Investigative Reporter on How Opioid Settlement Funds Are Spent | The Saving Dose Ep. 07 ft. Ed Mahon

In the seventh episode of The Saving Dose, Dr. John Hsu and William Pedranti are joined by Ed Mahon, an investigative journalist at Spotlight PA who has spent years covering how opioid settlement funds are being allocated across Pennsylvania and who actually has a say in those decisions.

The opioid epidemic has generated one of the largest legal settlements in American history. Billions of dollars have been distributed to states and counties with the stated purpose of funding addiction treatment, recovery services, and prevention programs. What is actually happening with that money, and whether the communities most affected by the crisis have a seat at the table when spending decisions are made, is a question most media coverage has not answered.

That is what Ed covers. This episode goes inside the accountability gap at the center of the settlement distribution process, why the voices of people directly affected by addiction are still being left out of policy decisions, and what investigative journalism is doing to close that gap in Pennsylvania.

In this episode:

What the opioid settlement funds are, where they came from, and why the distribution of billions of dollars to states and counties has not automatically translated into better treatment access for the people who need it most.

Who is making the decisions about how settlement money gets spent, why those decision-making bodies often do not include people with lived experience of addiction or recovery, and what that absence costs in terms of policy effectiveness.

What Spotlight PA's Voices of the Epidemic series uncovered about the gap between how officials describe the settlement spending and what is actually happening on the ground in affected communities.

Why Pennsylvania is a useful lens for the national picture: what the state's experience with the opioid crisis, from rural counties to Philadelphia, reveals about the structural challenges that no amount of settlement money fixes on its own.

The intersection of chronic pain and addiction: why 25% of Americans living with chronic pain and nearly 50 million Americans with some form of substance use disorder are not entirely separate populations, and what treating both in the same patient requires.

John's multimodal pain treatment approach: ultrasound-guided pain blocks, anti-seizure medications, acupuncture, TENS units, and physical therapy — a framework he has been using since 1999 when a colleague accused him of practicing Chinese medicine on American patients.

Why 75% of patients do not take their medications correctly, why complete medication transparency is essential to individualizing care, and what happens to treatment outcomes when that transparency is missing.

What people who want to make a difference on the opioid crisis can do, and where to follow Ed's ongoing investigative coverage.

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/

About the Guest

Ed Mahon is an investigative journalist at Spotlight PA covering opioid settlement accountability and addiction policy in Pennsylvania. His work focuses on how settlement funds are allocated, who has a voice in those spending decisions, and elevating the perspectives of people directly affected by the opioid crisis. Follow his work at spotlightpa.org.

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.

#OpioidSettlement #OpioidCrisis #AddictionRecovery #BehavioralHealth #PublicHealth #TheSavingDose #HealthcarePodcast #OpioidUseDisorder #InvestigativeJournalism #DrugPolicy #AddictionMedicine #ChronicPain #PainManagement #SubstanceUseDisorder #Pennsylvania #OpioidFunding #RecoveryPodcast #MOUD

Transcript

SPEAKER_00 0:00

So we had a young man, Tyler Cordero, in Bucks County, 24 years old. He had struggled with addiction. He had a medical marijuana card. He was trying to get into treatment for opioid addiction. Not for medical marijuana. He just happened to have a medical marijuana card. But he was trying to get into treatment for opioid addiction. But because of these confusions, he was turned away because the people thought that they couldn't provide him assistance with funding because of his medical marijuana card, even though there was a state program that promises help to everybody, regardless of their access to insurance. You know, he tragically died of an overdose a few weeks after being turned away. His mother became very active and sort of first just trying to find out what went wrong and to stop it from going wrong again. And finally, she reached out to us because she wasn't getting the progress that she had hoped for. And then we spent about a month looking into it, published a story, and then a bunch of things were happening behind the scenes that we didn't know about immediately. But state lawmakers were reaching out to the state officials. And then I think about a month after the story came out, the feds changed the policy. They cleared up the confusion.

