We're Out of Time - What Happens When Pregnant Women Seek Substance Abuse Help?

Episode Date: December 17, 2024

Join @RichardTaiteOfficial and special guests Dr. Kenneth Spielvogel and lair Steel Psy D for an eye-opening and informative conversation about helping expectant mothers who are suffering from substance abuse issues. Dr. Kenneth Spielvogel is a Senior Medical Officer with a Special Interest in Addiction Medicine and Blair Steel Psy D. is a Licensed Psychologist. For all things Richard Taite, the We're Out Of Time podcast, and Carrara Treatment Wellness & Spa: https://linktr.ee/richardtaite Key moments from this conversation with Blair Steel Psy D, Dr. Kenneth Spielvogel & Richard Taite. Intro 00:00 What has Dr. Spielvogel seen firsthand during the last 5 years of the addiction epidemic? 02:02 What are some of the primary issues that Dr. Steel sees facing women today and how is substance use playing a negative role? 03:11 Are women not receiving the medical attention they need concerning substance abuse especially due to stigma? 06:20 What is M.A.T., medication-assisted treatment? 18:11 What psychological factors does Dr. Steel see with her patients regarding early recovery? 24:36 Why is trust a primary factor in helping those in need of addiction & substance use disorder? 27:06 How is AI technology becoming a part of treating patients in recovery more effectively? 32:50 #advocate #losangeles #substanceabuseawareness

How do we erase the stigma around women who are pregnant coming into treatment? So much has changed in women's issues. One of them is the prevalence of substance abuse. And there's nothing more tragic than seeing an overdosed mom in the ER who's potentially unrevivable for unborn child suffers the consequences as well. As you guys know, my name's Richard Tate. I'm the founder of Carrara Treatment Facility. I call this podcast, we're out of time. And the reason I do that is because we actually are with this fentanyl crisis that we're having. I mean, the opioid epidemic has been going on for a while, okay? But now it's killing everybody with fentanyl.

And, you know, when you were back in the day, when you were scoring cocaine or heroin or pills off the street, It wasn't, you thought you were getting it. You know, you were getting the percocet. You were getting the heroin. You were getting all these drugs. Today, that's not what you're bargaining for. Okay, it's being laced with fentanyl. It's killing about 112,000 people a year, right?

And it's increased 30-fold over the last, you know, 10 years. and most of it has been in the last five since I've been gone. And one of the reasons I came back was because of this. This is Dr. Blair. She's a psychologist. Fantastic. She's been doing this for about 20 years. This is Dr. Kenneth Spiel Vogel,

one of the finest women's physicians in the city. And let's start with Dr. Spiel Vogel. Good morning. Thank you for having me. That's my pleasure. Thanks for being here. Yeah, I mean, this is an epidemic. And it's in the realm of pregnancy and delivery, it is a unique problem because in my job, it's a unique area of medicine because we treat at least two patients at once.

We'll have a mom and unborn child. If it's a singleton, if it's twins, triplets, obviously that brings more individuals that are affected into the picture. So, you know, this problem I've definitely seen, you know, the pandemic weirdly kind of brought a certain quiet to it and definitely started to rear its head up again. And there's nothing more tragic than seeing an overdosed mom in the ER who's potentially unrevivable and, you know, her unborn child suffers the consequences as well, too. So, you know, I wanted to be involved.

I wanted to have a voice that extends well beyond the hospital. So I really appreciate you having me here. It's my pleasure. Thanks for adding to the conversation. Blair. Yeah, you know, so much has changed with time and women's issues. And one of them is the prevalence of substance abuse in women. And women, as we know, are mothers.

And there is a lot of stigma attached that can really prevent someone from seeking treatment and asking for help. And some of it can come from extremely well-meaning practitioners. Especially when they show up to treatment, pregnant, showing. Yes. Because there's so much judgment around it. There is. And you have to be aware of that and work through it. And to be honest and vulnerable, I've had to work through this myself.

