Why Addiction Treatment Is Failing America | The Saving Dose Ep. 01

In the first episode of The Saving Dose, three addiction medicine and behavioral health executives discuss why opioid use disorder treatment is failing patients, what the medication adherence gap actually looks like from inside the clinic, and what it will take to fix it. Topics include MOUD access, buprenorphine barriers, pain management misconceptions, behavioral health revenue challenges, and the infrastructure gap driving medication non-adherence across America.

This episode covers who they are, what brought them to this space, and why they believe the addiction treatment system is failing not because the science is missing, but because the infrastructure to deliver it consistently has never been built.

In this episode:

Why John Hsu MD walked away from a traditional anesthesiology career to build a medication security company, and the moment in his own clinic that made it impossible not to.

What William Pedranti learned after 20 years building biotech companies about the gap between clinical evidence and real-world patient outcomes, and why addiction treatment has the widest gap he has ever seen.

What Kendra Allen saw working on the frontlines of behavioral health, and why patients in active recovery were losing access to treatment not because they stopped trying, but because the system stopped making it possible.

The parking lot: what John's patients were doing before their appointments, and what it told him about the failure of in-home medication management.

The access problem in a single number: over 50% of patients can be saved by taking their medications consistently. Only 25% of them can access those medications.

Why every person William tells about iPill responds the same way, and what that says about how close this crisis is to every family in America.

What recovery actually requires: medication, consistency, and a system that does not make patients fight for both every single day.

About the Hosts

John Hsu, MD is the Founder and CEO of iPill and a practicing anesthesiologist with 25 years in pain management and addiction medicine. He has taken multiple products through FDA approval and commercial launch. Connect with John: https://www.linkedin.com/in/john-hsu-md-300a8b2a/

William Pedranti is the COO of iPill, a Georgetown Law graduate, and co-founder of PENG Life Science Ventures. He has taken a biotech company from founding through FDA approval, commercial launch, and exit. Connect with William: https://www.linkedin.com/in/williampedranti/

Kendra Allen is the CRO of iPill with 20 years in behavioral health revenue strategy, payer contracting, and regulatory navigation. She founded and exited a national healthcare consulting firm. Connect with Kendra: https://www.linkedin.com/in/kendra-allen-cro/

Website: thesavingdose.com

Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. Consult a qualified healthcare professional before making any treatment decisions.

#OpioidCrisis #AddictionRecovery #OpioidUseDisorder #MedicationAdherence #MOUD #BehavioralHealth #AddictionMedicine #PainManagement #SubstanceUseDisorder #HealthcarePodcast #TheSavingDose #MentalHealth #RecoveryPodcast #OpioidTreatment #PublicHealth

Transcript

SPEAKER_01 0:00

Over 50% of these patients can be saved by just taking these medications day in and day out. You know, if you take these medications, the chance of relapse, the chance of overdose and dying drops by over 50%. But only 25% of these patients are able to get these medications. And it's so sad. There's just not a strong consensus on how to treat these patients. And that's what makes treating addiction medicine so difficult.

SPEAKER_02 0:35

Hi, everybody, friends, and colleagues out there in the world. I'm here with my two wingmen, Dr. John Sue and our COO, William Pedrante. He's got lots of experience here in the pharma world. And we have John Sue, who has been a doctor for a very long time in the addiction and anesthesiology world. And we are here today to talk about our why. Everybody out there and LinkedIn and our communities were seem to be a topic of conversation of the things we're frustrated about in the industry and why we do what we do. And we really just wanted to get together and talk about that and invite other friends and colleagues to talk about it with us. So, John, why don't we kick it off with you? Tell me why you chose addiction of all of the medicines that you've practiced. Why would you bang your head against the wall on a daily basis?

SPEAKER_01 1:29

Well, I didn't start out this way. You know, I started out cardiothoracic intensive care and did a couple of fellowships in that in my anesthesia residency. And then in 2016, the CVC came out and said that no one should be on more than 90 MMEs of opioids. And then I started getting a lot of patients with opioid use disorder, opioid dependency, and pretty soon I kept on getting more and more patients to a point where my anesthesia practice and cardiothoracic and intensive care began to go down and my pain and addiction medicine started to go up.

