Inside the Black Box of Addiction Treatment | The Saving Dose Ep. 03

In the third episode of The Saving Dose, William Pedranti sits down with Kendra Allen to map the full continuum of addiction treatment in America and go inside the operational reality of the clinics trying to deliver it. This is not a conversation about clinical failure. It is a conversation about what happens in the seven days between appointments, why most practices have no visibility into that window, and why that invisibility is where most recoveries end.

This episode covers the levels of care most families do not know exist until they are desperate, what medication-assisted treatment actually is and why the stigma around it is costing lives, how opioid treatment programs are bleeding patients they cannot afford to lose, and what Kendra calls the black box: the gap between the clinic visit and the outcome where providers are flying blind and patients are on their own.

In this episode:

What you can do when a loved one needs addiction treatment, why calling your insurance company may not be the right first step, and how to potentially navigate a system that was not designed to be navigated by someone in crisis.

The full continuum of care from detox through residential to partial hospitalization, intensive outpatient, and MAT: what each level means, what it may cost, and what could drive the decision between them.

Why medication-assisted treatment may not be giving patients a synthetic high, where the stigma around MAT can come from, and what that stigma may do to the patients who need it most.

The shame cycle: some reasons why patients who relapse between visits do not tell their providers the truth, what that dishonesty can cost the clinical relationship, and why it may be a predictable system failure rather than a character flaw.

What it looks like inside a clinic when a patient walks in with a dirty drug test and a story about poppy seed muffins, and what a provider is supposed to do with that.

Why the seven to fourteen days of medication a patient takes home can be one of the highest-risk windows in recovery, and what can happen when that medication exists in a household where someone else is also struggling.

Outcomes happen between visits. What Kendra means by that, what her definition of the black box actually is, and why closing it can be the central operational and clinical challenge facing opioid treatment programs in America.

Why patient churn is not a marketing problem or a clinical problem but an infrastructure problem.

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

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 #OpioidTreatment #SubstanceUseDisorder #HealthcarePodcast #TheSavingDose #RecoveryPodcast #MentalHealth #PublicHealth #PatientRetention #MAT #ChronicPain

Transcript

SPEAKER_02 0:00

So if you look around our communities and the next homeless person you see, the next unhoused person you see, the next person who is standing on the side of the road down on their luck, those are often people who are struggling with addiction or mental health illness or both most often. And, you know, if you think about your high school friends and your childhood friends, no one said, I want to grow up and be homeless, or I want to grow up and be an addict. But um it happens. It happens a lot.

SPEAKER_01 0:45

Thank you for joining us today, wherever you are. Thank you for joining us on whatever platform you're using. Wherever you are, thank you for joining us today to hear about all things addiction recovery. So whether you're a patient or a caregiver or a loved one or a nurse or a clinician or a business owner or somebody just wants to know more about addiction, this podcast is for you. We're going to do deep dives in all things about addiction recovery and what we can do and learn. Uh, not only what we can try to teach you, but what we can learn from you about uh how we can help with addiction recovery. And so very excited on this third, third, third podcast. Hopefully you've caught the first two podcasts that we've had. Very first one was the three hosts, myself, William Padranti. I got Kendra Allen. Kendra, how are you doing today? I'm doing great. Great, here with us today. Unfortunately, Dr. John Sue couldn't be here with us today. So, but we had our first episode. If you haven't caught it, please do. It was the three of us just really talking about introducing ourselves, talking about our why, why we're passionate about the addiction recovery space and why we're doing what we're doing. Last week, it was just John and I really talking about some misperceptions between chronic pain management and the treatment of substance abuse disorder. So encourage you if you've got the time to go back and look at that. And please, thank you so much for being here. And we look forward to a wonderful discussion today. Our topic is going to be around it's going to be me interviewing Kendra and really talking about opioid treatment programs, right, that are out there working to try to help people in recovery and some of the challenges that they're facing today to help patients in recovery. So, Kendra, you know, super excited to get dive into this discussion. I'm looking forward to the next 30 minutes. Uh, but before we jump in to a bunch of questions I've got on you, I was just I was thinking about uh the other day, uh last week when we all had lunch together and with Dr. Sue and a bunch of other people, we were talking about addiction, addiction recovery, and some of the challenges. I was just sitting here thinking about this morning about that one gentleman who came and he had talked about his brother had suffered from addiction his whole life. And he we talked about the importance of caregivers in supporting addiction recovery, how they can mean in a situation where you in his particular situation, I talked about where a lot of those caregivers have got burned out, right? From years of trying and trying and trying to try to help people that just won't help themselves and just losing a lot of that support. And that really hit home to me, is is hard to imagine something like that. But I can imagine when you're dealing with a relative for so many years, trying to help them and they're not willing to help themselves, how that can happen. And so with you and your experience in being in the addiction, addiction recovery space for so many years, just kind of think, how did that how did that resonate with you? Like, what is have you seen that before? What is that what's your experience uh with it?

