The Adam and Dr. Drew Show - #1833 Talk Like People Talk

Episode Date: February 29, 2024

Today, Dr. Spaz continues filling in for Adam, while Dr. Drew talks about the past's epidemics, Dr. Bruce's take on modern pandemics, and the dangers of marijuana today. Plus, late night show lingo, and the high functioning 'Legion of Skanks'. Please Support Our Sponsors: The Jordan Harbinger Show - Available everywhere you listen to podcasts

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and start streaming. Pluto TV, stream now, pay never. Hey, everybody, good news. We're doing the Comedy Fantasy Camp again. Jay Leno's going to be there. I'm going to be there. John Lovitz is going to be there. Caroline Rae is going to be there. Many, many other big comedians are going to be there. February 29th through March 3rd, tickets are going to go fast, and it's all going to culminate at the world-famous Hollywood Improv. So come and join us at the Comedy Fantasy Camp and work with the pros. Get your tickets at ComedyFantasyCamp.com. Globally, humans are facing massive problems that are widely ignored by governments and the media, We'll see you next time. Hi, I'm Jennifer. And I'm Angie. We call her Pumps, and we're the hosts of I've Had It. Pumps, tell the listener where they can find us.

Apple, Spotify, Amazon, or wherever you get your podcasts. Nailed it. See you next Tuesday. Recorded live at Corolla One Studios with Dr. Spaz and board-certified physician and addiction medicine specialist dr drew pinsky you're listening to the dr bruce and dr drew show all right all right indeed get it on i got to get it on no choice but to get it on emmy knows how to make us happy brilliant i'm telling you it's brilliant i'm gonna bring bruce back just to hear that some. Dr. Spaz. Everyone knows Bruce.

Hi, Showbird. Dr. Bruce, Dr. Spaz. He's been, like I said, alongside my career since, were we in our 20s when we first met? 89 or 90. Yeah, a long time ago. Where were you then? I'm trying, I remember where I was. Normal Linda, emergency medicine.

Just emergency medicine at that point? So you were doing addiction there too? I was doing adolescent addiction at Redlands Community Hospital. That's what it was, Loma Linda, emergency medicine. Just emergency medicine at that point? So you were doing addiction there too. I was doing adolescent addiction at Redlands Community Hospital. That's what it was, yeah. 87 to 90 and then went to Riverside. And you did residency over at Loma Linda, right? Loma Linda, yeah. And filling in for you on Loveline did not endear me to the Adventist health system.

Oh, really? I didn't know that. Well, then I did that radio show for Loma Linda, the Adventist health system. Oh, really? I didn't know that. Well, then I did that radio show for Loma Linda, the Ask Your Doctor thing. Well, remember, in those days, this is what people can't appreciate. It was radical to talk to adolescents and young adults about reproductive health and STIs. Radical. And at the time, we had an epidemic on our hands. HIV was out of control. By the time you came along, I think we had not 100% fatality rate, but 100%

within five years, I'd say. Not 100% within six months, which is what it was during the 80s. And it was radical to talk about it. I mean, think about it. Right. Come on. Yeah, I think adolescent medicine now, I don't, I am not as much up on it. But back then, you guys did a love line from the World Adolescent Medicine Conference at one point. You and Adam, do you remember that? Me and Adam?

I think it was me and poor man then, wasn't it? No, no, no. Oh, me and Adam did it? then, wasn't it? No, no, no. Oh, me and Adam did? You and Adam did a Loveline broadcast from the American Society of Adolescent Medicines meetings in LA. Yes, I remember that. I remember that.

