Ask Dr. Drew - Beth Macy (Author of Dopesick) Exposes Billionaire Family Behind Opioid Crisis – Ask Dr. Drew – Episode 54

Episode Date: November 10, 2021

Beth Macy is a journalist and the author of the 2018 New York Times-bestselling book, DOPESICK: Dealers, Doctors, and the Drug Company That Addicted America.  A dramatized adaptation of the book debuted on Hulu as an eight-episode limited series on October 13, 2021. For DOPESICK, Macy drew upon thirty years of reporting from southwest Virginia communities. Her work has long sought to bring attention to outsiders and underdogs — the largely voiceless people left behind by growing inequality, technology, and globalization. Website: https://intrepidPaperGirl.com  Follow at: https://Twitter.com/PaperGirlMacy  Watch the series on Hulu: https://www.hulu.com/series/dopesick  Ask Dr. Drew is produced by Kaleb Nation ( https://kalebnation.com) and Susan Pinsky (https://twitter.com/FirstLadyOfLove). SPONSORS • BLUE MICS – After more than 30 years in broadcasting, Dr. Drew’s iconic voice has reached pristine clarity through Blue Microphones. But you don’t need a fancy studio to sound great with Blue’s lineup: ranging from high-quality USB mics like the Yeti, to studio-grade XLR mics like Dr. Drew’s Blueberry. Find your best sound at https://drdrew.com/blue  • HYDRALYTE – “In my opinion, the best oral rehydration product on the market.” Dr. Drew recommends Hydralyte’s easy-to-use packets of fast-absorbing electrolytes. Learn more about Hydralyte and use DRDREW25 at checkout for a special discount at https://drdrew.com/hydralyte  • ELGATO – Every week, Dr. Drew broadcasts live shows from his home studio under soft, clean lighting from Elgato’s Key Lights. From the control room, the producers manage Dr. Drew’s streams with a Stream Deck XL, and ingest HD video with a Camlink 4K. Add a professional touch to your streams or Zoom calls with Elgato. See how Elgato’s lights transformed Dr. Drew’s set: https://drdrew.com/sponsors/elgato/  THE SHOW: For over 30 years, Dr. Drew Pinsky has taken calls from all corners of the globe, answering thousands of questions from teens and young adults. To millions, he is a beacon of truth, integrity, fairness, and common sense. Now, after decades of hosting Loveline and multiple hit TV shows – including Celebrity Rehab, Teen Mom OG, Lifechangers, and more – Dr. Drew is opening his phone lines to the world by streaming LIVE from his home studio in California. On Ask Dr. Drew, no question is too extreme or embarrassing because the Dr. has heard it all. Don’t hold in your deepest, darkest questions any longer. Ask Dr. Drew and get real answers today. This show is not a substitute for medical advice, diagnosis, or treatment. All information exchanged during participation in this program, including interactions with DrDrew.com and any affiliated websites, are intended for educational and/or entertainment purposes only. Learn more about your ad choices. Visit megaphone.fm/adchoices

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BetMGM operates pursuant to an operating agreement with iGaming Ontario. Thank you, everybody, for joining us. I have a special guest today. I have limited time with her, so I'm going to get to her in just a moment. Let me introduce her. She is the author of the 2018 New York Times bestselling book, Dope Sick, Dealers, Doctors, and the Drug Companies that Addicted America. Beth Macy is a journalist and author. The book now has been presented in a dramatized adaptation on Hulu, an eight-episode series. It came out in October, just came out. Mary drew upon 30 years of reporting from

southwestern Virginia communities, and her work has long sought to bring attention to so many people that have suffered from this illness. Welcome, Beth Macy, to the program. Our laws as it pertained to substances are draconian and bizarre. A psychopath started this. He was an alcoholic because of social media and pornography, PTSD, love addiction, fentanyl and heroin. Ridiculous. I'm a doctor. Where the hell do you think I learned that? I'm just saying you go to treatment before you kill people. I am a clinician. I observe things about these chemicals. Let's just deal with what's real. We used to get these calls on Loveline all the time, educate adolescents and to prevent and to treat. If you have trouble, you can't stop

and you want to help stop it, I can help. I got a lot to say. I got a lot more to say. I want to give a shout out to our good friends at Blue Mics. If you've heard my voice on this show anytime

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Be sure to use the code drDREW25 for a special discount. Beth, thank you for joining me. Thanks for having me, Drew. So I don't want to start this conversation because I have limited time with you. So I don't want to start with what made you write the book. But let me first turn over all my cards. I ran a large addiction recovery program for 25 years. And it was a full, I mean, we could handle anything. We had a

reputation for no matter how sick somebody was, provided they didn't need a ventilator, we could handle them. The psychiatric component, the medical component, the addiction component. So I saw the sickest of the sick. And towards the last maybe five years of my career running that program, I was almost exclusively taking patients off opiates who allegedly had pain. They would always come in saying their pain is a 20 out of 10, 15 out of 10. And with merely taking them off opiates, it would go down to a four or five out of 10. And they would literally dance out of the hospital. We would have them into the process of recovery and abstinence. And because they're addicts, they would go back to their doctors and the doctors would look at them and go,

why aren't you listening to me? I'm the doctor. You need to take these pain medicines the rest of your life. Why do you listen to those people who are trying to brainwash you? And my patients were dying hand over fist. I mean, they were killing them. My peers were killing my patient at such an accelerated rate, I could not stand it. And so I began fighting this years before your book, years before anybody else found out about it. And because of the way the discipline of opioid prescribing took over American medicine, I was looked after by the Department of Mental Health and the State Board

of Medical Quality Assurance and my hospital administration for being draconian and behind the times and such an outlying dinosaur and was interested in patient suffering. And I knew I was right. I knew I was right. And I knew the medical community was killing my patients. That's where I come from. So that's what I went through for years and years and years and years. So what you observed was not a surprise to me, not a surprise to me. Was it a surprise to you? Well, I first started reporting on what we then called the heroin epidemic. We now call it the overdose epidemic because it's more than just heroin. But this was about 2012. And I was a newspaper reporter in Roanoke, Virginia. And I wrote a lot about marginalized communities and inner city issues. But the story on everybody's mind the summer of 2012 was the fact that there was this nascent heroin cell. And it was among private school kids in the wealthiest suburbs of our community.

And so I did this three-part series about these two families who had been, their lives have been upended by the heroin crisis. And one young gentleman died of overdose and the other was about to go to prison for his role in having sold the heroin to his former private school classmates. And when I wrote this series, this is 2012, this is before the deaths of despair data, this is before dreamland or before we really even knew that the oxycontin and heroin epidemics were tied together, readers were really shocked. And so fast forward to 2015, I decided to write a proposal for my third book,

telling the story of how we got here. And because I'm a Virginia reporter, I wanted Virginia to stand in as a microcosm for three different kinds of communities in America. One is a distressed rural community where OxyContin really first emerged, where Purdue targeted their reps to former coal mining and logging area of far Southwest Virginia, Appalachia, basically. And then, you know, of course, when the pills got hard to get, that's when I pick up the story in Roanoke when I first knew of it when people made the switch from pills to heroin and then more recently to fentanyl and I literally drove up and down I-81 the interstate which people

called the heroin highway because that was the route that many of the drugs came in and I was surprised I was surprised that it had only gotten worse. And when I went back and I interviewed the first person who had sent the young man to federal prison, he said, what made him what what made the hair stand up on the back of his neck, what made him not sleep at night, and this is back in this is actually 2010. When he arrested the young man, Spencer, was that they were using and dealing with 50 different kids from this wealthy suburb. And so it was just the tippy