SPEAKER_02 2:06

So, how did that feel? Like that change from being a doctor in anesthesiology, the hospital world, that corporate medicine environment to treating addiction patients, how did that environment change for you?

SPEAKER_01 2:18

Oh, it was really frustrating because, you know, in cardiothoracic and intensive care, everything is done by the second, by the minute. And you we do something in medicine, and then we see the result. In pain and in addiction medicine, it takes a long time, really a long time to make a difference. I mean, one of the things that happened to me is that I was late to clinic one day and I saw my patients going from car to car. I kind of thought, wow, my patients are all friends. That's kind of cool. And then I started talking to one of my patients, and he started laughing because he said, you know, you get so angry when uh when our pill counts are not correct that we make sure our pill counts are correct because we sign a contract for being in pain, in addiction medicine, just to see you. You know, that's when I really figured out that, you know, my job is really difficult. I cannot tell if a patient's taking their medications as prescribed or not.

SPEAKER_02 3:23

So they're out there counting pills and they're saying, I only have five pills, I need five more. And then when the other one came out, they would change their pills around so everybody had to write them out when they saw you?

SPEAKER_01 3:34

Yes. I don't look like a very mean doctor, and I really have changed my demeanor. I used to be, but you know, with these patients, it's so difficult because over 50% of these patients can be saved by just taking these medications day in and day out. You know, if you take these medications, the chance of relapse, the chance of overdose and dying drops by over 50%. But only 25% of these patients are able to get these medications. And it's so sad. There's just not a strong consensus on how to treat these patients. And that's what makes treating addiction medicine so difficult.

SPEAKER_02 4:14

Yeah. Well, as a doctor and me as a nurse, you know, it's been a long time since I've been out there on the floor, but we're trained to save and treat and heal, and we have big hearts and lots of empathy. And so, Will, turning to you, what makes a pharma guy go from the side of evil pharma to uh, hey, we're gonna save the world? How how did you move from pharma to addiction, the healing and trying to help people? How did that change? I mean, not the pharma doesn't try to help people, right? Like that's the purpose, but the perception is always out there, right?

SPEAKER_00 4:50

Yeah, pharma. Yeah, yeah, no, absolutely. Yeah, yeah, for sure. Well, thank you, Kendra. So thanks for for being a part of this and letting me be part of this. I'm super excited about the saving dose, our first episode. I'm super excited with Kendra and you and John uh to be participating as hosts as we talk about really exciting and fun topics that I think are going to be very helpful to clinicians, to business owners, to investors, entrepreneurs, patients, right? As we dive deep into some of the challenges facing addictions face and other areas that I think have an impact. So very, very excited. I'll tell you a little bit about um my background real fast. I'm actually an attorney by training, got my start at a large international law firm many, many years ago.

SPEAKER_02 5:33

So a double bag to a good?

SPEAKER_00 5:35

You get branding points. You get branding points. Seriously. So I'm a rec, as I say, I'm a recovering attorney. So I'm trying to get as far as far away from practicing law as I can. But yeah, I started off as a big law firm, and to be can I think the last, you know, I've gotten I've been 20 years in this in the life science space now, and I think the last science class I took was oceanography at USC as a freshman, and that was because you got a free trip to Catalina out of it. So really, this was I kind of fell into this amazing industry of space of life science, really, because of clients, right? I went to work for a big law firm, got lots of clients based out here in Orange County, California. And I had one particular client that was an ontology company. It was small but growing, had some really exciting um you know products and development. I was doing a ton of work for them. They didn't have an in-house council. And eventually, after a number of years of working for them, I think the CEO got tired of paying a lot of my high rates as a lawyer at the law firm and brought me in-house. And that really introduced me and opened me to the world of ice. And that was a real introduction. This was this tiny little company, early stage. We had a couple products uh that we were moving into the clinic, and we were public, so that was kind of exciting. And it was just away we went. And I like to say that experience, I was there for a number of years, and I like to say that was really the complete anatomy of a biotech. I learned the anatomy of how to build a biotech company from working at this company. From starting with just 10 people when I started there, we ended up with several hundred by the time I was done, struggling to make ends meet to because Republicans raising a couple hundred million dollars on the capital market, so learned a lot about the challenges of raising money, raising capital, motivated investors to invest in companies and why. We did a ton of business development work. We were in licensing stuff, outlic stuff, buying companies, selling assets back and forth. Learned a ton about that, dove deep into regulatory stuff. We got several products approved and launched. So I learned a lot about the regulatory process from INDs and NDAs and annual filings, all the challenges going along with that. I learned a ton about intellectual property. I'm not an intellectual property lawyer. I learned the critical importance of protecting your assets. You invest tons of time and energy into these products, and largely what you have to protect them is IP, right? They're not is you don't have physical things. Like we're not building.

