the most powerful messages that kill someone in an instant. And you’re going to address that. In fact, you have a book that says this book will save your life. Welcome to the show. That’s correct. I’m thrilled to be here. Thank you so much for having me. You are a board-certified neurologist and addiction physician, addiction specialist, addiction doctor.

[ 00:01:15 ] And tell me, what is it that you want the world to know? Well, first of all, that addiction is a question. It’s a question. It’s a question. It’s a question. It’s a question. It’s a question. A brain disease. This is not an issue of a moral problem or a poor upbringing or a weakness of character or a psychological problem. It is a chronic relapsing brain disease. And so says my clinical experience, as well as now the American Society of Addiction Medicine defines it that way. We know from brain scans that we have now, like PET scans, that there are fundamental changes in the brain of somebody who has addiction. And we also, you know, see it clinically. We have medicines now that can target very specific receptors in the brain.

[ 00:02:00 ] And when you say you inject medicine in someone who is having a horrific addiction, it will shut down those behaviors, not permanently, but temporarily. And so we, based on that, based on the PET scans, and just based on seeing what happens to people with addiction. I mean, people live in the streets to use drugs one more time. You see girls prostituting. You see people, you know, a lot of these, these people you see that are suffering with addiction, living that way. They have family that loves them and warm homes, but their brain has become so hijacked by these drugs. And when you say addiction, can you clarify, are we talking about drug addiction? Is drug addiction from opioids different than drug addiction to say, I don’t know, a methamphetamine?

[ 00:02:47 ] How are we thinking about addiction? Yeah. Because I’m sure that they’re all different. For example, an addiction to porn might be different than, you know, a substance addiction. Well, so actually, you know, fundamentally, anything that leads to addiction, and just to define addiction for a moment, addiction is this loss of control where you continuously use the drug or engage in a behavior that is causing significant harm to your life and your world, but you can’t stop. It’s this loss of control. And so, you know, when any drug or behavior that leads to addiction, it goes through the same exact pathway in the brain. So when we talk about opioids or alcohol, these drugs ultimately will cause addiction through the same pathway in the brain, which I’m sure we’ll get into, but they tap into the same system, the same reward system in the brain, in this limbic system in the brain.

[ 00:03:42 ] And that’s what traps people and traps their brain and causes this disease. Is, or are people equally likely to become addicted if it’s a chronic brain disease? My addiction potential different than your addiction potential, which is different than my best friend’s addiction potential. It’s a great question. So much like every other condition in medicine, right? We all have our genetic predispositions and we have things we have genetic protections that we don’t even know we’re protected against, but you, you can have a genetic predisposition towards addiction. And it’s, it’s very complex, the genes. It’s not you have it or you don’t. It’s a cluster of genes that confer upon you a degree of susceptibility. So you can be somewhat susceptible or very easily susceptible.

[ 00:04:28 ] In someone who has the ability to develop addiction more quickly because of their genes, they only need to expose their brain to a small amount of the drug and that switch will go off, whereas someone else may be able to use drugs, you know, for a while before that would happen. So there’s a strong degree of genetic susceptibility. That’s, it’s very fascinating. You know, you’re a neurologist and also an addiction specialist. Why? It is, I mean, it can be a dark road. It is probably difficult, you know, when you see patients relapse and yeah. Yeah. So I’m a, I’m a board certified neurologist and board certified in addiction medicine. And there really aren’t many doctors, you know, like you said, that have those credentials in the country.

[ 00:05:17 ] And when I graduated from residency from North Shore LIJ in New York, I went into practice and I was focused on pain management. And I was a headache specialist until there were really two pivotal things that changed and transformed my world. And one of them is that my, my brother, my only sibling who I love, you know, more than anyone in the whole world, he developed an opioid addiction. And how old was he at the time? So it started when he was 16 after a surgery; like is the story with so many people. And what I saw happen, just radically just that. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Turn my world upside down. And, you know, he, he had a sports injury where he hurt his jaw and required surgery.

[ 00:06:03 ] He was a football player, right? Yes. And he required surgery on his jaw. And after that, they, in, in the recovery room, they gave him a drug called Dilaudid, which is hydromorphone. It’s one of the most powerful opioids, very much akin to fentanyl. And when given IV, it probably has the most addictive potential. And so I remember, you know, my brother had never done drugs. We come from a incredibly, we’re blessed to come from a supportive and loving household. Our parents are married 50 years. There was no psychological issues that my brother dealt with. He had a great social group. He was doing well in school. So future him. And I never, I never forget when I went to see him in the recovery room, he, he looked at me and he said, I don’t know what they gave me, but I’ve never felt anything like that in my life. Uh, it’s just, no

[ 00:07:02 ] way. Um,

[ 00:07:24 ] 31, you know the bed in my parents’ home and that uh seeing what happened to him just uh you know but through his life it gave me the strength and the purpose to to move into this and try to help other people. I just want to take a moment and say he is so lucky to have you as a brother and I know that you put your heart and soul out there all the time and you’re up against a lot and I applaud you for doing that. And I think all of us listening, we know where you’re coming from, we know where your heart is coming from, and well, I thank you for doing that. Yeah.

[ 00:08:03 ] 16 years old football player, happy home, never thought about drugs, never did drugs, gave him IV for a jaw injury in recovery and he was addicted in that moment, yes. And when we talk about um how addiction happens in the brain it will become obvious and very clear how and why this has happened to countless people and continues. to happen um which i feel like we need to to touch on and i was in preparation for this i read a statistic that said and we’re just talking about opioid addiction um as you had mentioned there are multiple avenues for addiction that opioid addiction is a very important thing and i think it’s a very

[ 00:08:50 ] important thing and i think it’s a very important thing and i think it’s a very important thing and we should define what opioids are killed last year uh seventy thousand people you said maybe eighty thousand more people that then that were killed in vietnam afghanistan and iraq wars that’s absolutely correct and by the time This interview is over about eight to ten more people will have died, um, it is a horrific epidemic and, um, it it all started with uh Purdue Pharmaceuticals in Canton in the early 90s so the 90’s if this is not opium uh opium type of you know, you hear these stories about the opium dens and all of that. Can you define what opioids are and you know we’re talking about opioids but again I suppose the the first question is do you think that that’s the biggest problem?

[ 00:09:40 ] Well um certainly other addictions like for example alcohol addiction is an incredibly serious and dangerous situation as well, the difference with opioids are And, especially now, with fentanyl, which I’m sure we’ll discuss, is that there are so incredibly deadly that people often don’t even have a chance to get help; they die before there’s even a chance to get to the first treatment episode. Um, and so that is that because they take a dose and and that’s life-ending or because twenty percent of people maybe twenty percent of people ever get treated, uh, it’s because of just how deadly it is. And especially now with fentanyl, which is the most powerful opioid that we’ve ever seen, has changed the landscape because even a granule, a speck of fentanyl, and by the way, they’re mixed into everything.

[ 00:10:30 ] they’re mixed into what look to be adderall pills into xanax pills uh mixed into cocaine so even if you the reason this has changed the landscape completely is because before it you know it was sort of understood okay well you have an addiction and that’s very dangerous and if you keep doing it you you know death is part of that condition but a lot of people said but it’s not my family we don’t have addiction that kind of a thing but now i mean to not worry that your adolescent child is going to experiment or try one thing one time at a party and there you’re at a you are now at a very high risk of sudden death from experimenting With anything, I mean, and that’s why it’s just utterly changed the landscape.

[ 00:11:20 ] And I think that’s why it’s so important that we’re not just changing the landscape, that that’s terrifying. First of all, what I’m hearing you say is that we went-you know when we were in high school um, you know I mean, I actually am pretty straight-laced as a human um, that’s that may be uh, you might argue that but there are lots of parties that kids go to. I mean, I went to lots of parties; I’m sure you went to lots of parties. Matt, no one likes him-my producer definitely didn’t go to parties but uh people are experimenting and that’s probably a natural part. of there’s i don’t know if there’s any way to protect

[ 00:11:55 ] our children from that and now what you’re saying is it is a totally different ball game it is and it’s petrified you know it as a parent right now you know i would imagine that um if you have if you have a child that’s you know 12 13 14 15 that age range it is it is frightening it is frightening and it has to change the country has to come together and and really it has to come together there have to be some specific changes to stop fentanyl from there’s flooded into every town in america right now and can you define what what drugs fall into the category of opiates sure so opiates are a group of pain medicines a class of pain drugs that bind specifically to our we all have these natural opioid receptors in our brain and throughout our body and when these drugs bind to those receptors they release a lot of dopamine and dopamine and dopamine and dopamine and dopamine

[ 00:12:50 ] to the brain and so one of the effects is that we feel less pain but along with that can come a dramatic change in how we feel emotionally as well it a lot of people feel um uh euphoric reduced anxiety increased mood so it becomes a very a drug that many people can um wind up liking more than just for what it does for them to help reduce their Pain and it works specifically on the dopamine reward system, it does. Okay, that’s right. What are the names if someone is thinking, okay well, is um, Vicodin, opiate? Is it Percocet? What are the drug names that one would think of when they think about legally available opioids? Sure, so hydrocodone is Vicodin and oxycodone is Percocet.

[ 00:13:46 ] Um, Percocet has Tylenol in it, but essentially oxycodone is is Perc what’s in Percocet um we have Dilaudid which is hydromorphone um Fentanyl is of course we’ve all heard of that, that is a Fentanyl come on the market so Fentanyl has been around as a prescription drug for a long time I don’t know the Exact year it was approved, but but fentanyl in prescription is typically given in a patch form where you wear a patch and the medicine’s slowly released over say 72 hours, okay the fentanyl that we’re dealing with now is very different, now that fentanyl in the patch form is extraordinarily powerful, and and was part of the what the opioids that that caused tremendous addiction um even before the illicit fentanyl came so you know the prescriptions were being abused constantly as well but the fentanyl you see on TV right now that that is being smuggled into the uh into the United States through the southern border and To be clear, these are all still given in the hospital.