tip of the iceberg. And because we know it's such a hard thing to recover from, I knew it was not going to go away overnight. Yeah, 2010 is where I got out because I couldn't, I couldn't take it anymore. And I could see what was happening, which was the, now we had a situation where there was a growing, slow, uh, burgeoning understanding that they'd created drug addicts. The patients would come in for their refills. The doctor would say, you're a bad patient, get out of here. And you tell an opiate addict that they're a bad patient. You and you, as opposed to bringing them in and going, look, we didn't, you, neither, you nor I intended to create the second problem. We have a second problem. You're addicted to these drugs. Let's get you some treatment. What they did was said,

get out of here. You're a bad patient. And of course the patients went to the street. That's where the heroin came from. Patient abandonment. It's still the number one barrier, I think is just we abandoned them on the now it's now going it's now yeah it's going the other way now with chronic pain patients who need some opioids who should be getting them can't get them so we have now the opposite problem but but at least it's not killing well not at the rate it was killing people at the time because it was unbelievable uh how much how much i i was just shocking to me but how did your uh understanding of what was going to reconcile with

what sam quinone just wrote in greenland greenland rather yeah so his book mostly takes place on the west coast and uh with the mexican cartels um we weren't seeing black tar heroin and still aren't seeing black tar heroin here still aren't seeing black tar heroin here in Roanoke, where I live, or in any of the communities that I report from. His big thing, his big report was, his big argument in the book is how the medical community caused the opiate epidemic. How the discipline of pain management how pain is the fifth vital sign how insurance companies and quality and board of medical quality insurances and jaco all demanded that we don't paint the patient's pulse we ask them what their pain scale

is which was a level of insanity that was just mind-boggling and that if a patient left the hospital with less than 90 pills you were considered abusing the patient and could not just malpractice you could go to jail for being abusive to the patient for inadequate treatment of pain this was this is where it came about the porter and jick study that so many of the less than one percent data comes from wasn't a study show really well wasn't a study at all it was a five sentence letter to the editor of the new england journal so the show really breaks that down in a dramatic way how that happened how so many people were quoting that study without ever

reading the original study which was it wasn't a study right it was a letter wasn't a study. Right. It was a letter. It was a letter. And there, there was a study with some observations on inpatients, post-surgical patients receiving opiates, not becoming dependent in a short period of time. Yeah. No kidding. Yeah. In a hospital center. It was, it was so awful. Literally I had peers telling me that addiction didn't exist and that and that if you had a pain patient you couldn't get addicted because the pain soaked up the the addictive potential of the drug soaked up the high it was so off base you were pseudo addicted you remember that great phrase by the uh purdue, Dr. David Haddock, who said, you weren't showing signs of addiction.

You were simply pseudo-addicted, and the cure was more ex-accountant. That's right. But he wasn't a minority. He came out of a discipline that he would not have been in a minority opinion. It's not like he was some crazy outlier just responding to the, obviously he was responding to the motivations of the company, but there was an army of physicians

that not just agreed with him, were literally taking board certifying exams that demanded that as answers for their board exams. Now, one of the things I write about in your book, which comes out next year is just the way we haven't treated we haven't taught doctors how to deal with addiction or how to deal with pain i mean we're still producing doctors that don't know how to recognize and treat a medical condition that kills 96 000 people in the last year. I completely agree with you 100%.

So you have Raising Lazarus. Can you tell me about that? Yeah, so it's about solutions. Dope Sick was about the problem. Raising Lazarus is about the solutions. And when I finished Dope Sick, the young woman I had been following at the end ends up murdered after being

abandoned by many systems. And I thought, I can't, I don't have the mental fortitude to write about this ever again. And then as I went out traveling to talk about the book, I started, you know, doing more reporting. People started telling me cool things that were happening and then I just decided I wasn't going to let it go. So I went back and I'm telling the story of the Purdue bankruptcy case as kind of the through line through the perspective of some of the activists that are trying to get the victims' voices heard in this very opaque bankruptcy court. But I'm also going back and forth through several communities that are

doing harm reduction. They're meeting people where they are. They're helping homeless folks who suffer from SUD and are doing things like treating people in jail instead of, you know, making them get off their drugs, releasing them when they're opioid naive. And we know they're then 29 times more likely to die of overdose. So I'm trying to write about the innovators and the helpers. And it was a great bomb to, it's not a happy story because we still have 88% treatment gap. So lots of work to do. But I'm hoping that the book could be kind of a guidebook for this opioid litigation

money coming out. Yeah, I have grave concerns about what's now happening in the addiction treatment field because there are people that call themselves experts that really don't understand this disease and have almost no psychiatric training sometimes. So it's gravely concerning and it is not a one-size-fits-all treatment paradigm by any mean. And I know John Kelly at Harvard and Keith Humphries at Stanford who run the programs there are very concerned about these things. And the unfortunate reality is that so many of the addicts are so far gone out on the streets that

all you can do is half measures that you can't really go into comprehensive treatment because people are psychotic and you know the importance of meeting them where they are is so key and which is like the main concept of harm reduction my book opens next to a dumpster in a McDonald's parking lot with a nurse practitioner doing treatment to a person who isn't in any kind of medical system. He's in North Carolina where they haven't passed the Medicaid expansion. He's between jobs. He doesn't have insurance. And this harm reduction group has figured out a way to offer folks entrees into care, giving them sterile syringes and then setting them up with buprenorphine until they're ready to do something more intensive.

So do we have long-term data on any of those patients? Because my gravest criticism of all addiction research is it never goes out more than six months. And you can do almost anything with six months. I mean, you can get all kinds of great data in six months, but at three years and six years, it's a whole different matter. Do they have any longer-term data? And John Kelly has just re-upped his study. He said it took eight years and five to six treatment attempts to get somebody with SUD just one year of sobriety. And now he has. That's just that's just that's just that's just severe alcoholics. That that data that you're reporting is from John Kelly's reporting on not drug addicts, severe alcoholics.

It may be worse for drug addicts. Well, that's what he said. He just updated it and he said not sud a ud and not sud not as you do a a ud alcohol use disorder not as you did not it's uh it's just strictly alcohol which suggests that it might be longer for other more addictive drugs or more more agnostically well yeah his latest data that he just shared with me in the last month said that it took two to three years longer for people with OUD, opioid use disorder, because they're so far out of the system.

And we know that 40% of folks don't want treatment. And that's the people we've got to go after. We've got to give them those carrots of the clean needles and other social supports if we want them to survive. I've never met a drug addict that wanted treatment. The only time that they appear somewhat motivated is when the consequences are so severe that the pain of continuing is worth considering treatment. But the part of the- I met numerous people who wanted treatment and couldn't get it and fell apart whenever they lost their access to it.

So we must be talking to different folks. So hold on. So wait a minute. So when they lose access to the drugs, then they want treatment. Is that that group? No, I'm talking about, well, if you read Dope Sick, there's a young woman I followed for a couple of years and whenever she lost her Medicaid coverage or whenever she didn't have access to her buprenorphine, she ended up homeless and doing

sex work. She desperately wanted to. Of course they it. She couldn't get it because she wasn't in a money-free expansion state. That's ongoing care. People that understand that treatment is worthwhile and get ongoing care want to continue their care. But naive patients, people who have never been treated for addiction before, it's very hard to get them to want to take treatment. Even when they tell you they want to take it, they don't stay with it. They don't want it. They don't admit they have a problem still, but they're still in that position of not admitting it. What do you think is the answer, Dr. Gere?

But not admitting it, I almost never ran into people that didn't admit it. They all go, I'm just not ready. I just want to keep doing it. I'd like to try. Probably I should. They're very contemplative about it, but they're actually doing it. No, no, no. Tomorrow, tomorrow, tomorrow, stop tomorrow, stop tomorrow. Stop. That's the way they always, I think about it. And that's the.

