Why Doctors Are Afraid to Prescribe Pain Medication | The Saving Dose Ep. 02

In the second episode of The Saving Dose, John Hsu MD and William Pedranti go deep into the most dangerous misconceptions driving the opioid epidemic, why physicians are afraid to prescribe, what the difference between dependency and addiction actually means clinically, and why America is in its fourth decade of a crisis that has a known solution most patients never receive.

This episode covers the clinical realities most pain physicians will not say publicly, the myths inside the healthcare system that are directly causing patient harm, and what it would actually take to close the gap between the treatments that exist and the patients who need them.

In this episode:

Why over 90% of pain physicians John knows personally are afraid to prescribe opioids, and what that fear is doing to patients in legitimate pain.

The difference between opioid dependency and opioid use disorder, why the healthcare system keeps confusing the two, and why that confusion is costing lives.

What happened in pain medicine clinics after the 2016 CDC guidelines, the term that emerged in physician circles, and what it tells us about the consequences of policy without infrastructure.

Why a cancer patient on opioids for years is not an addict, and what happens when their medication is stopped without a proper taper.

The multimodal pain therapy approach John was using in 1999 that colleagues thought was acupuncture from China, and why Medicare took 30 years to catch up.

What happens when an OUD patient goes into surgery and their anesthesiologist does not know how to manage their medications, and why this scenario is more common than anyone admits.

88% of opioid overdoses today are from illicit fentanyl, not prescription medications, and what that means for how we are treating the wrong problem.

48 million Americans living with addiction, 5,000 board-certified addiction medicine physicians, and what that ratio says about why we are still in the fourth decade of this epidemic.

Why the medications that reduce overdose risk by more than 50% exist, and why only 25% of the people who need them are receiving them consistently.

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 #PainManagement #MOUD #BehavioralHealth #AddictionMedicine #SubstanceUseDisorder #HealthcarePodcast #TheSavingDose #RecoveryPodcast #OpioidTreatment #ChronicPain #PublicHealth #DrugPolicy #FentanylCrisis #OpioidEpidemic

Transcript

SPEAKER_00 0:00

If people think about high blood pressure, you take your high blood pressure medication every day. That just means you're dependent on those drugs. You're opioid dependent. It doesn't mean that you're abusing hypertension drugs. It just means you're taking them as prescribed. And that's really what chronic pain is.

SPEAKER_01 0:26

Welcome to the second episode of the Saving Dose Podcast. Thank you for wherever you are today for tuning in on your favorite podcast platform to listen to the Saving Dose, which where we talk about all things addiction recovery. So whether you're a patient or you're a caregiver or you're a nurse or you're a clinician or you're an operator, an executive at a facility or a treatment, outbreak treatment, or just somebody who cares about addiction, who has a friend that suffered from addiction. You want to learn about all things about addiction recovery, this is the podcast for you. So my name is William Pedranti. I'm an attorney and biotech entrepreneur. One of the hosts here we got with us today, Dr. John Sue, longtime anesthesiologist and a practitioner in addiction medicine with us. One of our other co-hosts here with us today. And then Kendra Alley, who's a business executive that's lived in the recovery space. She was a nurse working uh in treatment to help you in recovery, and then was a business executive for many years in addiction recovery. She's the other host. She unfortunately can't be here with us today, so it's just going to be Dr. Sue and I covering a very important topic today, and that is common misconceptions about pain management and opioid use disorder, or what we'll call uh an abbreviation OUD. You'll hear us use that a lot, but it's essentially opioid use disorder, and we'll dive into a little bit here in just a second. Uh, how are you doing today, uh, Dr. Sue? I'm good. Really busy, but I'm really good. Yeah, I know you are. Well, thank you so much. It's greet again to uh for episode two. I loved our first episode where it was just a really a launch kickoff with you, me, and Kendra talking about the addiction space, a lot of our backgrounds, what gets us so excited about being in the addiction space and helping with recovery, helping patients and doctors and clinicians and helping recovery. So super excited about episode two. Love this topic. So important this topic today, because there is a lot of misconceptions around pain management and OUD. So super excited to talk about that, talk about what opioid use disorder is. Before we even got started, though, you and I had a wonderful opportunity last weekend down in San Diego is the American Society of Addiction Medicine annual meeting, right? Where thousands of practitioners in the space and executives showed up down in San Diego to talk about addiction recovery. And I tell you, I just got more motivated, right, down there for three days, meeting with people who are living every single day in the addiction recovery space. People I met from California, from Texas, from Florida, North Carolina, Ohio, Alaska. Somebody who was from a tiny little town that I'd never heard of, between Fairbanks and Anchorant, Alaska, out there with the native community, right? Fighting, you know, alcohol use disorder and opioid use disorder, and trying to help save lives. And it's just awesome to see so many people out there committed, right, to trying to help people and help people recover. Just curious about your thoughts about ASAM and some of the takeaways maybe you had from that conference this past weekend.