SPEAKER_02 3:38

Oh, I've lived it. So that's the hard part, right? So um the reason why uh I continue to stay in this field, it's certainly not because it's easy or there's a ton of money in it. It really is because um it it's almost I don't want to say a calling, but if i I do believe if you have a talent um and it's to help humanity, that it's it's part of your, I don't know, destiny maybe to to help other people. I really do believe that. Um and you know, I've I've started nursing school when I was in high school. There was a program where you could become a nurse by the time you got out of high school. And that's where I started nursing. And then you start as a beginning nurse, you start in different places. So you could start at addiction treatment centers or you could start in nursing homes, and I did both. Um, and they're both hard, right? Like you see people's end of life and the worst days of their life, and but that's part of being a nurse, right? So as you go through your life and you get older, you try out different careers, but but addiction always calls me back to it because I have such a personal connection to it, and I understand it from a personal standpoint, and I under I can empathize with what people are going through. And to answer your question, that that person who was sharing that their brother has struggled for a really long time, and and it didn't sound like he was willing to be a support person, like that person's burned every bridge in that family, and you know, it sounds like he's gonna be protective over his parents and they're not gonna be support Pearson. So, you know, tough luck, but he's gonna have to find someone else. And I would say I've seen that time and time and time again in lots of families. So if you look around our communities and the next homeless person you see, the next unhoused person you see, the next person who is is standing on the side of the road down on their luck, those are often people who are struggling with addiction or mental health illness or both most often. And, you know, if you think about your high school friends and your childhood friends, no one said, I want to grow up and be homeless, or I want to grow up and be an addict. But um, it happens. It happens a lot. You don't look at your children and be like, one day, that's you hope that that's never them, right? So in my career, I've seen people trying to save their child, whether they're 50 or whether they're 15, and they're just trying to save them from themselves, really. And they just are a shadow of the person they once were, and it's painful, right? So I think I I 100% connected with that person who was explaining that, and I understand it from a very deep-rooted place. And, you know, it's okay because there's other people who are not emotionally attached to that person that can be that person's support and can help them get back on track. And maybe that person one day can, in the eyes of their family, redeem themselves, but sometimes not. Sometimes that person's lost their family forever. But the good news is in our society that we have tribes, right? Like you move to a new town, maybe you don't know family or friends there, but you build your own tribe around you. And in recovery, I often see the same thing. So even for the person who has exhausted every option they've ever had to go back to, they've burned the bridge and let the fire light their way, right? As they say. Right. Um, there's other communities that can support them so that they can be healthy and functional and um get their life back. And that is the best gift that you can get is a family coming to you and saying, Thank you for helping me save my child, or a person coming to you and saying, Thank you so much for fighting the insurance company so that I can continue to get this care and now I'm here. You know, I have people that I run into and they're 15 years sober now. And they're like, oh my God, without your sober living house, I would have been dead. With without your sober living house, I would have never got my kids back. And that's huge. That's you're impacting generations, right? Because if if those kids would have lost their mom forever and been in the foster care system, or worse yet, she died, you know, then what? Then it it perpetuates and they have to deal with that pain. I mean, everyone has to deal with the circumstances of what happened, but um, you know.

SPEAKER_00 8:22

Yeah. Yeah.

SPEAKER_02 8:23

So anyway, that's that's the long answer to the question. I don't know that you asked all that.