And it's very important that I get to the place that this person needs and deserves as much love and care and attention as anyone else. Yeah. Someone asked me last week, they said, what's one of the biggest barriers to treatment when it comes to opioid-addicted moms? I said, judgment. Honestly, judgment is probably the biggest one because I can walk in a problem. room, introduce myself to every family member to patient, really get on a level to where they feel safe and cared for and in a judgment-free environment to do so, which honestly to get a patient who's addicted to trust their health care provider is an incredible challenge. And especially

when you mix in race and we look at the outcomes, especially for African-American women these days and that they clearly have a disparity when it comes to health care, you know, being able to bridge those gaps and get to a place, have them feel safe and cared for and trust you. And then you leave at the end of your shift and someone else comes in and that trust is eroded instantaneously with the person walking in the room. I mean, that's the biggest barrier. It takes more than one person that's willing to come out from a judgment-free point of view. True. An AI, which is scary and lot of domains, I find is hopeful when it comes to this. I think AI will really help when it comes to stigma and judgment. How so? So heart disease, for example, is the leading cause of death

in women. And to this day, a man and a woman can enter an ER with the same symptoms, chest pain, etc. And he will be screened for a heart attack and she will be screened for a panic attack. So if we can have, right, it happens. So if we can have AI just read symptoms by symptoms, not with race and gender and socioeconomic and everything else. I feel like that gives some hope to people receiving the treatment that they need. Yeah, it's ridiculous how women. It's funny. I had somebody bring in my dry cleaning, right?

a woman bringing my dry cleaning, and it cost three times more for her than it cost for me. Right. And they do that mechanics too. Like women get the short end of the stick. Hair stylists. Everything. Yeah, women get the short end of the stick everywhere. You know, how do we go ahead and erase the stigma around women who are pregnant?

coming into treatment. Well, it's vital. I mean, it's because the majority of women who are using will not come in for prenatal care. They'll essentially show up for delivery or if they're having an acute episode, vaginal bleeding, contractions, whatever it may be. That's the biggest stigma. I mean, it really is. It's getting women to a place where they, you know, are being treated for recovery.

if they're on buprenorphine, that they feel like they can come in, if they're requiring additional dose, you know, that that's done without kind of any judgment. And that's around, to me, it's around education and, you know, an awareness of the pathophysiology of addiction. I mean, it really is. And I can tell you, if you asked, what's the amount of hours that I receive training in specific to addiction during a four-year residency. One hour.

Well, my answer would be we do a internal medicine rotation as an intern, your first year training, and essentially, you know, somebody drunk comes in the ER, you admit them for, you know, treatment of withdrawal, very patient-specific, probably totals about four hours. In four years. In four years of when I train, 90-hour work weeks. Right. So there's no understanding. Wow.

You know. I hear often working with clients who have to go to the hospital and when addiction is the primary diagnosis, right, substance use disorder, they feel like they're treated like second-class citizens, kind of thrown in the hallway, not giving the attention. And I truly believe that healthcare professionals are well-meaning, but we're still human. So to answer your question, I feel like talking

about it and injecting it with compassion is essential to getting people aware of where their biases are. Not if but where. Right. And bringing it to surface, bringing it to light. I find if you relate it to a disease that people are already well versed in, that's a good way to do it. So what's a good example of that? Diabetes. Somebody's diabetic. They take insulin for their diabetes. Nobody looks at a person who's diabetic and on insulin says, why are you on so much insulin? Like, why are you on 120 units a day? Let's put you down. That's not true. People are getting fat shamed all the time. They may be getting fat shamed, but point being is there's a recognition of a chronic illness. This is the treatment. In the medical community. Right. Okay.

So now you take somebody who's pregnant. Maybe they're already having, you know, medically assisted recovery. And they're on buprenorphine. They're on 8 milligrams a day. And they walk into an uneducated provider in the first trimester. He says, oh, my God, you got to taper down. We've got to get you tapered down. Can't be on that during pregnancy. What do they do?

They start tapering the patient down. They start to experience withdrawal symptoms, uncomfortable. Then the trust erodes. And that patient disappears. And they show up at the hospital in labor, no prenatal care and all the associated complications thereof. So understanding, there are some people, that will be on it for life.

