Fatal Facts of Fentanyl
The Fatal Facts of Fentanyl is dedicated to raising awareness of the illicit fentanyl crisis hitting the USA. It is killing tens-of-thousands of people who suffer from substance abuse disorders and first-time users.
There are no boundaries. It is straight across the board with the number of deaths without any regard to race, sex, socio-economics, age, education, religious background, location. It is in every community within our country.
The fentanyl crisis is deadlier than ever before for various reasons. It is time to address the many issues surrounding this crisis. It is time to listen and learn from experts. It is time to hear the many stories from people who have lost their loved ones due to death by deception.
Change begins with each of us as individuals and collaboration with others towards this positive transformation. The goal is to save lives and families from this travesty.
Awareness and Education are the key.
Knowledge is Power.
Fatal Facts of Fentanyl
Understanding Addiction as a Disease ~ Know Science, NO Stigma
Understanding Addiction - Know Science, No Stigma... Interview with Dr. Charles Smith, author of this most informative book ... a must-read for those struggling from the tragic effects of drugs and alcohol.. and for their families to understand the behaviors often associated with this disease of addiction.
Dr. Smith is an expert in this field with personal, firsthand experience with the humiliation and shame that accompanies substance use disorder. He points out that addiction is a disease .. no less so than diabetes, heart disease or hypertension... and needs to be treated as such.
Unlike most other illnesses, substance use disorder is characterized predominantly by behavior. Stigma is our biggest killer. It is a deterrent in combatting addiction and to get to the root of this disease. It hinders growth and progression.
Knowledge is POWER...
https://www.amazon.com/Understanding-Addiction-Know-Science-Stigma/dp/173723520X
The Fatal Facts of Fentanyl podcast is dedicated to raising Awareness to the illicit FENTANYL crisis hitting the USA.
The goal is to SAVE LIVES and families from this travesty.
Awareness and Education are the Key.
Knowledge is Power!
The Fatal Facts of Fentanyl podcast is dedicated to raising Awareness to the illicit FENTANYL crisis hitting the USA.
The goal is to SAVE LIVES and families from this travesty.
Awareness and Education are the Key.
Knowledge is Power!
Understanding Addiction. Know Science, which is K-N-O-W, and NO Stigma, which is N-O. Let's end stigma surrounding addiction in this country. Stigma is our biggest killer. I have today as my guest Dr Charles Smith. He and his colleague Dr Jason Hunt are the authors of their book Understanding Addiction ~ Know Science, No Stigma. They bring a unique and important perspective to the subject of addiction. An expert in this field, Dr Smith, has a personal, firsthand experience with the shame and humiliation that accompanies substance use disorder. Addiction is a disease, no less so than diabetes or heart disease, and it needs to be treated as such. Hi, Charles, Welcome. I hope you don't mind me calling you Charles, but first let's clarify that statement for our audience. Addiction is a disease. Tell me what you know about that and let's begin with the science behind that statement.
Dr. Charles Smith:Well, my interest in that particular phrase happened when I went to treatment myself in 2009. I had been a family practice physician in West Virginia and Kentucky for 26 years and in 2009, due to a series of interventions that I describe in the book, I went to treatment myself. But when I got there and spoke with the addiction medicine physician and the counselors and the therapists, they told me you have a disease. And I said wait a minute, I drank too much, okay, and you know I got hooked on those pills, but that can happen to anyone, because I had a sample cabinet full of them and that was my knowledge and my mindset at that point. And, of course, that was almost 13 years ago now.
Dr. Charles Smith:Since then, I have learned that it is a disease just like diabetes, just like heart disease, just like hypertension, and it can be identified through a particular area of the brain and a particular system of the brain the dopamine reward system and the dopamine reward system's effect on the prefrontal cortex and our decision making. And that's really what prompted me to write the book. I check in patients at the two detoxes that I work here in South Florida daily and I go over this with them that certainly they did have some bad behaviors, but I think those bad behaviors can be explained due to the fact that he had a vulnerable dopamine reward system.
Lisa Carole Cude:I read your book, by the way, thank you, and I actually learned a lot from it. I wish I knew then what I know now that I've learned more about addiction. Can you explain to our audience about what you mean about the dopamine receptors, because a lot of us parents or people who have a loved one who has an addiction, especially an opioid addiction, we can never understand why can't they just stop, like you know? Explain that to us. I mean, I found it very interesting about that part of the brain.
Dr. Charles Smith:Well, you know, I always start out by using that little example. The newborn infant you have a newborn infant in the nursery goes through the trauma of childbirth. Then you know a couple of hours he's going to be laying under the incubator and he's going to start crying. So I always pull my audience. Why does this baby start crying?