[ 00:14:50 ] Right? Um, Dilaudid is given to hospital patients. They’re still prescribed Percocet, Vicodin. You don’t have to be in the hospital, I mean right. I mean, listen. Because the headwinds have changed and and doctors are very frightened. A lot of uh, physicians went to prison for the very first time uh, you know, relating to anything about prescription medicines uh, so they’re very scared um, as they should be. And so it’s gotten extremely hard actually to get these drugs now. The pendulum has swung in the complete other direction um, and so you know. But not that long ago, they would Prescribe them very easily, and that’s ultimately how we got here. Yeah, tell me a little bit about the history so the you know I think that addiction definitely affects everybody and so everyone knows someone who has uh struggled with alcohol or drugs at some point um or knows someone that lost someone

[ 00:15:51 ] opioids particularly seem to be top of mind for you um a little bit about the history and why how how did we get here? So essentially, the worst villain is uh Purdue Pharmaceuticals. They made OxyContin in the mid-90s and OxyContin is a powerful opioid drug now at that time opioids were only prescribed for very serious situations. For end-of-life hospice care, metastatic cancer-maybe for a few days after a major surgery, but that was it. But Purdue figured out that hey, if we can convince doctors to write these drugs, these opioid painkillers, for everyday aches and pains like arthritis or headaches, then there’s no limit to the amount of money we can make. And so they hired a massive sales force to basically go out and deceive doctors.

[ 00:16:45 ] Um, in which they they basically told doctors that because it’s a long-acting formulation that the medicine was an extended-release type of drug, that it’s not addictive. There were no studies to show that, of course. They Just said it as if there was and look, a lot of doctors knew better um and they got kickbacks from the company um they were you know for speaking pre for speaker presentations they never did, they got a lot of money for that. Some doctors realized that they were addicting people but you know what? Their practices were they’re building all these huge practices just basically getting people hooked to the drug. But then there were some well-meaning doctors too, you know. Doctors overprescribed them like we overprescribe antibiotics.

[ 00:17:21 ] They wanted to help their patients and and they really were deceived about how the risks of These drugs, and so um how does that even happen? It seems like the FDA is pretty tight on various things, like say female Viagra, but somehow they were able to get a nation addicted. Yeah it is um pretty wild uh well what happened was actually um by within like five ten years of this happening um the amount of of addiction overdose deaths to opiates had skyrocketed to such a degree that it you could not ignore what was happening and so they were getting hundreds of lawsuits but mostly by parents who lost their children to addiction and in

[ 00:18:07 ] basically about five years ago i think 2019 they started getting sued by actual states in the country and they piled up and now they’re getting sued by the states and they’re getting now every every state in the country has sued them basically for the amount of money the states have to now have to to cover the destruction the death all the problems they have because of the opiate crisis and um the purdue purdue has to now basically pay back around eight billion dollars they went into bankruptcy uh it’s still going on um but it was it was just horrific and um and ultimately even though they got the purdue um company the purdue uh it it lives on now through fentanyl and other drugs talk to me about fentanyl fentanyl From what I understand, uh, completely man-made and you’re saying that there’s um illegal fentanyl versus regular quote regular fentanyl.

[ 00:19:03 ] Are they are they different? There are um so fent, you know we say fentanyl like it’s all the same. It’s not a lot of this fentanyl is made in sort of these clandestine labs; they’re analogs of each other and so you know they’re not all exactly the same um and everyone sort of knows it all comes, it’s not grown here, all comes through the southern border and a lot of people have a sense that China is involved but what they don’t know is just how involved China is at every step in getting the Drugs are here and killing Americans. Um, and we can go into that in more detail if you like, but it is scary. Where okay, so where is fentanyl coming from? It’s coming from China. Is coming from Mexico.

[ 00:19:45 ] Making it here in the U. s no okay none in the united states and over there in china where they make it they don’t have the addiction problem they ship it over here intentionally they essentially um the the fentanyl the precursors to fentanyl come from china into this place called the port of manzanillo in mexico it’s well known yes and it is run by the chinese and what they do there is they basically take those precursors and they make it into fake pills they have they have machines that press this into fake pills um the machines come from china and then what they do is they ship it to the then once they do

[ 00:20:23 ] it at the port of manzanillo they then ship it to the right a border town right near the southern border and these drugs then get you know get pushed in through the mexican cartels now the mexican cartels work hand in hand with them because they use the chinese communications uh systems so they can communicate knowing that china won’t reveal that to the united states and then the money gets loaded back into chinese banks and they just they they push it Right across the border into our country and every day, floods in here to give you an idea: one pound of fentanyl will will kill a hundred people, okay? They said one pound. So, think about a pound of protein powder or a pound of you know just visualize a pound-one pound will kill 100 people, just about.

[ 00:21:08 ] And last year they confiscated about 27, 000 pounds of fentanyl coming across the border, that’s what they caught. How do we separate? Dealing with if we were to take a step back, we have this opiate opioid addiction right, and that would exist no matter what someone takes, they become addicted. Is that fair to say? Yeah, if you have the susceptibility and you expose your brain to enough of the drug it’s going to hijack this area in the brain called the limbic system and that’s when the that’s when addiction sets in and people lose control how do we have an idea of what percentage of people because i would say for example i’ve had patients where i know that they’re having um root canals or tooth surgeries or some major oral issues tylenol is not going to cover them how does one risk stratifter okay am i going to try percocet hydrocodone how how do we begin to risk stratify ourselves selves for the components that we can control.

[ 00:22:13 ] So the motto now for physicians is as little as possible and for as short a time as possible. Like, for example, we know that if you give somebody oxycodone and you give it to them for 10 days straight, okay, about 15% of the population will develop an addiction to opioids. And that’s what was happening. Essentially, everyone from dentists to general practitioners were just flooding people with these drugs. And when you have 15% of the population that’s highly susceptible to their brain getting hijacked by these drugs, this is the outcome. I mean, dentists were writing; you would have a tooth pulled or a root canal, and they’re writing a month of oxycodone to 15-year-olds. And that’s part of the destruction. And now a lot of laws are in place to try to stop that from happening.

[ 00:23:07 ] Like, in other words, like in New York. For example, the first prescription of, say, even tramadol can’t be for more than a week unless you tell the pharmacy why. Wow. How do you see people thinking about taking it, not taking it? So, for example, I don’t know if someone breaks their leg. Are you concerned about if we were to take a step back and think about what happened with your brother? He didn’t really have a, I mean, they gave him pain medication. He had jaw surgery. When? When I was working in the hospital, we would give people Dilaudid. They were in the ICU. A portion of those people, is it fair to say that their lives will never be the same? Or how do we think about it? Well, that’s correct.

[ 00:23:53 ] I mean, look, these drugs are meant to be used in these emergency situations. Now, while we don’t have studies, it’s very hard to study some of these nuances. But perhaps when patients are actually in severe pain, and they’re exposed to these drugs, in those scenarios, it may not hijack the area of the brain as easily as someone who’s not in as much pain, and they’re just taking them. It may be easier for them to feel euphoric and have those drugs really hijack that reward system in the brain than perhaps someone who’s in severe pain. Do you think that part of our way of life makes us predisposed? You talk about the genetic predisposition to addiction. Addiction, you know, they are able to, or something overrides this limbic system, this dopamine reward system.

[ 00:24:44 ] We hear a lot of the conversation all about dopamine right now, right? Dopamine reward system. Do you think that we are doing things like screens and outside experiences that are actually lowering our threshold? Yeah, well, that’s a great question. I think I could better answer it if we backed up a little bit. So it’s all about the threshold, right? And so what happens is these drugs are just incredibly, incredibly, incredibly, incredibly, incredibly, incredibly, incredibly powerful. So for example, very deep inside the brain, we have our limbic system. It’s made up of a few different structures in the brain. The names aren’t so critical, but it’s the limbic system, and it’s in the brainstem. We have no conscious control over the limbic system.

[ 00:25:20 ] It runs our autonomic nervous system, our organs, and our survival drives, like feeling hungry, feeling thirsty, sex drive, those types of things, things that nature didn’t want to leave for you to remember that have to do. Now, the cortex in the front of the brain, the prefrontal cortex, that’s the brain that we plan with. When you take drugs, these types of drugs, opioids, for example, and alcohol in many people too, the amount of the limbic system, there’s a concept called salience. The limbic system has to learn what is important in life. What am I supposed to be doing every day? What am I supposed to be driven towards? And it uses dopamine, levels of dopamine to understand what’s most important.

[ 00:26:03 ] So when you have a delicious meal, or you do something that’s very rewarding, there’s a certain amount of dopamine that’s important. And so when you have a delicious meal, there’s a certain amount of dopamine that’s released, okay? And that tells your limbic system, the part that you don’t have control over, this is what I’m supposed to look for and crave and push the thinking brain to find every day. These drugs, they’re able to hijack the limbic system because they use the language of salience. They explode dopamine into that limbic system to such a degree that it hijacks the circuitry. The limbic system then says, oh, this is what I’m really supposed to go after. And so now, it doesn’t even come on par with food and water. It actually surpasses it.

[ 00:26:42 ] So now the limbic system is in survival drive mode every day looking for this drug. And that’s why when you see people who are hooked on heroin and fentanyl, everything falls apart in their life, and yet they keep using the drug. The brain circuitry has been hijacked, and now every day that, if you think about this, the neurons that go from your limbic system to your cortex, there’s a lot of them because nature wanted you not to be able to not do the thing that the limbic system wants you to do, the survival drives. But your rational brain and the cortex doesn’t have the neurons to go back and stop the limbic system. That’s nature’s beautiful design. That’s so you can’t say, ah, I’ll eat later, right?

[ 00:27:24 ] Because we would all die, right? So if you think about it, when you’re hungry, try to out-think it, your hunger with your thinking brain. You can’t do it. Nature won’t let you do it, right? So think about it this way. It’s the cortex versus the limbic system. The limbic system will always win, but the limbic system now is chasing the drug, and that’s why every day when someone wakes up and they’re addicted, the limbic system, the rational brain understands the destruction that’s happening in someone’s life. It’s not that someone with addiction doesn’t see all the problems that are happening, but every day when they get up, the limbic system tricks the rational brain. So your rational brain says, listen, we got to stop. Everything’s falling apart.