SPEAKER_00 3:40

Wow, that's a tough one because um, you know, we're in the fourth decade of the opioid epidemic. That means that we've had 40 years of this. And, you know, it's it just goes to show you that it's really tough to deal with opioid use disorder. That's a politically correct term for addiction. And really, what addiction is, or opioid use disorder, it involves behavioral components and of compulsive use of opioids and loss of control and continued use despite harm. You know, people can be physically dependent without having OUD, but that's really part of the start of the misconceptions of pain and OUD. So, you know, ASAM was great because there's a lot of people that come together, and if we can form a consensus, we can treat a lot more patients and be more successful.

SPEAKER_01 4:34

Absolutely, absolutely. No, I agree. It was again just it's so encouraging to see so many people in their addiction recovery fight, right, to help people that afflicts millions of people, right? I think I was reading some of the statistics coming out of ASAM that talked about 48 million Americans suffer from addiction. 48 million. It's like one of every seven people has some form of addiction, half of which is alcohol, the other half is drugs, and then a crossover, about 7 million, those 48 million, suffer from both. And so we got big challenges ahead. I'm glad that we're doing this. It's great to work with you, uh, Dr. Sue. It's really an honor and a privilege to work with you in addiction recovery. So let's dive right in to our topic today. Again, misconceptions about pain management and opioid use disorder treatment. And so, you know, I'll be asking you, firing you some questions, Dr. Sue, to really dive deep into your decades of experience in this space treating patients, helping patients. And so we'll start it off by a question I've got. Does somebody, if somebody is prescribed opioids, right? So they're prescribed opioids by a doctor for chronic pain. So they're taking opioids every day to try to treat chronic pain. Does that automatically mean that patient has developed an opioid use disorder?

SPEAKER_00 5:47

No, because if people think about high blood pressure, you take your high blood pressure medication every day. That just means you're dependent on those drugs. You're opioid dependent. It doesn't mean that you're abusing hypertension drugs. It just means you're taking them as prescribed. And that's really what chronic pain is. Or people with cancer, let's say people with cancer, they have years of treatment and they've been on opioids for years. And that means that they're opioid dependent because they're tolerant to opioids. You try to stop those opioids, you know, you're gonna be, you're really gonna harm them because then you have a patient on opioids and you try to stop the opioids. If you don't stop it in a slow fashion, you just start stop it all of a sudden, those patients are gonna go into withdrawal. They're gonna have cravings, they're gonna have withdrawal, and that's when you get that compulsive use, and then you develop opioid use disorder. The diagnosis of opioid dependency and opioid use disorder are totally different. The treatment is totally different. It's just really, it's it's really frustrating that as a physician, people just assume if you're taking opioids, you have opioid use disorder. And that's simply not true.