SPEAKER_02 7:53

What do you mean by IP?

SPEAKER_00 7:55

Yeah, intellectual property, patents, right? Because you know, we're not building cars. We got, you know, 100,000 cars sitting in a warehouse. It's all intellectual property, right? It's patents that you're filing around what you've built that give you the protection that go out for many years. That's the value you got, right? To be able to protect that and launch that and and keep others, right, from copying what you got. That's the value you bring in that people are interested in what you have in your company. So learned a ton about intellectual property about companies. Learned a ton about compliance, right? And just doing things right and a building a compliance infrastructure within a company to make sure you complied with all the various laws. I mean, the amount of laws that are out there internationally, because we did studies internationally when I was at this company, right? International laws, federal laws, state laws, right, that you have to comply with as a pharmaceutical company are fast. So developing programs, right, to make sure you don't run afoul of these various rules and regulations and laws that you have to comply with. Right. So learn a lot. A lot of my go go ahead.

SPEAKER_02 8:54

I was to say in addiction treatment, that's one of our biggest struggles is compliance and regulatory law. Even it seems like every state has a regulation and every then there's federal regulations and there's regional regulations. So a lot of our colleagues really struggle with trying to make sure their documentation is right and then the payers want something else. And it is uh a bane of our existence because they can come scoop back money up to six years later. Six years. So in in pharma, is it like that? Does the FDA come and really give you penalties like that? Or is is it really just kind of on the medical treatment side?

SPEAKER_00 9:29

No, it's it is on both sides, right? It's super challenging, right? Particularly if you're a small company, you've got limited resources and you're trying to go fast, fast, fast, fast, right? Trying to push things moving, move things forward, get things down the pathway, but making sure you're doing things the right way, right? Right way from a regulatory perspective, right way from a compliance perspective, right way from you know, clinical studies, non-clinical studies, and manufacturing, doing all the things the right way to know everything you need to know, to be able to afford all the consultants and attorneys and other people you need can be very, very challenging in a small company. So I learned a ton about managing that process, right? Because it is managing risk. You know, you there was no perfection, right? You're always striving to do everything perfect, but everybody falls short. So it is getting it 90 to 100 90 to 95% right, right? And keeping things moving forward at the same time.

SPEAKER_02 10:20

I take back everything I said. This sounds easier than that. But I take back all of the bad things I said. This sounds way easier than that. So, John, have you struggled with regulatory issues or or licensing and kind of insurance take backs and stuff in in your practice?

SPEAKER_01 10:36

Uh, that's a lot of questions, but yeah.

SPEAKER_02 10:38

Yeah, yeah, the short answer is yes. Everything, right?

SPEAKER_01 10:41

Yes, yes, and yes.

SPEAKER_02 10:42

Yeah.

SPEAKER_01 10:43

I have two pharma companies as well. And these two pharma companies are all in the opioid space. I'm trying to prevent problems in the opioid space. And that's the easy part. You know, science is the easy part for me. The business part, the insurance claims, insurance coding, collections, that's the difficult part because, you know, uh just the other day I had a call from an insurance company. They were, you know, they were asking for money because the patient didn't do well, and they they thought that it's my fault that the patient didn't do well.