[ 00:28:00 ] We’re losing everything in our life. And the limbic system says, oh, you’re right, but we’ll just do it one more time today. And we’ll stop tomorrow. And that’s how it tricks the rational brain. And then that person will go out and use the drug again, and the same thing happens every day, unfortunately, often ending in death. Yeah. How long does that take and if someone is at home? And I guess the other question is, are you as concerned about opioids that are prescribable as fentanyl? I’m extremely concerned about all of it, because I know that there’s nothing you can do about it. Because there’s no difference between heroin or oxycodone or fentanyl. They’re all very similar. The only difference is, and it is an important difference, is with fentanyl, literally a granule mixed into something else will kill you in a moment.

[ 00:28:56 ] And that’s the difference with fentanyl. You know, there used to be, you know, not that long ago, there were people using heroin and people would, you know, go to rehab after rehab and relapse. And they’d use heroin for decades sometimes, right? But they’d stay alive. That doesn’t happen anymore. The drugs are, fentanyl is so powerful that people can’t use opioids for years. And it’s just not possible because you’ll die. Every time someone uses a drug now, it’s literally, literally life and death, right? It’s rushing away every time. So people don’t live years using drugs anymore. Most people don’t even. They don’t even get to the first treatment place. Actually, most people don’t even have addiction. They just try something. I mean, they tried and then that’s it. I have so many questions.

[ 00:29:49 ] You know, I have the medical side to the conversation that I want to know, you know, what are we doing in our daily lives that can improve this dopamine reward system? And there might not be anything. We might talk about it and there might be things that if you have a propensity to become addicted. Then you are that person. And then the other side is we have a real crisis on our hands that it’s one and done. And that is not prescribed by physicians. I don’t even, you know, are people in search of this? I mean, that is a, I don’t even know if we can solve that problem. Well, you know, when someone has addiction to opioids, the only drive on their, in their brain, every day in their hijacked brains to go out and find that drug, and there’s no rational thought process; it’s all limbic system.

[ 00:30:40 ] And what happens is, you would think, why would they want to go find fentanyl, right? Because it could kill them. But actually, if you ask, you know, if you ask people who are actively using drugs, why did you, you know, when I, there were many patients who would tell me when I’d see, because we do urine testing, you know, on everybody and I, we would see what’s fentanyl and we’d say like, did, you know, what, you know, go through the history with them. And they would say, oh, yeah, I mean, I purposely seek out that dealer because they have fentanyl. And when you ask them, well, why would you do that? In their addicted brain, the drive was, well, you know, because maybe I’ll feel that much high, higher, more euphoric, but I don’t think I’ll die.

[ 00:31:21 ] But, you know, I’ll try it again because it’s the best, you know, and you’d say, a lot of people say, why does the dealer want to kill their customers? But, you know, with fentanyl. Fentanyl, the high wears off very quickly. How long are we talking? A few hours. And you’re talking about oral, you’re not talking about patch, right? This is patches separate. Yes. The patches are not an issue really right now in society because doctors don’t really prescribe them that much anymore. And fentanyl is all about this illicit fentanyl. And so the dealers, though, because it wears off so quickly and people start feeling sick and going to withdrawal, they need to buy more and more. Right.

[ 00:32:03 ] Even if some people die, they actually make more money by selling fentanyl than they do heroin because heroin, there’s a much longer time period where someone can feel relatively okay and they could go back the next day and buy it. But fentanyl is a different animal. And the part of the thought process is how is this getting started? Is this getting started from opioid distribution in the regular medical realm? And we can’t identify any that haven’t been given away to the medical field. So this is, this is where it’s all about the opioid, right? And I’d like to stop here, because you can imagine that some people who have, about property owners, the puppy owners, they get out on boat and they have an opioid.

[ 00:32:39 ] That helps, but a couple ways back home, and I’m not going to go into too much detail on a bit of love and watermelon. But really thinking about what’s happening. Dr. There are still a lot of doctors that prescribe them too liberally. But what you see now is that the pendulum swung the other way. Doctors are very afraid to prescribe them. They know they’re under a lot of scrutiny. If they do, there’s a lot of laws now. Pharmacists will push back a little bit about it. So it’s not as much with the doctors. It’s very hard to find these pills. So what happens, though, is because it’s hard to find them, all the pills are actually fake. All of the pills on the street now are fake.

[ 00:33:29 ] It is extremely rare that someone gets a real oxycodone pill because doctors just aren’t flooding the streets with them. But all these pills, the dealers, these pill presses actually inscribe the numbers, the letters onto the pill, so that if someone said, let me check if this is real, it looks identical. And trust me, even if someone out there is listening, thinks that they can tell the difference, you can’t tell the difference. But they’re all fake. Every single person in the last year or two that I’ve seen in the year in Texas, that comes in for opiate addiction, their yarns, it’s all fentanyl. There’s really not much else. That’s it. I recommend taking Puree O3 Ultra Pure Fish Oil. Why? Because I did my training in nutritional sciences with a heavy focus on muscle health.

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[ 00:38:52 ] Are there things that someone could do to improve their immune reward system to protect them against that threshold of addiction? Well, look, I think that you well, first of all, another area that makes you more vulnerable is if you have certain mental health conditions and you don’t treat them. You become significantly more at risk things like untreated ADHD, bipolar disorder, and borderline personality disorder. There are some mental health issues that people are not treating as much as they should, and you know, the risk of you becoming addicted is much higher than someone else’s. I really appreciate how you answer that question. I’m going to tell you why because I am pressing you on this idea of how do we improve this dopamine reward system?

[ 00:39:52 ] And again, I’m very interested in the literature of the natural ways to augment dopamine, whether it is exercise or these short bursts intermittent dopamine reward schedules, but the reality is none of that will likely ever-in my opinion-again. I don’t know all the data will never touch a chronic diseased addicted brain, and there’s probably nothing that we can do short of treatment. To prevent that, and you’re right; and that’s why I did answer that. And so I really appreciate that answer, and it’s not all fluff. He said it doesn’t mean that you shouldn’t do again. We’re talking about the dopamine reward system. And I’m curious as to whether you think that there are validated ways for a brain to maintain baseline levels of dopamine outside of medication, and then do things that are potentially helpful like an intermittent reward schedule.

[ 00:40:47 ] I am very interested in that from an optimization standpoint. Yeah, the the I think that we don’t have a heck of a lot of research and in that area. Certainly those are all the things you mentioned. Are extremely healthy, you know physically mentally and and for a whole host of reasons. You should do those things how much that augments or would change this type of issue, you know, it’s it’s I don’t know really if there’s a connection with it with one another because these addictive behaviors like gambling use disorder is very much akin, by the way gambling specifically people have a gambling addiction. If you watch them, they the way that they lose control is is. All the same as you see someone that has an alcohol and opiate addiction.

[ 00:41:31 ] They’ll gamble every last dollar away. It’s as powerful. It’s hijacks the same reward system in the certain vulnerable people and and so someone in certain behaviors are certain these drugs and these behaviors stimulate that reward system to such an artificial level and artificial. That’s why the things that we’re discussing they they just can’t compete and that’s a critical. I thank you for saying that so elegantly that is a critical component to the conversation is that. Health is so important and we’re we will talk about those things that are healthy but this whole other level this hyper stimulation this this unnatural hijacking is something that has to be treated by a trained providers after to say because I I know that there’s a various suboxone clinics.

[ 00:42:18 ] There’s various different types of clinics and we I do want to talk about the various ways in which someone would treat an opioid addiction but also to circle back and say. Whether it is opiates gambling porn whatever the addiction is. It requires a trained professional is that is that also fair to say. For sure, I mean, and that’s why there is a separate field of medicine for now. The problem is that there’s so few doctors and train you know, train doctors in the field. I think you know more than half the counties in the country don’t have anyone that has any experience in treating. Let alone a good amount of experience right. So it’s very hard, there are certainly now because of telemedicine. There’s a lot more resources for people to get help.

[ 00:43:09 ] But but it can be very tough, the nearest clinic that could potentially help you could be hours and hours away, and every day counts as life or death, so it’s a very very critical issue. Are there particular signs and symptoms of addiction a certain criteria that they have to fall under. Well I yes but addiction if you look at the criteria they all the criteria basically point to that it’s a loss of control you try to stop you can’t you want to stop because the drugs are hurting your life and yet you keep using the drug and that’s ultimately what addiction is about now there’s a very big difference and it’s a very important difference between physical dependency. IE withdrawal that someone may experience. And. Addiction. They’re not the same. And.

[ 00:44:02 ] Wait say that again so there’s the physical there’s the withdrawal symptoms. And then. You said there’s the addiction. Compound yes and I and it’s. A lot of people you know. Just sort of equate them as the same thing. But they’re not at all. And. When you use a drug repeatedly, it doesn’t even have to be drug of abuse, hypertensive drugs. All types of drugs, yeah, exactly. There are compensatory changes that happen in the body, in the brain specifically, that if you suddenly pull it away, you could experience a characteristic symptom of the withdrawal of that substance right. It can range from relatively mild to very, very severe. But that’s not addiction. So for example, If I were to take a hundred people randomly.

[ 00:44:50 ] And put them in a room, I put an IV in everyone’s arm, and I gave them opioids right every day for two months and then stopped. Everyone in that room would have the same opioid withdrawal symptoms right. But only a certain percentage of them then after going through all that would then go out. Keep seeking out the drug, keep using the drug despite their world falling apart. And it literally takes everything they have from them. So the withdrawal part is not the addiction if they were the same than everyone with addiction could just go to a detox. But you know, having a monitored withdrawal. And then their addiction would be cured, but that’s not what happens at all; detoxes are revolving doors for the same people.

[ 00:45:33 ] Because addiction is what happens after someone goes through that withdrawal process. You have to treat withdrawal, especially from these drugs. It can be very dangerous, and if you want people to have a chance at getting better, they have to have the withdrawal, the detox. But that is not treatment for addiction; addiction is the harder part. The treatment for addiction comes after. Why is addiction so much more difficult to treat? It’s a great question. I think part of the reason is that Once you have addiction, the brain has been fundamentally changed such that. Even after prolonged sobriety away from a drug. There are many things that can trigger that limbic system to start lighting up again. And so things like for example I’ll be very specific with you: the brain uses a neurotransmitter called glutamate.