At Disneyland or something, wasn't it? Was it out there? It was at a hotel somewhere. Yeah, yeah. But they recognized... But we've been doing it for 10 years at that point. No, no, no. This was like 90... This had to be 95, 96, 97. 14 years at that point oh right you but not with not with them oh right different a different time but not only did no one talk about reproductive

health but substance abuse issues i remember i filled in one time and and the brilliance was you you were able to hold the line as a professional right you weren't you know sort of like being goofy right and adam was brilliant but to the point i remember a kid called in and this i got i got not heat but i remember a couple of doctors that would listen they went oh you shouldn't be doing that making fun of kids kid calls in like absolutely stoned and he goes oh dude can i get brain damage from smoking out of an aluminum bong and you know adam just went you know he made i forget what he said but the point with adam's making fun of him was it's not the aluminum bong you have to worry about it's the pot right yeah and it was brilliant right man and and the studies i'd seen

said look if you want to if you want to um counteract advertising for alcohol for for whatever cigarettes the only way is with humor. Yes. And so it was brilliant. It was like any kid listening to that, what the message got through, got through all the- Well, there was even a bigger discipline that developed around HIV, right? And I knew it instinctively because I was 24 years old. And they were trying desperately to figure out how to change sexual behavior, right? A fatal illness. And how do you get people not to have sex or to change sexual behavior, right? A fatal illness. And how do you get people not to have sex or to wear a condom?

They couldn't figure it out. And Fauci at the time was advising, guess what? Use fear. Tell them that they, if they have sex with one person, everyone they ever had sex with, they're having sex with them too.

He was, he was a maniac about fear. I used it. I apologize now for using it. We see how dysfunctional that is with COVID. Terrible strategy. Never use fear. And in HIV, because it didn't work, we then had a discipline develop, a case that was relatable to the audience.

You want to reach somebody the same age, same sort of issues. The choices that person makes that don't work out. Somebody to explain those choices, humor and music. That's it. That's it. Why did we abandon, fucking totally abandon that during covid completely we had a whole discipline it evolved for 20 years as this this well-established discipline and we just in covid we lost our minds like no no we're not gonna do that anymore

yeah we could have done that during covid too if they want to change they can do it now if they want to get vaccine adaptation you know get more vaccine uptake do it now if they want to get vaccine adaptation, you know, get more vaccine uptake. Do it now. Wow. It's a political cudgel is what COVID turned into, I think. And none of the principles that you're talking about were applied to COVID in any way. So you and I have not had a public political conversation. Does the current situation shock you? Like, look at this.

Look at this. Adam has interviewed Phil McGraw, and here is his book in here. And I am, you know, Phil's a psychologist. He had a talk show. Still does, apparently. Did great television. On the back of this book, I admire so much what this man is saying, so much. I'm 1,000% behind what he's saying in this book.

The book is called We've Got Issues. He's right. We've got issues. I mean, I cannot stand behind him more completely. We do have issues. What do you think they are? God, my son told me, don't talk politics, Dad.

Well, you don't have to get deep into it. I mean, just sort of generally. You know, Adam and I talk about this crap all the time. Yeah. politics dad well you don't have to get deep into it i mean just sort of generally it's you know adam and i talk about this crap all the time yeah well uh i mean i look i'm not saying who do we vote for it's not what i'm saying i'm just saying what do we think has happened here because i i've been thinking a lot about the sweep of history and about trends in history and i saw a tweet by uh elon musk this morning it was a retweet of a tweet about the Roman, the city of Rome, how it was the biggest city in history with a million plus people. And it wasn't until the 1800s that London was again able to come back to that level.

And he said in his tweet, he just simply said, civilizations rise, civilizations fall. And I thought, why is that? And people love to say it as though it's some sort of mathematical process. But I'm beginning to believe that it has something to do with the way we raise kids over time and the way families change over time and the way values change over long periods of time. That things decay. They decay. And when they decay, religion, which has a useful input, changes or decays.

