The Zac Clark Show - The Story of Dr. Bonnie Milas: How Losing Her Children to Fentanyl Inspired Her Fight Against the Deadly Epidemic

Episode Date: November 13, 2024

In this powerful episode of The Zac Clark Show, Dr. Bonnie Milas shares her deeply personal journey through unimaginable tragedy and her mission to protect other families from the same fate. A cardiac anesthesiologist, intensivist, and clinical professor of anesthesiology and critical care medicine at the University of Pennsylvania, Dr. Milas lost both of her sons to accidental fentanyl overdoses within 15 months. Professionally, she’s on the frontlines treating patients affected by opioid use disorder, and she is a passionate advocate for the availability of naloxone—a life-saving nasal spray that can reverse opioid overdoses when administered in time. Dr. Milas’s advocacy is vast and tireless: she’s lobbied for over-the-counter naloxone access, provided testimony to the FDA and Philadelphia city council, and collaborates with organizations like the American Society of Anesthesiologists to spread overdose rescue education nationwide. She also leads training on naloxone administration through her initiative REVIVEme.com and serves as Chief Narcan Rescue Officer at her institution. Driven by her own loss, Dr. Milas is devoted to breaking the stigma around opioid addiction and empowering families with the tools to prevent overdose deaths. Join us as she opens up about her experiences, the emotional toll, and her relentless fight to save lives through advocacy and education. Editor’s Note: Zac Clark and Dr. Bonnie Milas are brand ambassadors for NARCAN® Nasal Spray. However, the thoughts and opinions expressed during this conversation are solely their own.  To learn more: About NARCAN® Nasal Spray: https://narcannasalspray.ca/en/ REVIVEme: https://www.asahq.org/advocating-for-you/reviveme More about Dr. Bonnie Milas’s Story

Okay, so Dr. Mylus and myself, Zach Clark, are here today as brand ambassadors for Narcan nasal spray. It's important to mention that the thoughts and opinions expressed during this episode are our own. Okay, before we introduce today's guest, I am going to read the title of a Newsweek article that our guest wrote and was published earlier this year. And then I'm going to ask her to read an... excerpt from that article. I buried my two sons in 15 months. I implore parents to be prepared. It was dark, but as I turned your head, I could see that your lips were dark blue. You were not breathing. I screamed for Grandpap to get my emergency kit for the Narcan. I immediately tried to give you mouth-to-mouth resuscitation, but I struggled and could not get your mouth open. I knew

from past experience with you that I could do mouth to nose resuscitation. So I quickly started doing that. I remember saying out loud, oh no, no, no. I remember I checked for a pulse, or actually I can't remember if I checked for a pulse, but you were not coming around. So I started doing chest compressions and breathing, compressions and breathing. Call 911 now. Grand Pat brought the emergency kit. I gave you one dose of Narcan. You were not yet coming around. I kept working at reviving you as I heard the police and EMTs charging through the front door. You had just started to make breathing efforts, but you were not yet responsive. They gave you a second dose of Narcan and suddenly your eyes were open and you were wondering why you were on the floor and with strangers

hovering over you. I heard the police laughing and one saying, hey, haven't we been here before? You were startled and mortified, yet I was full of adrenaline and so full of anger and disappointment. I was yelling. How could you? And one day out of, one day out of rehab. One of the female EMTs turned to me and scornfully said, Ma'am, can you keep your voice down? I'm trying to do my job here. And with that, my private thoughts were raging. Oh, really?

You're trying to do your job? Well, as his mother, I just did your job. Do you have any idea what it's like to do CPR on your son and know that as a doctor you brought back many other patients? but yet this time you may not get your very most important patient back to life. Well, I do know that firsthand, and it is the worst experience that I have had in my lifetime, bar none, the worst ever. And I'm just up there.

Today's guest is Dr. Bonnie Milus. Dr. Milus is a cardiac anesthesiologist. just an intensivist, but more importantly, she's an advocate for naloxone, rescue, and she represents patients and their families really nationwide in the fight against their substance use disorders. Dr. Mylus, thank you for being here today. Thank you for having me. Your bravery is inspiring. I can't imagine how hard it is to read what you just read and hear me read the title of of that article having lost two sons to accidental overdoses. What are you feeling right now just coming out of that, reading that,

and being here? Well, I can tell you that, you know, just reliving that circumstance, it's why I'm an advocate for naloxone rescue and you would say well what would inspire you finding your son overdosing on the kitchen floor it's a terrifying moment and that's coming from somebody who has the experience I have the knowledge and I also had the medication immediately on hand but it made me realize that most people who are in this situation, they don't have what I have. So therefore, that's why I am an advocate and I go out and teach. This was a public health need that at the time, when I ultimately lost my first son in 2018, that information really was not being discussed

and people weren't talking about naloxone. So this really needs to be kind of a boots on the ground approach. We need to put the medication and the knowledge in the hands of those who need it. Yeah. I have a couple of questions following up to that, but I'm thinking about my experience and it's wild because we're doing this interview for those you that are listening at University of Pennsylvania Hospital, which is where I had my brain tumor about 16 years ago and was sent home. And to know, I don't fault the doctors. I don't point fingers. I'm actually very grateful for shout out Donald Overk, who did my surgery. I think you know even.