SPEAKER_02 11:17

It's always amazing how the providers blame for it. So, much like Will, that's kind of how I got a lot of my industry experience. You know, I started really young, you know, right out of high school. I went to nursing school, and you end up working for these large corporations. And before I even graduated nursing school, I was already working in the business office and at the front desk and scheduling nurses and whatever. And at that time, I was in the skilled nursing industry. By the time I progressed in my career and I worked on and off for UHS, one of the largest hospitals chains and in medical acute chains and subacute chains in in the nation. And I learned just a ton of experience. And I got sucked from the nursing floor into administration eventually. I mean, obviously, this is a fast-forward version. But yeah, you you get all of that experience. And with when your passion can take over what you do, you really can win, right? And I think that's the message for all of our colleagues. And none of us would be in this industry if we didn't have some kind of passion for treatment of um addiction clients because we have hope. We have hope for them and we have hope from their families. And I think everyone I've ever worked with stays for the why because they've been touched by it. There's very few people that their family, they're someone they care about, someone at church, someone, you know, they can see the pain. And so if they can change the pain in the world and you have a capacity to do that, you kind of feel like you have to use those talents for good, right? If you can, right? And so if someone's gonna be able to give you a salary to do that every day, you have to do it, right? There's just it's not much of a choice. So that's my why. Like I I really believe that for every family that's called me and said, thank you, thank you for allowing us not to lose our house, thank you for fighting the insurance company. So my child, whether they're 15 or 50, didn't die today. You know, that's powerful. And and it means that although I had pain for the last two weeks at work, that one day will carry me again for a month. So, John, is it the same way for you when when you can see maybe that someone's making progress that it fuels you to carry on? I mean, what you've been trying to get uh one of your devices through regulatory since, gosh, I've known you since 2015. You've been carrying this thing around in a box all over the country, trying to get people to invest in it. You've talked to every politician on the face of the planet. Um, you've used your own money to slog around the country, come hell or high water, snow, rain, sleet. But yeah, you really have been a champion, but yet you very particularly haven't been touched with addiction or your family member hasn't. It's it's just that you believe in the healing power of people. And so tell me why you continue to carry this banner.

SPEAKER_01 14:10

Well, Kendra, you're really impressive. You've really helped a lot of patients, and I really on behalf of patients, I want to say thank you. Oh, thanks. Well, the reason I do it, uh, you know, I started off in the medical field and went from one field to another, but four years ago I had a heart attack, and this heart attack, my heart rate was down to 10. I kind of thought I was gonna die. And I said to myself, in the last time that I lay my head down, I'm gonna try to do something to help people as much as I can. And I think what I'm doing now is I'm really trying to help as many people as I can because people with opioid use disorder, people with substance use disorder, opioid use disorder, cannabid use disorder, they're ignored. There's a huge stigma, there's a huge private issue, privacy issue, and no one's helping these people, and they're ignored. And you know, it's costing our country $2.7 trillion a year, and there's a hundred thousand people dying, and these medications are not that expensive. And I I wish I could get all these people on medications.

SPEAKER_02 15:22

And insurance companies don't want to pay. One of the hardest claims to get paid ever are mental health and addiction claims. And there's some payers that are way worse than others, and we all know who they are out there. But yes, not mentioning any names, but yes, they there are some that are just terrible and and uh it makes it hard. It makes it hard for providers to carry on. And um, I think I saw a statistic that so many providers are leaving the addiction industry and going even over to emergency medicine because they just don't want to do to have the regulatory burden of the DEA licensure. And some states have more regulatory scrutiny for those Schedule II drugs than others. And then the second part is just getting paid. It's too hard to have a practice. And so they're closing down their practice, they're going to work for a hospital, and even if it's in the ED, it doesn't matter. You know, they they're just happy to be done with the pain, right? So, Will, you know, even though you haven't been touched by this, I think when I talk to uh to you, it's also for the future of your family, you know, to make sure that in your community and around, you know, the people that you know that that you can make a difference in their world as well.