[ 00:46:18 ] And it uses that when you engage in a pleasurable activity and dopamine is released; the hippocampus, the memory center in the brain starts storing. Everything about that scenario is a survival mechanism. So where was it? What time of day was it? What the environment looked like? What did I smell? What did I see? It encodes all this information because that could have been a delicious meal, and your brain wants you to find that again. And so what happens is now those memories are indelibly in the hippocampus. And so triggers are enormously powerful to someone who’s in recovery, people, places, things, even if that person consciously isn’t even aware they’re being triggered. That back part of the brain is lighting up and we see it on the scans.

[ 00:47:00 ] We see the limbic system lighting up when we show people that in recovery, even 15 years in recovery. We show them triggering things and they may not even report that they know that they’re having a craving or anything. But we see that midbrain that Hilaria just spark lighting up and this is why so and these things were all over society. That’s the problem for someone in recovery from alcohol. What’s the first thing that you get in the restaurant the wine menu when you look around you hear the clinging of the glasses. You see people drinking even if you say I’m just going to have a seltzer. I’m going to go out to the bar at my friends.

[ 00:47:32 ] I’m just going to have a seltzer though and you go out and you have a seltzer and you go home that night and you think see that was easy. But not necessarily because that limbic system is now tingling. It’s lighting up now all of a sudden. Why are you dreaming about it? Why are you thinking about it when you haven’t thought about for 10 years and then here comes the relapse five days later. I mean, this is a very common scenario for doctors who treat patients with addiction. We see this scenario happen. So that’s why it’s so hard for people to stay in recovery and not relapse. It is a it is a day at a time. It really is.

[ 00:48:05 ] And if it’s a chronic brain disease, is it fair to say if it’s a chronic brain disease, then somebody would never get better? Well, there’s a couple components that so currently we don’t have a cure. Okay, we have what we call MIT medication-assisted treatment that dramatically helps that person stay in recovery and blunts the effect of triggers in the environment. And this is why in a general sense, without going into too much detail. This is why a lot of people say, oh, you’re on that medication. Oh, you know, doctors just put you on and now you’re on forever. That’s what they do sort of thing, right? But a lot of doctors are weighing risk and benefit. And the fact of the matter is, is that one relapse in one time can so dramatically and fundamentally destroy your life, your family’s life.

[ 00:48:55 ] The risk is so enormous that to say, you know what you’re on this medicine; you’ve been sober for three years before this, you couldn’t get two days. Just stay on the medicine. Just, you know, one use can kill you. Do you think that there is a stigma against medication use in general, and that prevents people from seeking help and getting out? For sure. I mean, absolutely. This is something that people hear from friends and family. They read on the Internet; influencers on social media that opine on things that they don’t have expertise in-sort of this like raw, raw, natural. You don’t need medication. You can fix everything. Medicine’s bad. All medicine’s bad, you know, completely irrational. Not not any kind of critical thinking going on there.

[ 00:49:49 ] And and so it makes people feel like they’re there’s a stigma. And they hide away. And then they don’t share these things and they don’t want to take medicine. And so you’re absolutely right. What about the, the stigma of. The ability to get better naturally, for example, let’s say someone goes on the medication, let’s say so Vivitrol, which I want to talk about. There’s there’s some treatment strategies, right? And then. It be fair to say, how do people experience it? Does that mean once addicted, always addicted? Do they think about it in terms of being a chronic brain disease? Because with all of these triggers, it seems you wouldn’t even know. That it’s happening and then it leaves someone susceptible, right?

[ 00:50:42 ] And then I would imagine that if the Olympic system is dealing with incoming signals, you know, we are just talking about addiction. There’s a busy life. There’s, you know, you’re a mom or dad. You have all these other things that are inputs into the brain. You have social media of all of this stuff. I could only imagine that it would lower. I don’t know, cognitive capacity, the load, even the brain reward pathways. Absolutely. So stress certainly is a trigger for people to relapse. And it’s I mean, how do you avoid stress as part of life, right? And so one of the reasons that counseling is important is not just about medication. It’s both. But but the only only if you’re addicted or it’s important for both. Either way. Meaning, meaning what?

[ 00:51:28 ] If somebody is, you know, you give the example of an individual being in, you know, ten people all on Dilaudid for two weeks and the people that are treated with going through withdrawal symptoms. Once you go through withdrawal, do they need to be treated cognitively or is it purely the addicted brain has both a cognitive component? I mean, if you have, you have not developed addiction, say you went out and you party with your friends and you did drugs, but but I mean the next week to eat like you don’t think about it. You’re not obsessing about it. You know, you almost forget about it. You don’t have addiction that doesn’t happen. Think of it. I mean, like, you know, and someone who’s in recovery from alcohol, right?

[ 00:52:16 ] They could be ten years sober and putting tons of work one day at a time to stay sober. If they have one drink of alcohol, it lights up that limbic area so fast and it sends it can send them on a spiral that then destroys their whole life after ten years over one drink, yet somebody else could walk into a party, have a drink, put it down, forget that was even there, go about their night. Someone with addiction to alcohol could never in a million years do that because the key is not it’s not just about the drug. It’s about your brain and how the two interact, not everyone’s brain is different. And so the way the way you necessarily feel from alcohol is not the same as somebody else, and we know that for sure.

[ 00:53:02 ] And so that is it’s so important to recognize that that it’s not just a drug. It’s your brain too. And it’s how they mix those two and what are some of the treatment treatment strategies for we could start with opioids. So, the I mean the first key thing is that if someone’s addicted to drugs, the drugs. The first thing is that if there’s going to be a withdrawal you have to treat the withdrawal and that’s the detox part because it could be very dangerous or deadly, that’s the alcohol, that’s the benzos like Xanax which a lot of people take Xanax, Ativan, Klonopin, Valium. If you were to suddenly stop those drugs, you’d have a pretty, pretty painful and wicked withdrawal, even if it it’s fair to say even if it’s a low dose, again different for everybody, the biology everyone’s different, but if you’ve been on the medicines, you know, for a good deal of time, your brain has undergone some adaptation to that drug.

[ 00:53:59 ] What about something like in this obviously a different class of drugs like Ambien or sleeping pill? Do people become addicted to those and I appreciate that. This is a very general question. No, it’s not. It’s a great question. Okay, so people don’t become addicted. This is a great thing to ask because what we see is that they, their withdrawal pattern to say Ambien is that if they stop suddenly, They won’t sleep for a week or they’ll have terribly disrupted sleep, right? Eventually, their sleep cycle comes back, but there’s not addiction; people aren’t selling their stuff to get Ambien. It’s not a drug that creates this sort of compulsive, obsessive thinking. This is a perfect example of someone that of people that get dependent on, and they need it; they would have withdrawal, but they don’t get addicted.

[ 00:54:50 ] It’s not a drug that does that if that makes sense. Yeah. Again, I’m thinking about having to treat the you have to treat the detox right because first of all, most people even if they want to get better can’t make it through that period of time. It’s too painful. Okay, and so, if you want them to have a chance, you’ve got to treat it medically. You have to treat medically, and sometimes it’s very dangerous. If you don’t treat medically, people die from alcohol and benzodiazepines; seizures, hallucinations-most of the time, they have to go through detox in the hospital, which is brutal. Okay. I mean insomnia that goes on for every day for a long time. If you don’t help someone through that, panic attacks, anxiety-I mean, you know, very bad symptoms-and opioids have their own set of things that happen, but you’ve got to treat people for that.

[ 00:55:32 ] But then when they’re done with that, that’s when addiction treatment starts and that includes medication for many people and counseling for many people. It’s not one size fits all but most people 12-step type programs things of that nature on the counseling side 12 steps is one of the more common ones. Yeah, I know we didn’t totally plan to talk about this. So you can say I don’t want to talk. About this. I don’t think it’s relevant but I feel like there’s a lot of marijuana use. I don’t know if people seek your advice on that. They want your perspective on it. But I am very curious about your perspective as an addiction physician. It’s a complex topic because again, it’s not one-size-fits-all. It’s about your brain and how the drug interacts with that.

[ 00:56:15 ] So, for example, obviously, you know, the state laws are all over the map. It could be, you know, written as a prescription for medical use in some states. It’s completely rational, and others but in New York, for example, where I practice, they approved it medically specifically for opiate addiction as an indication, and there’s not a heck of a lot of studies on that, but it was approved for that, and I’ll tell you what I see in practice. Some people are sober from they got in recovery, and they’re staying sober from opiates, and they find that they smoke marijuana in times when they feel overly stressed. They feel like they’re having maybe some thoughts they don’t want to have in terms of a craving something if they smoke marijuana, it seems to soothe it for them and it’s like a very so you look at like harm reduction, right?

[ 00:57:03 ] The marijuana is not hurting them and you see that from real-world evidence. You see that they’re moving through to life. They’re there. They’re fulfilling, you know what they want to do in life, but they smoke marijuana here there. They’re in recovery from opiates and it and but but the pudding speaks for itself. They’re staying in recovery. Their life is moving forward. You have your evidence. It’s for them. It seems to be fine, but there are people and I’ve had many patients in the situation where they’re in recovery. They start, they start bringing back a drug like marijuana, and what that does for them is it starts interacting them with their limbic system in a way that, in the beginning, it’s like ‘oh yeah, marijuana’, but now there are certain telltale signs.

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[ 01:01:56 ] Is there a way for someone to circumvent that and know, for example, if let’s say someone is exposed to something? Is there a period of time? Is there something that can be done to then calm down that Olympic system response so that there isn’t a relapse or a ‘danger zone’ such a great question. I just want to give you a couple of real-world examples as a doctor who sees this every day. I have people who will say, ‘I’ll give you perfect examples of things that come up constantly.’ They’re in recovery, but someone that’s very close to them is getting married and going to a wedding. Okay, that is a very common scenario and there’s a lot of of course alcohol there; another thing is I’m going on a vacation and it’s a ‘you know, all-inclusive type of vacation with alcohol’ right?