Do you agree? I agree. I could say that my own experience on a firsthand basis, there's a very strong narrative out there, and it's being pushed by, you know, I read, I have a New York times, uh,

subscription every day. I start reading that. And you can't read it anymore. No. Well, right. So, so there's my heart,

right. And, and then there's, I did a thing with a certain UC system. It was just an informal thing talking about, because I'd done some substance abuse stuff in the community, uh, opiates, fentanyl. It's just an informal thing talking about because I'd done some substance abuse stuff in the community, opiates, fentanyl. And I just happened to mention with the border being porous and all this fentanyl coming in, oh, Dr. Heisselberg, hang on. And I said, what? And they

go, the border's not open. Oh, okay. And then I said, well, can I say that there's a ton more fentanyl? And they ended up saying to me, maybe you're seeing things through your white privilege filter. Oh, yeah, you always do. I've noticed that about you. And then, you know, I have very little, like when you asked how can people get a hold of me, I don't know. I mean, I don't have any presence on the Internet. I'm not a celebrity but because if somebody googles me i'm hooked up you know they'll see you they'll see adam who are you guys have had some exposure as being white racists of course race attacks well you know that you're not you're not but not been accused of but i don't

think well we all but inherently based on the oppressor oppress system right system, right? I didn't mean Israel's racist. White males are inherently, because of inherent bias, right? So I'm saying- I have no problem. Listen, I have studied the words of Frederick Douglass very carefully, and he opened my eyes to these issues. Right.

And I have no doubt that my, certainly, I don't know about white, but Eurocentric ideas for sure, for sure have influenced me. And I need to pay attention to that for sure. I wouldn't call those racist per se, but I guess they bleed into that. And of course, I come from a highly oppressed population that was escaping the whole of Delmore and had to come through Canada to get into this country and find, back in those days, we had to have sponsors bring us in. So, hmm, I've had an interesting, you know, journey into this country, but okay. All right. I have to watch it. I did come from Eastern Europe.

Right. So I'm not saying you were, I'm just saying that there's,, pale, stale, right? And so if you disagree with anything in terms of talking about ethics, race, then it becomes, like they said to me through your white privilege filter. How is fentanyl getting here? Did you ask them? They said through checkpoints. Okay. And it's no different than under Trump. And then Trump comes up trump i don't care

about trump i i care i what i care is the word porous i don't care porous means it's getting through right i don't care what it's getting through it's getting through so shut the fuck up that that's my you know that look elon musk words absolutely go fuck yourself. Those are his words. We need to adopt, we need to use them much, much, much more often. Porous. Use the word porous. Okay, let's keep talking about an important issue that's killing people. Right.

So what's going on now? It seems like it's very difficult to have a discourse, and it's so polarized. I mean, I'm not saying anything that a million other people haven't said, but even in the practice of medicine, you have to be careful in terms of what you say, how you say it, who you're saying it to. So politically, I think I'm more libertarian. I don't know.

Yeah, I thought I was. When you're libertarian, you get accused of being right. I thought it was left libertarian. I thought it was liberal libertarian. Right. But you get accused, if you're libertarian, of being right. Right. And the fact that your free speech is impinged upon is disgusting.

And thereby, of course, you're unable to discourse openly on the scientific matters of the day, which are really what medicine's all about. So the whole practice then becomes adulterated. Yeah. Well, it's just, you know, no IVF. It's like the extreme right, the extreme left. It's like it's just – They're insane on both sides. Insane on both sides.

That's no good. No bueno. Most of us are not there. Yeah. Yeah. Well, and I not there. Yeah, yeah. Well, and I have a Christian background, right? So, and again, then you get into, well, that's the Judeo-Christian, the Eurocentric. Then that's bad.

Okay, well. Listen, it's one thing. It's different. It's one thing to say you need to pay attention because you come from that background, which I am. Absolutely. Yay. Let's do that. Number one. Number two, to say you're bad because your heritage comes from that, man, everybody's

got problems then. Everybody. Right. Well, if my filter, it's saying I have a filter, that's basically saying my touch, I'm out of touch, I can't be in touch with reality, and there's nothing I can do to change it. Yeah, the nothing I can do to change it part is pathetic. Right.