Dr. Charles Smith:And people will say all sorts of things he's cold, he's wet, the lights are too bright, he misses his mother. But the bottom line answer is he's hungry. So his dopamine reward system signals him that there's stress and trauma and if he doesn't get some carbohydrates he's going to die, which is the fact. So when that infant gets carbohydrates, his dopamine reaches up to near top, what I call top normal levels. It goes up to almost 200 in the midbrain. When that happens, the infant's calm and serene, his restless, irritable, discontent goes away and he's comfortable.
Dr. Charles Smith:That system continues to operate on through life, with dopamine being released for eating when you're hungry, drinking fluids when you're thirsty, escaping danger. Even sex gives normal dopamine releases which start to modify our behaviors because we have that inherent desire to sustain life. Ben enters mind-altering substances and that's anything that releases dopamine higher than 200, alcohol, opiates, benzodiazepines, cannabis, amphetamines, and when those are released at that much higher level, it's a little bit like noise exposure hearing loss. If you go to a rock concert, what can you hear the next day? Not very much, just ringing in your ears. So those massive releases of dopamine are what dysregulate the system, and of particular importance here is that about 9 out of 10 people cannot accept those massive releases of dopamine the 1 in 10 people in the general population that can have a vulnerable dopamine reward system, and they're the ones that are very much at risk for the disease of addiction.
Lisa Carole Cude:I find it so fascinating because we all know people that can drink or do pills or whatever, and it doesn't affect them. They can easily walk away from it. And then we also have people that can drink or do pills and they become highly addicted to them. So I guess are you saying that some people's dopamine levels, that's what happens to the brain, why they just can't stop that population that I'm describing, that actually, that you had you know that exactly? Is that right?
Dr. Charles Smith:Yes, that's exactly what I had. I had many of the risk factors that set me up to be able to accept that reward when that large rewards release, and primarily that's due to dopamine subtype receptors. But there are also other factors involved. As far as amounts of dopamine released, the ability to accept that dopamine, it isn't quite as simple as that. I can simply accept the reward. But there's many other social factors involved.
Dr. Charles Smith:But the bottom line I use this as an example with patients many times of what I call an addiction stress test. And if I go up to anyone at a restaurant maybe they're having a margarita and I say well, you know what, it's your lucky day. You get five more margaritas on the house. Nine out of 10 people will decline those and when you ask them why, they're going to say very simply I don't like the way five make me feel. None of us at risk for the disease of addiction are going to say that Now we may decline that extra five if we still have the ability to make good decisions. Maybe we know we're driving, Maybe we don't have to work the next day, but for the most part we want them. So that's my stress test for addiction. Now it may not be that alcohol is the drug of choice. Maybe it was opiates, Maybe it's cannabis, Maybe it's cocaine, Maybe it's amphetamines, but the bottom line is nine out of 10 people simply don't enjoy or are able to receive that reward from those massive amounts of dopamine.
Lisa Carole Cude:That makes sense when you explained it. What are some of the risk factors?
Dr. Charles Smith:Well, the risk factors, the number one is the genetic predisposition. If you have a first or second order relative who has had problems with alcohol or drugs or has the disease of addiction, you have at least a 50% chance of having that yourself simply by being exposed to those substances, and that makes it very rare that you wouldn't be disposed. It's exposed, I mean. It's somewhere around 87% of people in the United States are exposed to alcohol at some point in their life. There are a few religious subsets that don't drink and some very health-conscious people just never drink alcohol. But that's very unusual. So genetic predisposition is one.
Dr. Charles Smith:Age of early use is another. Many of the patients I admit started their substance use 9, 10, 11, very young. This dopamine reward system doesn't mature until ages 24 or 25. So it's a very vulnerable time to have that massive release of dopamine. Another is adverse childhood experiences. Someone who's experienced abuse, trauma physical, emotional, sexual as a child also makes them very predisposed to this High tolerance to substance. If you're one of the teenagers who could drink 12, 16 cans of beer or a whole bottle of wine, it simply exposes you to more chemical and more milligrams of the substance. Another would be dual diagnosis Patients who have anxiety, depression, bipolar disorder, even schizoaffective disorder. All these also give you much higher risk of having a vulnerable dopamine reward system.
Lisa Carole Cude:Yes, sir, and from what I read in your book, it's not like a person has to have all of these risk factors. They can have simply one of them, right? Yes?
Dr. Charles Smith:Is that true? Yes, that's true, and you know. Also, when patients tell me, you know I don't have any family members, you know, I always say well, you know, when I look at your DNA, simply by your known family history. That's a little bit like asking you what a Harrison Ford movie is about. Simply by showing a snapshot of him, you wouldn't know if it's Star Wars, Indiana Jones or what the movie was about. So I'm still a big proponent of the genetic predisposition being the main risk factor.