SPEAKER_01 7:10

Well, that's that's an important point. I'm glad you said that, right? Because there's gonna be that stigma around that somebody's dealing with chronic pain, like you mentioned, cancer pain or low back pain, or something they're dealing with every day and they're prescribed opioids, that people look at them and say, Well, you you must be addicted to opioids. So you you talked about dependency and then opioid use disorder. So, so you know, tell me what that looks like. You know, so if somebody, just so I got clear, if somebody is being prescribed opioids, because they've got cancer, they got cancer pain, right? And they're taking an opioid every day to treat that cancer pain. And just like you said, if they're taking it as prescribed for weeks or months or whatever, because they're treating cancer, that is from your perspective, that's not an opioid use disorder, right? No, it's like I you know, it's like eating.

SPEAKER_00 7:57

Okay, if you don't eat, you're gonna be hungry. And that's really the we're dependent on food to survive. But what happens if you go to a buffet and you overeat? You're just not gonna feel good. And that's what happens with opioid use disorder. You uh take so many opioids like a buffet, and you just don't feel good afterwards. After you eat, you loosen your belt, your pants are too tight. Some people vomit, and that's what happens with withdrawal symptoms. People just don't feel good, they vomit, they have anxiety, headache, heart rate is going fast. It's just not a very comfortable feeling. And the only thing that gets rid of it is another opioid.

SPEAKER_01 8:43

Yeah. So it could be where somebody is taking opioids, and like you said, and and immediately they get taken off immediately, right? There's not a step-down treatment plan, but they get taken off immediately. Uh, that can result in somebody developing opioid use disorder. Is that right?

SPEAKER_00 9:00

Yeah, because you have rebound need for the opioid. And when you get rebound need, people have people have a passion to begin to get opioids, and that's all they think about. They there's a whole downward social economic situation. That's all they do is they think about getting the next high, the next hit of opioid. And they lose their job, they lose their wife, they lose their kid, they become homeless, they become unemployed. It's just a downward spiral. And it's very difficult. And that's the difference between opioid dependency and opioid use disorder, because people who have opioid dependency, they may have cancer, but they're living and they get better, meaning that their cancer is goes into remission. They're just like you and me, they're talking, but they're on high dose of opioids. I have a person who is on high dose opioids, over 300 milligrams. He's been on it for years and he works. And he's like you and me, he talked, but he takes it as prescribed, doesn't take one pill more, doesn't take one pill less. It's taking me years and years to try to reduce the amount of opioids he takes, but he's not abusing them. If I stopped his opioids all of a sudden, he's gonna go in withdrawal. He may end up in more pain, may end up with more need or cravings of opioids, and he may actually commit suicide. In 2016, when the CDC said that no patient should be on more than 90 MMEs of opioids, there was a concept called pain suicides. People couldn't get opioids because doctors were afraid of prescribing opioids, and people would just commit suicide because they felt no option, no alternative. They were in so much pain that the only thing they saw to end their pain was death.

SPEAKER_01 11:06

Gosh, gosh, that's that's so tragic. So the importance of, like you're saying, somebody's on dealing with chronic pain and they're on an opioid treatment program, they have that dependency because they need it to treat the pain. But as your example, somebody may get over cancer and that pain is now gone, and they'll work with a physician like you to titrate themselves off those opioids and reduce that dependency, right? Yes. Yeah. Okay. Wonderful. That that that's so um that's such great information. Thank you, that kind of differentiate between dependency when somebody's getting opioids and taking their should, and then when somebody develops truly an opioid use disorder, right? So I know in in your toolkit to treat somebody who's dealing with opioid use disorder, you're using medications like buprenorphine or methadone for opioid treatment. Is that just substituting one addiction for another when you do that for opioid use treatment or no?

SPEAKER_00 12:05

Well, that's really a common myth. Because if you're opioid use disorder, you're taking medications that above and beyond what I prescribe. If you're taking buprenorphine or buprenorphine and narcan, which is called suboxone, and meth or methadone, you're taking them as prescribed. And it actually stabilizes the brain chemistry. So you don't have those cravings, you don't have those withdrawal. And people can function normally, normally, with like just as you and I are talking on buprenorphine and methadone, and you know, it saves lives. I don't understand. We can reduce the overdose death rate by greater than 50%, but only 25% of people get these life-saving medications. You know, we really need to uh uh uh increase uh people with treatment because you mentioned earlier 48 million people need treatment. Well, uh, you know, I I hate to bring this up, but you know, we're in a war situation at this time, and in the VA system, there's 48 vet 44 veterans die a day from suicide and opioid use disorder, overdoses because they can't get treatment. There are 408 clinics in the VA system that treat 6,500 patients, but there's just too many patients. And when you have that situation, it's it's very disappointing for me because I can't treat as many as I can. There's only 24 hours in a day, there's only one of me. There should be more of me to treat more of these patients. Right.