SPEAKER_01 8:29

No, no, no. That's exactly why we're doing this. That's exactly why we're doing this. Because I'm I know there's so many people out there, Kendra, that are doing going through the same thing that are gonna listen to this and are maybe even feel guilty. Like, you know, gosh, am I giving up on a family member? You know what I mean? With my frustration after trying to help them for so many years and it's not working. So just being able to share that, you know, that you've been through that, you've seen that, the challenges of that is I think is so important. Thank you for for doing that. I think that's a nice dovetail, you know, particularly because you talked about some of your background, having done this for many years. It's a nice dovetail on our topic today, we're gonna hit is the challenges facing these opioid treatment programs, right? And their ability to help people with recovery. And so, you know, obviously you've been a you've been a business owner in this space in terms of addiction clinics, you've you've been on the business side too, helping operate and support practice groups from various means. So tell me what, from your perspective, what are the biggest challenges that these opioid treatment practices, and maybe I can take a step back, tell maybe define for our listeners what is an opioid treatment practice program, right? Maybe you can define that first and then dive into some of the challenges that they're facing today.

SPEAKER_02 9:38

I was actually talking to a friend today who was trying to find treatment for her her son. And and the hardest part is that you know that your loved one is uh having an addiction issue, and that's already a slap in the face. But then when you call your insurance company, they're no help. I mean, they don't know what the condition is, and so oftentimes they give you wrong information. So her information was take them to the emergency room and they'll point you in the right direction. And that is absolutely, unless they're, you know, completely high out of their minds and and you're not sure what to do with them, the emergency room isn't gonna help you, right? Because they have to be a danger to themselves or or someone else for the emergency room to even try to help you detox someone. And so you don't know what to do, right? You don't know who to call. So there's multiple levels of care within the addiction treatment system. So it starts at what we call acute care, which is typically a detox of some kind for most people. So if you have a person that is struggling in addiction, that is is typically where you start. Now, most people that are struggling with addiction do not want to go to detox. They're afraid of being sick, they're afraid of being in pain, and they're afraid of stopping doing what they're doing because their brain is telling them that that will be terrible for their body and their mind, and and they will have a horrible experience. Because once that drug starts to wear off, their body and mind starts telling them that they're going to die. Now, I realize that sounds like an exaggeration, but that is the desperation that that person feels. So a great place to start there is at your local. Um, I most insurance covers um inpatient detox for any kind of opiate and any kind of alcohol or benzodiazepine. And that's a um like a Xanax or a um a Lorazepam. Most most people don't just use one type of drug. They they oftentimes self-medicate across a spectrum. And so the only two things you can die from most typically in the addiction detox world is um any kind of alcohol is actually a very fatal detox. It can be. Um, and same thing with benzodiazepine. So those pills that everybody takes to relax themselves, that their doctor gives out, that you can actually die from withdrawals. So you should contact a detox center and get your loved one to a detox center. Now, if the first one tells you they don't take your insurance, that's okay. You can call your insurance and very specifically ask for a detox center. Um and if if it's uh alcohol or benzodiazepines, the emergency room will take that person and help start the detox and find placement for them. Um and again, it don't give up. If if the if the detox center tells you don't take your insurance, call the next four in the phone book, call. I I guess I'm old. There's no phone book anymore on Google, whatever. But take them to the emergency room and I love it. And they will um they'll help you find find placement. They won't be happy about it, to be clear, but but they by law will have to, right? Because they can die from that detox. Opiates you can't technically die for by itself. So it's important to tell the emergency room if your loved one is doing opiates, but at the same time they're drinking, you know, two six packs a day to balance that out. That that alcohol is actually the primary reason your insurance will cover not the opiates. So it's important to take that full history with lump it on the plate, give them everything, every little thing, because sometimes that will make a difference. So that's the most important piece of information I can put out there is that's the first step in getting someone somewhere. Now, sometimes they'll say, Well, your person um doesn't use enough drugs to be considered for detox. And you're like, okay, so where do we go from here? So your options are residential treatment, which can or or if if detox is telling you no, insurance sometimes will pay or not pay, but they will do an assessment so they can see if they belong at that care setting. And oftentimes they have referrals for you, and so will your insurance. The next level of care is partial hospitalization. That's where you drop someone off, and typically it's a most of the day type of program, and you pick them up at the end of the day and you take them home and you drop them off again in the morning. Um, the next level of care is intensive outpatient, which they go two or three times a week for up to nine hours a week typically, and they do groups and individual sessions, and um it's a great stable community for them, and a lot of people um get a lot out of it. And then there's uh mat treatment. So mat treatment is medication-assisted treatment. So if you're talking to your loved one and it just doesn't sound like they're ready to stop using drugs, and that's a reality. So if you think of it as a teenager, you know, your religion was always telling you abstinence till you're married, abstinence till you're married. It's we've taken that concept and put it to drugs, you know, it's very Reagan-era, you know, um type of drugs. Just say no, right? Um, and what we found study after study is just that that's not really a realistic approach to addiction for some for most people, honestly. And the statistics say that most people relapse at least five times um prior to becoming sober. And then um most of the relapses that are recorded um in the way of overdose or death are right after treatment because they get out of treatment and they feel like they have to go use. So it's a sad cycle. But to the point of medication-assisted treatment, which is OTP, um, they're kind of interchangeable terms. So we have MAT equals medicated assisted treatment. It's also called OTP or opiate treatment programs, which are way more structured. And then there's companies like Bicycle Health or smaller practitioners online that will provide you with a medication that keeps you kind of at a baseline. It and there's lots of misnomers about it. Oh, we're giving you synthetic opiates and you're making them high all the time. That's actually not true. Um, there's lots of stigma attached to mat medication, which there shouldn't be. These are people that are just struggling, and for whatever reason, maybe they can't take off work, maybe they have six kids and and they're a single parent. Maybe, I mean, there's 100 reasons why you could default to I'm scared. I mean, it could just be simply as I'm scared, or, you know, I've had 75 changes in my life, and this 76 one's gonna put me over the edge. So I just need to do this thing temporarily, right? So it doesn't really matter the reason why, but whoever is struggling has to pick one of this vast array of ways to get help in order to regain control of their life. And Matt is just one of those ways. And so these online companies, a lot of them can just um give them a prescription, they can do telehealth visits and they can continue on with their life. And in other ones, they have to go directly to the OTP clinic. And these are typically higher acuity patients, patients who really um can't have the medication in their hand all at once, or they'll be too tempted to take it all at once. So those people really need to go to the clinic every day and get their medication for that day in whatever way. And once they're stabilized, um, we give them more medication to be trusted with it, and then more medication to be trusted with it, and then they can build up to just having the the prescription. Um so those are the levels of care within addiction treatment. So there's lots of options for families. So families, if if you call somewhere and you can't get them a bed at a treatment center, that's not the end of the world. I mean, call these mat treatment places. Let's get them stabilized and at least off of street drugs, and then work the system from the other side. You know, there's yeah. Great options to get people off of street drugs and just start the process of trying to stabilize.