But then the Christian thing, it's like if you – I mean, I see – I think they should leave abortion and this stuff. They should leave it out of it. As a physician, I want to have a discussion. It's like, okay, at the point of viability, if you kill a woman that's pregnant, then it's a murder. You've murdered two people, right? And yet, so I want – and how do you have that discussion? Because the minute, even if you say third – oh, woman's right. It's like, well, you know, so it seems like it's – I don't have all the answers, but I want to have the discussion. But then now I'm afraid to say this is where it gets into freedom of speech issues.

And it's like Saul Alinsky's thing. It seems like right now the progressive side is, it's like Saul Alinsky's 13 Rules of Radicals, accuse the other side of what you're doing. These guys are, there's some sort of fascism because I'm not afraid to say, I don't like the KKK, I hate. But if I say the first thing that might offend a progressive,

then I'm in huge trouble. And that's- Well, unfortunately, everyone has to stand up and start saying those things. That's the reality. We have an obligation right now. Do it judiciously. Do it prudentially, using prudence. But we have to do it.

We have to stand up. Yeah. And I would say on the abortion front i'm looking for the same thing you're looking for which is consistency that you're you're saying why is it murder if a woman you know who's pregnant why is it two murders while if you just take the one out it's not a murder you've not done anything right and. And then the IVF thing, it's like a... Well, on the IVF thing, it's insane. But why... I don't know this for sure, but I'm going to bet in that same state, you can use an IUD. Oh, yeah. Right. IUDs are abortifacients. They cause abortion. That's how an IUD functions.

It's what, that's how an IUD functions. And yet, no problem with those. Yeah. So I just want people to acknowledge scientific reality and be consistent. That's all. I just want to start there. And they can't even do that. And that to me means, okay, well, now you're not interested in anything except being a problem.

Now you're just interested in exerting your will on other people. Yeah. Now you're just interested in exerting your will on other people. So if you were going to be totally consistent, you probably would get birth controls altogether because all birth control hormonal contraceptives can have a potential to interfere with implantation, which the strict right to life words would say is an abortion. Right. But you can't have that discussion with them either because then you're, that's right. You're going to have the same. That's my point. Blow back. That's right.

So it's whatever. Let me hear now a word from our friend, Jordan Harbinger. On the Jordan Harbinger show, you'll hear amazing stories from people that have lived them from spies to CEOs, even an undercover agent who infiltrated the Gambino crime family. You're about to hear a preview of the Jordan Harbinger show with Jack Garcia, who did just that. My career was 24 out of 26 years was solely dedicated working undercover. I walk in, I'm in the bar. Now there's a barmaid there, good looking young lady. She's serving me a drink. What would you like? I usually, my drink was, give me a kettle, one martini, three olives, glass of water on the side.

I finished the drink. The guys come in. I'm going to go, go in my pocket, take out the big wad of money. Bam, I give her a hundred dollars. If you're with the mob, I say, hey, Jordan, you're on record with us. That means we protect you. Nobody could shake you down. We can shake you down, but you're on record with us. That means we protect you. Nobody could shake you down. We could shake you down, but you're on record with us. For more on how Jack became so trusted in the highest levels of the Gambino organization, check out episode 392 of the Jordan Harbinger Show. So you asked me before the mic teed it up, does Greg Gutfeld ever get in trouble for some of the stuff that's said on that show?

And you were talking about the expletives that are used. Mike's heated up. Does Greg Gutfeld ever get in trouble for some of the stuff that's said on that show? And you were talking about the expletives that are used. They encourage it. Yeah. It's late night. You're allowed to say fuck. They bleep it out. I think it makes them seem edgy, cool, something.

So you just talk like people talk. Right. I think they tell you to talk like people talk. They're not telling you to use, drop as many f-bombs as you can it's no no no no it seems like it's a very like natural conversation conversation and i think tv shows like that that's a politically incorrect was remember that show yeah that was the best show on television in my opinion and uh and this is a form for us of that. This is like a more current. I think it's just hit a nerve with the right nerve with people. And that's why it has the listenership. I think that, you know, getting having comedians start, you know, dialoguing or, you know, having lectures on.