Lisa Carole Cude:Yes, I agree on that, and it's just like when you go to the doctor and they go well, what's your history of diabetes or cancer or heart disease in your family? It's like they don't ask you about addiction, but they ask you about, like, what you're predisposed to. And it makes perfect sense if we're going to treat addiction as a disease, because you know it can be like a grandparent, it can be uncles, it can be like somewhere down your you know generational lineage, so to speak. It doesn't necessarily have to be first generation, we can all go back somewhere down the bloodline. Is that correct in saying that?
Dr. Charles Smith:You say that physicians don't take that history. There's many reasons they don't. One may have to have to be that maybe they don't have the training to ask the question. The other is maybe it's uncomfortable for them to ask the question. But University of Florida, where I did my addiction medicine fellowship, was the first university to require a mandatory rotation for medical students in addiction. So during my two years there we rotated one or two medical students through each month and reinforced to them the reason they should ask the family history pertinent to addiction.
Lisa Carole Cude:That's awesome because I'm sure medical schools in the past did not train doctors about addiction and as prevalent as it is in our society now, I'm sure there's a bigger and greater need for that now. So ,are you saying that they're starting to do that? Implement that into training for our doctors and medical personnel.
Dr. Charles Smith:As far as I know now all medical schools do include addiction. It's very much to the forefront in continuing education. You know the whole prescribing of opioids has been revamped in the last few years so that physicians take that history that we just talked about family history of addiction and also that they monitor more closely the supply of opiates they give. You know, for example, say 30 years ago you had your gallbladder out. You may have got sent home with 30 Percocets. Today, when you have laparoscopic gallbladder surgery, you get sent home with, say, five, five milligram oxycodone and if you have more pain or require more, it's going to involve another physician interaction to get more, going to involve another physician interaction to get more. So those sample cabinets all through the country at home that may have 25 or 30 Percocet venom simply not there anymore due to the physicians being educated and simply not overprescribing.
Lisa Carole Cude:Right, it's more regulated. Is that correct in saying that? Yes, it is regulated? Is that correct in saying?
Dr. Charles Smith:that.
Lisa Carole Cude:Yes, it is Dr Charles. I'm going to ask you some personal questions, or I probably don't even have to ask you, but I find your history very, very interesting and I read your book and I learned so much about yourself and your colleague. But do you mind telling our audience about your history and what happened?
Dr. Charles Smith:No, I don't mind at all. I was born in West Virginia, went to medical school West Virginia School of Osteopathic Medicine and had a pretty inconsequential college career and medical school career. One thing was very important my grandfather on my father's side died of the town drunk in this very small town that I was raised in in southern West Virginia 5,000 people. I only met the man twice and my mother would simply say that's your dad's dad and he's a bad man, he's an alcoholic. So I only met the man twice and he died a street alcoholic and was never able to obtain treatment.
Dr. Charles Smith:So even with binge drinking in college, it didn't continue for me until my early 30s when I was faced with a lot of stress. I had work stress, I had financial stress, I had marital stress and I already knew that I could drink a pretty good lot. I had a high tolerance, pretty pretty good lot. I had high tolerance and my drinking picked up to the point that by my mid-30s I was coming into work with alcohol poisoning, just so sick I couldn't put one foot in front of the other. And that was late 80s and about the time Vicodin and Lortab and Xanax were being sampled to primary care physicians. So I went to my sample cabinet, looked at it and said I wonder if a few of these would help. And after that, the next 20 years, it's somewhat of a blur. I got my pills many different mechanisms from ordering them wholesale to finally writing fraudulent prescriptions which, in 2009, resulted in my intervention by the DEA and got me to treatment and subsequently saved my life.
Lisa Carole Cude:Wow. Well, you know the movie, you know the series. Dope Sick is very popular now and it kind of is describing a little bit what your experience was. Just like Michael Keaton, you know, the doctor in Dope Sick went through with his patients and then apparently he had a I don't know. He started on it because of pain and it was in. That's how easy what you just described about yourself. That's how easy and innocent it can start. Is that correct in saying it's like no one is bored or no one, I believe, says okay, I'm going to be an addict when I grow up, or I'm going to be an alcoholic, or I'm going to do this and that, and then it just starts innocently and it just continues in this downward spiral. Is that how you felt at times?
Dr. Charles Smith:Yes, you know, you're exactly right. At second in second grade, on career day, no one holds their hands up and says you know, I want to be an alcoholic or I want to be an opiate addict, so you're exactly right. But once that door was open and my alcohol consumption increased, it was really just a path of least resistance of what I could do to stay functional and what I could do to survive. So I don't want to make it sound like I didn't have a choice. It was just that ease of access I had to those pills made it the easiest route of choice for me. I had to. Those pills made it the easiest route of choice for me.