SPEAKER_00 16:40

Yeah, absolutely. You know, thanks, uh Kendra and thanks for sharing your why and and John, your why too. I appreciate all you guys are doing, what you're doing. It's a thrill for me and a real pleas pleasure and a privilege to work with you guys in this space to try to come up with solutions to the very challenging addiction crisis we're dealing with here in the United States and eventually all over the world, really. Right. So, but I'll say two things that are driving my why and what inspires me to get excited about what we're doing here every day is first, I and I recently I recently did a post on this on LinkedIn just recently, and that is um, you know, I've got five kids, and um, you know, my oldest is 22. And so we've been um we do a winter trip, we go skiing, and we do a summer trip, or we go to the mountains too and go mountain biking. I've been doing that probably since the 22 to was three or four years old. And so for the last 18 plus years, I've been loading up five kids, trekking up to the mountains, and you can imagine, right? You have a lot of children out there, two kindra, John's got three, and it's it's all it is is logistics. Like literally for a week, it's just logistics, right? It's loading them up, it's getting them fed, it's getting them clean, it's getting them dressed, it's getting their skis and boots and poles and all this other stuff, getting their lip tickets, making sure they get their mountain, they do a little bit, they all gotta come in for lunch, you gotta take your jacket off, eat lunch, put it back on, go out, you've got your mittens, it's not a parent vacation. No, it's not. And you've been doing that forever, right? Loading it up, and it's it's chaos, it's challenging, it's exhausting, but you love it. It's why I have five kids. It's awesome, it's fun, particularly at night, and you get back to the house you rented, and you're all sitting down for dinner and you start playing board games and laughing and seeing the interaction of your kids, and especially as they get older, they have adult relationships with each other. It's awesome. Well, this year, same thing, you know, week or so ago, spring break hit, so time to load everybody up and take them to skiing. But instead of five, I had one. And two are off, you know, one's graduated from college, the other one's in the Marines, two are in high school, and Eve's working, my younger one in high school, she went away with a friend. So I was left with my just one. And it kind of hit me, honestly, uh a little hard. I got in this car and I'm ready to drive to Mammoth, and I've just got one kid with me, and I'm just looking back. I love them, and I'm thankful that I get that time for them. But there's a little bit of like, you know, gosh, what's what happened here? Where did all this go? Right. In life. And it taught me certainly that time keeps moving. Time keeps moving. And life is full of seasons, right? That you live at various parts of your life. When you're young and you're a teenager in your 20s, 30s, 40s, 50s, that it does. Life has its seasons of where you're focused and what your energy is and what you care about. And certainly at home, as I was thinking about driving up there with my son and thinking about all this, it really showed me really this the time keeps moving. And took it as you get older, I'm in my mid-50s now, it's time is so valuable. And I only want to spend it doing stuff that really is meaningful.

SPEAKER_02 19:37

Yeah. Right?

SPEAKER_00 19:38

I mean really meaningful.

SPEAKER_02 19:38

Even something so simple, you know. At this point in our chapter in our life, there's I mean, even something so simple as uh I'm gonna go buy a mixer, right? Like I want to love anything I buy anymore. Like it's not out of necessity, like I have to love it to buy it. And I think that's for the same thing. If you're gonna spend eight hours in a room somewhere, love what you do, right? There's lots of parts of our industry that I hate, literally hate. And I know that's a very terrible and strong word, but I think all of our friends and colleagues out there can say, Oh, there's things I hate, but you know, because there's pain associated with it, right? But and for our friends and colleagues out there listening, tell us your why. Tell us what you hate and what you love so that we can have more conversations about it.

SPEAKER_00 20:23

Yeah. Well, and it you know, I agree with that a hundred percent. And I I agree with you. Let's there's opportunities to comment on these podcasts on whatever platform you're listening to. So I encourage people. We'd love to hear from you, hear your comments and questions so we can address them in future episodes and whatnot. But I'll say, so, you know, meaningfulness, wanting to do stuff that really matters in life. The second thing, because I mentioned there's two things. The second thing is, particularly on the addiction side, right? And I know you and John have years of history in addiction, right? God bless you guys for your commitment, what you're trying to do with addiction. I haven't worked in the addiction space. I've worked in the pain space, I've had companies in the pain space, but never in the addiction space. But I'll tell you this since I got involved with this company about nine months ago, focused on addiction, and I asked, uh, it doesn't matter where I am, I'm out about, whether I'm at a conference or I was at a holiday party, right? And somebody asked, What are you up to lately, Will? Let me tell you this company that I've got that's trying to help tackle addiction. It's almost guaranteed, every single person I talk to says, I've got an addiction story for you. Right? It's heartbreaking. It's my mother, it's my friend, it's my spouse, it's my child. It's overwhelming. Almost everybody I talk to shares their story, and it's all powerful. Every story you hear is while it's all under the umbrella of addiction, they're all different and they're all a struggle and they're all a battle, and they're all a fight, and it goes like this, and there's highs and there's lows. And I love to hear it. I ask them deep questions. Tell me about it. I want to know what was it when they say that when they say they're on the road to recovery, I wanna know what was it? What was that little thing that Happen that set that person on that road recovery. And it's all different. It is all different. Right? And a lot of it is intervention from a patient or a doctor or friend or brother that made a huge difference in this person's life. Or not. I've heard stories where it they haven't been successful. And one guy, like I mentioned, this guy was talking at a holiday party, so he lost his brother. Addiction. He lost his brother. And it just hit you hard.