SPEAKER_01 13:49

Well, thank you for saying that. You know, it's it's John, it's it's almost hard to even get your head around those types of numbers you just mentioned, right? In our veteran, the number of addiction veterans community, the number of overdose and suicides among veterans because of issues like this, it's just truly tragic. And I agree, you know, sounds like what you're saying. These these medications work, right? Eupenorphine and and methadone and other drugs, they work at helping people deal with their addiction, right? But it sounds like access, getting access to these medications is a real challenge for a lot of people. Yeah.

SPEAKER_00 14:24

It is because, you know, there's few doctors want to treat these patients because many of them have lost their jobs. So many of them are on Medicaid or in California, Medical, and they tend to take more time. So it ruins your um your flow in your office. So many of these patients are are difficult, they're more difficult, but they're difficult for a reason. Because I'm treating two patients in one. I'm treating the patient's mind because you know, they have a mental uh addiction or a mental need to take these drugs, and they have a physical need to take these drugs. So I have to assess their mental needs and their physical needs. You know, opioid use disorder is a chronic medical condition, just like high blood pressure. We treat high blood pressure with high blood pressure with medications, and you know, we don't treat opioid use disorder with medications as we should, because we can really reduce overdose deaths with it. Like I said, 50% reduction in overdose deaths, but only 25% medications or 25% get these medications. I really hope I can really encourage people to get treatment because it can be life-saving.

SPEAKER_01 15:45

Yeah, I love how you said that treat thinking of this as a chronic disease, right? A chronic disease that we're trying to treat, so important, right? It's not a, hey, go to go to a clinic for a month and you're gonna be good to go, right? Maybe that works for some, but really thinking about, like you said, for chronic disease, and it highlights a situation I was just thinking recently, I think I I shared with you offline, was uh a friend of mine's brother, right? And I'm 53, he's a little bit older than me, maybe he's 57, 58. And he literally, like a week ago, checked himself into a residential treatment facility. And he's been dealing with addiction for over 30 years. 30 years. He's been from me, one of the first it was over 30 years ago where he first got addicted to an opioid. And here he is, 30 years later. And in fact, he actually didn't start taking opioids again, but he knows after 30 years of dealing with this chronic disease, what signs internally for him look like where he becomes at risk for relapsing back. So he voluntarily checked himself into a residential facility just to make sure he doesn't. And it's just true. It's like 30 years he's been dealing with this. And then every day that goes by, he doesn't deal with it. And so I'm glad you said that, because it's really is a chronic disease and has to be thought about like that, right? And and I agree with you, getting access to these medications, so, so important because they work. And I and I love what you said about the important of these medications. It's not substitute addiction from one and the other. So it's that stigma we've got to get away from. That if somebody's getting methadone, if somebody's getting Suboxone, got to get away from that stick while they're an addict, right? They're they're just but they're taking methadone, so they're an addict. Got to get away from that and say, no, this person has a chronic disease and condition they're dealing with, and they're dealing with it the right way to make sure that they don't relapse. So I love what you said. So important to get that message out, John. Another question I've got too is so somebody, you start treating somebody, right, that's on now opio opioid use disorder treatment, so they're getting methadone or buprenorphine or some other medication for it. Can they still receive opioids for acute or chronic pain management?