I don't want to hear what a comedian has to say. I want to hear the, want to hear what comedy is. It's looking at the absurdities. Right. And they mix it up. You know, Kat is not a comedian per se. She is. But she's a libertarian also.

She's a commentator. She's a thinker. And she has some really interesting ideas and always comes up with an interesting twist on things. And I've always said, I thought, the reason I really came to the conclusion I'm not truly a libertarian is I got to know her. And she like is heartless about her libertarian ideals. Like, just let it fly. Nobody gets saved.

Everybody falls to the lowest level. It's like, okay, I don't know if I can do that. I'm a libertarian until I'd have to be judged by another libertarian. And then you've got to take that extra step like she does. And I can't. Yeah, I can't do it. I think maybe it's our training as physicians that prevent us from going all the way there.

Right. And then Tyrus. What's his name? Tyrus. Tyrus, yeah. That guy, he seems brilliant. He is. He's extremely bright.

And he says it like it is. He's African-American. He can say it. And he grew up over here in Pasadena. Yeah, yeah. I think I was, he was a bodyguard for Snoop, right? I knew he was a bodyguard for a minute for somebody. Was it Snoop?

Yeah. I think I filled in for you on Love Line when Snoop was a guest. Yeah. And he had the – I thought it was him and this other guy from the Dog Pound. They pulled out these things. Oh, they're smoking cigars. No, they were blunts or whatever, right? Yeah, yeah.

So about 10 minutes into the show, there was so much smoke in the room, I couldn't think straight. I swear to God, I got a contact high. I'm sure. Oh, I'm sure. Especially these days, the weed is so strong. Let's talk about that for a second. So apparently, are you seeing older people in the... You're not doing ER anymore. No. No, but just on addiction medicine. I mean, the chronic pain patients, invariably, either they're, you know, they're children of the 60s now, they're all grown up, and they look to, when they have pain and their docs are taking away their opiates, they're, oh, let's go to the cannabis store or whatever.

Right. And, or their grandkids are turning them on to high potency cannabis, and it's just devastating for some of them. And so what are you saying? So this is up to 100%, certainly 80, 90% is common. Well, you know, anxiety, depression, as they use, you know, it's a typical scenario. There's just the variable response to cannabis, right? I get cannabis, I can't talk, I won't, it's going to go away. But if it does make- Lightweight.

Right. If their anxiety does improve, then they'll want to do it again. But as you do it again and again and again, it sets you up for worsening anxiety, psychosis. And so you get these older people that despite them seeing their psychiatrist, they have chronic pain, they're on duloxetine or effects for their pain. Their depression is getting worse. Their anxiety is getting worse. So it tends to have that spiraling effect. They don't know what they're getting either. They're all – if it's their grandkids hooking them up, they're getting gummies, right?

Are the gummies CBD? Oh, they're just CBD. Well, they're CBD with 10% THC. And for some people, that's way too much. Or they're getting straight THC. So you mentioned psychosis. So I remember back in the 90s, lots of debate about just weed caused psychosis or does it just kind of bring something on in people who are predisposed or do people with schizophrenia just like weed more? What's your impression on all that now? Oh, with the high potency stuff, it's like, okay, if you want to go to the extreme, which if you take pure synthetic THC, what does it do?

It makes you psychotic. It's a psychotomimetic, pure and simple. So the higher the potency of THC, it becomes purely a psychotomimetic substance. Okay. So no longer is there any debate about does weed cause psychosis? It does. Right. Okay. I've seen it a shit ton. I've seen it in family members. I've seen it. It causes severe psychosis. We'd also withdrawal. I've seen more psychotic features in the withdrawal too than I had seen in years past. It was always just kind of no sleep, irritability, a little paranoia. Now I'm seeing a little psychotic stuff creeping into the withdrawal itself, which is interesting.