But I was sent home with bottle of pills, and that led to many years of struggling with my own personal opioid addiction. And I always share that had fentanyl been around like it is today in 2011, when I finally got sober and clean, I probably wouldn't be here because I was using it at an accelerator rate, and there was no naloxone, really, in 2011. So when you think back to 2018, 2019, you're a doctor. When's the first time you hear about naloxone, had your sons, one or both of them already been struggling? And why did you have it in the house that day? I mean, I'm just curious. How did we get to that? Well, I think it comes from my experience, both professionally

and also my lived experience. You mentioned I'm a cardiac anesthesiologist. So what that means is I frequently am putting in breathing tubes. I rescue breed for people every day for heart surgery, essentially. I know about opioids. I know all about melanchone. But additionally, I give very large doses of intravenous fentanyl every day safely to patients for heart surgery.

So I know what people look like when they're overdosing. And also my lived experience of having had to overdose rescue in my home a number of times repeatedly. So initially what I had in my home was intravenous narcan or naloxone. I had to give it intravenous. I knew that we had a high risk situation in my home. But the fact that we have now a medication that is a nasal spray, it's very straightforward, it's easy, and anyone can give it. And the other issue is you can't hurt someone if you guess wrong about an overdose situation. So it is absolutely a lifesaver.

Yeah. No, and I've seen it firsthand, and I have people that work for me at release recovery, the organization I run up. in New York City that are here today, you know, because they were, they were rescued. And, you know, I, I can't imagine being in your shoes. I can't. And unfortunately, in my work, I've met many mothers who have lost their loved ones, their sons, their daughters, or husbands, their wives. And it just never, it never, it never, gets easier and I think that for a lot of people they choose to stay in the shadows and I don't fault them for that but you've been someone that has come out of the shadows and brought a lot of

light and energy and awareness to to nooxone when it hasn't been easy because there is a stigma and there is a lot of negativity around a drug that people might say why would you why would you bring a drug addict? So could you share back to life? Why would you bring a drug addict back to life? Can you share why this drug is so important? And you mentioned in the article that that last hug you got with your son. How much you hold on to that? Right. Well, it's pretty clear when we have so many people dying from drug overdose. And these are predominantly it's due to opioids and specifically synthetic fentanyl. But the reason why it's critical and why I advocate for it is because it is a lifesaver. The way that it works is that

it displaces the opioid from the receptor in the brain. And that's what allows the individual, the victim, to start breathing again and to become responsive. So that's why I have partnered with emergent bio solutions in educating. I am a part of the Ready to Rescue.com campaign, and it's an effort to teach people, lay people, how to save a life if you're in that circumstance. So we teach three things. The motto is to lay, spray, and stay.

You want to lay the victim back. I always teach to tilt the chin. upward. You spray the nasal spray and I can show you right here. It's pretty straight forward. We're going to get alive, alive. Yep, live demonstration. You put the tip in the nose and you just push the plunder one time so you spray it. And then the last part of our motto is to stay with the victim. So you don't want to leave them alone and stay with them. The reality is, and what most people really don't understand is that the average time in the United States for 911 or the EMS squad to arrive at any location is approximately seven and a half minutes. So that is a very

long time to be standing around with a victim and you are essentially the immediate responder. You found them. Well, what are you going to do? So again, I teach people not only to lay sprain stay, but also if you have any basic life support skills that you would want to employ them, put them into place. So it would be things like if they're not breathing or breathing inadequately, you're going to breathe for them. Right. If you don't know the victim and you don't feel comfortable or you can just start doing

chest compressions. So I can share with you too that I'm also through my ASA, the American Society of anesthesiologists, I also have, I'm spearheaded the revive me.com campaign. So it's revive all caps, lowercase me.com. And we go into the mechanics of just very basics, how do you rescue breathe? How do you open someone's airway? How do you do chest compression? You know, a drug is not going to circulate if somebody is without a pulse. And is there some, is there merit to, If we're on the logistics of it, what we've seen is stronger, fentanyl, more fentanyl. Is one dose always enough?

And I just want to reiterate something that you said at the beginning. There's no harm in administering a dose. If they're having some other type of health episode and we misread it or we overindex it, giving a dose of naloxone is not going to harm them in any way, shape, or form. No, he's not. Yeah, yeah. Yeah, if there are no opioids present, then it will have absolutely no effect at all. If, you know, somebody is unconscious because they are having a stroke or they're having a heart attack, you're not going to hurt them, not going to hurt them.