That's their affectation. That's the medication that they take to treat it, just like we treat high blood pressure, just like we treat diabetes. You know what it is. They come in, I think you get pregnant if you're going to carry it to term, right? There's a part of the mama bear inside of you, right?

And it's protective and, right? And so then what happens is they feel such shame, right? That they're not coming to you in the first place. And so really what we got to do is we've just got to, it's got to be the same exact thing that we did to erode substance use disorder in the first place, which is you're not bad. You're just sick. Right. And now, like you said at the beginning, it's affecting more than just you. And what scares me the most while you're here is because I'm a father. And, And when you're as old as I was when I had kids, you don't just love your kids, you love all kids.

And I am desperately passionate about this opioid epidemic and specifically the fentanyl thing. It's causing more homeless, which I'm also passionate about. And if I see another child on the street in an encampment, I'm going to snap, right? I see that all the time. but this is so bad because they're being born with birth defects, right? I mean, birth defects, you know, you can, where there's smoke, there's fire. So somebody that's using is probably doing other harmful behaviors that potentially could contribute to an unhealthy pregnancy. But they're doing other harmful behaviors because they're loaded, right?

Right. Yeah. I mean, there's any number of reasons. You know, women, I'm sure you know, this player, is I mean, women who are addicts tend to use with their male partner, which is interesting because men generally use with another male compatriot. So women are using with, you know, their male partners. With that comes intimate partner violence. We see much more of that. We see much more smoking, poor nutrition, unstable housing, unstable food source.

So all of that is going to contribute to, you know, poor outcome in pregnancy. Right. And we're assuming here that the woman chose this pregnancy. We're assuming that she's aware that she's pregnant. I mean, we can assume that someone who's engaging in high-risk behaviors and not necessarily aware of the timing of things is likely having poor nutrition, which affects someone's menstrual cycle. So let's say she's been irregular for a long time. There's a chance that she wouldn't even be aware that she's pregnant until five, six months in until you're showing. But when you're five, six months showing and you're already in the grips of addiction in the first place, right?

How do we make it so that we can draw the distinction between, oh, you just found out that you're showing? This is different. Now this is going to affect your baby. She's going to be born or he's going to be born or they're going to be born addicted. And the withdrawal is painful. And I assume that sometimes that results in a fetal death, right? I mean, it can for sure. I mean, any of all the reasons that I named, we, more than on several occasions,

I have seen moms come into our OBER with a deceased fetus. So how is it in a hospital setting, how can we get like somebody like Dr. Blair, in there so that the second, on the first time they come in, right? They meet with somebody like you and you sit down with them and you connect one on one and you, you know, give them the reality of the position they're in and how to deal with it, maybe refer them to, you know, a treatment center, right? how isn't that isn't that something that um a hospital administrator would be open to yeah i mean we you know so if a patient comes in let's say they're untreated addict right i literally just had this

patient a couple of days ago um come in the first barrier is do you want to see do you want treatment are you willing to be treated wrong wrong question man wrong question nobody wants treatment okay the only thing harder to sell than treatment is adult circumcision i'm not even kidding swear to god it's the hardest thing i can tell you that in my experience though in the obeer when a pregnant mom comes in who's using and in withdrawal she's amendable to treatment like she's amendable to treatment she's having a moment it's called a moment of clarity okay if you don't take her right there if you can't transfer her right there to a treatment center, that moment passes like a cloud just goes, right?

So is there an apparatus? You're a teaching doctor there. They revere you, okay? Is there a way that maybe something like that can be put into place that somebody who's skilled like Blair can meet with them one on one, right? And then you make the referral right away to wherever you think is appropriate. And there'll be like a transfer portal, right? We know of those things, right?

Transfer a referral portal, right? And so you take that, you look into it, you do your assessment of where is appropriate for her, right? And you arrange for the pickup, right? And she's transferred immediately. It sounds ideal. It really does. Well, that's what this is about. It's about solutions.

Well, great. You know, even would you say, I'm curious. So I hear this from patients a lot that they'll go see a provider. And actually, the provider is inputting a lot of data and they're seeing someone's back. Is that accurate? Sure. Yeah. So we've got so many things to do before this.