SPEAKER_00 17:55

They should. Because if you're on these drugs, that just means that your brain cells are being stabilized for the mu receptor so that you don't have the cravings and the withdrawals as much. But if you have pain, there should be no reason for you to stop these drugs. In fact, you should take the correct dose for pain. As an anesthesiologist, if a patient comes in with suboxone or methadone, I don't stop it. I actually keep it going. And I give them medications for the pain. These two drugs are actually opioids, and they can actually treat some of the pain. I may give them the same dose, which makes many other doctors nervous. But, you know, if you have experience with these kind of patients, you become familiar with it. And that's very, very important. You need to be, as a physician, you need to be familiar with these patients because not all doctors are familiar with opioid use disorder and how to treat these patients with for surgery or acute pain. The more you leave a patient with acute pain in pain, the more they're gonna crave opioids and the higher the chance they're gonna relapse.

SPEAKER_01 19:08

Yeah, that's awesome. That last nugget's a good one. There's so many, there's several things you said there I want to unpack a little bit that I think were so important. I love that last thing that you just said, right? Don't forget to you got to adequately treat that cute pain, right? Because that could morph into something a lot more dangerous. So right now, if somebody's on, going back to what you said, one of the things you said at the beginning, so somebody's on, could be on bufinorph and methadone, so they're on an opioid for addiction opioid use disorder, right? They may be getting adequate pain relief to treat some painful condition they've got. Is that right?

SPEAKER_00 19:42

Sometimes. But you know, it's not really used to treat pain normally because the the action needs the the pain analgesic part of it only lasts for six to eight hours. But the stabilization of the brain chemistry lasts a lot longer. So if somebody is on suboxone or methadone, they can actually be taking other opioids for acute pain for a short that these medications for acute pain don't last as long, four to six hours or four to four to eight hours, and they can take those other pain medications. You just have to have a pain doctor who knows addiction medicine as well.

SPEAKER_01 20:23

I love that you said that last point, because that's a point I was gonna come right back to. So just to recap what you said, so somebody could be getting treating opioid use disorder, they're getting suboxin or methadone. They may have a surgery or something where they need additional opioids, right, to treat an acute pain, right? And that's okay. That's a very important point that you made. But that last piece is so important too, right? Just what you said is you need to make sure you're talking to a physician like yourself that understands pain management and addiction medicine, it sounds like, right? Somebody who's skilled and seen these types of patients, right? To really make sure somebody is getting the right type of therapy, what they're dealing with. Sounds like, right?

SPEAKER_00 21:03

Yeah, that's right. Absolutely. Before surgery, most doctors will tell you, most anesthesiologist, all anesthesiologists will tell you, don't eat or drink anything before surgery. And some are not so careful to tell you to ask you what medications you're taking. So some doctors will tell you not to take your diabetic pills or hypertensive pills, high blood pressure pills, or your pain management pills. And if that happens, you get a rebound diabetic increase in your sugar, you get a rebound high blood pressure because you didn't take your medications, obviously, and you get a rebound craving for opioids or withdrawal symptoms because you haven't taken your OUD medications. And that means the anesthesiologist is not going to give you a higher dose to cover that opioid use disorder. medication deficit and you're gonna wake up in extreme pain and you're gonna be dope sick and you're gonna be in you're gonna you're you're gonna be highly nauseated many doctors there's about 5,000 opioid use disorder medic uh doctors in the United States there's close to a million doctors in the United States and not everyone understands opioid use disorder yet there's no consensus for treatment and that's probably why we have the opioid epidemic in its fourth decade. That's crazy.

SPEAKER_01 22:41

You know a couple things you said there one first of all you mentioned dope sick right which I just have to say as a side note have you have you seen that uh I can't remember it was on Netflix or HBO or whatever it is. Have you seen that dope sick? But I think it's Michael Keaton it's good it's true. It's really true. Yeah it's well done and and stat it just shocking when you watch it right Michael Keaton what he goes through right he's a pain management doc right he gets hooked. I don't want to spoil it if you haven't seen it but if you haven't seen it go see it because it does a great job at highlighting what it uh and I think about you when I thought about the movie because when you talk you tell your story about patients in the parking lot and things like that I always think about uh that show Dopesick. So if you haven't seen it go out and see it. It's really really good. But so just so I you know I want to harp on one last point on what you said because I thought was so important is really this idea of of you you're treating opioid use disorder but if somebody has pain right and so they need to treat that as well. And so because you worry about I think you kind of said that if somebody is not getting their pain treated too, right? It sounds like they're they're potential at risk for relapse if that pain is not retreating. Is that right?