[ 01:02:42 ] And cannot tell you how many people will go, they will come home and they stayed sober during the trip. But a few days later they relapse because it’s lighting up that limbic area and I wanted to go over those real-world examples because I’m telling you that people in recovery face these things, and so it’s not that you can never go to a wedding, but you have to have a strategy in place and that strategy is that you have to be able to, and you know, your immediate family has to understand right because this is a life and death issue for you. If you feel that you’re uncomfortable, you have to have an exit strategy. You have to be able to leave, and you know, people in recovery going with a plan who’ve done counseling, the lot of them can do that.

[ 01:03:25 ] They can feel if they start feeling uncomfortable. They have an exit strategy. You have to have that or that and also they call their sponsor because in 12-step meetings to get a sponsor of someone who stayed in recovery for a long time, and you can reach out to them and they will talk you through what you’re feeling, so having a sponsor and an exit strategy are very effective ways to get out of those situations. But do I think, for example, families will often say to me, ‘Can we still drink?’ We like to have wine, you know, at dinner right? And you know, the truth is, the truth is that even though your son or daughter, brother sister may tell you that’s fine, and they may believe it’s fine.

[ 01:04:04 ] The truth is, it’s not fine because you don’t know what’s going to set them off, and it can be devastating. What can what can happen? So, you have to go out of your way and make those changes because you’re putting them at risk. You really are. It’s just reality. It’s I mean, it sounds like it’s a whole family disease. It is some if someone gets it. This is a whole family disease, and this is a real problem. What do I know when I think about some of the patients that I see for weight loss, I will hear a similar story that they will be able to not think about food, not go off their quote plan all the trip then they come home or it’s on the way home from the airport.

[ 01:04:47 ] They completely go off the rails. And it’s a it’s a day later. Again and again, based on the definition, it’s probably not a food addiction, but it sounds like there’s some similar overlap. There is what what would you say in terms of treatment strategy or just ways of framing and thinking about that? Well, what when we when we get into the medicines, what you kind of see is that with one of the medicines, for example, it is used to treat. To help with opioid addiction is also to help with alcohol addiction and to help with binge eating. Why? Because all these addictions tap into the same mesolimbic dopamine, probably that same limbic system. And so that the reason that person wants that food is a limbic system screaming at them for the food, right?

[ 01:05:35 ] It’s very hard for someone who has that sort of addiction with food, which does certainly exist in the realm of food. You know, if they have that susceptibility. Then it is it is it is a day at a time for them too. And they have to be careful what where they’re going, what restaurants they’re sitting in, what they’re what kind of desserts they keep. And you’ve seen this, you know what I’m talking about. A hundred percent. A hundred percent. And the point, the point I was trying to get to was that medicine. If you give that same medicine that’s used to help people with those conditions. Also, when you give it to someone with an eating issue, you know, like a binge eating issue, what they find is they don’t hear the food noise.

[ 01:06:18 ] The craving. They don’t hear it as much because it’s blunting. It blunts the limbic response to the environmental cues. So the environmental cue which would normally set it off now doesn’t set the limbic system off because the medication is keeping the limbic system more chill. And they can they can be exposed to the to the trigger. And this is the same reason now with food. They’re not going to suddenly die from having food. But in addiction, you can see why keeping people on medication assisted treatment ongoing. Is often the case because they’re you’re exposed to these things constantly. Do you have a thought as to how we can somewhat soften this stigma, right? You humans are so funny. They believe something or think something and then it’s almost as if it’s mob mentality.

[ 01:07:08 ] It’s sheep mentality. There’s, you know, because of this, it’s this or oh, no, not that person for sure. And the language. We use plays a huge part, actually, in this a very real tangible part with consequences. So I’ll give you a typical example, right? And a lot of people certainly don’t mean mean to be negative with it. But when you when you call someone an addict that language makes their entire identity about their problem, right? And you need to separate their like humanity from the condition; separate the condition from the person who suffers with it. We don’t call all this is, you know, Mike the epileptic. You know, we don’t use that language in other fields. And so you want, and it’s not just about it’s not just about making somebody feel disheartened.

[ 01:07:55 ] It has implications in terms of the language when we talk about the law in terms of punishment versus treatment for addiction, language matters. Tell me what you mean by that the law. Well, for example, you know, the laws in different states handle addiction and drug use very differently, you know, whether or not they have drug treatment courts where a lot of times it’s about more about treatment and making getting people help versus just kind of incarcerating them over and over again. And that seems like that’s a really tough thing if someone is. Addicted and it’s a chronic brain disease and they commit a crime because they’re trying to do the thing that the rain is telling them to do.

[ 01:08:38 ] And then they go to prison for it, that seems a very difficult conversation, even just a way of being able to parse that out because you can’t have both or you can’t have a chronic brain disease. And then we know that their behaviors that drives her. I mean, I’m not advocating that people that commit crimes because of drugs aren’t held responsible, but you can be held responsible and get treatment so that it doesn’t keep on happening to you. You know, and also did those people will those people sticking to their plans where they actually on treatment or did they not do you do the treatment when they know that that’s what’s supposed to help them and that matters too. But but the point is the language shifts the focus on how you, how you view it and how you help people.

[ 01:09:21 ] It also insurance companies change the way they reimburse for things based on the how they view and the language that’s used for addiction, right? Should should they have to cover rehab for people or, you know, they because, you know, in the world of medicine insurance companies basically dictate care now and any place that they can start swiping away at low-hanging fruit and they feel like they’ll get less pushback. They will. For profits and addictions one of those areas, you know, one of the other things I did want to highlight we didn’t we didn’t touch on I wasn’t sure if we should but I think that there while we’re talking about the stigma just in general and there was a period of time where it sounds like certain physicians got kicked back for prescribing opiates.

[ 01:10:06 ] Is that true? Certain? Okay, I would say 99% of doctors do not get paid anything for, you know, any kind of prescription. Or drug there’s again. I think that we have to clarify the the landscape. Can you speak to that? I love to clarify because again with social media you get these sort of camps of people who think such in such black-and-white terms doctors are bad. They’re all under the thumb of Big Pharma. They’re getting money to prescribe you any and all medicines and it couldn’t be further from the truth. Most doctors are trying to help their patients and they use medicines judiciously and and and you way. Benefit and risk. The problem is there’s just there.

[ 01:10:52 ] It’s almost like, you know, a little bit of information is worse than any information because it’s because a little bit of information makes somebody think that they understand the topic. And and but they but they don’t they’re trying to opine on things that are under the, you know, physician care. It’s it’s nuanced. It’s complex, and people feel like it’s just a simple thing, right? And they just kind of label doctors. All doing all do all medicines are bad, you know, it amazes me. It really amazes me because it takes away information and potential for treatment because of barriers to entry to physicians because of lack of trust that is. It’s not deserved the stigma placed even on the providing physician. It’s it’s misplaced. Well, the you know, listen how the government handled.

[ 01:11:45 ] What we just went through. I think so it’s a lot of that distrust, then people don’t know what to believe, but instead of like it’s sort of like this knee-jerk reaction. Like I’m in the camp of no medication ever and I’m going to, you know, bash anyone that talks about prescription medicines. It’s amazing. Like I’ll talk about in a very nuanced way right about a topic, you know, listen; we see this all the time now with GLP ones, which are definitely-I know that you’re an expert in and you look at, and these extreme camps. It’s like what? Saying that you would take no medicine ever is like saying that you want to take every medicine all the time that it doesn’t make there’s no critical thinking whatsoever.

[ 01:12:22 ] Yeah, come on guys, you know, it’s benefit versus risk. It is it is benefit and yeah, it is very divisive. But I also believe that we are in a time where everything seems to be divisive. It’s we need to take a step back. We need to start thinking more for ourselves and we need to start educating ourselves, which I think that you’ve been very vocal about treatments. Let’s talk about treatments methadone suboxone some of the treatments and some of the treatments that you utilize in and where we are and then I do want to definitely talk about GLP ones. Sure. And listen again, this is a complex. We can have a whole discussion on this whole podcast just on this but there’s a tremendous stigma with these medications.

[ 01:13:04 ] And that’s why it’s important to talk about. Yes. So I’m going to try to run through them and sort of compare and contrast them with the major points methadone is the oldest of these drugs. Okay now methadone is in. Opiate itself, right but and a lot of people say well, you’re just switching someone off and opiate for another one. What you know, how you helping them but let’s walk through that it methadone is it’s given in methadone clinic. It’s controlled. It is given in that certainly in the beginning one dose per day and the person has to go back there have to do counseling to get the medication. Now if you compare that to somebody who is living on the street there and they’re doing riskier and riskier behaviors to get these drugs.

[ 01:13:44 ] Whether it be prostituting themselves, they’re putting needles in their arm. They’re getting hepatitis, HIV. It you know, it is a horrific life, right? So they’re not even comparable. Okay. Yes, methadone is an opioid drug, but a lot of people on methadone can still have fulfilling lives. Okay. Now, is it still an opiate? Yes. Do people abuse it? Yes. Can and will you go into withdrawal if you stop? Yes, but it’s not the same. Okay, then came Suboxone. All right now. Suboxone. Is 95% of medication-assisted treatment is Suboxone. The drug is buprenorphine. Okay. Now this is an opiate. It’s a little bit different from methadone, which we call a full agonist opiate. It’s the same as when you take a painkiller, right?

[ 01:14:30 ] It binds to the opiate receptor releases a lot of dopamine; the more you take, the more dopamine gets released. Suboxone is different. Suboxone is a partial agonist opiate, which essentially what it does it binds to the opiate receptor and it releases some dopamine. And what that does is it satiates the compulsions and the cravings, but people aren’t, they’re not people don’t feel high. They’re not walking around euphoric. They most people on Suboxone will just say they feel fine, they, and they don’t have cravings. Does it affect mood at all? The only thing it would do the mood is perhaps it improve mood. Yeah, I was wondering. Yeah, I mean I would think for again from clinical experience it certainly can, but they’re not distorted; their brains not distorted. They function.