I mean, this is phenomenal. Right. But I want to get back to that. I want to get back to the solution. I don't want to veer off. So step one is, If somebody comes in, like I said, in withdrawal, data shows the opportunity to get them on a medically assisted program is right in that moment. That's right.

And that means starting them, I'm going to be very specific with you. So starting them with 8 milligrams of buprenorphine, right there. Treating other symptomatic elements of withdrawal, nausea, vomiting, whatever it may be along the way. waiting one to two hours seeing how they react if there's better but still feeling edgy agitated whatever it may be another eight milligrams why not four uh generally i mean there's a lot of different ways of skin and cat you can do four every hour you can do eight do it based on weight and all that other stuff yeah i mean eight milgaret the great thing about buprenorphine you're not going to overdose them right so it has a sealing effect so buprenorphine

has a very strong affinity for the mu receptor, which is the primary place where opioids act. So the reason why it's so important, and I would say, I'm going to go with 92% of health care providers don't know this. The reason why buprenorphine is so great is because it locks onto that receptor. And if that patient leaves, for whatever reason, their partner, whatever outside influences goes and scores a bunch of heroin laced with fentanyl they're not listen to me they're not going to die because buprenorphine binds to that receptor is protective so it won't it will prevent an overdose had philip simore hoffman had prince been in recovery on buprenorphine they'd probably still be alive today but isn't it i get that and i'm and i didn't know that okay isn't it if you're not

not taking Suboxone at the same time every day with the same dose and you're taking it, you know, early. You're like walking around two-tenths high. Yeah. Why? It's just not the mechanism of how it acts. Generally, it's a suppression of symptoms of withdrawal without necessarily a super-technical term, supertentorial sense of being high.

Okay, well, that you're going to have to explain. Right. So that's just, that's it being a partial agonist to that particular receptor. So its mechanism of action is such that it's not going to be a high as you would get, a dissociative high that you would get with heroin, fentanyl, whatever it may be. So isn't it like modern day methadone? No. So that's a good question.

So methadone is going to fall. First of all, methadone is a synthetic opioid. It binds weaker to that receptor. So the danger of methadone is that somebody could be on methadone, go out and score, use, and still have an overdose episode and die. So why is anybody using methadone? Well, we're not. So, you know, to grab it. Wait, wait, there's methadone clinics.

Yeah, there are methadone clinics, but definitely within the. realm of, you know, the focus on pregnancy, delivery, opioid-addicted moms, buprenorphine is drug A of choice. So here's an example of methadone. So here would be an example of methadone. You have, let's say, somebody who had a hip replacement that got, you know, 45 oxy to go home with, got three refills from a neglectful provider and gets addicted to opioids. So that's the patient where methadone is really going to be appropriate. Because it's a titration. Sure. It gives you long-term pain relief, you can dose down. So we have very specific protocols for 30% reductions over the course of three weeks and really trying to get somebody off. So buprenorphine, again,

that's where I get into this insulin diabetes analogy is buprenorphine is for primarily that management of the symptoms of withdrawal. Okay, but here's where I need the distinction drawn. If you've got somebody coming in, right? A mother who's pregnant coming in. And she's taken, I don't know, 320 oxycontin, right, a day, right? She's loaded and she's going to have a withdrawal if she's done it for any length of time, right? Why would you not detox her with the methadone if that's the way you do it with other populations, isn't she going to, how do you assist, how would you assist that detox process with a pregnant mother? Great question. So, and that's the very reason a pregnant mom, why we want to use buprenorphine, because when it comes to neonatal abstinence syndrome, which is essentially,

you know, infant withdrawal from opiate, chronic opioid exposure, using buprenorphine, we see less neonatal abstin syndrome. babies spend less time in the NICU, fewer days of withdrawal symptoms, and less narcotics. Yeah, but she's suffering. And less narcotics in order to treatment. So that's why we want to use buprenorphine. And then with the 8 milligram titration protocol that I gave you, those moms get to a place where they're not experiencing withdrawal symptoms. And they have enough of an effect, not to be loaded per se, but you have to have to be loaded.

per se, but you have to remember that when you're an addict, a lot of times you're using to prevent withdrawal. You could have a mom who's tortured by the fact that she's having to take two oxies every two hours, right? So she has now been treated to where, oh my God, I'm not getting jittery. I'm not getting craved. That's an excellent point, right? So she's using, right, to not just stay high, but to keep from getting sick. That's the primary motivation. Of course. Of course.