SPEAKER_00 23:54

Yeah absolutely well let me ask you a question if you have acute pain and I've been giving I prescribed opioids to you hypothetically right there's a hypothetical situation and you begin to take opioids and then your pain doesn't go away and I stop giving you opioids what medication are you gonna go to to relieve your pain Tylenol doesn't work motron doesn't work you know there's something called illicit you know fentanyl that's sold everywhere in the United States that's right a lot of people who can't get pain relief go to illicit fentanyl yep yep we have so many overdose deaths because of fentanyl right it's so tragic so so tragic 88% of opioid overdoses are from illicit fentanyl 12% are from prescription medications like prescription opioids and that presents another problem because when you try to save these patients with narcan or what's called naloxone many of these patients require two three four doses and you have narcan dosing ambiguity and really it's very difficult to reverse the opioid induced respiratory depression from illicit fentanyl because the doses are so high.

SPEAKER_01 25:25

It's just incredible yeah so dangerous a lot of times we don't even know like all these drugs are laced with fentanyl and things like that right people don't even know that they're taking fentanyl so so deadly so deadly so I want to thank you so much for this this is such good stuff John but just shift a little bit a different type of question is you know I think one of the challenges people hear because there's so much stigma around opioids and people that get hooked everybody's afraid to get hooked right afraid oh my gosh if I take this opioid that my doctor wrote me after my dental surgery or something like that. I'm worried about getting hooked. And so I kind of wanted you to address that question is is everyone that's prescribed opioids going to become addicted? So the doctor gives you something and I take it for a week because I'm in terrible pain? Is it oh you know I'm I'm in trouble because I'm gonna get addicted to this and I'm not gonna be able to get off it or is it more rare? What do you see in terms of opioids if people use them appropriately, right? What what kind of what are you seeing in terms of that?

SPEAKER_00 26:25

Well let's just look at the numbers first. You know there's about 137 million prescription of opioids prescribed by doctors per year. And we have 12,000 people overdose and dying the percentage is very very low of people who are overdose and dying on prescription opioids. It's close to 1% right but the the issue there is that if you are taking opioids for seven days and you end up taking it for more than seven days let's say 60 days the chance of becoming addicted or opioid dependent is higher. At the end of 30 days the chance of opioid abuse or 60 days the chance of opioid use disorder climbs. If you're on long-term opioids that doesn't mean you're a you're addicted yet but the chance of opioid use disorder goes up but that also the same at the same time the chances of opioid dependency go up as well and the problem is if you're opioid dependent this if you're on if you've been taking opioids for six months it's going to take a year for you to get off of those opioids because you have to reduce it so slowly. If you reduce it too quickly these patients they go in you can force someone who's opioid dependent into opioid use disorder because a treatment of opioid dependency is to treat the side effects because they need the opioid. As long as they're taking it as prescribed they're not abusing it. The problem with opioid use disorder is they're they're not taking it as prescribed they're taking other drugs 70% of opioid 70% of overdoses are polypharmacy meaning people take a lot of opioids and in those situations you have to treat it differently. Narcan which is just strictly for opioids doesn't work with the other drugs that patients may take patients may take xylazine or Tranc or dexamethadine or benzodiazepines those drugs require a different antidote.

SPEAKER_01 28:38

That's why many patients who overdose you give them a dose of narcane it doesn't work because it's not the right drug that it's trying to reverse yeah interesting couple takeaways there I take you know because like I said you know a lot of people fear opioids because of what's going on in the crisis that we're dealing with but you know what you're clearly saying is you know when opioids are prescribed appropriately right in a situation and patients take that compliantly so they follow the prescription program the doctor has we see you know the chances of getting hooked or addicted are very low, right? It sounds like in in many cases, which is great. But that also goes to the issue you said several times before you want to make sure you're you're getting those scripts from doctors who understand right pain management, understand how to prescribe appropriately, right? And and for pain and stuff like that.