It will have no effect whatsoever. So, no, it's a kind of common sense thing to have around. And in fact, I advocate for, you know, public health policy is very important in the United States. It helps to set the tone for how we address this problem. And quite honestly, the problem is we are not treating it with the same urgency that we would if we just pause and recognize that we are losing the same amount of people daily as if a jetliner is falling from the sky. guy. Right. And what would that look like in the news? Correct. And I'm sure we would be addressing it differently. So, you know, part of my mission is to get it into every first aid kit in every single home in the United States. I'd like to see it next to every AED in the country.

And that's going to take legislative or even maybe executive orders or actions in order to get that done. I got your back. I'm with you. Like, you're going to need us all. That's good. And you mentioned common sense. And she might get mad at me for sharing this story with you. But my sister knows that I am a heroin addict, knows that I'm in long-term recovery, follows me on social media, knows how much I speak about the importance of having naloxone readily available.

And I was visiting her three weeks ago. I said, Catherine, do you have, do you have naloxone here? So why would I have that? Right. And that's someone who sees it, knows it, whose brother is out there like flying this flag. Because in her mind, her home is not a high-risk home. The way I see it, and I'm curious how you see it, is that it's a high-risk world. It doesn't matter.

You have friends over for cocktails on a Friday night, and it's suburban America. Me, 13 years ago, could go into that bathroom. do drugs and not come back right I can just share with you a story you know that that also plays in with that

that an acquaintance she was she arrived at her son's home who was in long term recovery was doing well but she was driving him to work because he hadn't gotten his license

back I didn't have a license for my first two years I did it so he was in the midst of overdosing and he was just starting to lose consciousness but was still verbal and she asked him she said why why did you do this and he said I just needed to cut loose so she knew the importance of naloxone Narcan and she called her husband to say you need to get over here she left him before husband arrived she stood in line at the pharmacy in order to get the medication. By the time she got back, the EMS squad was there and he lost his life.

So the important thing is you must have it on hand. We need to get the message out. And quite honestly, right now it is an over-the-counter medication. You can go right into the pharmacy to Walmart. You can pick it up right next to the Tylenol. It's also a clickaway on Amazon.com. And if you're at all concerned about cost, somebody, you know, is watching their money very closely. And they might say, well, why would I want to have a medication around that I just might need, but I don't know if I'm going to need it?

So you can go into any police station, any fire company, county or public health department. And you can say, well, I need a dose of NARCAM. The same way you go out and get a fire extinguisher, right? The same way that you're going to, I mean, there is effort there. Right. But in this case, you can get this for free, okay? And I think we really need to change the narrative around having naloxone or narkin on hand because people are afraid.

They're afraid to ask for it. Now, being over the counter that removes the barrier of the pharmacy counter. It's no longer prescription. but a lot of people are afraid to say, I want to have this on hand. But I think we just need to change the narrative. It should be, I'm a concerned citizen. I want to be prepared in order to have this immediately available or I'm a loving sister. I want to have it immediately available should I have to be an immediate responder.

Well, that's the sad part for me. It's just the stigma that this whole, this whole. you know, public health crisis carries, you know, and people shouldn't have to give any reason, right? They should feel very confident about why they're walking into a pharmacy or a firehouse or a police station to pick up naloxone. It's very clear. Right. It is, but I will tell you, certainly drug overdose and naloxone, there's still a big stigma surrounding it. Of course. You know, I've been out in front of the ACPB market trying to hand it out free medication. And the stigma surrounding it is just stifling, correct.

I taught my children right from wrong. They would never do that. Other things that I've heard is, well, why would I want to rescue somebody who's trying to kill themselves? And in fact, if I rescue them, they're just going to repeatedly overdose. Why would I even bother? What's your answer? What's your response to that? Because that's something that I kind of touched on earlier.

And I'm curious to hear you're someone that's lived this in the worst possible way. What is your response to the person that says that? Well, so I usually turn the conversation into, okay, so you have a teenager, right, at home. And, you know, they're clean cut, get good grades. They're the star athlete, and they tell you they're never going to do that. Well, the reality is that we're all vulnerable, and there are times in our lives when we feel stressed or you're struggling with whatever it might be. And he or she is offered a tablet, a pill that they don't know is laced with fentanyl.

and they don't know and what you are probably missing to the person that just made that comment is that they could be minutes or seconds away from being dead, taking their very last breath. Now, are you trying to tell me that that person deserves to die because they made a horrible, horrible mistake? I think the answer to that question would be no. So please take this with you. Yeah, I mean, I think about high school hallways. I think about college campuses. I think about my experience showing up, you know, as a freshman at a small school in PA, and I'm trying to fit in. And someone offers me a line of cocaine. That line of cocaine in 2004 and 2005, I'm dating myself, is not the same line of cocaine being offered in 2024. Right. And, you know, the people that will say to me, well, I experimented with drugs and I walked away from it. Why didn't these people do the same? Because the fentanyl wasn't.