Honestly, that's not been my experience reporting for the new book. Um, and I have spent a lot of time at needle exchanges and with harm reduction groups. And these are folks that are coming for services. And they're not already but but many of them are. And, you know, like I say, in these states that haven't yet passed the Medicaid expansion, it's really, really tough when they don't have insurance. Yeah, the fact that we have an IMD exclusion is bizarre. It's

just terrible. You know, the many states, you can't get any resources for serious mental illness of any type. But I think it's all hands on deck. I think every available resource, every available modality, nothing should be off the table, as far as I'm concerned. But I don't think, I do think we have to be a little nuanced in what we do for each patient. That, I mean, it takes a long time to figure out what a given patient's actual situation is until they've been abstinent or in treatment for quite a period of time. And what their levels of capacity for treatment and what their ability to sort of engage in treatment or willingness to engage it's it's all over the place in terms of getting somebody well you can get somebody stabilized really easily it's it's not that hard to get somebody sort of uh sort of calmed down and maybe in a place to live, but getting somebody fully treated and stabilized and their best possible flourishing situation takes a long, long, long, long time. And as, as you know,

Dr. Kelly is pointing out multiple treatment episodes, you know, it's something you've got to keep at. To me, the biggest problem I have is housing. And, uh, it's so key. And I know you've, you've done a lot of work around homelessness. I've been following Charleston, West Virginia, which is right in the middle of an HIV outbreak right now. The state has just basically outlawed syringe exchange at the time when it's the most concerning HIV outbreak in the nation. And the politics in rural America have really made it tough for folks trying to help these people. See, I have no objection to anything as long as properly trained people are engaged with

the patients, trying to get them motivated over to full spectrum care. You can give them heroin as far as I'm concerned. I have no problem with that. As long as you're monitoring it and make sure they don't overdose, give them heroin. I don't care. There's no judgment in anything. It's everything. It's all about fighting this incredible biology and this distortion.

The real problem, from my perspective, is at least in California, the laws prevent you from helping the patients. If the patients have the slightest bit of resistance, you're not allowed to do anything. Just leave them alone. They're living their best life. Who are you to say? And that's why people are dying. They're dying five a day here in Los Angeles because you're not allowed to go in and treat and hold. And if we treated dementia patients like this, you would, again, be guilty of patient abuse. But because this condition has something called anosognosia associated with it, you must defer to the anosognosia, which is a neurological biological process some part of it is called denial but it's more it's more biological than that where they literally can't see what's happening they can't understand or they can't fight the motivational disturbance and that is privileged in the law right now

and makes it impossible to save lives makes it impossible those states uh i think you have that uh temporary detention order type um it in here it's almost impossible it's almost impossible here almost impossible for substance use essentially zero you have to you have to say i have no way to get food i don't know where i'm going to live and i'm going to kill myself and here's my plan then Then you can hold somebody for 24 to 48 hours, which accomplishes nothing. Which accomplishes nothing. So other than that, you're, and there's no such thing in this state as greatly disabled. So you could be lying on the sidewalk. Hopefully the show will shine a light on the stigma that pervades not just families, but also the laws and our institutions, you know, that prevents, you know, still prevents 88% of the population from getting help.

So, I mean, that's really my hope is that people realize how we got here as a nation with declining life expectancies for the first time since World War I. It's just getting worse every year. We've got to really do something about this. The other thing is that most addicts that are opiate addicts particularly have severe childhood trauma underlying. That's sort of what the motivation was to try to medicate their affect states in the beginning. And that never gets treated. No one ever gets to the childhood trauma, the sexual, physical abuse, neglect, all the stuff and abandonment and all the things that opiate addicts typically have. I, you know, I, again, I only dealt with the

sickest of the sick. And if somebody got to me, there was a 100% probability of childhood trauma. And we would get to it. Of course, we had, go ahead. I had a piece in the United Press May about a treatment innovator in rural Indiana who had figured out a way to, you know, basically get people coming out of jail with OUD into a really rigorous social supports, MAT, lots of counseling and lots of dealing with childhood trauma and she's just discovered that I'm not but now they're starting a program for foster kids because so many it's just exactly what you're saying

that we're now at the third generation of this. And until we get our arms around the problem of not enough foster parents, not enough counseling for these poor kids growing up in these households, you're just going to see it snowball. Yeah, a large percentage. And being a foster child is traumatic. It's abandonment. That's abandonment at the core. And then whatever else goes wrong during the foster system, of course, can be traumatic as well. And then going to multiple foster homes, traumatic. These are all severe childhood traumas. Let's be very clear about that. And the problem with getting the folks out of prison, I love programs like that, is there is an art form to determining

when to treat a drug addict, particularly opiate addicts, for trauma. Oftentimes, when you treat it, the relapse risk goes up. So you have to be sure they're stable enough to handle it and sufficiently off all meds, everything, that they can actually do the trauma work, which is a wiring function of the brain, which requires people to be off almost everything. So there's a really tricky piece to this, and that requires a long time and a lot of structure. And then where do we get the resources for that? It's so hard. Yeah.

Right? Do you guys have any with that woman? Does she have any luck with this? Are the outcomes good? Are they sure? Oh, yeah. Her outcomes were really good in the first year of studying. It was a small group because it was a rural area, but they had zero overdose tests.

Now they've had one since COVID because of the stresses and not being able to meet. But they have drastically reduced their ODs, but they are throwing all kinds of services at these folks. And many of these people, I mean, California is one thing, but rural Indiana, I met a, I profiled a young man named Kenny who had been in and out of jail, his whole starting at age 15. And he had never been offered treatment until he was forced in probation through this program to do it.

And he's now a restaurant manager. He's doing great. He wants to go back and become a substance use counselor. So it's very high touch though. And as you say, high cost, but they figured out how to do it with using basically grants and Medicaid dollars and it works. Right. Treatment works. Treatment works. That's the fundamental message here. It does work. I assume you're talking about assisted outpatient, AOT, assisted outpatient treatment that you got?

IOP, that is what they call it, intensive outpatient treatment. They do it right there in the courthouse. But it's mandated. It's mandated. In this particular situation, it is. It's part of their... It's like a drug court, but it's not as expensive and cumbersome as a drug court. And also if they fail the drug test, they don't automatically go to jail

if they are still trying really hard and they're convincing their counselor that they're taking it seriously. But it wouldn't be an expensive program to replicate, which is why I wanted to write about it. Her name is Nikki King. The article was in the Atlantic May of 2020. So this is essentially what's called

assisted outpatient treatment, which is available for serious mental illness as well. Some states do a lot with this and it works like crazy. So this is the point that I'm certain, although the young man says he was never offered treatment, people are offered treatment. They don't take it. But when he is required to go, he will get better. He gets better in the assisted outpatient program. And we need to do more of that. But there seems to be no, there's almost an ideology against it. They'd rather see people die than be urged into treatment. Have you, at least out here in the West, that's the way it is. Is it, are you seeing that? Yeah, I mean, we still have most of our drug courts don't allow medication-assisted treatment.

So then they're in that bad spot of being opioid naive. And when they use, that's when they're more prone to die. We have a lot of stigma still getting in the way of getting the treatment that science says reduces overdose death by 60% to 80%. So we have a really strong message about medication-assisted treatment in episode 7 and 8 of our Hulu show. You see people being stigmatized for being, quote, not clean in meetings. And you see them start to get better

when they're getting intensive counseling paired with the social supports and the MAT. And we're not just putting a smiley face on it. People can get better, but we're just not offering it at the scale to match the scale of the epidemic yet. I mean, not even close. I would argue that the ambivalence about medication-assisted treatment is not a stigma so much as a concern. Because we all, when you work in the field, you see people that abuse Suboxone, you see people that die and traffic Suboxone, that use other substances while they're on Suboxone. So there's just concern that either the person isn't serious. I still think it should be used, even a non-serious person.