SPEAKER_01 1:07

Welcome to the Saving Dose Podcast. We really appreciate you joining us today. Wherever you're coming from, however you found us, whether it was through our website, Saving DosePodcast.com or YouTube or your favorite podcast channel, we appreciate you being here with us today. On the Saving Dose Podcast, we focus on all things addiction recovery. So whether you're a patient or a caregiver or a nurse or a doctor or somebody who works in a clinic or just somebody who's interested in about addiction recovery and how we try to address this absolute crisis going on in our country, thank you for joining us. You've got the right podcast. My name is William Pedranti. I'm one of the co-hosts here today. I'm here with my other co-host, Dr. John Stu. Dr. John, how are you doing today? Pretty good. Well, thank you for uh for mentioning my name. Of course, Doctor. It's great to have you on here today. We are thrilled. We are so lucky today. We've got a very, very special guest today here joining us today. Super excited, so blessed to be here to part, helped to continue this conversation about what's going on with the opioid crisis, particularly in a tough area that we know in the United States where opioids hit today, and that's in Pennsylvania. So I want to introduce to you to Ed Mahan. He's joining us here today. He's an investigator journalist with spotlight PA. He reports on addiction treatment and the opioid epidemic in Pennsylvania, as I mentioned, which has one of the highest fatal drug overdose rates in the country. He covers social service programs and reports on what happens when the government fails the people it's supposed to help. Children who need care, families in poverty, those with disabilities. A native of Delaware County, he worked in newsrooms across Pennsylvania before joining Spotlight. His reporting has earned national recognition, including a 2018 finalist splot for the Livingston Awards for Young Journalists and a 2021 investigative award from the Institute for Nonprofit News. Absolutely thrilled. Thank you so much for being here, Ed. It's a pleasure to have you on the podcast. We'd love to start off just to, if you don't mind taking a few minutes to introduce yourself to our listeners so they can get to know you a little bit better and then we'll dive right in.

SPEAKER_00 3:16

All right, fantastic. And thanks so much for having me. I'm really excited to be here and to have this important conversation. And so I've been a journalist since about 20, 2005. Started out uh working at my college paper or in Philadelphia. I grew up outside Philadelphia. I went to school at LaSalle University, fell in love with working on the college paper, and I've been doing this ever since. And so I started out as a journalist in 2005, and it's been, you know, that's one of the challenges of finding journalism jobs where you can do impactful and meaningful work. And so that's sort of the context. And that that broader context, I'll tell you about my own journey. So I started out uh after college. I did a volunteer program in Tacoma, Washington. I worked at a homeless shelter, a drop-in shelter, people with all sorts of issues coming in, uh, including substance issues. And one of the things we did there is we had a uh a newspaper. We came out once a month. The people who came to the shelter, they wrote for the newspaper, they helped to edit it, they helped put it together, and I was one of the editors who helped get that out there into the world. And that was a blast and an important work. Came back, uh, freelanced in the Philadelphia suburbs for a while, covering my home community of Delaware County and then some other outside counties in the Philadelphia area, and then got a job at the state at a newspaper in the center in SmackDad, middle of Pennsylvania, center county, did a lot of education reporting there, moved closer to Harrisburg, our state capital, a few years into that, uh, covering uh worked for a local paper, covering all sorts of things, including um, you know, domestic violence issues and other topics for our investigative team. And then worked in public radio for a few years. And finally I joined Spotlight PA in 2020. And since joining Spotlight PA, I've focused a lot on marijuana, opioids, other addiction issues as well. And so what we've tried to do at Spotlight P and what I've tried to do at my and why I keep doing this job. Like it's a it's the most interesting job in the world. I really do believe that being a journalist. But why I keep doing it is because I really have seen so much impact. I think it's a really important job. I think there are so many policies that have changed as a result of the work that we do. And I think we are in a position as journalists to do accountability work that others don't or can't do because we just have this, you know, that's our mission and that's our goal is to understand what's not working and find and identify the consequences. You know, we identify if there's something that's happening that's happened, we identify the consequences of that. And sometimes people in power don't like those consequences and changes happen as a result. So that's my journey, that's my arc and my free time. I've got uh two two growing kids. Uh I coach soccer uh in the spring and fall, and that's how I spend a lot of my my other time.