[ 01:15:13 ] They have full everything. They want in life. They’re not losing things. They’re they’re living great lives. A lot of people on Suboxone and Suboxone. You don’t have to go to a clinic. It took the stigma out. You can go to a doctor in the private office. They can prescribe it to you, and you can go to your local CVS and pick it up. People could be on the same dose of Suboxone for 20 years. It doesn’t keep escalating. It’s not the kind of thing. The partial agonist effect has a ceiling effect. What that means is that should you take more than you’re prescribed after a certain level? Nothing else. Is getting released in the body. It’s a ceiling, so you can’t overdose on Suboxone. It just won’t happen. Okay, but here’s the thing.

[ 01:15:51 ] It still is an opioid and if you were to stop it suddenly, you will still have the same withdrawal as someone using heroin. It’s the same withdrawal process. Okay, and also Suboxone, you could wake up one day and sign up to take it and go get high from street drugs, right? So now they have sublocade which is a once a month injection of Suboxone. That’s brand new. But that. That helps with that that aspect of it, but that’s how Suboxone works. Does a physician have to be trained specifically in Suboxone? Great question. So the way it is is you have physicians have to get a lot of certification to prescribe buprenorphine. Okay, that certification is not hard to get.

[ 01:16:32 ] It’s an eight-hour course and it just teaches physicians the mechanics of taking someone from an illicit opioid and putting them on Suboxone, how the process works. Okay, that does not make one an addiction specialist, and this is the problem because what happened was a lot of doctors saw this as an opportunity to charge patients a lot of money who are desperate, and it’s a lot of cash practices. They will take insurance for everything else, but then they’ll charge you for the Suboxone visits and and then if there’s complications or issues, they’re not very good at helping because they’re not addiction specialists. They learned how to give Suboxone and that’s important. Suboxone is life-saving, but there’s another option as well. Talk to me about that option, and that option. I’m guessing it’s Vivitrol.

[ 01:17:14 ] It is so Vivitrol is in stark contrast to the other drugs. It’s not an opioid; Vivitrol is an opioid antagonist and opiate receptor antagonist. It binds to the opiate receptor, the mu opiate receptor, and it blocks it. It shields it off. Okay, it does not release dopamine at all; nothing. But the way it interacts with that receptor is it stops cravings, believe it or not. And there’s studies now proving it clinically. We saw it. But proving it now. Yes, that it can do it just as good as any opioid drug, even though it’s not an opiate and at the same time it shields the brain. It’s a once-a-month injection, and what happens is that not only the craving stuff, but if you were to go out say, and let’s just say, even though the cravings come down, you use drugs.

[ 01:17:58 ] Anyway, you take an opioid drug; you inject heroin, whatever-maybe that shield is going to block that for that month. It’s going to block the drug from binding. You’re not going to overdose. You’re not going to get high. It’s not going to start the addictive process again, and imagine for a family. Whether kids out at night and they’re in recovery always not being able to even rest for a minute knowing they have Vivitrol is a protection. It’s not perfect, but it does a hell of a job and Vivitrol over time helps their brain heal, you know, it’s not a life necessarily a life sentence of medicine. You can do it as long as you want.

[ 01:18:33 ] But clinically we try to get people on it about a year and make sure they’re okay in other aspects of the life before we would pull it away if they want to pull away some people stay on it and what’s fascinating, is it was FDA approved 2010. How come nobody knows about it? Couple of big reasons. Well, first of all, it’s FDA-approved to treat alcohol addiction as well. I didn’t know that and I I keep up to date. Yeah, they don’t ask that in any kind of board question or review course. Why yeah, why is that? So because a two reasons I’ll tell you the clinical reason first: You have to be off of opioids. You have to be detoxed for several days. Usually a week is what the recommendation is.

[ 01:19:15 ] Okay, to give someone Vivitrol; why because if you were to give someone an opiate antagonist and they have opioids sitting in their brain from the last drug use it will push them out with a lot of force. The Vivitrol will knock out that opioid and it will put them into puts called precipitated withdrawal, which is very severe opiate withdrawal all at once and you try to avoid that for people. So you want to wait that week. The problem is is that to treat a to have the clinical skill set to be able to use the right medicines the right combinations to get someone through those seven days and keep them completely comfortable without using any kind of opioid.

[ 01:19:51 ] That is a takes experience and practice and being able to but being able to do that, which I think my neurology background certainly helps is what got me over that hump. And what got me to build a help so many more people and not only do you have to the skill set, you have to be able to talk to your patient and look at someone who is deathly afraid of withdrawal, even a minute of it, and tell them that. You are confident, and they see the confidence and you’re going to help them, and you’re going to really-you know, you know that you can help them. They have to have a confidence in you to be willing to go through that process, and the only way the confidence happens is if you know what you’re doing and you’ve done it.

[ 01:20:27 ] So, if you can, and you take the time to care and talk to your patient, and if you do that, you can get a lot more people onto the medicine. It’s far easier for a doctor just give someone Suboxone as they’re coming off the street on opioid drugs, and instantly the patient feels better. And there’s nothing wrong with Suboxone, but patients never get the option because doctors don’t want to go through the process. There were some other political reasons why the company who made Suboxone tried to really-really shut down yeah that’s what I hear about a lot of things in medicine. I was I have a we were doing a pre-interview for a plastic surgeon who was talking about implants or alternative things for the body, and it seems like the U.

[ 01:21:08 ]S. Companies or various companies are doing a lot of things for the body and it seems like the U.S. Companies, whether it’s pharmaceuticals or certain industries that already have the market share, don’t want opportunities that could potentially be better for the patient. Yeah, well listen these are private companies they want to they want to get rid of competition and in Divya who makes Suboxone, they really tried to go after Vivitrol when they first started to try to advertise about their drug and actually believe it or not Kamala Harris who is a senator in California she opened an investigation against the Vivitrol company trying to discourage them from advertising the medicine and when you go back and you look at it and you see that there was a lot of campaign contributions coming from law firms that were helping Suboxone, it was a whole big convoluted thing that’s pretty challenging, it’s very sad to think about that.

[ 01:21:58 ] Where do you think Vivitrol sits now? How where do you see the future of its use and also I think it’s fascinating that it’s used it’s FDA approved for opioid and alcohol are there other off-label uses that could potentially really benefit people especially being a once a month injection, yes I love to talk about this. because it’s really incredible so Vivitrol what you know alcohol is a different completely different animal but ultimately the way alcohol addicts somebody where they get compulsively like alcohol is through the same reward pathway you know alcohol is a dirty drug it hits other areas it hits the GABA receptors it does different things but the addictive liking comes through the reward pathway it actually spikes dopamine in the same area that an opiate does and for genetically susceptible people and when you use Vivitrol I’m going to tell you something fascinating what happens to someone who drinks when they’re First of all, there’s no detox period.

[ 01:22:56 ] You can give someone Vivitrol the day they drink alcohol; nothing there’s no withdrawal from it. But the fascinating thing is, and we all the studies-I can briefly go through but the studies are remarkable in both both opiates and alcohol. You give somebody a Vivitrol injection and you give somebody a Vivitrol injection and in it uh in the in the one of the major studies they had patients that were heavy drinkers, okay heavy drinking meant five drinks in a sitting, okay. And in this study, they were drinking at people in the study; the median person was drinking at least um fifth 15 days a month. in that way okay and when they gave gave them Vivitrol the the amount of drinking when um went from 15 and a half days a month to less than one day a month

[ 01:23:40 ] in one day from 15 97 reduction and everyone said the same thing i have a drink of alcohol and i could put it down i don’t i don’t i don’t like it right or it’s it’s like me drinking a coke like incredible because what is the vivitrol doing it’s not allowing the dope the lighting up of that limbic area so all of a sudden alcohol can put it down and and that’s incredible and so we don’t encourage people to drink on the medicine because when once the medicine comes away they’ll keep Drinking eventually, so we try to help people get sober on the medicine, but there are definitely people who use it as harm reduction. Now I can have a drink sometimes and I don’t go off the rails, and you know if that’s how it helps them then that’s how it helps them.

[ 01:24:20 ] You can’t dictate to someone how they have to get better on the medicine. I have a lot of people on Vivitrol who will say they drink sometimes and they have a severe history of alcohol, but now they can have a drink and put it down-it’s really remarkable, that is remarkable. Do you think that there’s other uses for Vivitrol that you’re hearing? Yeah, there are studies. Being done, um, and I’ve used it for this, but there are studies being done looking at how people with gambling addiction what happens to them if they have Vivitrol in their system and one of the studies they took, um, uh, naloxone which is by the way that it’s Narcan, Vivitrol is extended release Narcan, which saves people’s lives when they have an opiate overdose and you spray it in their nose.

[ 01:24:55 ] We didn’t get into that but Vivitrol is that circulating constantly and so when somebody has, you want to explain what the just so they they heard it, they I’ve used I’ve actually used Narcan for a patient and um, yeah, it was probably the One and only time I looked like a hero in residency, uh, it was someone who was using and they couldn’t figure out, and I had talked to her before, and I kind of had this sense gave her Narcan; she popped right back up, truly life-saving. Um, so essentially when someone’s having an opiate overdose, when when the opiates have saturated those receptors it shuts down someone’s breathing um drive in that limbic area that that controls your survival, and that’s why it’s so important to have that um yeah, and you’re so sedated that you don’t wake up.

[ 01:25:45 ] So what happens is if you find someone in that situation, you can use Narcan which Is naloxone okay? And basically, you can now get naloxone or Narcan at pharmacies without a prescription, and that’s a great thing because there’s nothing dangerous when did that change? Um, different state to state, but pretty much now every most states you can get it now in the last couple of years um, and now what happens is so every single person that you prescribe an opiate to, I’m speaking to physicians right now um, I’m speaking to if you’re a patient or you’re a family member of someone opiates go get this and keep it in your house no matter what is standard practice, someone’s on opiate suboxone they have an addiction anything.