Don't get me wrong. But in the community where abstinence is valued and returning to a flourishing life is the goal, there is concern about people that are taking half measures. What I try to get them to understand is, like you say, you meet people where you are and you get them further along. You get them further in. Yeah. You hate to let the perfect be the enemy of the good. In an era of fentanyl, it's so dangerous. I mean, I have a good friend who's a judge

and he says, Beth, I'm not going to let my patients or my probationers be on Suboxone because they'll sell it in order to buy meth. They do. A lot of that happens. Some do, but many people don't, and too much policy gets made around the people that aren't using it correctly instead of the people for whom it's saving their lives.

Yeah, Diane is saying Suboxone is harder to come off than a full agonist, meaning heroin. Yeah, Suboxone is hard to get off. But if you can get down around five milligrams, and a lot of people can get down to two, and you're in pretty good shape at that point. In fact, at two milligrams, even four milligrams, you can really kind of start to participate in treatment. The problem is, back to my peers, they don't understand how to treat addiction and so they leave them on 32 milligrams

and they're high when they're at 32 milligrams and that might be better than dying on fentanyl, I understand, but look, there are other outcomes, there are other endpoints other than death that we're trying to achieve, that we're trying to avoid. In other words, we're trying to achieve returning to work, returning to independence, returning to autonomy,

return to a flourishing life. And people cannot do that when they're on high doses of opioids, they just don't. But they can go from high doses to low doses. They can certainly do that if they're in the right hands and the right structure and the right circumstances. Yeah, and I wish more doctors were willing to become educated about it. You know, so many people, they don't want those people in their waiting room.

Well, guess what? They're in your waiting room already. Oh, they already are. But they also... When I give a talk to doctors, I will say, you know, I know maybe all didn't over prescribe, but many of your peers did. And and I know you were lied to by the reps, but you did help us indirectly or not get it, get us into this mess. You need to help us get out.

And so starting to see like emergency departments, you know, doing buprenorphine and doing the funneling with the peer support and into the outpatient. Yep. And then AOT, if we can get the courts to mandate treatment, it saves lives. Absolutely. AOT is a big assisted outpatient treatment is the euphemism for this. And they need to have large scale AOT. There's no doubt about that for both

substance use disorder and serious mental illness of other types. What was something I was thinking about here with the, oh, lost my train of thought. Susan, are you, is this all familiar territory to you? Yes, indeed. Yeah. Oh, Anthony Brown says, this is why I'm going to become a nurse practitioner. Yeah. So this is what I was going to say. And Anthony Brown is a nurse who's recovering. He's a recovering friend and he gets this disease very, very well because he himself had it. which is that the physicians and primary care providers that don't have lots of experience with addiction or are not recovering themselves don't understand how to create the structure for using Suboxone even.

In other words, many of these folks only test for opioids and count pills, as opposed to screening for multiple other substances, which people often use alongside of the Suboxone and how they get into serious trouble. But they don't do that. It's hard work to confront drug addicts. It's really hard. And you actually can't do it one-on-one. You have to have a team because it's too powerful.

I tell people, Beth, that you ever see the little shop of horror, the musical, the movie, the plant and little shop of horror, the Audrey two is a perfect model for a drug addiction. If you go in the room alone, you go in the plant. That's it. The plant takes you in. You can, I can't do it. I know a lot about, I always brought a nurse in with me because some, somehow I would get engaged with the disease in ways that I couldn't see, but a nurse would kick my chair when it would happen to pull me out of the plan. They'll have people in recovery on their teams and we'll be like, Hey doc, the guy's playing you, you know, they, they can tell. And that person at the front desk is so important because so many people going to the hospital for abscess

treatment or whatever have been so stigmatized that it's really important that uh you know just the people at the front desk the ambulance drivers the emts that they all get stigma training in my opinion because um but but the community the oh yeah the recovering community that i i don't you because the people are just dying alone. Obviously. Oh yeah, the recovering community that I don't, you cannot run a program without a lot of recovering people in the room because as a normie, you don't think the way a drug addict thinks. Your brain doesn't do that. And their brains do it automatically.

They see it. I would go in the room and come out and talk to some of my recovering counselors and go, oh my God, she was so into it she this she was uh talking about her mom and the trauma and she was connecting and making a commitment to ongoing care and my my uh my uh uh counsel looks at me and goes yeah yeah she wants drugs i go no no she's she's engaged yeah she sees that you have a prescription pad she wants you to register some drugs she'll be out she'll tell you you watch you watch she'll be here she'll be out. She'll tell you. You watch.

You watch. She'll be here. She'll be at the window in a second. She wants drugs. That's all bullshit. And you can't tell if you're not a drug addict. And these are people in treatment, motivated. The disease always has lying, manipulating, and distorting, and obfuscating are symptoms of the illness.

And those symptoms don't go away for a long, long time, like the order of years. So to blame addicts and alcoholics for being manipulative, obfuscating, or lying is to blame them for having their condition. It's almost comical. Those are symptoms of the disease. And your job is to see through all that and try to figure out what's really going on and not even not listen to some of the nonsense that they always engage in so that's kind of back to your point about what i really admire um like the fellow that was just on who's going to become a nurse practitioner

i mean it's really the people the people doing this work are are. They're angels on the earth. And I've seen a lot. Don't do too much. I mean, I did it for 25 years with a big group and we love doing it and we love being a team. Anthony, why don't you go over to Clubhouse and you can get on the, I'll pull you up on the podium here. Put your hand up. I'll look for you and you can talk about your experience as a recovering person and what your plan is. What's that, Susan? Say hi. Say hi. I mean, by raising his hand. Let's see if I can get him over here. Is he on Clubhouse? Yeah. Okay. Come on over, buddy. And let's see if he has any input in all this. So Anthony was years and years and years on the streets using and stealing. And he has these great stories about addictive thinking, how he was sitting in prison going, what is wrong with me?

What's wrong? I know. I got to put the drugs in my socks. That's the problem. Or he decided to change corners. I know the problem is I'm on the wrong corner. I'm on the right, dealing my drugs. Anthony, are you going to come or no?

Let's see if I can get him over here. Does it take a long time to get onto the page? All right, Beth, one second. I know you've got to go in just a second here. I'm going to let you go in mere moments. If I can get Anthony out of here, I think it would be an interesting. Susan, you're on there. Are you going to call him?

All right, in the meantime, let me just quickly look at some of the, um, uh, people's yeah. Methadone. I have grave concern about methadone. Do you have any feeling about that? Methadone works really good for people who need that daily check-in, you know, they have to go every day. And, um, Michael Keaton, the Michael Keaton doctor character has a great methadone storyline. And yeah, I think it's good. I think there's a lot of restrictions. We saw during COVID that some of the restrictions were loosened, and I think we should continue

to loosen them. Dr. Justin Marchegiani Yeah, methadone can, again, it depends what you're in, what you're looking for. If it's just survival, you can survive on methadone, but it's kind of a prison methadone. It's almost impossible to get off that drug. I've almost never seen anybody get off it. And if you can get down on a low, low, low dose, okay, but it's extremely difficult to do that. The withdrawal from methadone can last up to six months, and it's

nasty. It is really rough. Suboxone has been such, and now I'll tell you what you can do is you can switch from methadone over to suboxone, and although suboxone is more intense, the withdrawal, than heroin, it is only 10 days, and it's not. And you can do it really slow, taper.