SPEAKER_01 18:40

Yeah. Thank you so much for kind of for walking us through that. I wasn't even aware of all these steps and options, the detox and the different steps you can go. Thank you for explaining that to our listeners. I think that's gonna be very valuable when they think about a family member that they're trying to help and where do we go? So if if we focus, though, on these mat treatments or these opioid treatment programs, what is that, what does a typical clinic look like in a mat opioid treatment program? The physical building, they have nurses, doctors, pharmacy. What's going on in the business of a of a mat and how are they, what are they doing every day, and how are they interacting with patients?

SPEAKER_02 19:16

Well, it's it's come to be a lot less clinic feeling over the years. I mean, back in the day we we had glass windows that people stepped up to, and now it's very, very much like your doctor's office. You either step up to a window or they call you back, or it very much is very doctor office-y, or sometimes they just have your stuff sitting at the window and you check in at the window, they give it to you, you sign a paper and you and you leave. So it doesn't have to be as intimidating as people believe it to be, because you know, most people that have struggled with addiction have have struggled for a while. And maybe they've had a bad experience at a clinic where they didn't feel they were treated well, or they felt it was uncomfortable, or there were barriers to to getting it where they just they just didn't like the environment, right? So I say try another treatment center because they're not all the same. Um there's lots of independent owners. I I have some clinics with some other providers, and and you know, we try very hard to make it comfortable and welcoming and supportive environments. And I think I don't know, I would say 90th percentile of all the treatment centers are on that bandwagon right now.

SPEAKER_01 20:34

Yeah, we so pay patients are coming every day to get medication. I think you said some people show up every day. Some some are taking it at home, right? Those patients you mentioned, maybe more mature patients that can reliably and I assume patients are coming in for consultation or therapy or those kinds of things.