So my question then again is, what do you use along with bupren to detox this woman so that she's not suffering because it would seem like, yeah, it's better for the baby, but it would have been better for the baby not to be using in the first place, right?

So how do you assist this process of buprenorphine with what other drugs? to keep the mom comfortable so that she sticks with it. Right. Great question. So we'll use buprenorphine and then we'll use hydroxasine, which is Adirax, which is essentially like a Benadryl-type drug that actually works really well. We'll use gabapentin.

Which is? Gabbapentin. Essentially, you know, it's used as a pain reliever drug, but it does work really well with addiction-like symptoms, reducing crave as well too. And then if there's mental illness as well, too, you know, treatment of that. So, you know, there's a lot of different ways. But again, primarily it's preventing this patient from going into fulminant withdrawal and not feeling like they have to use to stave off withdrawal.

Dr. Blair, is that what you're experiencing with women who are showing? And when you see them addicted to drugs, what's your experience around that? It's just that. And with everyone truly, the fun, whatever that high was is long gone. People are fighting to just feel normal, to have some sort of baseline of functioning. So keep in mind, by the time we see them, people's lives have been in absolute shambles. It's true, right? So we're trying to get to like this level of clarity where maybe they could show up for work, right?

Maybe they can show up for other family members and relationships that they already had preexisting. It's truly a fight. I'm really curious. Are there any legal repercussions for a woman coming in to see you in an ER who has substances, elicit substance here system? I'll tell you a brief story. So when I first graduated from residency from University of Colorado, I started working in South Carolina. And there was a landmark case. This is, I'm going to age myself, 2001.

And a woman that was on crack, that crack overdosed, she had an abruption of the placenta, which is a premature separation of the placenta from the wall of the uterus. She bled out almost died. Her baby died. And she was put in jail for murder. Wow. In South Carolina.

I literally hadn't stepped a day in a doctor's office and I was on the news talking about whether or not I thought it was right to charge a crack addicted mom with murder. So there is an absolute fear around, you know, for a woman using of coming into the hospital that this potentially could be them. And California is as like mom addicted friendly as they come. In the South, forget about it. I mean, it's a totally different set of rules. You know, when I ask this for barriers, I'm trying to understand the barriers for women to come and see treatment. Right.

And we discuss judgment and we discuss stigma. But I'm curious what other things that people would really be terrified of. They can't get off the couch. They can't get off the couch. You know, the reason people use opiates a lot of the times. And the reason they're called pain killers is because they work better on emotional pain than they do on physical pain. And we're a depressive society, you know, in disdemean dispensual. is getting worse and worse. It's getting harder. Careers are not careers any longer. You're

changing careers every three years now. It's not like when we were kids and you could be, you know, whatever it is you were. You work in an auto plant okay for 30 years. With a pension. Right, with a pension. And, you know, those days are over. Now, you know, the technology, it's like every day, right? It's changing. So, um, I want to get back, if you don't mind, I want to get back to the solution, okay, one more time, okay? Because we can either talk about it or be about it. And, you know, you're a big shot there, okay? How would it be received if we put an outline together that said, hey, look, when they come in like this, right?

when a pregnant mother comes in and she's showing and or not, right, but it's not going to happen if they're not showing in this case, chances are, right? So if she comes in, she's showing, right? She has an accidental overdose. She's in the ER. How do we get Blair in there right away these centers that will take people for Medicare and Medicare and Medicare and Medicare? and all these insurances that treatment centers don't typically take.

So we put those in the portal. She then refers, gets them to pick them up, or you guys transfer them right to the treatment center, and we save a couple lives. How is that going to happen? So I think going back to what we were speaking of specifically to starting them on medication. So starting them on buprenorphine, gets them to a place of I'm not addicted, feeling trusted, feeling like I'm going to go along.