Correct. And the thing that I want to clarify just for the listeners, when you talk about this pill, right? Not all pills on the streets today come from a pharmacy. There's actually, I would say, just as many pressed pills, which are people somewhere in some lab mixing up things that they hope to have the same effect as a Xanax, as an Adderall, as some of these other drugs that people seek. And they're being laced with fentanyl because of whatever is happening, you know, in those environments. And that's where we're seeing truly an accidental overdose, which is why we're having this conversation today. And if we have the attention of people at home listening to this, I cannot emphasize the importance of having naloxone in your home, in your school, in your deli, in your business, talking about it amongst your employees. because if you think it's the person that thinks it'll never touch them,

that sure enough, it ends up getting them. And I'm getting emotional here and passionate because I don't know how much better it's getting. I mean, you talk about public health. I think I just saw the numbers 10%. Numbers are down 10% I think year over year. But what does that really mean for overdoses? I mean, like, can you talk? Are we really acknowledging this as a public health?

issue? Is it really acknowledged as substance use disorder? Is it a disease? What are your thoughts on the overall kind of climate here in our country? Well, I would say that from a public perspective, I still think that the attitude is that, well, these people deserve what they get. And if they die, then it's deserved. outcome, or they have a misconception that the drug user is the person that's portrayed in the media, say, somebody from an inner city area who's disheveled and is using openly on the street, and that somehow that those individuals are disposable or dispensable, and just not realizing that those individuals are someone's wife or their brother and they deserve a chance.

And it might be their third chance, their 10th chance, but still that these people deserve a chance to live. And yeah, from a public health perspective, there's a lot more we can do besides, as I already mentioned, having a naloxone product immediately available. But also, we, need better access treatment and fast tracking treatment, you know, well, okay, you've rescued that individual. You want them to get into the ambulance. You want them to head to the emergency department and have expedited care so that they can go on to whatever is the next phase if they're ready for it of their treatment, essentially. There are programs where you can have a certified recovery specialist. I want to stop you on the treatment for a second just to share

because I feel like sometimes the real-life experiences really hit home. And I'm thinking of about 18 months ago, I caught a call. I get calls all the time, as I'm sure you do. And it's part of what makes, I think, us good people because we pick up the phone, we try to show up. And what had happened is this person had overdosed. I know this person. They were Narcan.

They were given a dose of naloxone. They were rushed to the emergency room. I had been in contact with this family for six months. I got the phone call from the wife, screaming a scream I never want to hear. He overdosed at the top of her lungs, not knowing if he made it or not. And so I got in my car and I drove down to the hospital where he was. And I sat there and I said, brother, it's time like you're going to treatment. he looked to me square in the eye, I said, no, I'm not.

What do you mean? I don't need treatment. This thing, the psychological aspect of a substance use disorder, the defiance, the cunning nature of it is really hard for people to understand. It's hard for me to understand his response in that moment. We ultimately got him to treatment because I had the tools as having done many interventions and brought in some of my clinicians to help with the process, but that's hard work. So when you talk about getting someone from that overdose into a treatment program, we need boots on the ground.

Right. We need boots on the ground. And that's a tough thing because had I not been there, there's no way he's going to treatment. Right. Well, you know, take it from a mother who knows, you know, that's something that I'd like to get across to your audience is that it is indeed a lot of work. I've had the experience of, okay, the best time to talk to somebody about getting them into treatment is right after they overdose.

I'd say that is a key touch point. Now, your friend may not have been ready to go, but usually most people are ashamed. They are embarrassed. They, you know, we make a point to them that you just died. We did CPR on you. We gave you Narcan. Are you finally ready? Okay.

So my experience was, well, we, one son said, okay, I'm ready. I'm going. So we're in the car. We're driving down the, we're trying to get on the Pennsylvania turnpike. I slow at the gate to get on. on and he opens the door and rolls out of the car, out of the moving car. So then, all right. Pull over to the side of the road, get him back in the car.

And I'm like, okay, you have to do this. You've got to do this. And he's like, I know I do. I know I do. But yeah, that brain chemistry is he's just starting to feel better. And that chemistry is telling him I need to use again. So we drive, we get to, and of course I'm not stopping the car anymore. I'm not slowing down.

I'm going to drive as fast as I can to get to the recovery center. So then we arrive and he's, I'm not getting out of the car. I'm not going to treatment. I'm not going. So we sit there for a while. He doesn't get out of the car until he has to use the facilities. And then he walks into the recovery center. And I left him there.