SPEAKER_02 6:09

Wow. Wonderful. Well, Pennsylvania has you know, honestly, Pennsylvania in in my book has one of the highest overdose death rates in the country. What does that look like on the ground? What doesn't the numbers catch? Because you know, there's always a story behind the story. Of course.

SPEAKER_00 6:27

Yeah, I would say some of the big things that, you know, that that raw number doesn't catch it for me is, you know, there's the families who are affected and the lasting generational impacts. And I'll I'll talk about a couple things as well. But one is just there's so many families I've talked to who where the grandparents are now raising children. You know, the the parents have died, and now the grandparents are the are the ones that are older and they're they're left behind raising these young children. I talked to one mother who talked about the toll of losing her daughter and how she basically feels like she's holding it together for these grandkids. And if it wasn't for them, who knows what she would be doing or how she would be coping? And there's so that those stick with me, and those always stick with me. There's also journeys of recovery, and I think that's important to understand and to recognize because so many people do recovery, recover. Um, and there are people like uh Jessica Berry, she was a person in Berks County. She talked to me about and she spoke at a forum that we organized, but who she spent years in active addiction. One of her overdoses ended up making sort of like a news article. She wasn't identified by name, but she knew it was her that they were talking about. She was like identified as someone who overdosed in a public area, or and she they were describing how um there were people in the comments questioning whether she, you know, why she was worth saving or if she was worth saving. And that really that stung. I mean, that that had a that was, you know, she described how much that hurt. Um, but she also said to sort of lit a fire in her. And she, you know, that was, you know, probably over a decade ago now, and she's really turned things around. Um, you know, she spoke at a forum, she's working in the in this field now, pursuing a career in this field, trying to help other people who are going through the same issue. So those are the two big things. I think like the lasting impact um for the people who are left behind, but also the lasting impact for people who have been through this and are recovering or trying to recover or are dealing with the after effects of it all.

SPEAKER_02 8:36

You know, being a physician, one of the things that I have to deal with is stigma. And I also try to look for something that's positive in a way. And this is only a doctor can say this, but with all the overdose tests, you know, we have a greater number of organs for transplants. And it is it's good in a way because now more transplants are available available for people who are overdosing, sorry, who have who need a transplant, but it's also not so good for the people who are overdosing and dying. I mean, when when you talk about failure, what what do you think the government has supposed what do you what do you think the government's supposed to do?

SPEAKER_00 9:22

Yeah. Well, I would say some of the failures that like we've covered and we've reported on, you know, we've reported on, you know, you know, failures to properly oversee addiction treatment providers. I mean, that was a big one, and that's been a big focus of some of our investigations at Spotlight PA. Just that there's addiction treatment providers who are essentially the concern is that they aren't providing the level of care that they're essentially billing for. Um, and that's you know, the concern there is that it's bad for taxpayers or insurance other, you know, because a lot of it is through Medicaid. It's, you know, bad for the people who are actually paying for this, but also it's bad for the people who need these services. So that's one big area of concern that we've reported on. And there are other, you know, one of the one of the things we do at SPALAPA is we, you know, try to focus on areas where we can actually have an impact. There are some areas where people are sort of hardened in positions, and and there's only so much time in my day. And so we try to focus on areas where we can have an impact. And one of the things we reported on is a couple several years ago now, there was this miscommunication, this failure to communicate properly around addiction treatment and medical marijuana. And basically, there was a situation where, because of confusion at the federal, state, and local level, people were being turned away from this program that was supposed to provide help to everybody in Pennsylvania because of their medical marijuana card. So we had a young man, Tyler Cordero, in Bucks County, 24 years old. He had struggled with addiction. He had a medical marijuana card. He was trying to get into treatment for opioid addiction, not for medical marijuana. He just happened to have a medical marijuana card, but he was trying to get into treatment for opioid addiction. Um, but because of these confusions, he was turned away because the people thought that they couldn't provide him assistance with funding because of his medical marijuana card, even though there was a state program that promises help to everybody, regardless of their access to insurance. Uh, so we reported on that. We reported on Tyler's story. I can talk more about Tyler too and impact. Um, but you know, he tragically died of an overdose a few weeks after being turned away. And his mother became very active and sort of first just trying to find out what went wrong and to stop it from going wrong again. Because I mean, and so she reached out for months to state, local officials, and finally she reached out to us because she had just sort of reached, she w wasn't getting the progress that she had hoped for. And then we spent about a month looking into it, published a story, and then a bunch of things were happening behind the scenes that we didn't know about immediately, but state lawmakers were reaching out to the state officials. And then I think about a month after the story came out, the feds changed the policy. They cleared up the confusion where they got rid of some of the language that had caused so much confusion. And part of that whole failure that we reported on was that there had been guidance that tried to clear this up at the state level that was given earlier from the feds to the state, but that wasn't shared. And so we looked into why that wasn't shared and some of the issues there. But that but that policy changed. I got I talked to some local providers who changed their policies as a result. The state sent out some notices about their policy changes or communication changes. And that was an area where we saw like real tangible impact. Um, and that's sort of one of the reasons I keep doing this job is because of situations where you can have an impact like that.