Wait a minute. Hold on a second. That's true. That's the first step. But they're not going to have, wait, wait, hold on a second. But they're not going to trust. She's the one that gets the trust because not every doctor's like you. The patients that you have trust you because you're unusual. We need somebody, a social worker, okay, who has. the ability to connect and really love them and express to them how serious this is and that it's going to be okay and then make the transfer and stay with this woman until they actually picked them up. That is how I envision it. So how do we get that done? Will they be, will the people be receptive to that? If you don't treat the symptoms immediately when they come in, because a lot of these women come in, let's say, just 24, 26 weeks. 40 weeks is a completed pregnancy.

They're coming in because they want to check on the baby, quote unquote. So we do an ultrasound, we check some labs, they get their prenatal labs done, they know the baby's okay. Let's say they're in withdrawal at this point. If you don't treat that, I don't care if you have Dr. Joyce brothers, whoever it may be out there,

as the greatest possible psychologist, social worker, counselor, if you don't treat those symptoms, you lose them. Period. Because they're sick and they need to get well. I get that. Let me finish. So there's things called a warm handoff, which essentially is once we've done that initial treatment, it's not give them a prescription, send them on their way and have them follow up.

Now, granted, follow up is important when it comes to medicine. Where we might not see a pregnant woman, you know, every three to four weeks until she gets closer to term, these women need every week to every two week follow-up. But in that process, once we get them stabilized medically, because you have to understand, the majority of these women are not in a place mentally where they can hear from a Blair. They're so agitated and in withdrawal. If you don't treat that, I don't care who comes in the room. They are out. They're gone. So you establish that trust, a warm handoff. I have a relationship with you. I call you. I say, I need you to come. I need you to speak to this person.

Whoever it may be. There needs to be an alliance. It has to be a team between medical providers and social work slash psych. And we do not have that. And if that can't be done in the hospital, then to have a facility that's willing to come get that person to take them into a coordinated treatment program. To me, that's the way to do it. and one where, you know, the obstetrician in this particular case for pregnant women is in coordination with them. They're speaking to me. I'm speaking to them. I know how she's doing there. They know how she's doing with me. So it's a coordinated care system.

Sounds beautiful. Really? It is beautiful. But you're talking about the person, right, that actually has the wherewithal to come in and check on the baby. And that happens all the time because you're seeing it. I'm specifically talking about the woman who is overdosed or med seeking and going into the ER, right? And that woman is like the baby is an afterthought, right? And so what I'm saying is, is there a way procedurally, right, to work it out with the hospital, right? to actually have this policy so that we can save the masses. I know what you're going to do, right?

But you're one of one, okay? What I want is a policy that they have to follow every single time this happens. Is there a way to, listen, I don't care if you got to shame these administrators or shame the hospital system. That's okay. Or incentivize them as probably their language. Okay. How do you incentivize them? Right. Right. I'm always looking for the punishing program.

Right. Yeah. Because hospitals encourage, as an example, when we take maternal transports from outside facilities, the hospital gets a stipend for every patient that they take as a transfer. Can we get the opposite? Can we get them incentivized for everyone they send to treatment? Right. I mean, it's a great idea. You know, it's beyond my pay.

grade to understand how you go about that. But definitely from the standpoint of protocols, I mean, we live for protocols. And AI, I mean, AI is going to generate protocol. It is. Oh, that's great. You know, where that'll really make a difference. You know, the insurance companies, okay, are all about outcomes now. Yeah. Right. It would seem that insurance companies would have a, um, uh, uh, a horse in this fight, right? I know. that's wrong. A dog. Whatever. What is the horse in the race? Yes. A dog in the fight. Right. Both of them. Both of them are good. Right? It would seem that they have a self interest in getting this transfer to treatment to prevent the ongoing med seeking and the ongoing

survival. Because the cost of treatment for an addicted baby is probably about half a million Don't. Shut up. Sure. I mean, it's an ICU stay for, you know, whatever length of time, five to seven days in the ICU on top of aftercare treatment. I mean, absolutely. If you could tackle that alone, you could probably save the health care industry $10 billion a year. Well, there you go.