I drove off, figured, well, this is my opportunity. So you're right, it takes a lot of effort. And the families out there who have been in this situation, they know exactly what I'm talking about. Exactly. Very difficult. Yeah. You're so inspiring.

I mean, I just want to clarify, too, for families, mothers, fathers who are listening to this, there is some data that suggests willingness doesn't actually impact outcome. You know, there aren't a lot of people that go into a recovery center or a treatment program high-fiving their counselors and saying, I'm so excited to be here, right? So we do get jammed up at times on, well, my son or daughter's not willing, so we're just going to let them bottom out. And that bottoming out has as much, the stakes are much higher today than they were 10 years ago, or 10 years ago. Can you talk a little bit? So obviously, one or both of your sons, did go to treatment?

Do you have thoughts on treatment? Does it work? What was your experience? Did you feel supported as a family member? In regards to does treatment work? Certainly it does. And everybody finds their own pathway to success. Now, in our situation, lots of treatment.

it included inpatient outpatient medications you know it included buprenorphine vivitrol you know every aspect of treatment we've pretty much we saw now in our case they got very close to being successful but ultimately trying to sustain themselves off of buprenorphine was the real challenge. And in fact, when they relapsed, ultimately, it was fentanyl that brought about the end of their life. So from our standpoint, we did not meet with success. But I've spent time with many families, many individuals who have met with success, whether it was NA, whether it was long-term buprenorphine therapy. There are many ways in which people go about it. faith-based treatment.

So, yes, it is, and it can be successful. You have to find what fits best with you. Yeah, I'm a big, I mean, I wouldn't be here without treatment. As I mentioned to you, I went to Karen, treatment centers right out in, in Warnersville, Pennsylvania, Redding, Pennsylvania, I went for four and a half months. That worked for me. It was longer than that 30-day kind of rinse and repeat. And then I did, you know, three or four months.

more months of a transitional living program. And, uh, you know, I'm a, I'm proof that treatment does work. Uh, but I do want to, so that should be some hope, right? Like we, we do want to deliver some hope today. Of course. And, uh, I do want to talk for a moment about. If I could just talk, though, in terms of treatment, um, when we're talking about, um, you know, public health policy, I think that not only easy access to treatment, but we need to have federally funded treatment for an extended period of time. So if you're at the point where you cannot, you've really developed dependence either to pills or you're using IV drugs that the bare minimum, bare minimum of federally supported treatment should be 90 days inpatient. And if you've

had an episode where you've relapsed, I think that needs to be a full year, a full year worth of a confined treatment program. Because, you know, brain chemistry, how long it takes for receptors to reset and for individuals to develop really a healthy mindset and be fully committed to recovery. It takes time. Yeah. I'm a big believer in the year. for sure. That's a lot of what we talk about, again, at release is getting our clients, our patients to that one year mark in hopes that they have not just the brain chemistry has healed, but they have purpose. They have a sense of, hey, I can live this life. I can live a fully autonomous life. I'm not reliant on my, on my parents for, you know, to pay my tolls or

whatever it might be. And, you know, you struck a chord with something there because we're sitting here and you, before we turn the cameras on, we're showing me the beautiful new building where your office is here at University of Pennsylvania Hospital. We talked about this beautiful wing that we're sitting in that is here because someone donated a lot of money and obviously had a passion for healthcare. And I've been to a lot of hospitals. I've been to a lot of medical facilities, the detox, the outpatient program, the inpatient program, the psychiatric unit are never, are never the best looking place in the building. And they're always tucked away in some basement with linoleum floors. And there's not a lot of hope in those rooms.

And then I walk here today and I have this dream of, you know, it was 20 years from now, 10 years from now, five years from now, whatever it is, a real center. of excellence, a wing, a behavioral health care wing, where we are really giving patients the care that they deserve. Well, I can share with you that the University of Pennsylvania, we have a relationship with Karen as well. But to your point, we do have a vacated ICU unit, which I'm trying hard to get my hospital administration to consider to have a detox and an initial therapy unit there where, well, if you want to expedite things, well, let's go from the ER and go right upstairs. That would be a great thing to have. So I'm hopeful. Yeah, what's going to be the

Sloan Kettering of, you know, you live in New York City, you know what Sloan Kettering is, you know it's can't, you know that and where, I mean, I don't know, like, how far away do you think we are from, you know, the Dr. Milus Center, you know, or whatever it is. I mean, it sounds good, right? I like the sound of that. Yeah, yeah, yeah. I mean, do you think we're years away? You think ever, you think? Um, again, I think we still need to break down stigma. Um, you need to convince an institution that they want to be the center of excellence. for opioid use disorder or substance use disorders. And I think that if we get the funds from the government or maybe it's private funds

or maybe it's from the insurance industry, I don't know. But when the money comes, I think that also is very influential because some of our clients who suffer from substance use disorders, they are not currently working. They may not have insurance. So that's why I'm saying that that money is really important to make that happen. Yeah. Access to care as someone who does this every day is really, it's scary. And I, you know, my personal experience is I was fortunate enough to come from a family that at the time could afford for me to get really good treatment.