SPEAKER_02 12:46

Wow, that's so inspiring because you know that's that's really huge. And you kind of touched on my next concept, but you know, Pennsylvania really receives over a billion dollars in opioid settlement money. And is that where this is going? Where they is the misconceptions within the um policy makers that's preventing people from getting help? Because you know, three-quarters of people use not just opioids, but a host of other drugs. And you know, f with these other drugs that can that can really help people not overdose and die, you know, these three drugs that are FDA approved can reduce the overdose deaths by greater than 50%. But 75% of people can't get these medications or can't get treatment. Why do you think that is?

SPEAKER_00 13:41

Yeah, I mean, we have when it comes to the opioid sediment money, that's something we've been following, you know, uh very closely from very early on. And one of the reasons is because uh Tyler Cordero's mother, Susan Osterman, you know, I had stayed, we did a bunch of reporting on Tyler's situation. I did a bunch of other reporting on other topics, but then she reached out to me pretty early on as this opioid sediment money was rolling out saying there's some problems here. And then she connected, I connected with some other mothers, other family members who said there are problems here. And we kept looking into it and we found some problems as well. And so for anybody who's not familiar, you know, there's all these uh settlements with drug companies, various drug companies. Um, all these billions of dollars are coming to states. Pennsylvania, you know, is originally up about 1 billion with the initial settlements. Now the projections are about 2 billion with some settlements. And we, most of our money comes to the state to an oversight board, and then it's dispersed to counties. About like 85% is local, like either counties or townships, municipalities. And so there's a lot of communities across the state where they are making these decisions. And, you know, it's it's hard to track. We've done a lot of work to try and track it, but that's sort of why we've tried to track it, is because it's hard. And so, you know, some of the big things we're seeing is sort of there's like advertising programs, there's like, you know, billboards, that type of thing. There's a lot of money is going, we found, to jails to try and give uh in uh inmates, people who are incarcerated, some of those medications that you mentioned. And there's um, you know, some, you know, there's bufenorphrine um is and then vivitrol and methadone. There's um and there there is some yeah, there's some different aspects about which which drugs it's going to in those treatment programs. Um, but you know, it's it's hard to sort of just uh it's hard to like do a full quantify quantify it all, qu quantify all but where it's all going. But that's why we've been trying to like put information in readers' hands with some databases we've created. But I'm curious about you, I mean, what your thoughts are about where opioid settlement money should be going.

SPEAKER_02 15:51

Well, what I've read, and you'll have to verify this, but uh, I've heard it goes to policemen's overtime. There was a place in the Midwest where some of the opioid settlement funds $57 billion to the different states went to build a new police headquarters. Um and there there was one that went to a park. Um I know that I know that we should be spending money on opioid use disorder patients, but you know, the medications are cost hundreds of dollars per month, but the cost of care is in the trillions of dollars. You know, there's reports of 2.7 trillion to $4 trillion, and the whole cost of care to the United States is roughly about $40 trillion. So 10% of the money is going to people who have opioid use disorder. So I think that you know, perhaps uh uh I would hope that a lot of that money is going to really worthy causes for people with opioid use disorder.