That's the ticket, right? I threw that number out of somewhere. No, but it won't. I get it. No, I get it, but it's basically it's not, it's not so much anecdotal. It's, it's more or less field research for you, right? So, um, that's the ticket right there. That's the ticket.

Or even liability. Like, what if the hospitals were liable at that point? Like, they are the ones now responsible for the life of the fetus. Yeah, but I think it's 250 for a wrongful death and it's not. Yeah, but they don't care. I like the, I like the, I like the fact that. the CEOs, right, of these insurance companies are making between $30 and $50 million a year, right? And they're doing it based on, you know, gains quarter over quarter year over year.

And I think that this is something that would be genius for certain companies. They'll all jump on, but you have a Cigna or an Atena or Anthem or whoever it is. Some stud walks in and says, no, no, this is the policy right here. Okay. and, you know, everybody jumps on the bandwagon. Right. So if you took it from a, there's several programs across the country that are doing this,

if you have it from an ambulatory standpoint where they're non-impatient, and you take that mom who comes in overdosed in the ER, stabilizer there, and then Clinton actually wanted to do something similar to this, where you get a, you literally have a facility where you have Blairs, I hope you don't mind me referring to you as a noun,

but that's fine. But you have Blairs, you have physicians trained in addiction. They don't need to be addiction specialists. They just have to have an interest. You have the potential to do ultrasound. This is very specific to pregnancy. Everything in place for aftercare, home visits, and those moms go to those places and get their care there.

Then they come back to your facility for the big ticket, the delivery. So the hospital recuse that. Right. Right? But then the mom follows up in a specialty clinic that understands her affliction and is able to treat accordingly. Can we get that in the continuing education protocols and programs to where guys like you, maybe you train a handful of guys and they're responsible for training a handful of guys and so on and so on, right? And that is, we're educating OBGYNs right from the gate, right, so that they understand what these protocols are and they can identify the med seekers and the people who are overdosing and addicted. Is there a way to do that? I mean, that's been a dream of mine is to literally have a traveling circus to residency programs across the country.

to be able to do whatever symposium, an hour, two hours, half a day, full day, which honestly, it doesn't require much more than that to at least give them the tools to feel comfortable treating. It really doesn't. And then they just have to give a shit and be a human being. And therein lies the blarets of the world to help fill the holes in that caring empathy. I'm talking about the doctors. Yeah.

Because, you know, a lot of doctors are desensitized. Right. To the process of helping another. But if we can get a drone to just like eight milligrams of this, da, da, da, da, I send you on your way. But then we have on the other side of it, the loving, caring people for that patient to go to and know that she's going to be judgment-free and get care and treatment with people that understand.

I mean, that would be amazing. You know, it would be a good idea, Blair. This is for you. Because I've spoken in a lot of these psychological universities, right? wouldn't the seniors or the people who are about to graduate that have to do their hours right and they get out they've got to do their hours wouldn't it be great and they're altruistic at that point right right they're on fire so they come out they're trained in this right they go ahead and they do you and their hours are actually signed off on by the hospital that seems like you know a cost effective way to do you do it for everybody in really the best way. It does. If you had an important center where you had a reputation for treating people in a way that was,

you know, so globally effective. And then you bring in residence, resident psychiatry, my field, whatever else. I mean, yes. That is, it's not groundbreaking. It's done in many other areas. It really is. It's done in reproductive health services. it would be amazing.

It's even done in hospice. Right? And these people are on the way out. Right? This is something where they've got like, what, an 80-year life expectancy. There's a separated fellowship for hospice care in medicine. And there's a fellowship as well for treating mothers.

There's one in Ventura. A friend of mine is interested in doing it. And she's an MD. She's 33. And, you know, female doctors, the statistics of a female doctor's is rising on the rise. And universities is totally flipped now. There's more females and males.

So I'm hopeful that... I'm the only male in a 14 physician group. Wow. So... Amazing. And I love that. Get them while they're fresh, not jaded, not, not, you know, towards the end where they're being desensitized.