Yeah, but even when you, there's something about Suboxone, when you go, even from a low dose to zero, there's always a pretty nasty six to 10 days. Uh, it just is for whatever reason. But getting down is much, much easier, much easier. Do you have any final question about the show? Anthony's not responding. I can't get Anthony in here. I thought he might have something interesting to say about his work as a nurse practitioner. Give us a brief rundown of what people are going to see on the show so they are motivated to go watch. And then the new book. Yeah. So the show tells the story of the introduction of OxyContin. And it goes from the boardrooms of Purdue to you see sales reps telling these falsehoods about the alleged safety of the drug. And then you see the doctors prescribing it and you see this whole community change in Appalachia. And, you know, we do address

treatment at the end and all the barriers to treatment and the stigma that folks face. And, you know, somebody who read my book came up to me and said, thank you for writing this book. Before I read it, I didn't understand I was part of a bigger story. I thought I was just a really bad person. And I think that's what the show does. It shows you how this happened. And almost like in real time, over 15 years. Great. It is dope sick.

And the new book is Raising Lazarus. Is Raising Lazarus out yet or coming soon? No, it'll come out next August. So I really just turned in the first. Yeah, we will look for that. And thank you for coming on Beth. And thank you for the book.

They just, that, that what you said about somebody understanding they have an illness and it's not them as a person being bad or problematic or shameful. It's really very powerful. And hopefully it does a lot more of that. Also, didn't you say you had,

you wrote this book before the pandemic and then you're taking some heat for what you wrote in the book as well? Did we talk about that? Oh, we were talking earlier just about chronic pain patients feel like the book as well as the show and all this emphasis on overprescribing has hurt them. And I know some data came out not long after I turned the book in showing that some people who are being force-tapered, who are on steady doses of opioids, they've gone to the illicit market and gotten fentanyl and died

or committed suicide. And so people are being hurt by doctors who don't really see the issue with nuance and maybe are over-correcting because of the CDC guidelines. So, I mean, I have a lot of heart for those folks too. And I just wish, you know, we trained our healthcare providers better on both addiction and which can be so entwined. That's right. If you understood addiction, you wouldn't understand more what you're dealing with. You wouldn't, again, just dismiss people because they have pain. But I will tell you, the one thing that I'm fighting about, I'm fighting suboxone is really good for chronic pain. Buprenorphine,

really good helping. I'm seeing so much great outcome with that. There needs to be a much greater pickup by the pain community for the use of buprenorphine. It's sort of exceptional. Anthony made it. Yeah, I heard that as well. Well, Beth's got to go though. The dogs need to come in. All right, Beth's got to go. I'll bring Banthie up in the comments. So thank you, Beth. Appreciate the website. Take care. You bet. Beth's site is

at Paper Girl Macy. At Paper Girl Macy, you can follow her there. Author of Dope Sick. And thank you so much. I'll take a little break. I want to get back with my friend Anthony Brown

up here. Here with my daughter, Paulina, to share an exciting new project. Over the years, we've talked to a ton of young people about what they really want

to know about relationships. It's difficult to know who you are and what you want, especially as a teenager. And not everyone has access to an expert in their house like I did. Of course, it wasn't like I was always that receptive to that advice. Right, no kidding. But now we have written the book on consent.

It is called It Doesn't Have to be Awkward, and it explores relationships romantic relationships and sex It's a great guide for teens parents and educators to go beyond the talk and have honest and meaningful conversations It doesn't have to be awkward will be on sale September 21st You can order your book anywhere books are sold Amazon Barnes & Noble Target and of course your independent local bookstore Links are available on dr. Drewcom. So pre-ordering the book will help people, well raise awareness obviously and it'll get that conversation

going early so more people can notice this and spread the word of positivity about healthy relationships. So if you can, we would love your support by pre-ordering now. Totally. And as we said before, this is a book that both teenagers and their parents should read. Read the book, have the conversation. It doesn't have to be awkward. On sale September 21st.

All right, we're back. Let's get my friend Anthony Brown up here. Anthony has an interesting story himself. And there you are, Nurse Anthony. How are you, my friend? I'm good. How are you, Dr. Drew? Good. Did you hear that conversation just had with Beth? Oh my God, I loved it. Good. So here's one thing I wanted to ask is I always bristle when people talk about addicts feeling stigmatized. Did you feel stigmatized when you were in your illness?

When I was in my illness? No, I didn't feel anything. No, nobody. I've never met an addict that feels stigmatized ever. What were you interested in when you were in your disease? Getting high. Right. And that's the only thing I find of my patients. They are interested in getting high, and I'm either a source of drugs or I am not. And if I'm a source of drugs, I can be manipulated.

What about the idea that drug addicts are motivated for care? I've never seen one motivated for care until the consequences get so too great well we have moments of clarity we want care but it lasts briefly right right right right you know and um that's that's when you know you just have to have like when i finally gave up i wanted care and i just happened to be in the back of a police car and ran out of drugs right and so yeah care was a good idea right right and and if the right person hadn't come along at that moment, you would have gone back into your usual patterns, right? Oh, absolutely. There is no deterring.

I mean, once you get that physical addiction, you have to have it. That's just the way it is. Right. And it doesn't matter. And as you explained, we were talking to Jason Waller last week that you were the kind of person that would steal your friend's wallet and then help him look for it. Yes. Even if it's only us two in the same room. Right.

So good. Addiction is so funny. This is the part you got to appreciate about it. So back to medically assisted treatment and all these half measures and things. We have to do these things because people are so far gone. How do you think about that? I think it's, I'm on both sides of the fence because I got sober back when they just throw you in jail and you detox and that's it. Yeah.

But now since everybody wants to keep their jobs and stuff, yeah, that's fine. You know, Matt works, but you have to have therapy to go with it right that's exactly right and you have to be structured you have to make sure you're not using other drugs or selling it it has to be highly highly monitored you don't just you don't just give persons some opioids and go hey go here take these opioids they're better yeah yeah we'll mail them to your house okay yeah yeah i mean it's it's you, but believe me, there are plenty of physicians out there doing stuff like that. It's too much.

It's too much. Yeah. You have to understand the addiction. You have to understand all the, and you can't deal with it alone. You have to. So when you think about getting involved in the treatment of addiction, what do you imagine you'll be involved with? Definitely.

Once I get to the nurse practitioner part um being able to i would like to go back to the old school of detoxing opiates you know um with the robaxin and yeah all of that stuff instead of you know doing the suboxone round i mean that's great but people are getting addicted to that too right and so the so you here's the here's the really challenging thing you're bringing up here. You have to select the proper treatment. That's Anthony's book, Park Bench to Park Avenue. You have to select the right treatment for the right patient, right? You have to be sure this patient has the ability to stay in a structured system going forward

so they don't overdose and die when they're still opioid naive. And if you heard Beth saying that, she was really giving, there's a world out there that says there's no such thing as abstinence from opiates because it's too dangerous. Well, I'm here to tell you, I treated 5,000 people

that successfully remained off opioids and they did not die of an overdose, even when they relapsed, if they did. You can treat it. You just have to select the right patients and there's gotta be the right resources available off opioids and they did not die of an overdose, even when they relapsed, if they did, you can treat it. You just have to select the right patients and there's got to be the right resources available for ongoing care. And that's hard. And as the other, and if you're going to run an abstinence-based program and Anthony, this is your point about the clonidine, Ravaxin, Motrin, all that stuff. And by the way, um, used to use Geodon. We used to use, uh, oh man, a lot of, uh, injectable

Toradol and stuff. And, and even a lot of Mirapax because a lot of the restless leg, the pain stuff, uh, when you're coming off opiate, that's actually restless leg syndrome and it responds to Mirapax. Um, having said all that, you can make opioid withdrawal pretty tolerable in about three days. I never once in the three decades I was working in the units never said, how are we going to get these opiate addicts off opiates? I can't get anybody off heroin. No, I never had any problem getting people off heroin in three to five days. Never. We had no problem doing it. We knew how to do it. It was uncomfortable, but we got them through it. No big deal. And the problem I had was I couldn't run my unit for the abstinence-based patients if I was bringing an opiate into the nursing station.