Lisa Carole Cude:Right, which happens, you know, with a lot of people that I've interviewed and people that I've known that to have some sort of substance use disorder. I call it substance use disorder. Let's talk about that. How can we as a society break the stigma of this so people do not feel ashamed or guilty and there's a thin line behold, holding someone accountable for the behavior of the addiction. But I feel like to understand the addiction, like you said, like the science behind it. It will give people, or our society, a little bit more compassion and not judge people so harshly. But yet some of the behavior that is displayed, I feel like people need to be accountable. Do you kind of see where I'm going with this? It's kind of like a catch-22 situation. How do you feel about some of those statements I just made? How can we end the stigma first?
Dr. Charles Smith:Well, I think by sticking with current and even more progressive scientific literature is exactly the way to go. You know, it would be real easy to put out stigma-related statements for diabetes, for overweight, for lung disease, because many diseases patients play a part in that disease, coming along by their behavior. So with addiction, you know the words alcoholic, the word addict, junkie, abuser tend to have a negative connotation. Words are hurtful. It's much better when we describe them for just what they are Substance use disorder, habitual use, substance use disorder, habitual use, overtaking of substances I mean, if it's done thoroughly yet compassionately, is the best word. You know I was thinking.
Dr. Charles Smith:One of the things is whenever we go to do interventions, or whether I see a patient with intervention, I don't look at this any different than if I saw a skin cancer or a suspicious skin cancer on your face. I approach it with that same vigor and intensity. Person or the family has done the screening tools that we can talk about and they have it. I tell them not to give up any more than they would if they said, oh, I think that's a malignant melanoma on his shoulder. Well, you wouldn't just sweep it under the rug and say, no, maybe it's a freckle, you would get professional evaluation. So this is no different. We really advocate that people get professional evaluation. Then maybe it turns out that they are just a light social drinker and it was all a big hubbub. But that's not very likely or the family wouldn't have noticed the changes.
Lisa Carole Cude:Right. What do you do when you want to call in an interventionist and you want to call in an addiction specialist? This is for someone that you love very, very much and you see the person struggling and you see the daily fight, like moment to moment, with an addiction, and I'm talking now an opioid addiction, which I think is so strongly, highly potent, whether they're prescription or illicit drugs. But how can you encourage and love that person through this without enabling them? And then also, how can you lead a horse to water if they don't want to drink, so to speak?
Dr. Charles Smith:Well, I understand exactly what you're saying. In my years out of medicine I did get trained in interventions and did professional interventions for a few years. It is difficult. Once again, I take them back to that same medical scenario. If you had a patient who you were suspicious, say you had a sister who had a breast lump, you're suspicious of breast cancer, but she just simply says, well, I'm not going, you wouldn't give up on her. That's what you have to do with, say, the opioid-addicted patient. You can't give up on them.
Dr. Charles Smith:Where most families would fail is that ultimately it may mean loving, detachment or, you know, used to be called tough love. But you said, how do you do it without supporting them? You may have to say, well, you know, if you choose, for example, to keep this cancer and not seek medical care, then we're going to have a break in our relationship and most people have difficulty with that. Obviously they love them. You know, one of the definitions of codependency is love, because that's what is the root of it. Codependency is love because that's what, that's what is the root of it.
Lisa Carole Cude:Yeah, there's a there's a thin line between codependency and interdependency in all relationships actually, and you do have to love and encourage him through it and not be judgmental. But then ultimately it seems that it's up to the person to take that step and seek medical detox because I feel that's what's needed and I'm sure you feel that's what's needed, and rehab and long term treatment centers, and let's talk about that. How long does it take if a person who goes through all those steps as far as to get out of active addiction into active recovery, how long does it take for the brain to heal if they follow all those steps? Is there a number of years attached to that or is there like variables in there?
Dr. Charles Smith:Well, there are some variables, but you can find very consistent that it's one to two years before this dopamine reward system is going to heal, and primarily the prefrontal cortex or the decision-making portion of our brain one to two years.
Dr. Charles Smith:So you know that old minnesota model of 30 days rehab is basically archaic.
Dr. Charles Smith:If you just go for 30 days and you go home and you expect to be recovered, that would be no different than putting a cast on a broken leg for two weeks and say you know what, we're going to take this off and you go well, that won't work, doctor, because it's going to take the bone six to eight weeks to heal. This is the same thing. We need that sort of intensive treatment for addiction for one to two years. Now that doesn't mean we keep them out of their home, but once they do return to their home, we still have cognitive behavioral therapy, 12-step mutual aid and possibly the most important factor here is we have random testing so that we keep mind-altering substances out of the body, and that's the biggest failure we see with laypeople treatment in the United States. We've figured that out when it comes to doctors, nurses and airline pilots, because that's the type of programs that we're put in and we have 90% success rate. But for the general public that's simply not in place yet.