SPEAKER_02 20:50

Yeah. So we the first step is that we see a patient and the doctor sees the patient very specifically and goes over their um history of mental health and um struggles with addiction, and they they go through that whole history with them. And regardless of what that is, there's no judgment. Um, it's just a matter of, okay, well, thanks for coming in and let's figure out how to help you. And they give them a prescription. That prec that prescription can be Suboxone, it can be methadone, it could be buprenorphine, it could be a taper, and we call this this kind of an induction phase is what it's called. Um, and then that that's kind of a most often a larger dose of medication, and then they taper it down for a certain period of time based on that history. And then the patient can stop coming every day and eventually and take seven days home at a time. And then once they've been trusted with seven days at a time, then they can go 14 days. And when they've been trusted with 14 days for a certain period of time, they can go 30 days. And you can stay on these medications for years. It doesn't have to be, you know, like you're you have an expiration date, and once that date hits, you have to go do something else. You have you get to, as a patient, have a right, you have patient rights, and you get to choose the course of your treatment and and what that looks for, what that looks like for you in your life.

SPEAKER_01 22:23

Yeah. So patients, they're coming in and they're getting treatment, like you said, you've got some various line, you know, whether they're coming every day or every week or two weeks or three weeks and getting therapy and that kind of stuff. So talk to me about so some of the what are some of the challenges that these practices, these OTP clinics are dealing with in order to see success, to get good patient engagement, good outcomes. What what is what are some of the challenges that they're dealing with every day?

SPEAKER_02 22:50

It's crazy. It varies from state to state and region to region. And that's insane that our in the year 2026, that we still have these problems. So, like in some states, you have to have a pre-authorization. So before I can see the patient and get paid for it, I have to call the insurance and wait for pre-authorization that can take 24 to 72 to 96 hours. And by then this poor soul is back. Oops, sorry. Um, this poor soul's back using again because they're not going to, they're not stable enough to wait that long, right? It was some point of clarity for that day that they were gonna get this taken care of, but now I've lost them. And it doesn't matter how much cost how much I call them or text them, that to get them back in, they're in a they're in a shame cycle, or they're just not able to to be functional enough to do it. So that's that's unfortunate, and we need to fix that. That's something that I think providers are are all in agreement with, right? And oftentimes um it doesn't seem to matter if it's commercial or Medicaid, and many states have um stopped that requirement, but we still have quite a few that require it.

SPEAKER_00 24:09

Yeah.

SPEAKER_02 24:09

Um, so that's unfortunate. But it is a business of low margin, high stress. We have a hard time filling positions um for staffing. We're already short staffed nationwide. We don't have enough psychiatry providers, we don't have enough addiction providers, um, we don't have enough prescribers to hit all of the areas of behavioral health that we need to, which includes addiction. So we have staffing shortages in both providers and nursing. And the second part is, you know, we can't keep the doors open unless we get paid. And I can't tell you how many treatment centers. So I've been in the consulting world for, I don't know, at least the past 15 years, where I go out and help um facilities figure out where their bigger problems are with collecting from insurance and where they're leaving money on the table and how how they can better their business. And I would say that most providers um they are really struggling to keep the doors open because of low reimbursement. The lowest reimbursement is, and there's no medication, there's no real margin on these medications. Um, they're trying to pay these providers or bridge providers like nurse practitioners and PAs less than doctors, which makes sense, right? They're not as credentialed. Um, but also you can't pay them under what I'm paying them on the market because I can't stay in business, right? And then I also have to pay for the medication and I have to pay for a therapist and I have to pay for support staff. Um, and some of those roles aren't don't get reimbursement. So it really is a struggle to build a program that is robust enough that we can get paid, but not so demanding that a patient quits us and goes somewhere else because it's it's too rigorous for them in where they are in their recovery. So it's a balancing act. And then as patients churn, you know, I'm counting on that patient to, you know, pay for the provider and whoever else. And so if I have so many patients leave a month, I have to replace them to even pay our bills. So it's, you know, it's always a struggle for any um type of doctor's office. I mean, it doesn't matter what kind of practice you have, this is always, you know, the calculation we do for for patient values and such. But um in the addiction world, because our patient base is so um various and unstable, it it makes it makes it hard to have a great business unless you have lots of volume. It's a high volume business.