SPEAKER_00 17:01

Yeah, yours are you go on, go on, Welling.

SPEAKER_01 17:03

I was gonna say just jump in real fast. No, and I have heard, you know, you mentioned Ed uh incarceration and correctional facilities. I have heard that too. John and I have had a number of conversations with people uh in in that community, and they are getting some settlement opid funds. And that's a massive issue. You know, I I'm I'm sure you probably see it there in in PA too, right? Um, you know, the the the studies I've I've read, you see, you know, anywhere from 60 to 80 percent of people today incarcerated have an addiction issue. They also have a mental health issue, right? And only a fraction of those people are getting treatment in the crack shell facilities. You know, I've heard Dr. John say in the past it's easier for somebody today to get an illegal drug in prison than it is to get treatment for their addiction. Right? And then they they get out, they re-enter society, and the fundamental reason that is keeping them unstable in life, such that they could live a a stable life, um, is addiction and mental health and not getting treatment. And then we wonder why there's recidivism. They're right back in it because we're not fundamentally helping them out. One of the key pieces that's needed to bring stability to their life. But I have heard that that some of that opioid treatment money is going to that. And I hope so, because that that's certainly an area of a massive need.

SPEAKER_00 18:16

Yeah. No, I would the the the prison thing is interesting because some of the part of the motivation for prisons, basically we've seen in documents, they've said is that they're worried about lawsuits. They don't want to get some have gotten sued for not providing this treatment and care um for inmates, because if people go in there and there are inmates who might overdose because of or they're they might be in withdrawal and suffer consequences. And so part of this concern from these facilities is that under the current system, that they might get sued essentially. It's not necessarily just because they want to for everybody's well-being. They're concerned about their own, you know, bottom line or getting sued. And one of the concerns we've heard from some people is that they should do this anyway. They shouldn't need opiate sediment money. This opiate sediment money should go to things that they are not already required to do. And they do that medical care for inmates is something they're required to do. So it just sort of opens up this interesting question as well about whether this is the best use of opiate sediment money. And one of the reasons we've done so much reporting on opiate sediment money is because it's like an opportunity to assess how are we actually responding to this epidemic, to this crisis and this infusion of money, you know, and the attention on it. It's like everybody, people see it as a great opportunity, but they also have great hopes for it, and people have been disappointed with it as well. Um, and there are other interesting aspects too. I mean, there's the prevention question. So much money is going to various prevention programs, but what is prevention, what is proper prevention and how targeted it has to be is a big question that's going, you know, into court cases in Pennsylvania right now.

SPEAKER_02 19:44

Yeah, you know, it's very difficult because treatment is very, very difficult. Prevention is very difficult because, you know, uh for let's say for these jail detainees, um they have a chronic medical condition called opioid use disorder and they're not being treated. That's equivalent to saying, I have high blood pressure, but I'm not gonna treat you, I'm gonna throw you in jail. And I think that's very difficult. And there's been, you know, some chatterings on social media that, you know, someone's trying to get together a situation where they sue a jail because they're not uh following the American Disabilities Act mandates that talk about health care as a right. And I think that's disappointing. What do you think about that whole use of litigation, the whole use of legislation to to help these patients?

SPEAKER_00 20:38

Yeah, I mean I think it's a good idea. I mean, I think it's a it's a fascinating, it's a fashion from for for as a journalist point of view, it's it's a it's a way of sort of tracking some of these issues, some of these litigation um and like legislative efforts, it's it's helpful as a way of seeing just how what is the situation. Because we've had a lot of facilities in Pennsylvania and there's been a lot of good local reporting that have had a high number of deaths related to substance issues, and trying to figure out what happened, what went wrong in those situations. And from our point of view, it's a chance to see what happens when these people don't have access to this this treatment, to this care, and sort of just examining the consequences of that. And then, you know, we're not out here advocating for one policy solution or or whatever, but when you when you focus on what the consequences are, people might make changes.