And I think insurance payers are getting a little bit better, you know, as we kind of progress and they open their eyes to some of the things. and the lives that we're losing, but the government funding and some of the bigger dollars definitely need to start paying attention. Yeah, and we are making progress in the United States. You know, the information from the CDC is that our overdose death rates are down by about 3%. But, and here in Pennsylvania, we're doing a little better than that. We're down by about 15%.

But there are areas in the United States that are not doing as well. So some of our southwestern states, their overdose death rate is up by 25%. It increased by 25%. So, you know, we need to address this as the crisis that it is, and we need backing. Yeah, we need legislative and funding support. You know, we are losing more people to drug overdose than to motor vehicle. accidents. And we have been for a number of years. So yes, we're making progress, but not fast enough. We are, you know, going back to the issue of a teen, we are losing 22 teens every week due to

drug overdose, accidental drug overdose. And that's an entire- Most of those are fentanyl poisoning. Yes, correct. And that's preventable loss of life. We need to do better for, our children. Yeah. Yeah. So, and I'm with you, I think that medications and everyone has their own pathway, and for me, the detox is obviously so important because if we don't actually physically remove the drugs from someone's body, it's going to be very hard for them to get well. It's going to be very hard for them to get well. And you touched on buprenorphin. We've talked a lot about naloxone today. I know these are very, if you're not familiar with the language, Google them or look them up and read about what these medications do. Naloxone, again, is the

overdose reversal drug. But buprenorphine is, can you talk a little bit about buprenorphine and your personal experience? Because there is a lot of energy in recovery communities around whether or not you're even sober, which I hate. But then this whole idea that when someone does go on buprenorphin or as someone would know it's suboxone they they lose their tolerance and then there might be an overdose or something shortly after they stop taking the medication right so buprenorphine is the generic name for the other names that it's known by is subutex suboxone sublocade is the injectable form again i it I would never say that any particular form of medication treatment is bad or good.

I think if it prevents you from sticking a needle in your arm, if it allows you to go about your life, to have a productive career, I think it is a very good choice. The other medication assisted treatment medicines are methadone, Vivitrol is another agent that's been used as well. And again, there's no right or wrong pathway to having a productive life that you are no longer using. But yes, indeed, that for everyone coming off of buprenorphine, and maybe you're not someone who should be off of buphenorphine.

Maybe it should be a lifetime of therapy. But coming off of bup is not always easy for everyone. And yes, that as you try to wean yourself off, that you may be at higher risk of drug overdose. Because you, you know, if you have relapsed and you use that you're exposing yourself to something that you are probably your tolerance is profoundly low. So you're at increased risk of drug overdose. Yeah. Yeah. And for me, when you talk about Matt, which is an acronym for medication-assisted treatment,

I really like to focus on VA. It's not medication as treatment. It's assisted. So the hope is if you're taking any of these medications or if you are working towards a productive life, having been suffering from a substitute, disorder that you are finding community, right, that you are moving around and there's some level of physical fitness. You're paying attention to what you eat. You're looking at how you sleep because it really is a holistic approach and it's confusing and every case is different.

Right. Well, that leads to the point that it's not just medication alone. It's having the right therapy, having the right environment. And as I already mentioned, for some individuals, it needs to be that confined environment until brain receptors reset. It's really of critical importance. Yeah, I mean, I'm grateful, and I can just share quickly my experience because I feel like that's valuable and something that people are interested in. You know, when I went to treatment, I was put on Suboxone or Suburtex. I stayed on that for about 14 days.

They slowly made me off it in a safe environment, and I did start to feel withdrawals, and I did have those moments of wanting to get high. I was in the container of a treatment center. And then I was able to kind of tough that out, extend there, like I said, for four months. And then right before I left, I did get Vivitra, which helped me with cravings when I walked out into the world. And now, 13 years later, you know, I'm in weekly therapy. I'm still involved in my, you know, own personal program of recovery where I go to meetings and I connect with others and I and I usher along people who are in earlier recovery. And that's just what worked for me.

Correct. That's what worked for me. And that's what I tell people today. This isn't, I wanted to feel like this. Right. It's not one size fits all clearly. And, you know, for those that have a strong faith background, you know, NA and giving up your power is very powerful for them. And it works.

So, yeah, there is certainly a lot of hope. in this recovery story. Yeah. Can we, and I hope everyone's been paying attention to the fact that we're speaking with a doctor here. I mean, this is the highest level of professional that we get on this show and in the world.