Okay, so now with the hypotency, no longer any question, does it cause psychosis? It does. Okay. Does it cause addiction? Oh, absolutely. Yeah. No longer any debate about that. Right.

And when it does, it's rough. Right. Right? It's very hard to treat people. And plus, they keep drifting back into a culture that tells them it's no big deal. That doctor isn't what he's talking about. He's old school. Okay.

And Kratom. Kratom and herbal. We can get into that later. Yeah, I was just flipping through the series. The song comes on from Roadhouse Blues. The doors, you know, woke up this morning, got myself a beer. And I was thinking, woke up this morning and got myself a bowl. Oh, sure.

Oh, sure. There is less concern amongst individuals today. I think it's not young, middle. Cannabis is not – it's just sort of – Harmless. Considered harmless. Harmless. And it's so much more dangerous.

Yeah, that's right. Now, not to say it's dangerous for all people in all settings or should never be used. We are not saying that, nor are we saying you can't figure out a dose that might be okay and not so dangerous. We're not saying that. How do you figure out a dose? I don't know. I don't know. The other thing, now this is what I was asking about at the beginning in terms of the ER visits.

Apparently 65 plus are showing up with anticholinergic delirium at an extremely high rate. I tried weed recently with a famous person. I had that reaction. I almost had a seizure. Seriously? Terrible. Full anticholinergic delirium. I was like, what is happening?

Dry mouth, eye photophobia, agitation. Oh, shit. I'm in an anticholiner high no nothing just misery i and i couldn't drive for five days after that come on yeah yeah crazy right well it's it's the potency that i don't know what kind of it was with some famous weed smokers who would who bought smoke crazy stuff but right well and then you get into the wax. I was – Well, my daughter's a recovering weed addict. Yeah. Yeah.

And she was into the wax and stuff. I was with a group of people that they were highly into cannabis. Anyway, they went to the pot. What's that pot thing that you go to the cannabis fair or whatever it is? Sure, there are lots of them. These guys were like – and these guys are daily chronic smokers. Oh, man, we got some wax and they got the pipe and the whole thing. And I watched these guys like a few blasts of things.

Yeah, it's like crack. It's like – Oh, my God. They fell literally, these guys. We were watching them. They fell off their chairs. It's so different. It's a different substance, a different... You know, it's funny.

I was giving the Legion of Skanks guys some shit about this. Do you know Legion of Skanks, these guys? No. Louis Gomez and stuff. And Louis Gomez and David Smith. I used to be their intern. What? Was I a guest when you were the intern there? You were, yeah. What the fuck? Why did you

say something? So tell me what those guys would do did you have to load up their pipes during the show okay so they didn't know what to do with me for like the longest time so my job just became giving the comedians and porn stars that ran through the studio drugs like dabs and things so uh mostly i don't the only jobs i saw was dabs which is wax yeah and and and they had those glass pipes, right? And you would get the blowtorch out and you'd hand it to Lewis, yeah?

You would demand it. And they were not affected by it. That was the thing that- Big J passed out for like five seconds after doing a really big dab once, but besides that, they're cool. Apparently he's made guests knock out on the show. I couldn't imagine.

The thing I, what I was telling them during the show i'm like guys how the fuck do you function after taking and they're and they're not doing it once right they take like three or four dabs they're high functioning high functioning they're they're brilliant they're brilliant comedians they're having high level discourse for two hours i'm going back there next week, by the way. And they do it on day. Please send them my love. I will. I absolutely will. Was it at the stand back in the – it's always been at the stand, right?

Always at the stand, yeah. Yeah. But I marvel at them. I'm like, how do you guys do this? And I worry about them because you know one day they're going to have to do something about this. Right. You can only do that for so long. Slippery slope.