SPEAKER_00 29:34

Yeah you you know what's very very interesting is that patients some patients fear opioids. You know we had an opium wars in the 1830s and 1850s where Britain put um the opiums in China and it it caused many people to have opioid use disorder. You know physicians are afraid to prescribe opioids as well because in the last decade there's been a 44% drop in opioid prescriptions for acute pain and incredibly a 40% drop of opioids for terminal cancer pain. That means that people are left in pain for acute pain and for terminal cancer pain. Are we really leaving patients who are dying in pain?

SPEAKER_01 30:23

I really hope not yeah I don't really hope not exactly yeah no and and and I think I said this crisis has scared a lot of people scared a lot of docs away from wanting to do that. And you're exactly right so I think that's so important. We're just about out of time so we just got one more question here. I want to kind of be the last question we can kind of wrap this up here too is when thinking about treating pain management just like we talk about somebody's got pain want to make sure that they're appropriately being treated with opioids in the appropriate circumstances people are compliantly taking it all so it asks this next question is are all pain management approaches primarily about opioids or are there other treatment options if if for some reason opioids are not appropriate or somebody's looking for something other than opioids are there other effective non-opioid treatments for pain well you know let me start off by saying opioid use disorder is a symptom of something else pain is the etiology but for patients who have pain there are other drugs that can reduce pain.

SPEAKER_00 31:26

This is a fun this is a funny story and um when I first started with the opioid epidemic in 1999 I was pushing a concept called multimodal pain therapy. And I was using other types of drugs to reduce other reasons that pain can be magnified. So I would use an anti-seizure drug to reduce conductive impulses getting into the brain to have the brain perceive that as pain. Then I would use a strong antidepressant to reduce the concept or perception of the mind to pain. Then I would use something to reduce nausea which you know if you're nauseated and you try to throw up it's going to increase your pain. I would try to reduce anxiety by giving something to reduce anxiety as well and to something else to reduce pain. There's a lot of different types of drugs to reduce pain one of the funniest things that happened to me was that you know medicine is a very conservative practice. If you do something new people just think you're crazy and there you know people will just say the funniest things yeah you know people think of acupuncture there's other physical things that can do it acupuncture can reduce pain. And I was doing pain blocks with the ultrasound before a lot of my colleagues are doing it and people thought I was doing acupuncture on my patients and asked me if I was bringing something from China to the US to treat American patients. I said no this is something that is up to date we're doing multimodal pain therapy where we're trying to reduce opioid uses not get rid of but reduce it you know 30 years down the road Medicare has now said that they are making sure they will not penalize doctors who use multimodal pain therapy. And you know it just seems like I'm kind of ahead of my time I'm not bragging but I'm just ahead of my time and it's really for a good reason. I really care about my patients and I really try to do my best.

SPEAKER_01 33:43

Yeah I know you do. I know you do so thank you so much. We're out of time but I I wish we had more time this is such a great topic of learned so much. And then that last point about you know we did I know we just dipped our toe into talking about other non-opioid ways to treat pain and maybe we could do another podcast in the future just on that topic because I'm sure you could get a ton of great information from you, John, in the 30 minute segment about all the other alternative approaches that you've used in your multimodal treatment programs over the last few several decades. But I've learned a ton. Thank you so much, John this has been great for me. I've learned a ton despite having built a pain management company in the past in this space I still learned a ton. I hope all our listeners out there have learned a lot as well if you like this podcast please like it on your favorite platform. If you want to leave comments please do that. We'll do our best to get to those could certainly reach out to us at our website we're building if you have any questions but we really appreciate you listening. If you have any future ideas or things you'd love for us to talk about on this podcast please submit it because this again is all about all things rediction recovery. And so thank you so much I appreciate you guys spending time with us today. Thank you, Dr. Sue I really enjoyed it and we'll see you guys in two weeks next on the Saving Dose Podcast