[ 01:26:24 ] Give them this, keep it in the house, you never know, and it will save lives. So many people deal with opiate addiction now. That when I’ve given people this, half the time they come in, they didn’t save their family members’ life; they saved the neighbor’s family members’ life. What percentage of people you think are struggling with this, specifically opioid addiction? Um, I think that it’s probably in the ballpark of um, probably between five and ten percent of the population. Just curious, do you think um or do you know the numbers? Do we in the U.S? s here have the highest addiction rate it’s not even close first of all 90 95 percent of the world’s opiates are prescribed in the united states just curious just

[ 01:27:05 ] wow um what else um can vivitrol be used for it obviously it’s not used for mood or eating or is it used for eating disorder it is so in this study by the way they they um sprayed naloxone into people’s nose and then sent gambling people with gambling addiction severe gambling addiction into casinos and what do you know they weren’t into it they could play a game and walk away they’re not getting they’re not getting the reward do you think people get concerned that um medications to help them would also change their personality i’m sure that that’s A concern we just don’t see it translate in that way, okay. Um, and now to your point, also, so gambling, yes, and um, what we find actually is when we give people Vivitrol for their opiate addiction, many of those, many of these patients will say that I don’t have as much cravings for bad foods because it’s oral naltrexone, well, or what is not.

[ 01:28:03 ] I’m sorry, there’s oral naltrexone and there’s long-lasting injectable naltrexone which is what Vivitrol is, yes, there’s a significant advantage to the shot, okay. My what I was going to ask about is that there you know some people use low-dose naltrexone for inflammation, for weight, and I’m curious if any of the the oral usage in the low dose translate to the the higher usage so i’m very familiar um low-dose naltrexone is considered to be experimental in all these different fields and it is safe and i am not saying that not to use it it may very well help people um we just don’t have a lot of studies showing exactly what it’s doing and

[ 01:28:43 ] in whom it’s going to help so um you know certainly a lot of people do take it to try but it will not produce this when we give a vivitrol injection it’s 380 milligrams of naltrexone circulating through you know you have to use the medicine in a way it’s going to really augment their their Entire reward pathway right and so um, a low-dose naltrexone in three milligrams for us it just isn’t going to do that um, but to get back quickly to what you had asked about um, what we find is that um, people have less reward from the refined carbohydrates, the sugars, the things that scream at them and and and when they’re on Vivitrol and I think that that is probably going to be also very helpful especially in the highly palatable world that we’re in right now

[ 01:29:29 ] if a physician is listening to this or a patient is listening to this, how can they find someone that is skilled with Vivitrol usage so I think the best thing to do whether you you’re suffering someone your family’s suffering with addiction or you’re just trying to find the best care the best resource is not google can be a good resource but it’s it’s mixed in with all kinds of for-profit places that are leading you astray what you want to do is you want to um look up samsha that’s s-a-m-h-s-a substance abuse and mental health services and there’s a number there if you call them they’ll pick up and

[ 01:30:05 ] they will give you a number and they will give you a number and they will give you a treatment program near you that will help you in this way you can also by the way text um you can text your Zip code to help the number four, the letter u, help for you, help for you, and they will, they will, reach out immediately and help you get to a program, this is the important part, because medication for addiction is the gold standard. You cannot be a certified addiction treatment center anymore unless you have a physician who’s experienced and will see every single person there, and help them with medication-assisted treatment, because the fatality rates and the relapse rates are just so much worse if you don’t give people medicine.

[ 01:30:44 ] So, they’ll only send you to a place that has a physician that is it challenging to. Vet these um treatment centers for the average person tremendously, I think even as a physician if you are looking at a treatment center to send a patient how can we do a better job at thinking about the treatment center? Well, I think the biggest thing you have to find out is: Is there a physician there that is that is trained in addiction medicine? Because that will be the thing that’s most likely to help save your life and set you on the right path. Because if they don’t have medical care then they’re all the other therapies while they may be helpful, they don’t replace that care.

[ 01:31:24 ] And if you don’t have that, your chances of getting Sober and staying sober dramatically plummet, and that is the key question: is there a physician there that will see my son, my daughter, me, my mother, my father, or whatever it may be who will be evaluated because let me tell you something else: you have to treat if someone has a co-occurring mental health issue which we didn’t talk about that much but if somebody has that which often is the case: you have to treat both conditions; you have to treat the addiction as a separate issue and then you got to treat the mental health piece, and if you’re not a physician to treat any of it, you know, and yeah, that’s concerning and in your book.

[ 01:31:58 ] You mentioned specifically ADHD, depression, and bipolar um are those individuals predisposed to treatment and to treatment as long as they’re pain-free and they’re fulfilling their psych if they’re affected by the treatment you know what I mean as long as they’re healthy are predisposed to potentially addiction. I mean, certainly impulsivity, potentially risk-taking behaviors. And I think that if you do, if we were to do the math, what percentage of the population either has ADHD or depression? Yeah, it’s a lot. And that’s the main point here, which is it’s so ubiquitous that 5%, 10% of the population has some degree of ADHD. And ADHD is a neurobiological disorder that starts in childhood, okay? It has tentacles that go into every domain of life. It’s not just about school. It’s about how you communicate.

[ 01:32:39 ] Can you hold a job down? People with ADHD, all the studies show they lose jobs. They get into more car accidents. They do more impulsive and dangerous behaviors. It’s a significant problem. And the medicine, proper medicine for people that have ADHD can turn their life around. And unfortunately, this is another one of those conditions on the internet where you have a lot of people sort of saying, oh, it’s a discipline problem. They don’t use medicine. That’s big pharma. You know, and I’m not going to sit here and tell you that it’s not over-prescribed or over-diagnosed, but many, it is a real condition that affects people in a very significant way. And if you don’t treat them, their quality of life is so much worse off.

[ 01:33:23 ] And so they’re more, and one of the biggest things they’re more at risk for is addiction from impulsive behavior. Let me tell you this. If you have an adolescent child right now, with fentanyl out there, and they’re impulsive because they have significant ADHD and you don’t treat it, a lot of parents think that if they expose their kid to the medicines for ADHD, that, that, and I understand, I understand why intuitively you might think that, that that may increase their chance of addiction because you’re exposing them to pills, right? And I get the, understand the feeling, but it’s just not what happens. What we see is the opposite. When you treat ADHD, the impulsivity gets much better. They are not as risk-taking. They don’t jump first, think later.

[ 01:34:03 ] They make better decisions and they’re much, they’re less likely to use drugs and get addicted if you actually treat them. And I’m going to tell you, a lot of, a lot of people and, and even doctors who may, you know, take this position, again, you see it a lot on social media, against all medicine for ADHD or, or some kind of against the condition or whatever it may be. They’re never the doctors who actually treat the condition. I know. No, I, I agree with you. How can we clear that up for, for the listener? You know, to think about serving that landscape of being able to treat ADHD and, and will they say, you know, yes, they talk about natural treatments. I don’t know if those are effective or not.

[ 01:34:51 ] Again, if we are really dealing with a diseased brain, then why would we not take treatment strategies, that we know are efficacious, that could actually save people’s lives from down the, down the road? I mean, it comes back to stigma, I think. And, this sort of cacophony of voices that people are exposed to every day that are not experts, but they can’t distinguish between it. And, and, and I get it, right? It’s hard. How can a lay person distinguish between all these, you have one person on one hand saying, oh my God, big pharma, they’re going to kill you, the drugs, the side effects. And then you have, you know, a doctor on there trying to say, no, but listen, I treat this every day. And if we don’t treat it, people get much worse.

[ 01:35:35 ] This is what I do every day, you know, and they don’t. And, but it’s still hard. You don’t know who’s telling you the truth, who’s not, whatever. It’s, it’s rough. But, in, in, in cases of, for example, ADHD, there’s strong genetics behind it too. Let me tell you when I, half the time when a child comes in and I diagnose that, that, that child or adolescent with ADHD, the parent that’s sitting in the room gets diagnosed at the same time, because they recognize all the same behavioral patterns. And they wind up saying, they wind up then needing treatment, saying, oh, if only I would have done this when I was younger, but that generation didn’t really pick up on it and didn’t treat it.

[ 01:36:10 ] And then, but if you look at the arc of somebody’s life that has ADHD, you see patterns and they’re not always healthy patterns and they’re, and they’re more at risk of a lot of things. And I, I think that they make different decisions in their life, big decisions. They make different decisions about major things throughout their life because they have untreated ADHD. And it’s, and I think that that’s really disheartening. Yeah. Right now, are most people being undertreated for it? It’s confusing because the landscape I, what I see is, and what I hear is. I don’t want to treat my child for ADHD. I don’t want to be treated for ADHD. I’m not sure if you’re experiencing that or if you’re aware of the numbers.

[ 01:36:54 ] Well, what I often see is when the kid, when a child’s younger, they look there’s nothing wrong. If you have the ability to hold off and more and do more evaluation and see a child’s brain is still developing. If you want to wait and see, you know, to let’s say it’s not impacting them in a very significant way, maybe they have some traits that might be certainly take the time, let them develop and watch, watch them. But the problem is, is that a lot of those kids ultimately wind up having to get medicine because once they get to middle school and they can’t organize their life at all and they keep one step forward, two steps back in different areas, and then the more dangerous things, when they get into high school, they’re not, you know, they’re just not doing, they’re not living to their potential.

[ 01:37:37 ] ADHD, by the way, it’s an important point, has nothing to do with how smart you are. Many of the brightest people have it. It’s a processing, how they process things. So what we find is that a very intelligent people have ADHD, but the problem is in today’s world and the way society is, it’s a huge negative because they’ll never reach their potential or anywhere near it because they just don’t keep up the self-discipline, they don’t do the work, they, they, they don’t, you know, they just, they, they make a lot of careless mistakes, they don’t hand things in, they, it just, they lose jobs, it’s, it’s, it’s, it’s rough. And they, and they, a lot of times they can’t figure out what’s wrong with me. Why can’t I, why can’t I do what my friend’s doing?

[ 01:38:13 ] Well, I know I’m smart. Why can’t I get through these things? Why does something that takes me an hour take me all day long because I start one project and I jump to the other one and I do the other one and everything’s open and I don’t, and then I get anxiety about it. These are the common things that people live with and they don’t know why. And when you treat them, it, it changes them. It changes their life. Again, I’m not saying it’s not one size fits all. Not every single person has to be on lots of medicine. I’m saying though, that what we know indisputably is counseling doesn’t do anything for ADHD. It’s a brain condition. And do we know that it’s easy to treat typically? You, you mean with medication?