You know what I mean, Anthony? Yeah, absolutely. Because that's what, I mean, word gets around. We addicts talk to each other. And if we know that there's some goodies on the unit, then I'm going to have some symptoms. Yeah. And so I couldn't, I could not even allow a benzodiazepine or an opioid of any type into the nursing station because I knew, I knew if they even came on board, the unit

would start vibrating. I'd be actually, I certainly have been able to do treatment. I can't even run the unit. It just starts flying apart as everyone gets agitated and, you know, they start fighting with each other because so-and-so got something and somebody didn't get something. Oh my God. It just goes all over the place. Yeah.

Suboxone too. That's what I'm, suboxone is the opiate I used to not be able to bring on the unit. So what I would say was, look, if you want to get suboxone, you want to get on a replacement therapy, you have to go to a different unit because I can't run an abstinence-based unit with any benzodiazepine, any suboxone on the unit, which is kind of a weird challenge. It's like we need two different units. We need one for medical assisted treatment and one for abstinence-based therapy. And then how do you determine who the right patients are for the right treatment? That's a really serious art form. Yeah, that is difficult because word spreads.

I mean, regardless of what anybody says, we talk, we're human beings. We talk and we develop a sense. We know where the drugs are. We can tell where it is and we can tell when we're about to get it because we will sit back and examine you. And we will figure out what does it take to get dr drew to give me something yep that's why i have to have recovering people around me all the time because they pick up when that's happening and and i don't because i'm in it with you that's the little shop of horrors thing tell if you don't mind share the story of when we were out on the streets in uh downtown los angeles and you showed me where the drugs were coming from and I had no idea yeah you can spot it I mean you look over and there's there's a group of people there you got to look out there and you know you start seeing a stream of people waiting in line it's like okay

we know what's going on there you know and everybody looks all happy and fidgety and it's like okay that's the spot you know then it's like hey there it is right there you know and but you had you had multiple roles picked out for all the people and i i didn't even see the line and the fidgetiness that was that was not exactly obvious to me but but you also picked out people with specific jobs as it as it pertained to how the drugs were being sort of distributed right yeah yeah you can you can see the lookout you can see the enforcer the guy that was like leaning against the fence looking at everybody with his arms crossed you can see the lookout. You can see the enforcer, the guy that was like leaning against the fence, looking at everybody with his arms crossed. You can see the connect. You can even see her pulling out her bosom. I mean, it's all there.

I thought you said it was in the vagina in this one woman. Yeah, believe me, it was coming out of places. So Susan, Anthony comes up to me and goes, you see that guy over there? He's the lookout. You see this guy over here? He's the lookout. You see this guy over here? He's the muscle. And that lady over there in the corner, she's got a bunch of meth in her vagina. She's the purse. She's the...

You may have developed a new nomenclature for the streets. I like that. She's the purse. Yes, she was. Yes, she was. Ladies and gentlemen, she'll be here all night. My wife, Susan Pinsky. But that was surprising to me how ignorant I was. I thought I was usually kind of aware of what people were up to, but that was very covert from my perspective, even as somebody who kind of understands what's going on out there. Yeah, it's, I mean, when you're around it for so long,

it's like, you know, you're at home pretty much. Yeah, yeah, yeah. And this is the part that, again, you have to understand if you're going to deal with this illness because that's what comes at you. And it comes at you for a long time, even when people are genuinely engaged in treatment. How long, because you had a major relapse along the way

after you were actively involved in treatment. During that time, as you sort of ramped up to your relapse, were you still having trouble with the truth? The truth was no problem. I just got bored because living this new lifestyle, it was boring. I was used to excitement and, you know, people picking at themselves and staying up and, you know, all that stuff. And then I get to sobriety and everybody's like going to sleep. And it's like, what, you know, what's this all about? What's this? What's this eight hours of sleep business?

Yeah. What's that all about? Yeah. Yeah. Well, well, when are you done with your training? When are you going to be fully an NP? I have, oh Jesus, 20 more months. That'll go fast.

You'll be shocked. Is some of that clinical? Yeah, I'm going to do a whole year in clinical. And how do you, is it hospital-based or outpatient? How do you do that? It depends because I'm doing NPs. I have to go across the entire life spectrum from birth to death because I'm going to go all over the place

you're going to probably hear me crying Dr. Drew this is tough if you have questions I'm all in I've got pretty good instincts on these things I've been doing it a long time so let me know what you see alright ok thank you I appreciate it alright buddy we'll talk soon

Anthony Brown everybody now I was Okay, thank you. I appreciate it. All right, buddy. We'll talk soon. Okay. All right. Anthony Brown, everybody. Now, I was... Let's see what I want to talk about now. There's a few other things. Oh, yes. Oh, yes, yes, yes. I need to read to you a breaking news. Okay? The breaking news is both a source of relief and anger for me.

Uh-oh. I will... Get the Dr. Drew Strikes Back ready, Caleb. Oh, and Susan wants me. Uh-oh. Get the Dr. Drew strikes back ready, Caleb. Oh, and Susan wants my editex score. Don't worry about it. It's going to take me a second. We'll do it tomorrow. All right.

So Lisa Stroman sent me an article, and I'm going to read you the opening paragraph, and it was a source of great inspiration and anger anger for me so here it is this is uh the a american academy of child and adolescent psychiatry remember i've been saying where is the american academy of psychiatry where is american the the apa the american psychiatric association where are these people what have they been doing as it pertains to what's happening to 15 to 18 year olds in this country with the lockdowns and the lack of schooling and the homelessness? Now, this is not about the homelessness, but I have hope that maybe this will be the next thing to come. But this

pertains, this is from the Child and Adolescent Group in specific. So American Academy of Child and Adolescent Psychiatry and the Children's Hospital Association have declared a national emergency in children's mental health, citing the toll of the pandemic, the lack of being at school. Here's the quote. Young people have endured so much of the pandemic. Attention is often placed on physical health consequences. We cannot overlook the escalating mental health crisis facing young people.

There it is. Thank you. Thank you. Thank you. Where have you been? Where have you been? We've been talking about this for nearly a year and it's too little too well. It's never too little too late.

It's just shocking to me that it's taken until now for these organizations to step up and take a position. Most of the fear of the pandemic, the panic porn around the pandemic, the overreach of the unions closing the schools, the overreach of the lockdown scaring the shit out of people. This is how we have damaged young people.

And then kids falling behind at school. Fourth grade reading proficiency is at an all-time low. Fourth grade reading proficiency is at an all-time low. Fourth grade reading efficiency, efficiency rather, the ability to read at a fourth grade level, you're 10 years old and you can't read at a fourth grade level. That's common now. Well done, everybody. Well done, government.

It's going to be a horrible generation. This is what I was screaming about from the beginning and why I just saw this coming and why I was saying you shouldn't listen to the press because the panic can only hurt things. It can only make things worse. Think about how different if we had said, this is going to be bad, everybody. Get ready. We're going to get through this together. I want everyone to listen to the CDC and Dr. Fauci. Do not listen to CNN. Do not listen to Fox News. We'll get this. It may take some time. We're going to have Project Warp Speed underway. We are incredibly improvisational in our health care system in the United States, and we'll figure out a way to get

enough beds, which we've managed to do. If we had taken that position at the beginning and said, we're going to get this, stay positive, let's go, let's stay open as much as we can, let's take the best possible route, but protect ourselves from one another. My God, would this have been a different experience and kept kids in school like most countries did? Oh my gosh. Oh my goodness. So anyway. Feel better? No, I feel better that these organizations are coming forward. You got to get this information out there. I was thinking about when Douglas broke his leg when he was in high school and he was,

he, he really broke his leg and he was out for a couple of weeks cause he had to take painkillers and stuff. And he fell behind just two weeks behind in his private school. And you know, a lot of the kids are still in private school, but the, but just the anxiety that he went through trying to catch up. Like, remember you had had to come home at night and work on his vocabulary lessons. We would be doing lessons until three in the morning and stuff. It was terrible. Yeah, because he wanted to get into college. I know.