SPEAKER_02 22:26

Every homeless person you see from now on, you'll wonder what their story is. Every homeless person you'll see, you'll be that was someone's brother. No one goes to high school and is like, I'm going to end up the homeless guy on the corner. No one. No. Right? And that and those are the things I think of because I'm I'm a frontline treat person, right? Like I thought when I went back to school I was going to be Brene Brown. And she's a wonderful researcher, and I admire her so much. And I love how she talks about therapeutic interventions. And I wanted so badly to be as good as Brene Brown. I am a terrible therapist. And I'm great at collecting money from insurance companies, and I am great at making insurance companies pay, but I am horrible at therapy. So going to therapy or giving therapy, I have to leave my skills in the office. When you see those, when you see those unfortunate souls who are just hurting, and I mean they all have underlying mental health conditions. You know, I have a friend that always says happy people don't do drugs. Well, maybe they did at first, right? It started out as a social experiment. But when you're addicted, you are not a happy person. And so you know, the depression, the anxiety, and sometimes drugs cause additional harm, right? Like I would say most of the time, right? But obviously I'm not a doctor. But, you know, that's that is the struggle. It changes your worldview forever.

SPEAKER_00 23:49

It does.

SPEAKER_02 23:49

So it does. Well, to that point about it.

SPEAKER_00 23:53

I was gonna say, to that point we just said about mental health being a part of it and the challenges. It interesting perspective I got from one a woman I was talking to, had a brother who suffered from addiction his entire life, right? And she said, you know, what's interesting is when they're chasing those opioids or whatever it is they're chasing, right? Whatever drugs they're chasing, they're not chasing that to get high. They're chasing that to not feel bad. Yes, 100% That's what they're doing. They're chasing that just to not feel bad.

SPEAKER_02 24:20

Yeah.

SPEAKER_00 24:21

Right? Because without it, they're just absolutely miserable and feel just that craving is just wrecking their body. So the high is gone. It's just they need to get that just to feel like they need to do that to survive. Yeah. Right. And when you hear that, you know, what these people are going through, it just you want to help, you want to do anything you can to help.

SPEAKER_02 24:40

Yeah, I I would say that uh if there's anything evil in this world, it is addiction. It it just it takes a hold of someone's soul and just twists it. It just it it's so painful. So, John, when when we talk about addiction, a lot of the time it is opiates because that's the splash in the news, right? That's that's what we get funding for. Those are the things that people now have accepted are true addictions, and it's been forever. I mean, I remember not too long ago when we couldn't even get Medicaid reimbursement for mat treatment. It was so unacceptable because the only way to treat an addiction patient was abstinence. Just don't do it, right? So everybody had to pay cash if they wanted mat. Medicaid didn't even cover it. So I mean, that wasn't very long ago, honestly. That was, gosh, I mean, we were still early, I would say we were still uh 2012, 2014. This was still kind of the way it was in in most states, right? So, but the other one, big one, is alcohol, right? I mean, how many alcoholics have you seen where opiates and alcoholics, I think, are the the two that are really the hardest to help someone navigate through their addiction? I mean, they're all terrible, right? But these are the ones that last the longest. But for pain, John, I mean, how many pain patients have you seen that become struggles with become I guess substance dependent? And if they and then they lose their insurance or they can't get a prescription any longer because their doctor doesn't want to prescribe anymore, they won't go to a pain clinic and so they end up using illicit substances. How many? I mean, if you had 10 patients, how many would you say that affected?

SPEAKER_01 26:20

Seven.

SPEAKER_02 26:21

Yeah.