[ 01:38:48 ] Yeah, success rate of medication, symptom resolution. So it’s a spectrum. Everyone has, you know, it’s different degrees of ADHD, but typically what I see in practice is that once you get started on medicine, it makes a very big change very quickly. And you do see a lot of practical results in people’s lives. So, sometimes you have to try different doses or try different medicines to help people because everyone’s different, but by and large, a lot of people get help quickly. I want to touch on GLP-1s, your position on them, how you use them, where do you see their role in addiction? Because I have been reading more and more that it seems to blunt the desire for alcohol. So, you know, like all of the medications, right, it’s not one size fits all.

[ 01:39:41 ] To say that all GLP-1 medicines are bad is preposterous. I mean, look at what people in America are dealing with. I mean, all over the world, but look at it, look at the health of American citizens. Look at the obesity, the cardiac disease, the diabetes, look at the, the strokes. I mean, look at society. know, you’ve been telling people know about diet and exercise. They know. Right. And but not everyone, I mean, is doing it. They’re not doing it. And there’s different reasons for that. But but to say that you can’t augment and help them, you know, sometimes, you know, momentum is seeing results is sometimes the biggest driver of momentum. And people are so discouraged.

[ 01:40:21 ] And so sometimes when you can help them, if you can use some medicine to help them, help them reduce their obesity, reduce their diabetes, get their blood pressure under control, which these medicines do and more perhaps, you know, get rid of the metabolic syndrome that they’re living with. A lot of them are then more likely to partake in maybe some other healthier activities. I think that a lot of people are very discouraged because it is very hard for people to not to continuously not eat to eat the right foods, not eat the wrong foods. And so, these medicines, as you as we would expect. Right. We know that metabolic health is so critical. So what do we see with these studies in GLP-1s? They’re new. But yet all of a sudden there’s these signals.

[ 01:41:02 ] Wait a minute. Maybe dementia is getting better. You know, maybe they’re not as having as much addiction. Maybe they’re not getting as many heart attacks. Of course, because what’s behind all of these downstream issues is this metabolic syndrome. And so, of course, we’re going to see all these positive things. And to say like only diet and exercise, it just doesn’t match reality. I absolutely agree with you. And I frankly, I do believe that there is some positive benefit, at least some of the early data that I’m seeing on skeletal muscle health, by the way. But the other question that I have on GLP-1s is it seems to. So I have patients that have now, by the way, I am very hesitant to ever think about using the word food addiction if it’s not real or a disorder if it’s not real, but have a proclivity to say binge eat or be hyper-focused on food.

[ 01:42:01 ] And we will put them on a GLP-1 or GLP-2, you know, these combo medications. There’s new generations coming out. Their food noise goes away. Their life is changed. But I am not aware of how it affects the brain, if it affects these dopamine reward centers or if this is more of a satiation effect. You know, I don’t think that anyone really knows. The exact mechanism. It’s very early. In all likelihood, look, I’m sure it’s multifactorial. Things are very complex, of course, but I’m sure that it’s somehow acting centrally. I think it’s acting centrally. I think it’s acting on the dopaminergic system. And I believe that what probably we’re going to find out is that it blunts the cues that, again, I think that they’re not feeling the food noise.

[ 01:42:51 ] I think the environment, the exposure is not lighting up their brain as much. I think. I think it’s blunting that response to the environment. And I think that’s really the food noise is the compulsions and cravings. I think it’s blunting that. Is it a satiety? Is it a matter of satiety? And is that a mechanism too? Perhaps. I don’t think we know. But when you have people, when you see people that very definitively tell you, like, whoa, this changed my whole way I feel about food noise and food and my, like. Something’s happening in the brain, clearly. Yeah. And I think that’s what we’re going to find out. You know, and in this book, I learned a lot. I, again, being a physician, you know, I did psychiatry for two years.

[ 01:43:39 ] I think I told you that. Did I tell you that? I had no idea. I did. I trained at the University of Louisville for two years, and then I switched to family medicine. I did not know that about you. And I learned, as someone who trained in psychiatry for two years, a lot. And there are components to this. For example, Vivitrol, I had no idea. And also this idea of how we got to where we are, because it’s concerning, right? And so we have this. It’s frightening. Right. It’s frightening. We have this older population. And I think that if we don’t become very conscious, then, you know, I worry about my kids. I don’t know how you couldn’t, you know? I mean, how could anyone couldn’t, you know?

[ 01:44:25 ] And, you know, there’s a lot of really important information in this book. What was your reason? If you could say, I have fulfilled my purpose with this book, what is it? The, and I lived through it personally, the amount of suffering that happens in someone’s life for addiction is brutal, because it’s not just a, it’s not just you. It’s a family disease. The person that’s addicted chases the drug, the family chases the person, and it ripples across families. And so many people and families are affected by this, that having lived through what that’s like to feel like you can’t control someone who’s going out and doing something that’s going to kill them every day. It is, it is, it is a type of hell.

[ 01:45:13 ] And if you can alleviate that or help someone get out of that situation, I think there’s, there’s, there’s no, there’s no price you could pay to take someone and relieve them of what that’s like to live through that with a family member. They would probably do anything to make that stop. And so I, having helped people and, and, and been working on this, and the other thing is, and we could talk about this certainly another time, but what we’re doing at the hospital now with the high-intensity ultrasound, with the MRI-guided ultrasound to try to ablate these tracks in the brain, because ultimately that’s where we’re going. I believe that, you know, if we can help people get them out of the suffering and misery that comes with this, you know, I mean, it’s, it’s, it’s not easy work, but for me, that’s my, that’s my purpose.

[ 01:45:58 ] That’s my mission. And you feel very passionate about it. It’s not easy work that you do. You’re out there charging ahead and, you know, there’s a lot of controversy and you’re out there, you’re willing to stand up. And I think the only way that that happens is from deep pain or experience to be able to go and fight every day, like the way that you do. Do you think that you’ll ever take a pause on this? Um, sometimes I do, you know, um, and, and, you know, part of the reason is also that the reality of addiction is that a doctor can do everything that they can possibly do. Um, but that doesn’t guarantee, um, that that person’s not going to go out one day and just decide to use a drug or not take their medicine.

[ 01:46:46 ] And the reality is that that happens a lot in this field. So it can be very, very disheartening when you, when a patient goes out and relapses and the, the, what transpires, Matt, if they die, what happens to the family, just all of that. And that can happen at any time for any of your patients when you’re dealing with addiction. And it is brutal. So I think there’ll probably come a time for some more self-care because that is important when you’re in a field like this. Do you think that we are going to get better at treating addiction? You know, you’re talking about the MRI guided. We have to. I mean, there’s just no way when you have a prevalence of a condition like this, that society can sort of not catch up in any way.

[ 01:47:30 ] It’s just impacting too many people. And now, with fentanyl, I think you’re going to see people that otherwise would maybe not have spoken up about it because, oh, it’s a them. It’s an addiction issue. But now when their kids and they’re frightened and they’re worried their kid’s going to go to a party because they have a 13-year-old or 15-year-old and that they can die from trying something, I think you’re going to see that also push this forward. Do you think we’re going? Do you think we’re going to get better at mitigating exposure now with fentanyl? There have, I mean, there has to be, there has to be a change in how our government handles that border because it doesn’t matter what treatments we come up with.

[ 01:48:10 ] It won’t turn the tide if the fentanyl keeps flooding into the country. They have to do, they have to figure out a way to stop it. They’re poisoning the country. You know, I was looking at some of the data and just reading how it’s getting in. And I think that they have something like 200,000 people coming in. I don’t know if you’ve looked at the data, but I don’t want to misquote. It was early; my kids were probably screaming, kept me up, you know, three hours of sleep. Yeah. But I remember thinking that the volume of people coming in, and it would be nearly impossible to be able to protect the country from that. Well, listen, it wasn’t always a problem. You know, they can listen.

[ 01:48:51 ] If they have the right motivation, they can stop it. They can. They can turn the tide on how much fentanyl is coming in. They have to be motivated enough, the government, to do what they have to do. Sometimes you hear politicians. I’ve heard President Trump talk about this, where he, you know, declaring that basically that we’re at war with that border, right, where we have military there and they stop these things from happening. It’s going to take that level of commitment because it is war. Those drugs are important. They’re poisoning the country. They’re destroying families, countless families. If they don’t stop it, you know, how is that not an act of war? They have to stop it because I don’t see how we turn the tide.

[ 01:49:36 ] What advice would you give a family member or someone who has a teenager or even someone who is experimenting on the weekends, not even thinking, you know, even adults go out and they party? Well, it’s very hard because, you know, I think, look, you have the knowledge. You have the knowledge. You’ve heard this information. You know, it could be in anything. And it is much more risky than maybe what it was. Not maybe. It’s much riskier than it ever was before. And you’re taking a very big chance here. I think you need to educate your children and tell them that one time can kill them. And one last thing I want to mention here is that this is a very critical thing, which is the fact that most people with addiction, because how does a family member know how to help someone with addiction?

[ 01:50:23 ] It’s such a complex issue. But what winds up happening to most people is the family enables them. And it’s out of love, right? They cover for them. They give them money, all those things. But what that does, the fastest way to have somebody die from addiction is to enable them. And so, you know, most people with addiction, most people who overdose and die do it in their warm bed, in their family’s house, because it’s too easy to keep doing it when you don’t face the repercussions. So it’s not that you pull love away. You have to be supportive and loving, but you don’t do anything that could promote their use of drugs. So you don’t just give them money because they say they want to go to the store and get food.

[ 01:51:05 ] You can buy them the food. You can help drive them places, but you don’t do anything that could hurt them. Dr. Russell Swarovski, you are an amazing human and you are really champion, championing, moving protection forward for people. So thank you. We will link Save Your Life. This book will save your life. I know that we will continue to hear from you. And if there are any last words that you want to say, again, we will link everywhere to find you. Just there is always hope. It doesn’t matter if someone’s been to 10 rehabs or eight rehabs or they’ve relapsed 15 times. It doesn’t matter. I’ve seen people in all those situations get better, get into recovery and stay sober. So don’t give up on anybody. Thank you, my friend.