And so we're both addictionologists, right? My feeling on all that is God bless them. God bless them. They can function like that. They like it like that. Good. Fine. When there's trouble, please call me.

Yeah. Because it will come. Right. We both know that, right? Right. The problem with high-profile people is they're projecting it's a safe, okay-to-use thing. And then the average kid, what percentage of kids get psychosis? What percent does it destroy their lives?

Yeah, I get that. But I don't want to be that guy. No. That goes, oh, you guys can't do that. Because they don't promote it. They would argue that they don't. They're using it. They do it themselves.

And if you want to use it too. and that's kind of my libertarian thing, you know, people want to use, fine. If you have trouble stopping, we can help. You know what I mean? That's, that's, what's wrong with that? No, it's a combination. It's a combination of the capitalism. And then the, if you drive to, when you drive to Arizona, it's like you go through the desert there. It's like, it struck me, maybe it's that way also. Every other billboard is for a cannabis. You need to use that microphone there,

my friend. I'm relaxed. I'm chilling. You mean on the way back from Arizona, you mean? No, just driving, just off the 10 freeway,

there's like 10 million sites. There's so many. But coming into California. Yeah, either going, I'm just saying, that stretch, I don't know why it is, but Palm Springs, Palm Desert, every other, every other road sign. Oh, I see, in California. Yeah, either going – I'm just saying that stretch, I don't know why it is, but Palm Springs, every other road sign.

Oh, I see, in California. Yeah, yeah, yeah. A lot of cannabis. All over the place. Yeah, so it's a combination. Sure, these guys aren't promoting it for kids. It's not like they're trying to push. But there's so many people doing it, and I think that's the exception, people that can dab and use wax and function.

I mean, the average kid in high school and brain development i have patients that are worried about the brain development i'm pregnant oh the best thing for nausea is is pot oh my god speaking of which the other thing we're seeing in er is in addition to 65 year old are you going to do this with us today chris awesome in addition to 65 year old plus uh in the er uh the other thing is hyperemesis oh yeah and if you hear somebody do you know how many years do you know how many years i i screamed this has been around for a while hyperemesis and inevitably people would come to me and go my boyfriend he vomits every other day, and he's had a gallbladder. They want to take his gallbladder out now.

He's had an endoscopy. He's had a CAT scan. I'm like, does he smoke weed? Nobody ever asked for years. And by the way, the GI guys are not routinely asking. ER is asking, finally. Oh, yeah, because they hear the ambulance coming in. One of the last shifts I worked, the ambulance comes in, and then they don't believe you.

It's like it's the pot. No, it's not the pot. We fucking doctors can't figure out what's wrong. I know. It's like, okay. And this guy on the gurney is screaming. So they used to call it, early on they call it scrommeting because they would scream and vomit at the same time. Right, right.

Yeah, I've seen less of that, strangely, but a lot of the daily vomit. My daughter had that. Had the big workup. Hot shower. Hot shower. VMA receptors. And she fucking destroyed a rug in my house I'll never forgive her for. But her sobriety is glorious and, you know, like her sobriety always is. You know, people, the miracle of sobriety is glorious. Her sobriety always is. The miracle of sobriety

is just... Yeah. Well, that's why we do this. I tell my patients, why don't you go retire? I say, because if anything I've done in medicine, when somebody gets their life back... It's why I got into it. I saw that happen. I was like, what is that? What just happened to this person who was dying, losing everything, all of a sudden a miracle. That's why I was like, what is that? What just happened to this person who was dying, losing everything, all of a sudden a miracle. That's why I was sort of not hot on Suboxone because it seemed to get in the way of that full recovery that I got involved with this for. I don't object to people using Suboxone. I just wasn't interested in using that. I got the X certification, all that stuff, even though we don't even need that anymore, which I which i find weird oh no no but it's it's based on anybody that makes the diagnosis of obese disorder they have to start

it they have to start so if anyone has to start it pediatrician ob then they need to be able to be wavered so they're everybody's automatically wavered just to get your dea license now you have to take the eight hour course oh right so everyone has to take the course and be proficient here's the way i look at it and i took it i took and it was it was oh what's happening now though with fentanyl in the in emergency medicine is crazy people are getting up to 64 milligrams oh my god there there's byron i at the at the stand dude i do remember somebody How long ago was that? Like over two years ago.