SPEAKER_01 26:21

Because the other three are already dead. I mean it's a thing. Uh it's a slightest thing. It's true. I I'm sorry to be, you know, when I I'm sorry to be so uh negative, so to speak, but you know, uh we need to do something. And Will is correct because um there are many, many people. One in one in four Americans know someone with an addiction problem. And you know what we many times we treat patients with addiction with jail, judicial incarceration. And you know, opioid use disorder is a chronic medical disease. And we treat it with jail? That's not right, that's not medicine. We know that medications can reduce opioid overdoses by 50%, but they don't get medications. And the worst part of it is these patients that go to jail, 20% of them can get opioids smuggled in, but they can't get medications that'll prevent the relapse, prevent the withdrawal symptoms, prevent the cravings. You know, there's a lot of logistical problems, administrative problems, legal problems. You know, you talk about the opioid epidemic. We're in our fourth decade, and we're doing the same thing over and over again. We talk about abstinence, we don't talk about medications, we don't talk about holistic care of treating someone's mental health issues as well, because many of these patients have some sort of mental health comorbidity that's not being addressed. And, you know, this is unpopular, but opioid use disorder is a symptom of a disease that really develops from an etiology of something else. Depression, anxiety, someone gets addicted to medications, but you know, there's a concept that many people in chronic pain have. They have opioid dependency, which is not opioid use disorder. And people are making the diagnosis of the two into one and they're not treating it properly. And that's the problem. If these patients don't get medications because they're opioid dependent, they go through withdrawal and then they try to get more illicit drugs, which is really the problem.

SPEAKER_02 28:42

So in the medical world, when you go to conferences or you speak with other doctors, I mean, do you talk about that or is that kind of like a taboo subject in the pain world?

SPEAKER_01 28:53

Well, it's a very difficult subject to really talk to doctors about because most doctors are afraid. Yeah. They're afraid of prescribing opioids. They're afraid of their patients because patient satisfaction scores, if you're a doctor and you don't give an opioid, they're going to blackmail you. And many doctors are really hesitant at prescribe. What do you mean by that? Well, if I prescribe an opioid and a patient overdoses and dies, the DEA comes after me, the district attorney comes after me because they'll say that I did not follow my patient properly. I did not inform them of the dangers of opioids, I did not look at their medication adherence. I did not follow them with enough office visits. And, you know, they can put me in jail for murder. Yeah. Which makes me, you know, I went to 12 years of school. And if a patient overdoses and dies, the DA, the FDA, sorry, DA and the L the district attorney can come after me and put me in jail. That means I don't see any more patients anymore.

SPEAKER_02 29:58

So do you feel like your colleagues, there's a vast majority, if you had 10 colleagues with you, how many of your colleagues would say they feel this way?

SPEAKER_01 30:05

10.

SPEAKER_02 30:06

Yeah.

SPEAKER_01 30:07

Interesting. No one is prescribing opioids. And you have a, like, for instance, one of my relatives had a total knee operation. That's one of the most painful operations in the world where they take out your bone and put it in a piece of metal. It hurts for a long time. And the doctors give you Tylenol and Motrin. And, you know, doctors have been so afraid that there's been a reduction in opioid prescriptions of 44% in the last decade. And for terminal cancer pain, it's 40%.

SPEAKER_02 30:42

Yeah, there's not much of a reason for that. I've heard you say that before that we have patients that aren't being treated for their pain because doctors are scared.

SPEAKER_00 30:50

Uh-huh.

SPEAKER_02 30:51

Yeah. So we, I mean, friends and colleagues, we clearly have a bigger discussion here around this. But if you if you want to weigh in, we'd love to have anyone that would like to talk about the example of the medication treatment in jails and the lack of addiction treatment in jails. We'd love to talk further about this idea of doctors not being able to get their patients out of pain. But we're running up on the hour here, gentlemen. Thanks for being my wingman. And uh thanks for hanging out with me talking about this industry and the problems. And hopefully in the future, we'll be able to touch on the pain points and really get more of our industry colleagues and friends to talk about those with us and uh let that venting happen a little bit. It'll be good for all of us.

SPEAKER_00 31:36

Yep, absolutely. Looking forward to it. Thank you very much, Kendra. Thanks for coming. Have a great night. All right, yep.

SPEAKER_02 31:43

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SPEAKER_00 31:46

That's right. And like it if you like it. Give us a like