Lisa Carole Cude:Do you feel like I know through the years that I watched my loved one? I feel like each year it's getting better and better. There's more education about this. There's more awareness about this. The programs are getting better. I still think there's a major, big need in this country, but do you have hope about this? I know you work in a treatment center yourself and medical detox with your patients. Do you see a growing awareness of this in our country that people are starting to open up and there's more our country that people are starting to open up and there's more avenues for people and their families to seek this? Do you see that or am I naive about it?
Dr. Charles Smith:No, I actually do see it and, to tell you the truth, it mirrors almost any other disease that we've seen progression in. It mirrors almost any other disease that we've seen progression in Since I graduated medical school in 1982, that was right at the beginning of the HIV AIDS crisis, so I saw all the stigma associated with that. Then, basically, the opening up of that to get more funding for research made it a more mainstream disease and ultimately we're at where we are today, which there's excellent treatment and it doesn't shorten lives. Today, that same type vigor and enthusiasm is starting in addiction. It's not there yet but, as you said, there's many, many avenues now that are pursuing more intense education, early education and also advocacy for treatment. It's more understood by most major companies now that this is a disease and that, once properly treated, they can have a better employee than they had before.
Lisa Carole Cude:Yes, sir, as far as recovery treatment, what do you feel like the components or the important components for someone to have a high success rate? Because, from what I understand and correct me if I'm wrong there's a very high incidence of relapse and during recovery, during active recovery. So, with your experience, what are the components that someone has to follow through with in order to have that high success rate, and is this something that they live with every day of their life? Like you said, a lot of people I think falsely leave treatment centers or recovery centers and think, oh, I'm cured, everything's going to be fine, I can go back to that lifestyle, or I can be doing this, and I have found personally in my loved one's life that wasn't the case. So can you kind of elaborate on that for my audience please?
Dr. Charles Smith:Yes, and you know the perfect analogy that I use with patients is the treatment of high blood pressure, treatment of hypertension. I did family medicine for 26 years. It was not unusual at all for me to see a patient diagnose them with hypertension, start the medication, ask them to come back in a month and see them. They came back in a month. Pressure's good. I said okay, any questions? Here's your six-month refills on your medication. Come back and see me in six months. Patient comes back in six months. Blood pressure sky high, I go. What happened? He goes. You know, I just didn't think I needed that.
Dr. Charles Smith:Addiction is actually no different. It's very important that initially they get a good professional evaluation so that they can see what level of care they go in. Maybe they don't need detox, maybe they don't have enough comorbidities to require residential treatment, maybe they don't need sober living, but the big thing is they've got to have treatment for two years. We've got to keep mind-altering substances out of them and that's the advantage to monitoring when you're monitoring one slip, even if it's not their drug of choice. Maybe they were opiate addicted and they smoked cannabis. Maybe they were methamphetamine and they drank some beer. We still need to know it, because then we can intervene at a much less intense level of care.
Dr. Charles Smith:So always with patients parallel to hypertension, because hypertension, still in the United States today, is very difficult to treat because it requires so much patient compliance. That's what addiction treatment requires patient compliance. But you know, most of the time with this 30-day model of treatment and then send you to your local AA group is not enough accountability.
Lisa Carole Cude:No, I agree with that. That's why I highly recommend your book, so people can understand the science behind this. I assume do you consider this a brain disease.
Dr. Charles Smith:Oh, absolutely. You know. No different than the dopamine reward system is dysregulated. No different than the glucose insulin system and diabetes, the renin-angiotensin system and hypertension. This is a bodily system that becomes dysregulated, results in a disease. However, with appropriate treatment and management, the disease can go into remission. Now I never want patients to get confused. Remission does that mean I can go over here and drink some beer now? No, it doesn't. It means my brain's healed enough now that I actually make good decisions and know that. I'm one of the one in 10 people in the world it's not a good idea to drink and drug. I'm one of the one in 10 people in the world it's not a good idea to drink and drug. ; --tw-#fff; It is impossible.