That was an Afro go too. But is that, I can't. It must have been the first time I'd done it, right? I can't believe I've been doing it that long. To me, they feel like new friends. It's so weird. And I didn't notice the guy coming by with the pipe until last time I was there. So that was not you.

No, Jake is new, yeah. Jake, okay. But wow. Hey, thank you, V-Shred. I've lost a little weight since then. I've lost like 15 pounds. Yeah. So that shit works.

But in any event, you were saying that with the fentanyl. Oh, my God. So, yeah, in other words, fentanyl has a very high affinity for the receptor. So even after you're not high and you're not in withdrawal during that period, you give somebody Suboxone and they go into precipitated withdrawal. So it's like there's a couple of beds in the average ER now for inductions, right? Because now the big thing is start it. In the ER, yeah. Right. Which I'm all for.

Oh, yeah. That's something. But what do you do when they start going to precipitated withdrawal? They'll push right. Which I'm all for. Oh, yeah. That's something. But what do you do when they start going to precipitate withdrawal? They'll push to it. I'm confused because fentanyl is also very, very short acting. Why can't you just wait a couple hours before you do the induction? Because it sits on the receptor for a long time. Even though it's not active?

Even though it's not active, yeah. Longer than other organs? Right. Think of it like methadone in terms of how long do you have to wait. Yeah. Well, not as long, but that's in the protocols. Why do they keep having to use it so frequently then? Use the-

The fentanyl they're using every four hours, the addicts. Because the high doesn't go to weight, but it's still on the receptors. I see. And so- That's weird. Is it maybe not on the mu receptors, on some of the other receptors? No, it's on the the receptors. I see. That's weird. Is it maybe not on the mu receptors, on some of the other receptors? No, it's on the mu.

That's weird. It seems weird to me that they not have high and have withdrawal. It seems weird. Those two things seem connected. There's this period of time, and then the next step is IV versed or out of van, and then IV ketamine. So they have beds in the ER

where people that go into precipitated withdrawal, they'll go up to 64 milligrams of Suboxone. Remember when Suboxone, the maximum was 8 milligrams, the first day, 12, it's like out the window if you look at these protocols. What do they do now? Well, you just keep pushing it. Yeah.

So I'm a little, I'm pushing back on the Burset a little bit because in my world, at least heroin, intermediate, even short-acting benzos make withdrawal worse. But it's the- Unless you put them to sleep. Why don't they use propofol or something like that? Probably need anesthesia for that. Yeah, yeah.

So, I mean, I'm not doing – I'm not in the ER doing this, but I've just – I've sort of consulted and they'll call and it was – So it got to be – it's almost like a psychotic state. The precipitated withdrawal is so intense and so out of control. How long does it take to get the dose where they need it? Just curious, a fentanyl addict. Can they get an induction in six or eight hours? Well, when they get into that state, sometimes they keep longer than that. And how do they predict who's going to get it?

Is there any way to predict who's going to get it? Something's not right with how we're thinking about this. Something's not right. But the idea is why? Because if it were really just receptor occupation, everybody would have it. There's something else that we're not thinking about. I don't know. Anyway, we've got to wrap it up.

All right. Good. Fast half. Interesting. Yes, interesting. A little history, a little skank history, a little addiction medicine. And yeah, I hope people learn something. So thank you, Bruce.

Always great to see you. And we'll be back again next show with the great Max Apata. We'll be in here as well. And, yeah, find me at Rumble. Sign up, subscribe on the Rumble channel, please, everybody. See you there. Bye. Mahalo.

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