SPEAKER_01 27:01

Yeah. Well, gosh, so the challenges you just laid out are many, right? Yeah, I think you talked about prior authorizations, getting authorations for coverage, and then the follow-up of getting actually paid, right? And certainly with the you know, concerns about crunches and and Medicaid over the next number of years, right? Cuts in Medicaid. I'm sure I imagine there's probably a sizable Medicaid population in the addiction community. Um so you worry about cuts to that. So and then you know, staffing, I know you mentioned mentioned staffing, the challenges that not only nationwide we have with clinical staff, but I'm sure very, very challenges in addiction space as well to find good staffing. You also mentioned churn, right? Patient loss, and maybe some of those reasons we mentioned before cause churn. But talk to me about that. Like, how big of a problem is that for opiate treatment programs is churn, patient churn.

SPEAKER_02 27:51

It's huge. So let's say in a given month in a practice, I get 10 new patients, I lose six of those patients within the first 30 days. They relapse. So unless I have a a really great way to insulate them from relapse, um, which really means a lot of hand holding, a lot of peer counseling, a lot of you can do this kind of coaching. And even then, I might still lose three of the six, right? Um it really is hard, right? This uh becoming sober and not relying on these substances that your brain and body believe you're going to die without is is a horrible trap to be in. And um it's we have no fathom of the understanding of of what it truly is to be trapped in that cycle. I mean, we we can conceptualize it, right? But I can't tell you how many people have told me I will die without it, which isn't true, right? We know that it's not true, but their brain and body are telling them that they have to have it. And and that is the most important thing. More important than food, more important than a roof over your head, more important than your kid, your job. Any of the things that when they were rational were important to them. This takes over. It's yeah, you know, it's horrible. So the churn is real, and the only way to combat it that I have found is to try to overcome those barriers. And for each clinic, the barriers to treatment can be very different. So they're very different for an urban clinic than a rural clinic. So in a rural clinic, I lose patients mostly because of transportation, um, childcare, um, shut-ins, um you know, that kind of thing. In an urban environment, I'm losing uh uh patients for this for a different reason. It's typically still transportation, um, but from a different viewpoint. It's not that I can't get a ride in, it's that the bus doesn't come by the clinic till a certain time, and I have to be at work by a certain time, and then I have to have my kid to school by a certain time, it's a different kind of transportation crisis. Um and if I'm requiring them to come five days a week or seven days a week, you know, how how do you if you could think of yourself trying to get your kids off to school and get to work on time and oh, by the way, now you have to go by this clinic and get a pill, it's sometimes just I mean, you and I have bad days. Can you imagine having a bad day and not being able to get your medication and then you're full-on ready for a relapse at that point? The question is, can you pull out of it the next day?

SPEAKER_00 31:02

Yeah.

SPEAKER_02 31:03

So, you know, support systems are very important, and like we covered earlier, you know, they burnt a lot of bridges to be a support system. So unless unless a person or their clinic support system sets them up from the very beginning of having net safety nets, they will have a high churn in that clinic. And if you don't have the ability to pay more staff to create those safety nets, then those don't happen, right? You're just doing the best you can. Yeah. So it's a problem, right? Like it's it's like um reaching into a spider web. It's you every clinic has its own struggle, and you could have the two clinics in the same town and and they'll have two different sets of struggles.

SPEAKER_01 31:52

So but many, right? And and you know, I we're almost running out of time, so and it's unfortunate because it's uh maybe we're gonna do a part two with this with you and me, Kenga. There's so much here that I want to get to, we can get a chance to get to, because there's so much good stuff here, uh, and this is so important. So, but one one kind of follow-up, we kind of try to wrap it up, actually, I guess of our time here today. I want to have is I know you talked about this before is when thinking about churn, why they lose patients, and you kind of hinted around some of it, you know, how do you stay connected with patients and support groups and all these kinds of things? We can talk about like I can't read exactly how you describe it, but that sort of you know, that gulf between when they're in my office today and and they're not that and I don't come back for another week or two. Like we don't have visibility into what's going on with this patient, right? When they're not in the office, when they're not sitting here in front of my desk with the clinician talking about what's going on. So it sounds like that's a big challenge for a lot of practice groups, right? Is they just, you know, they're not with you know it's not a live-in facility. So these patients are home and they're living and they're working and they're doing whatever. A lot of these practices just don't have the ability to connect and stay on top of what patients are doing when they're not in the facility.