Lisa Carole Cude:I'm thinking, oh my goodness, okay, he's in the hospital now. They're going to take care of him. They're going to know that he has a highly addictive you know he's highly addicted to these opioids and heroin at the time and you know whatever else and so they left the decision up to him. They left this hardcore decision up to him. They did not offer him treatment, they just talked to him, where me, as a mother, thought, oh my goodness, they're going to do something now or they're going to help him or offer something. But they left this hard decision up to him and he walked out of that emergency room. He refused any sort of help and treatment. So I know that's because of the HIPAA laws, but is that something that can that you feel needs to be changed in this country, because the loved ones have their hands tied and they're leaving this important decision up to somebody who isn't capable of making this decision to save their life? Do you understand what I'm trying to convey? -snap-strictness: proximity; --tw-ordinal: ; --tw-slashed-zero: ; --tw-numeric-figure: ; --tw-numeric-spacing: ; --tw-numeric-fraction: ; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; rotate: x="26" --tw-numeric-figure: ; --tw-numeric-spacing: ; --tw-numeric-fraction: ; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,. 5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; --tw-blur: ; --tw-brightness: ; --tw-contrast: ; --tw-grayscale: ; --tw-hue-rotate: ; --tw-invert: ;
Dr. Charles Smith:Yes, I do, and most states have some sort of legal alternatives to follow. Here In Florida it's called the Marchman Act, other states it may be called something else, but anyway it's a substance use disorder, involuntary treatment. Now it results to start with just an involuntary evaluation. But see, that would be the start of the treatment anyway. So I always told family you know, should I pursue that? And I said of course you should. You know, I still remember one intervention I did back in Alabama.
Dr. Charles Smith:A gentleman was drinking. His sisters actually called me in to do the intervention and he was drinking significantly. He had alcoholic cardiomyopathy, so severe drinking and his life really depended on it. He refused. He refused to go. After the family intervention, after the letters, after all the loving pleading, he still told them no. They asked me what our next step is and I said you need to call law enforcement. He just left here to drive home and he's intoxicated and they said oh no, we can't do that, he'll never speak to us again. I told them pretty soon he's not going to speak to you again anyway.
Lisa Carole Cude:Well, I want to let you know something. I was going to do that and I was going to go to the county, the sheriff's department, and I spoke to them and they told me about what needed to be done. They had to go, arrest my son and then take him to the hospital and talk to a psychiatrist, an interventionist, a medical doctor, be evaluated, and they would hold him for 72 hours. But then I was told if he could still walk after 72 hours. So actually, when I spoke to the sheriff's department here locally, they kind of talked me out of doing that to be quite honest with you, out of doing that to be quite honest with you, because they said, well, they're going to let him go anyway. So do you understand what I'm saying? That's what happened in my state. I don't know if they've changed it in the last four years, but that's what happened.
Dr. Charles Smith:It needs perfected in every state. But even three years ago, in the two years I spent at the University of Florida, we marksman acted many patients and kept them for 90 days. The judge had that ability once we showed evidence. Now patients can have a show, cause hearing and go up in front of the judge where both sides present their cases. But we kept many patients for 90 days, which in itself wasn't still enough, but it was sure better than 72 hours you're talking about.
Dr. Charles Smith:Yes, sir, and yes, and I know what you're saying having them arrested, go through that trauma, go through that embarrassment of being involuntary and committed. It does seem like a horrible thing. I understand that, but when we're talking about a deadly illness, it's necessary.
Lisa Carole Cude:Well, I would have done it in a heartbeat if I knew that they would have kept him and they still left the decision up to him to walk. You know what I mean.
Dr. Charles Smith:Yeah, but see the true involuntary commitment. For substance use disorder is the decision to leave not left up to the patient, it's left up to the addiction professional.
Lisa Carole Cude:Well, I hope they've changed that here in the state that I live in Because, like I said, this was four years ago and yes, sir, I knew all about it. I was ready to do it and they talked me out of not doing it because they said that he would walk. They couldn't keep him against his will. That was what was told to me. But anyway, let me ask you something. You know my podcast deals with the fatal facts of fentanyl. So, in your experience as a doctor, tell me what you feel about illicit fentanyl. Are you seeing a rise in this? Has illicit fentanyl been around? From what I understand, it's been around at least four years and people are highly addicted to it. Tell me your experience about illicit fentanyl and how you think about this or what you think about it.
Dr. Charles Smith:It certainly was just a game changer For at least the last couple of years. Most of my opiate patients that I've admitted to detox or to residential rehab did not even know that it was fentanyl they were getting. They were buying these pressed pills that they thought were oxycodone 30s or they thought they were Xanax bars. They did not even know they were fentanyl. The degree of strength of that fentanyl just varies on how much it was cut. It may be thousands of times stronger than morphine or heroin, or it may not be.