You've worked really hard to get to where you are in the career. Do I have permission to take the doctor hat on and put your mom hat on? Sure. I think. Although I think I've been wearing my mom hat too. Yeah. I just, I know that my audience, for better or for worse, is a lot of women, there's a lot of mothers.

A lot of the messages I get are from mothers who have lost children, mothers who are worried about losing their children. And I would just love to hear for those people, you lost. Just your only two kids. That's great. How have you been able to endure that and now be sitting in this chair talking to me, sharing your experience in a way that I believe is changing the world? What did you do?

What was your process? Sure. So, you know, just like recovery from drug abuse is not one size fits all. I would also say that is true with the recovery process from grief or from loss. Not everyone handles this in the same manner. Myself, I would say that it was faith, it was friends, and it was support. So from a faith standpoint, I believe in God.

The Bible tells us not to look back, but to look forward. I certainly have no regrets, neither does my husband, who also has faith, that we did... Did it challenge your guy's relationship at any point? Oh, sure. Yeah, sure. Oh, yeah, because we didn't always necessarily agree with steps in recovery or what we should do with our boys at any given time. And they weren't necessarily struggling at the same time either. So, yeah, we definitely had.

And yes, it certainly put a strain on our relationship when they were alive. But once they passed, we had different approaches to our grief as well. He's more of a, I'm going to put it in a box and it's put away. My boys are no longer here. And I'm likewise, yeah, I'm looking forward. I'm moving on with my life. And again, I don't have any regrets on what was done. Otherwise, I would say from a friend's standpoint, you know, going back to the, how do I cope in that friend's group, but I would also include work.

So my friends are also my work environment. And so I, after we really had funeral services for the boys, that we, I immediately went back to work. And it was hugs from colleagues. I spoke openly about this. People knew exactly. It wasn't hidden. So even like the housekeeper in the hospital building would know. And it was a hi, how you doing?

Oh, I'm hanging in there. And they knew exactly what that meant. Yeah, I'm hanging in there. But I also, from a professional standpoint, I see individuals who have infected heart valves. So they develop endocarditis. And material, infected material that's clinging to those heart valves, they break off and it travel someplace. And where it goes to is the brain, their kidneys. so they've had massive strokes, they lose their kidney function, they're on dialysis, they've

lost limbs as a result of heart valve infection. That's from intravenous drug use. So I see these individuals and I see them suffering and I know that, well, you know, my boys might have been spared the outcomes that I see in some of my patients. And, you know, it's not for me to say that, you know, it was right or wrong for them to have passed. But I certainly do think that they have been spared some of the outcomes that I see that the patients and those families are going through. So seeing that every day, I know that I'm helping them and really trying to move forward, helping them on their way as well. Yeah. No, it sounds like you've really put in a lot of time and an effort and energy and so it's safe to say I think you shared with

me before that one of your son went to treatment 10 times or eight times right prior to his passing during that was there was there moments of hope and in between losing your first son and your second son were you guys able to talk about you know I think that's probably what's what's confusing for some people is how did how did it happen again you know it just shows the power of this thing you know it shows the power of this well you know again each of them was dealing with substance use at different points in their lives um i think my older son to some extent he might have felt some responsibility for his younger brother not that one introduced the other to a substance at any point in time.

It was more of maybe I should have been there or that I should have been a better big brother to my little brother. Yeah, so, but ultimately, ultimately, I think the struggle was with the disease itself, with not being able to be without or just not having reached the point of success. And then fentanyl intervened. And that was the game changer. Game changer. So what's next?

What do we do? We've talked about a lot today, the importance of naloxone. to me is obvious and something that hopefully we're going to work together on and partner on and push out to the world and just I believe it's one by one with that you know like we need a we need an army of folks but what else I mean when we look at these numbers and everything and we talked about public funding and how do people get trained like what do you tell people that want to get involved in being a part of the solution well I do tell them and I do refer them to the ready to rescue campaign and that really that message says it all and the messaging that I tried to bring

forward is that for somebody who's saying not my kid not in my home I tell them look that is meaningless when you find your kid overdosing on the floor you know this this is there are no do-overs yeah there there's no instant replay where you get to look at the tape and say well next time I'm going to do this no this is a do or die circumstance and we need to treat it as that and we need to have the medication and the skills on hand so whether you're going to the ready to rescue.com campaign or the revive me.com campaign that's information it's immediately available it's at your fingertips you can do this in the privacy. of your own home. I would say to teach your children, start early, talk to them about the risks

of opioids, what in an opioid emergency, what does it look like, and to have, you know, how does naloxone work? How do you administer it? And this is, these are teachable moments. You go to the website and you'll learn together. And, you know, certainly if you hear about an overdose in the school system and your kids talking about it, well, you talk to them and you teach them. You know, I've also talked about having a kind of a friends and family program or a buddy system. So you teach your children to be socially aware that when you're at that football game or a party and somebody seems to be collapsed or unconscious is please go check on them.