He was going to fall behind. That's just two weeks. Imagine a whole year. What's the plan, everybody? What was the plan when you did this? I remember I was doing a nightly show on a local newscast here in Los Angeles, Fox 11, which is where the Simpsons are played and that kind of stuff. Not Fox News, Fox 11. And a couple of weeks into it, somebody from the school board came in

and said, we're closing the schools. And I said, why? Who made this decision? Who told you to do that? Is there some infectious disease experts that schools have to be closed indefinitely? What, what, what, where did this come from? Well, of course it came from the high school project in Albuquerque in 1991, Dr. Green's daughter. Now, what's interesting to me is he is still saying that that was the right move, even though it was never designed to be a nationwide lockdown. I know in Florida, they weren't doing that. Right. And Florida and California, we've ended up in the same place. It's not like we've gone to two different pandemics. We've had different courses

to the pandemic. We've ended in the same place. And I'll be curious to see if the mental health of children is worse in california than in florida that will be an important measure let's not hide that the other thing somebody yesterday it will be somebody yesterday was saying on the twitter they said you know we we i get very angry when i hear about the labor force being reduced um and they're not being enough available workers because of course we had 700,000 deaths. And I said, we had 580,000 above the age of 65 and something like 450,000 above the age of 75.

So we lost about 200,000 people of working age, maybe, maybe 150,000 really. I don't think that really impacted the workforce measurably. Not to say that it's not a tragedy, but that we have hid the age data, the majority, the highest percentage represented of deaths from COVID is 85 plus. Again, we were talking about this at the beginning of the pandemic, look at the data, look at

realistically and think about how different it would have been if we'd said, let's take this risk population, let's really protect that group, and let's keep everybody else's life going as much as possible. We would have avoided the mental health consequences that I don't know how we get out of or how long we'll be dealing with. I don't even know. It's really... Kate Dunleavy said her fifth grade son had a student from California join his class. His parents were fed up and moved to Texas.

Interesting. The new students is far behind. He missed more than a year. It's so sad. It's so sad. I mean, you would have to move if it, you know, I would have. I don't think, I mean, I don't even know if our kids school stayed in session but um if i had to train my kids that they'd just be illiterate like me well it would be well it would

it wouldn't just be the it'd be hard uh probably what you would have done is hired tutors i would have had to like move them into the house yeah and think how many people can afford to hire tutors nobody can do that it would have been as expensive as private school privilege yeah talk about no but there's no way it would have been they would have gotten the education that they got and they would be where they are today and and i'm trying to think of what college you know what colleges are going to be like you know who's going to get into colleges. It's going to be people from other countries. We're not going to have, our kids are not going to be able to, to survive. Margaret Campbell on the Restream is asking, what about long COVID? Uh, people with long COVID typically stay in work. They don't, they don't drop out of the workforce. They just are miserable.

Um, but I don't, I have lots of people I know with long COVID, none of them have stayed out of the workforce. Um, it, not that it doesn't happen, I'm sure it does, but it's not typically the case. Let's see. Yeah, it's gonna be interesting. I wonder what they're gonna call this generation too. Generation lost. It should be like a lost generation.

Yeah, a lost generation. Generation screwed. Yeah, that's exactly what the... I mean, look- Yeah, I'm laughing out of anxiety. Here's what typically happens when there are significant disparities like this, which is, or significant stressors like this, let's say, is usually what happens is some kids really rise above it and develop, people that are very resilient develop skill sets and actually sort of are better because of the stressor. Most people fall away or suffer as a result.

We'll have a lot more people interested in the tech though, because they got to, you know, be on a computer all day. Well, I was thinking today, I told Adam this, that one of the biggest barriers to mental health treatment, I'm convinced is the waiting room, the psychologist waiting room. Nobody likes sitting in that waiting room, waiting for somebody else to walk out while they walk in. Nobody likes the idea of maybe there are other offices in the area. You have to walk into the psychologist's office. That is the, to me, that's the barrier to entry for psychological services. And with things like BetterHelp, and

there's a bunch of them now, you can get online therapeutic services. I think that will help the access to, so I'm, I would say that's one of the positive benefits of all that has happened here. Miss Kaylee wants us to talk about Dope Sick. As far as what? Stop talking about this. Can we talk about Dope Sick? What does she want to talk about? I don't know. It's just a conversation that it's like, I don't know. Miss Kaylee, what do you want to ask about Dope Sick? Go ahead. do you want to call in are you on club yeah you want a clubhouse let me see if you're over here uh give me a second i don't see you come on over to a clubhouse if you want to talk about that uh just kind of raise your hand i think she just wanted us to stop talking about kids all right well i'm gonna i'm thinking about wrapping up the homeless

are in the bike lanes yeah i know and by the way some homeless are people are getting hit they're just wandering across the street which is another source of disaster uh all right miss kaylee is that it is that your just your statement for us to get off the get off the uh well i don't know miss kaylee here we go i want to know what you thought of COVID? I don't know. Miss Kaylee, here we go. I want to know what you thought of the show. Okay, Miss Kaylee, what you thought of the show. There's a lot of stuff I bristle at. I bristle at people that start talking about stigma.

Families feel stigmatized. Drug addicts never feel stigmatized when they're using. And Anthony pointed that out. Of course he didn't. I've never met a drug addict that felt stigmatized. Also, the idea that drug addicts... Oh, Miss Kaylee's on Clubhouse. Yeah.

The idea that drug addicts want treatment, there you are, is, of course they do in moments of clarity, but they go right back to their using. She's gone. No, I brought Kaylee up. Oh, there she is. Hi, Kaylee.

Hello. Hey there. So what are your thoughts? Well, I just finished watching this series and I just loved the background information. And I work in outpatient substance use disorder. And to see the history and to see the root of this was actually very helpful for me because I realized that people just didn't start dying of fentanyl overnight. Oh, no, it started with my profession. It absolutely started there.

100%. Right. Have you read Dreamland yet? No. Please read the book Dreamland by Sam Quinones. It is the most accurate discussion of that history, par none. And you really get to understand how this happened. It's called Dreamland.

I think I heard a podcast you were talking to him about the book. Okay. Yeah, definitely. It's just, you know, I have a, I have a patient that is in recovery for fentanyl. She's getting methadone every morning. And every time I turn on my zoom and she's in my group, I'm so grateful just that she shows up because I know her chances are so low of even living. And so I think it's so good that this series was created and that people can start to understand what they're seeing all around them, but they don't know what happened. Good.

That's good. That is a great observation and a huge service of this series of people take away the same thing you're taking away. Be very careful with the methadone. Yeah, like why are there encampments? You know, what's happening? Why can't you get your pain pills? You know, all of this.

Encampments are really meth encampments. That's a different story. That's another book you should read by Sam Quinone is called The Least of Us, which really tells you the story of how meth took over. And the encampments are meth gangs. You know, that's clearly what that is now. What was it like for you as a doctor when you were going through that?

It must have been traumatic. Oh, it was terrible. It's one of the reasons I got out of the treatment field. As I said, I saw it was happening. My peers were killing my patients on a regular basis. I spent most of my time taking patients in pain off opiates. They would all come in with a complaint of their pain being 15 or 20 on a scale of 10. Always say 15 or 20.

I'd say out of 10, how many? 15. They'd always say that. Do no other treatment other than take them off opiates. They would stop talking about their pain unless prompted, and they would always go down to a scale around four or five out of 10, just taking them off the opiates. They engaged in treatment. They did well. Unfortunately, they would go back to see their doctors. The doctors would say, why do you let those people try to brainwash you? You're going to need to be on this medicine the rest of your life.