Dr. Charles Smith:Simply, there's no quality control among the illicit drug world. With the massive escalation in overdose deaths that we've had 93,000 in the US, and that's a low number, because many died that we don't know why and it probably was opiate overdose we're starting to get some more attention to these illicit pills. The DEA sent out several emails and newsletters focused on these pressed pills, as they call them that. They look like the prescription pills, but they're not. They're fentanyl. So the fentanyl entering the market has been a game changer and we certainly saw a lot of overdose deaths with OxyContin, with Oxycodone and Xanax, and then mixtures with alcohol also, but nothing like we're seeing now.
Lisa Carole Cude:Yes, sir, it seems like the illicit fentanyl has changed the paradigm of drug use in this country. The way I look at it, I've talked to several experts about this and also people who have lost loved ones to this it seems like there are three kind of scenarios for this, and you can correct me if I'm wrong or add another scenario if you know of one. But it seems like we've got the seasoned. I call them the seasoned users, the people that do knowingly know that they are buying fentanyl and they are ingesting fentanyl, and there's different ways to ingest it, of course. And then you've got the people you said that feel like maybe they're buying an oxy cotton, I guess roxy's, is that what they're called? M30s, whatever, is that what they're called?
Lisa Carole Cude:yeah, yeah okay, there's so much, so many terminologies, but, um, or they might be thinking they're buying cocaine, or do it buying a xanax or heroin, even even even though I've read and heard that heroin is the most obsolete now because of the fentanyl. But anyway, they kind of are deceived. All of a sudden they're dying from ingesting straight fentanyl instead of like thinking they're doing a line of cocaine. And then you've got, like you said, the press counterfeit pills, now this. And then you've got, like you said, the press counterfeit pills, now this. All of it breaks my heart. But the press counterfeit pills think they're buying Percocet or Aroxi or something. And they're almost being groomed by known dealers on Snapchat let's just say Snapchat and they are sold or given something and all of a sudden they're dying. I mean, it's crazy in this country. Do you know of any other scenario that I'm forgetting or not mentioning.
Dr. Charles Smith:That's actually a very good synopsis that you said. We have the severely addicted substance use disorder patient who intended on fentanyl, has high tolerance, injects fentanyl, smokes it or snorts it. They have a large physical dependence. They get very sick If they don't take it. That would be the first level you described. And also heroin simply isn't available anymore. Most of the patients, I admit, here in South Florida don't test positive for heroin or opiate, they test positive for fentanyl. The second level would, as you said, maybe they just intended to party some but they've used enough opiates. They may have withdrawal and they thought they were getting a Percocet or Xanax or some pill that came from a pharmacy but it's not. And then, even as you said, the scariest level to me is the bachelorette party or the bachelor party where maybe they took a Xanax when they were in college or something and celebrating this weekend they thought they were going to do some cocaine and take a Xanax and you know they have no tolerance for this very powerful opiate and they die on the spot.
Lisa Carole Cude:So, with all that being said, do you feel that these should be? These deaths should be described as overdoses or poisoning.
Dr. Charles Smith:You know that's excellent to even bring it up in that light. I had just read today that this should be looked at as a national security issue. You know, no different than someone were attacking our country with chemical warfare.
Lisa Carole Cude:Exactly, it does seem to be that way chemical warfare, and it's like you said. I think the numbers I believe last year, in 2020, were 94,000. And I don't know how many of that is illicit fentanyl. I've read so many different things 50, 60, 70, 80 percent but I think the numbers are a lot higher and I think in 2021, they're going to be a lot higher. I don't know how accurate the information is, but I just feel like it's going to escalate and keep escalating. Is that how you think, or feel?
Dr. Charles Smith:Yes, you know, I think it has to be approached as any national security problem. When you think or feel, yes, you know, I think it has to be approached as any national security problem. Would you know? I think back on how we've approached terrorism. So we both did more screening at the sites. We've done more screening at the borders. I think addiction has particularly the fentanyl problem, the opioid crisis has to be addressed. The same way, we need to enhance our abilities so it doesn't get into the country, but at the same time, don't overlook its marketplace. These patients who have a vulnerable dopamine reward system, no matter where they fit in that spectrum of people who are going to use them we just described all those three scenarios need treatment and we've got to make that treatment available and offer you know, I won't say necessarily pay these people to do it, but offer a rewarding lifestyle that they can see. They need some incentive for it.
Lisa Carole Cude:Yes, I see that, and the journey with addiction and the stigma attached to it. A lot of people cannot get jobs. So, yeah, they do need to be rewarded, they need some incentive to work towards to better their life, to better themselves, not necessarily all the punishment, or I think you know what I'm saying, because you live this yourself. You live this yourself.