You know, don't make an assumption they've had too many beers. They could be seconds away from taking their very last breath. And, oh, by the way, you have Narcan in your backpack. What an amazing experience for them to be a lifesaver for that individual. You know, I just recently saw a commercial out by the CDC. I thought it was awesome. It's a young girl. She's getting ready to go out.

She's taking a shower, does her hair, picks out the perfect outfit. Got those fine shoes on. She goes to her bag. She pulls out to make sure she has her cell phone. She's got her keys and wallet. Yeah, wallet. And she's getting ready to walk out the door and she pauses. She goes back to her vanity and she pulls out the Narcan dose, the naloxone.

She puts it in her bag. That's where we need to be as a community, as a society. we need to be ready to respond, ready to rescue, revive me. Yeah, I mean, I always, when I talk about my story, you know, it's crazy because the person that saved my life was not a doctor, they were not a therapist, they weren't a psychiatrist, they weren't a psychologist, it was a bank teller, it was a bank teller, I was trying to cash one of my father's checks, I wasn't overdosing, it wasn't a, a, a, a, a, a crisis situation. It could have been if I'd gotten the money from her, but she was just kind and she knew

something was going on. And she picked up the phone. She made a little extra effort. And that's really all we're asking people today is to make a little extra effort, get the naloxone, throw it in your glove box or have it in your person or make it part of your daily routine. Because we never know when that moment is going to come. And I don't want to be the person and I'm sure the listeners don't want to be the person that isn't ready to react and respond and revive if they are given that opportunity. Well, I will tell your audience that it certainly is better than a lifetime of regret, a lifetime of regret that you stood by and you didn't do anything, whether this was your family member or a friend when you're standing there and you don't know what to do. do and you don't have the medication or the education on hand, that will be traumatic for the person who is first on the scene and it's likely to be family or friend.

Are you, before I let you go, are you still in touch with your son's friends today? Is that something that's therapeutic for you? I always think about those relationships and I'm sure they're. They were, I've gotten to know you a little bit, and if they're anything like their mom, they were special, you know, and I think they're guiding this conversation today. I think they're guiding your work. I believe that. What do those relationships look like? How do those help you kind of push forward? I still get phone calls or I get texts from people that one of my friends, there's a song that one of my boys used to sing when they were going to, yeah, I think it's. it's, I'm blocking on the name, but I think it has, I smell sex and candy. Does that sound familiar? So we know, uh, Macy's playground. Yes, yes. Anyway, my son, when they were driving to soccer practice, he did not have a good singing voice, but he would sing the lyrics and she would call me

saying, hey, I just heard, heard that song on the radio. And I was thinking of your son today. Um, so I get things like that all the time. I'm still in close contact with my son's girlfriends. She texts me all the time. We share jokes. You know, and I work with my other son's prior fiancé. So I still have lots of contacts with people. And yeah, it's a very positive thing. And, you know, once one of my sons had to stand up to another kid who was bullying somebody at the bus stop. And he said, you know, I thought about him today and how he stood up for me. So, yeah, they were great kids.

I don't doubt it. I don't doubt it. And they have a great mom. And I just, I always tell moms. parents, there's no playbook. There's no playbook for this thing. Right. And there's no reason to live with regret as parents, and I'm not one, but I've seen, I've seen a lot of them in the middle of this, and everyone's doing the best they can. Correct. Everyone's so in the best they can. Right. You did, your husband did. Yep. You know, my parents did, and sometimes the outcomes,

Sometimes the outcomes are different, and we don't sometimes have a say. Powerless, right? That's absolutely true. Well, Dr. Myles, I am deeply inspired by this conversation. I am going to push it out as much as I can because I feel like it's something that the people of our country and the world need to hear. Is there anything we didn't touch on? Is there anything you want to share before we let you go today that you think it's just important for folks to hear about whether it's naloxone or substance use disorder or being a mother or anything that comes up for you? No, I think I've made my message pretty clear that we have a picture in our mind of what somebody who uses drugs, what they look like.

and that's a misconception. It's very likely to be your neighbor or the person sitting in the cubicle right next to you at work and for us to really keep in mind that we should have a buddy system. We should be looking out for each other and to show them kindness.

Yeah. Well, thank you very much. I like to give mom's hugs. Can I give you a hug before we Sure. Sure. Bring it in. A nice way to end today. I appreciate everything that you've done. Thank you so much for everything.

Oh, you're welcome. Thank you. Thank you. You're nice and warm. Well, you're an amazing person, and I felt that hug, and I love hugs, and they're so important. So until next time, thank you, Dr. Mylus. You're welcome. Thank you so much for having me. Get your neloxone now.

That's right. Bye-bye.