SPEAKER_02 33:04

Yeah, outcomes happen between visits is something I I like to say because it's true, right? Our patient outcomes don't happen in the clinic, they happen between the visits to the clinic. So they'll they'll leave with their medication today. Let's say we gave them seven days of medication, and in that seven days, what happens in their life? Are they taking one pill or are they taking all seven pills on day two? Um, are they fighting with their spouse? Are they going to work every day? Are they, you know, are they because they've, you know, had a relapse, you know, they're not coming back to the clinic next week. You know, all of these things are a struggle. Um and then when they do come back, oftentimes they don't they don't tell the truth because of their own guilt and shame cycle, right? So they don't say, hey, doc, I'm sorry. Uh we took, we, me and my wife, we took all of my pills on Tuesday night because that seemed like the right thing to do. Now I realize that's not the right thing to do now. And because of that, I relapsed, but here I am again. Um, I would say very few patients have the moxie to have that conversation because of their shame and guilt cycle. And so what we get is yeah, we I took it according to the plan and everything's great. Oh, my drug test. I ate some poppy seed muffins, that's what happened. And if I had a dollar for every time someone ate a poppy seed muffin, I would be a rich woman. But a very rich woman, okay? Poppy seed muffins are contaminating the country. But in FYI, they don't make your drug test dirty, just so you know. But you know, so we have these dirty drug tests, and then we have these terrible explanations, and but you know, as a provider, you're stuck. You know, do you do you cut this person off? What is that gonna do? That's that's of no use to anyone. Are you empathetic and you're like, okay, John, we need to give you a better support system. How how can we help you help yourself? But the temptation of someone that's struggling for addiction to have seven to 14 days of pills with them, and oftentimes a person who's struggling with addiction who isn't stable is staying with another person who's also struggling from addiction who isn't stable. There's often times that that they've used together, or that they're both trying to get sober together, or that they're living with their mom, so they're taking their moms on pain medication, and that medication is isn't guarded within the home. And so it's an incredible temptation for someone struggling with opiates. So, I mean, even something as little as cough syrup, right? So um it's it's an act of desperation, right? So there's so many um of these black holes that someone can get caught in within a seven-day period that they don't tell their physician about.

unknown 36:06

Yeah.

SPEAKER_02 36:06

And so yeah, we really we as a country have moved to a less office-centric base of care, which is fantastic. And I think the only thing that one of the only things that came positive out of COVID, I think, was that our country relaxed some of those rules surrounding how providers get paid so that more patients can get care, even if it's in the home. What we haven't caught up to is how to have visibility when your patient is at home. And although you're trying to help them, they're still at risk. And so we have to fix that problem. That I call it a black box. You have a black box they step into, and at the end of the week they step out, right? Absolutely.

SPEAKER_01 36:51

Absolutely. Yeah.

SPEAKER_02 36:52

We have to figure that out.

SPEAKER_01 36:53

Yep. Yeah, we do. That I I know you've heard you talk about that before. That black box, right? That's where we lose a lot of patients, right? Back to relapse. Um, and the big huge challenges for these opium treatment uh clinics.

SPEAKER_02 37:06

And it sounds scary, a black box. It is scary.

SPEAKER_01 37:10

Yeah, yeah. It is. Absolutely, it is. But unfortunately, I'm sad we're out of time, right? We're trying to keep this at you know 30 minutes, but this has been awesome, Kendra. This has been absolutely awesome. I thank you so much for taking us through just the initial beginning, some more of your background, which is so important, you know, and your knowledge. But the option treatment options for somebody who's who's fallen into addiction. I loved our we've started to, I think, honestly, just start to dip our toe in to MAT clinics and the opiate treatment clinics and how they operate and some of their challenges. We're gonna do a part two. I'm gonna bring we're gonna bring you back uh where as a host with me, right, focusing just on this topic because I think it's so important for uh for our people out there involved with this this space to learn what are the challenges are. They could be very helpful. So, but I think this is a great podcast. I want to thank you. You know, we missed Dr. S uh Dr. Uh Sue here, but it was a great podcast. Thank you so much out there. If you're listening to us today, please send us comments. Please follow if you haven't. That'll help us a lot grow this thing. Please follow it, please like it. You know, we'll be back in two weeks uh for our next podcast. But I just wanted to thank you very much today for listening to the Saving Dose podcast and have a wonderful day. Thank you.

SPEAKER_02 38:25

Bye. Thanks, Will.