Dr. Charles Smith:Yeah, and I advocate for a term called contingency management. It's that all of these fruits of my recovery don't continue if I don't have negative drug screen tests. So you know, instead of that oh my God, you know what Mom's driving me crazy? She's making me give urine specimens four times a year, next year or something. But those come with a reward that, yeah, not only that, but your car insurance is cheaper, your college tuition is cheaper, your college tuition is cheaper, but all of the fruits that go with that mind-altering substance free become more readily apparent to them. And that the testing is not looked at as a penalty, which is what it's looked at now.
Lisa Carole Cude:Yes, it is Well, you have come a long way. I just I don't want to give too much about your book because I really want people to buy it. I bought mine on Amazon I'm going to put plug in there about Amazon but I really learned so much from your book and it really opened my eyes. I loved reading about your firsthand experience with this yourself and what was involved, and also your colleague, dr Hunt. Is that correct? Yeah, that's Jason Hunt, and you both were medical doctors and you both suffered with this for years and it changed your life and you had to do some really soul searching and hard work to get your life back. You both lost your medical licenses over this. Is that correct?
Dr. Charles Smith:Yes, it is.
Lisa Carole Cude:And then you worked and did what you had to do and got it back. My goodness,god gbless Gbless bless you both. I mean, I used to tell my son you're like the strongest person I know Because I saw his battle. You know every day with this and this is something that you live with the rest of your life and it is a battle. Is that correct?
Dr. Charles Smith:Well, additionally, yes, it is, but it actually with appropriate and proper care and compliance of the patient, most of us believe this day, the disease goes into remission. I look at it no different than I use the example of a breast cancer patient. Quite often I have a breast cancer patient. They have a lumpectomy, a radiation chemotherapy and 15 years later they're good. Now that doesn't mean they stop doing mammograms. That doesn't mean they stop doing breast exams. That doesn't mean they start smoking cigarettes. That means they start drinking alcohol, they start going to the tan and bed anything that would be increased risk factor for cancer. So the same now.
Dr. Charles Smith:I'm sure my disease is in remission today, but I go to a wedding, I make plans. I don't drink champagne. You know if I go to the sports bar for Buffalo Wings, you know I have Diet Coke. I have a lemonade. You know Mexican restaurant, you know it's frozen lemonade, not a margarita. And that doesn't happen by accident. That happened by good scientific medical care and, importantly, compliance with treatment. I have to have that from patients. So that's why I need the families involved, because it's not them nagging them, it's just helping me ensure compliance.
Lisa Carole Cude:Exactly Right. Nagging doesn't help anything.
Dr. Charles Smith:But help. You know they call that their sober support network. Their sober support network, you know, would be involved. And when you're going out with these 10 guys that you went to high school with and all you all ever did was drink and smoke pot, what do you think you're going to do with those guys tonight? What would you possibly have in common with them? And if you say, well, I do have to meet them, et cetera, then I'm going to take a sober friend, I'm going to have extra accountability and even say you know what? You get a pee in this cup when you get home too.
Lisa Carole Cude:And if they say no to that, that's a problem. So you're more aware, definitely, and more conscious about all of this, and that's what it takes right.
Dr. Charles Smith:Education is the pathway out of this one.
Lisa Carole Cude:Yes, sir, I believe education is the pathway out of this one. Yes, sir, I believe education is power.
Dr. Charles Smith:What seems to be a voluntary disease is actually not because of all the social pressures. You know I had that phrase in my book that in this country alcohol is not just socially acceptable, it's socially expected. You're right, that has to change.
Lisa Carole Cude:You're right. Yeah, it does has to change.
Dr. Charles Smith:You're right. Yeah, it does have to change. Teens get peer pressure bullied into alcohol and cannabis.
Lisa Carole Cude:Most definitely Peer pressure is a major thing, and now nowadays it's pill parties. They're pressured into taking pills. It's just not. I mean, it used to be just smoking cigarettes or drinking a couple beers. That has changed a long time ago. Peer pressure has a lot to do with it.
Lisa Carole Cude:Yes, sir, well gosh, charles, I could talk to you all night and you're just a wealth of information and I just want to thank you for being so transparent with your own story about your journey and I want you to know that you are so loved and appreciated in doing so and in also helping to make a difference with others with their continued battle with this. And if you are my audience, if you or a loved one is struggling with addiction, you'll find help in Dr Smith and Dr Hunt's book, and it is called again, understanding Addiction, no Science, which is K-N-O-W, and to no Stigma. Let's end the stigma. It's up to us as individuals to end the stigma in this country, and when one understands the science behind addiction, one can begin to move forward, because beyond stigma, there's always hope. There still lies hope, and thank you, charles, I really do appreciate it.
Lisa Carole Cude:I hope we can possibly interview some time again in the future. Okay, okay, it's been a pleasure, thank you.
Dr. Charles Smith:Take care.
Lisa Carole Cude:Bye, thank you.