That was my idea to deal with the homeless issue, right? Just you get one guy. It's the Pied Piper, right? They 25 of them follow this guy because this isn't something that you can teach, right? I mean, I guess it is if you see, the problem is normally you can video yourself and, but you can't in the homeless population, right? Because if you're doing it that way, these people get creeped out and they don't want it, right? So that can't happen. But if you walk around with coffee and breakfast and whatever sandwich, whatever it is, right? Sox, jackets,

It's blankets, whatever it is, and you're of service, and you have the conversation, and you can pull a couple people off the street a day and put them somewhere. You know, it's magic, right? I mean, that's how I envision this, right? You go in and you have, you know, I've seen the doctors walk in. You've got four guys in tow, right? And so same thing here. You know, you walk in.

You've got four of these trainees. these people straight out of school. They come on in. They see how you do it and they branch out. And the next thing you know, they're training. And they don't have to do a bunch of hours. They can do, you know, 100 hours of this and then become proficient. And they grab the next four, each one grabs another four.

And you can make a difference in a whole hospital in like, you know, three, four months, right? And these hospitals are all chains now, right? And then they go to the next chain and the next chain. Like you're at Memorial, that chain, right? They're like the third biggest in the nation, aren't they? Okay? I mean, you could do that. These could be positions.

And in every major city, you've got these psychological universities, right? And think about it. These people are such good. Most of the people that go in to be a therapist, right? They've got good souls. Right? Right? Right?

Well, meaning. Yeah. Sure. I mean, can you imagine, that's not a hard sell to get them to, you know, take care of babies and mothers. That's not hard at all. You're caring for two. That's right. At least.

At least. Or a four deal. Yeah, exactly. All right. What else we got? This has been so productive. I don't even know what to say. I'm so grateful that the both of you came today.

Thank you. I really am. It at times feels like. a, it really feels like an insurmountable problem to solve. You know, when you, you treat a mom and a baby who doesn't survive, you just, it'll haunt you. But Kenny, I get it. But you got to take the first step in on anything. So if it was easy, everybody would be doing it. You got to just got to drag these people across a goal line. No, it feels really hopeful. It really does. Because to me, You know, it's funny, I've had this conversation before, but when you have it and you realize, yeah, it's not that hard.

It's not that hard to do it. And it's not that hard to get other people involved to figure out how to do it. It's hard to start it. It is. It's hard to get people in power to get on board. Okay. And you really have to give them the credit. Right?

You have to, and you just have to be, you know, hey, man, you almost have to talk to them and make it their idea. right so that oh true right so that they're married to it yeah i don't suffer that affliction i'm always like great idea rich i really don't hey man i don't that's like that is politics to a t i do not need credit credit is for politicians all right right well this has been really really nice and it's been a pleasure to talk with you blair likewise i would forward to war yeah so guys Thank you so much for coming. I just, before I leave, Kenny, how can they find you? If anybody needs you, how can they reach you?

Just call my name when I'm there. Right. Isn't that a song? Carrier. You just call out my name. Hey, by Carrier Pigeon or what, man? You can reach me at kennispielorgal.com. I actually have a web page.

So happy to have you reach me that way. You can email me from there. I'm a faculty member for the UCI. OB-G-Y-N-R-D-Y-N-R-R-N-R-N-R-N-R-N-R-E-L-E-R-N-R-E-R-N-R-E-L. I'm always up, so we never close. I got one more question for you so that people can actually find you. How do you spell Spiel-V-V-E-L? Like Spiel-B-E-L-V-O-G-E-L. So S-P-I-E-L.

Very good. Blair, how can they find you? You can find me at Correct. Treatment, Wellness, and Spa. I'm actively working with them. You can Google them. You'll find their website. And you can find me personally at Dr. Blair's ID on Instagram.

Outstanding. Thank you guys. Oh, you were going to fact-check me on something. Yes. I have not been doing this for 20 years on 39. That dates me a little older. Sorry, sorry, Doc. How long have you been doing this, Kay?

30 years. Amazing. Did I get that right? Yeah. Okay. All right, guys. Thank you so much. Thank you. I appreciate it.

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