Then I was being scrutinized by the Joint Commission of Hospital Accreditation, the Department of Mental Health, the Board of Medical Quality Assurance, because I was a dinosaur. I was interested in human suffering. Didn't I understand that pain was the fifth vital sign, that I was allowing my patients in heroin withdrawal to be uncomfortable? God forbid. It was an unbelievable time. And I could see exactly what was happening. And I knew how pathetic it was. And I was being assailed by my pain management peers, particularly who were the ones killing my patients. And they were saying that they were saying that you couldn't get addictive to, they literally say out loud, if you had pain, you couldn't get addicted because the pain soaked up the

high of the pain. That was literally their words and And that they would then question where their addiction existed at all. And they would say at most it's something called pseudo addiction, which is just some weird hand-waving idea that they just made all this up. They made it all up. And they, and if you set a patient out of an emergency room with less than 90 pills for Oxycontin or at least Vicodin, you were guilty not just of malpractice, but you were guilty of patient abuse for which you could go to jail. So if you didn't adequately treat pain, you remember pain is the fifth vital sign,

right? That's in the show. I never heard that before. Oh my God. They didn't. Don't tell me the pulse or the patient's breathing. What's their pain scale before you do anything else? That's what all the, that's what all the review agencies were on us about constantly. It was horrific and insane. And I knew it and I was fighting it for a decade and a half. And finally, finally something was done about it. So it was not just the drug company. The drug company was duplicitous in the whole thing. They were certainly not a help, but it was, it was a discipline, literally board, the board testing for these, these subsets of, of, uh, medical specialties would include mandating these, this kind of pain management for people with addiction. And they, and the, do they talk about the Porter and Jick letter and all that stuff in the

series? How one letter to the, it's called the Porter and Jick letter. It was one letter written to the New England Journal of Medicine that was used as a defense for all of this prescribing. It was ridiculous. They talked about the label that the time release was the way the FDA got around it. Yeah, yeah, yeah.

They talk about that. Yeah, well, just all the different kinds of drugs that were available. It just got more and more and more addictive. That's all. I mean, you know, the methods out there is worse. I think a lot of people owe you an apology. What's that? I think a lot of people owe you an apology.

Go on. Believe me, that's true. I don't care. I was fighting for of people owe you an apology. Go on. Believe me, that's true. I don't care. I was fighting for the people's lives. And the fact that it was going unchecked was like, it was unbelievable to me. It was really just, you got to, it was so obvious what was happening. Yeah, this is the overdose deaths data involving opioids. And it was before, and then what they did, Kaylee, is they then brought the patient,

they cut the patients off. Once they started realizing they were in trouble with these overdose deaths, they cut the patients off rather than bringing them into the office and going, look, you didn't intend this. I didn't intend this. We have a new problem. We have caused a second problem. They do touch on that in the show. They show what happened when the girl just stopped the oxy. What do you think? You're a drug addict.

Where are you going? Right. Going to the street. Well, before she was even an addict, she was just using it. She was in pain from a minor accident. She was a minor. And then she didn't understand and the doctor didn't understand. Well, the doctor told her, don't just quit.

But she threw it away and then it showed her going through withdrawal. Yeah. The problem is, I'm guessing that was after about eight weeks. And if that had been after one week, it would have been fine. But eight weeks, you've now triggered the illness. And so what happens is then those kids became a behavior problem. They start seeking other drugs. They start acting out.

And no one recognizes that a doctor triggered addiction with the opiates months earlier. I saw tons of that oh my god did i see a lot of that children adolescents i think you'll really like the show what's that what's that i think you'll really identify with the show i think you'll get a lot out of it that's good news all right well thanks for coming up and saying hi you bet all right keep doing the good work thank you and then that patient on methadone be very careful you got to get her down quickly that stuff is a prison if you're not if you don't watch out all right uh i think i'm gonna wrap up i think we kind of did we needed to do today uh caleb any questions or comments from your standpoint

uh not not not from my end i just wanted to remind everybody on october 22nd we have uh greg ellis coming in too yeah greg ellis is coming back on friday um casey gates is putting up the samsa helplines up there 800-662-4357 uh there's lots of and there's lots of stuff 12 stuff available online now there's a lot of zoom meetings yeah greg ellis can be interesting i asked him to think about the histrionic turn i talked to a another psychiatrist today on another podcast and he was he was observing the same thing I did. He was more thinking about all the delusionality, the delusional nature of our thinking in the last six to 12 months has been rather profound. And it reminded me, he was trying

to make the case. He went to a pet shop and they tried to make him wear a mask. And he said, I'm a woman and I have a mask on. I identify as a woman with a mask on. How dare you tell me I need to wear something that you call a mask. I identify as a mask wearer. He was being facetious and silly, but it reminded me of a quote from Abraham Lincoln. And there must have been a lot of this kind of nonsense swirling or lack of truth, you know, lots of foundation, thinking of foundation and truth or mixing up language in the roll up to the Civil War, because Lincoln is famous for having said to his cabinet members, he walked into the cabinet meeting one day and said, gentlemen, if I call an elephant's trunk a leg, how many legs does that elephant have?

Susan, if I call an elephant's trunk a leg, how many legs does that elephant have? Susan? Five. No, four. Because calling it a leg does not make it a leg. The elephant still has four legs. So his point was, apparently there was a lot of manipulation of language back in those days that he was getting frustrated with. So just remind everybody

that calling something so doesn't make it so. That's just something to kind of put in your quiver when you get frustrated with some of the silliness around language these days. All right, thank you to Clubhouse. I'm going to end the Clubhouse room. We appreciate you guys being there. I'll be back again on Friday with Greg Ellis.

And as far as the restream, I've been watching you guys today. And thank you, Michelle Poe. Thank you, Michelle Poe for setting up. She can, she not only puts together an amazing set,

she is my booker. Thank you for Caleb for doing back-to-back shows. We appreciate it very much. Yeah. I like that. And we'll be back. Don't you? Yeah.

And I hope we're going to get, um, Brene facade in here. I just saw another article about him that I just thought was so ridiculous. And I need to get his point of view. I don't think they haven't gotten back to us. I don't know why they're avoiding us. And then our Kaplan,

the, uh, I believe we've got him scheduled to, he is, of course, medical ethicist been around for a long time. They haven't gotten back to us. I don't know why they're avoiding us. And then Art Kaplan, I believe we got him scheduled too. He is, of course, a medical ethicist, been around for a long time. He's got some unusual opinions these days. I want to kind of thump on them a little bit. What's that, Susan?

I have to ask Michelle what's going on. With Vinay? That's next week. We're still finishing up this week. Okay. And you have a lot going on. We won't be here tomorrow or Thursday because Drew's going to be working on the MTV Teen Mom set for two days. Teen Mom reunion, everybody. We're going to do another reunion this week, so we'll see how that

goes. 24 hours. And yeah, it's going to be 48 hours of straight work. That is heavy lifting. All right, everybody. Thank you for being here and we will see you on Friday. Ask Dr. Drew is produced by Caleb Nation and Susan Pinsky. As a reminder, the discussions here are not a substitute

for medical care, diagnosis, or treatment. This show is intended for educational and informational purposes only. I am a licensed physician, but I am not a replacement for your personal doctor and I am not practicing medicine here. Always remember that our understanding of medicine and science is constantly evolving.

Though my opinion is based on the information that is available to me today, some of the contents of this show could be outdated in the future. Be sure to check with trusted resources in case any of the information has been updated since this was published. If you or someone you know is in immediate danger, don't call me, call 911. If you're feeling hopeless or suicidal, call the National Suicide Prevention Lifeline at 800-273-8255. You can find more of my recommended organizations and helpful resources at drdrew.com slash help.