SPEAKER_02 21:29

Yeah, I mean, it could be as simple as transportation. You know, in rural Pennsylvania, it may take a couple hours on a bus to get to a doctor's office, let's say my office, or to get medications. And a lot of people don't have the time. They're they they you know, they're trying to find work. They have childcare. And you know, if if we can do something about that transportation, because Medicaid actually spends billions. Dollars on transportation issues.

SPEAKER_00 22:02

Well, that's really interesting. Yeah. I mean, I one of the other things I covered, I covered uh pharmacy closures in Pennsylvania. We had a bunch of right aids close. I mean, they close across the country, but we all we've also had, you know, hundreds of pharmacies close in Pennsylvania, including in rural areas. And you know, we had a little contact form, let us know your story. And one of the people we heard from talked about how he basically had like an hour of a bus to get his medication for opioid use disorder, he would have to spend hours on the bus because of a pharmacy closure. And that's just that's a very steep, it's a very difficult situation to be in.

SPEAKER_02 22:35

Yeah, you know, and it's really hard because if you had hypertension, you have to do the same thing. You have opioid use disorder, you do the same thing. But many of these people with opioid use disorder, they have a physical withdrawal symptom that they have to deal with, and they have a mental craving issue they have to deal with. And many people feel that treatment is should be either medication or psychosocial issues, and they're not treating both. And I find that to be incomplete care because you and I are mind and body. We're not just body. We have elevated ourselves above and beyond most other living species because we have a mind. And most people don't understand. We have to treat the mind. Yeah. That makes a lot of sense. So when you invest do do you investigate agencies like the D the drug and alcohol programs or human services? Have have you gotten some friction? What do they least want you to find?

SPEAKER_00 23:41

You know, I would say with Spot IPA, where we do a lot of work that is um, and we sort of one of the core missions of Spot IPA, especially early on, was like to focus on these agencies, because there's so much power in these agencies. And one of the things that we do that's you know, what you know that's most difficult to do is to find out where agencies might have, you know, might have messed up essentially, uh and messed up in a nonpartisan way. I guess like that, because there are some a lot of agencies may have, you know, their different parties in power and there are choices about what Medicaid is going to fund, for instance. And those are sort of like policy considerations, and you can cover the impact of those. Um, but that's like conscious choices where where we've sort of find the most interesting often is situations where it's not necessarily a political or partisan choice. It's someone might have an error might have happened, or something might have not been shared that was supposed to be shared, or something's just very difficult to do. You know, it's very it can be difficult to provide oversight to addiction treatment providers, you know, across a big spectrum. You might not have the staff and resources to do that. But where we do a lot of our reporting is, and I do this, other reporters do this, is looking at where those agencies might not be living up to what they're legally required to, but what they're also just, you know, expected to do. Um, and I've done that with the medical marijuana program in Pennsylvania. We've done a lot of reporting on, you know, Pennsylvania, recreational marijuana isn't legal, medical marijuana is legal in Pennsylvania. We've, you know, some of that, the initial like Tyler Cordero story, it led us to just sort of like look into what was going on with the medical program, and we kept hearing more tips as well. Um, but you know, we wanted data just to sort of understand why patients were qualifying for the program. We met resistance from the state agency at the time. They eventually essentially, we eventually we appealed to an independent agency, ruled in our favor, but then the Department of Health took us to court. We were successful in court um with the reporters, Committee for Freedom of the Press, gave us free legal representation. But yeah, they they uh they filed you know a lawsuit to block that us from trying to get those records. We got the records, yeah. We got the records, and then we did a big uh investigation just looking at so you know what we found was sort of anxiety disorders were the main reason patients were qualifying. We looked into that. Um we did that, and then and then we also uh we did a write to know request for which doctors are qualified are approving the most patients for the program. We never saw it individual patient information, just like we never saw a patient's name or anything like that, but we saw information on which doctors were approving the most in the program to try and help understand it. That independent agency wrote in our favor. Department of Health again took us to court, uh, sued us again, but um we were able this time a new administration came in and we were able to uh resolve it through mediation. The reporters committee for freedom of the press helped us out again, and we were able to get that. And you know, we did a big investigation into some of the doctors who were approving the most patients. Uh, some doctors approving more than you know, 10,000 in a year. Uh some can lawmakers had concerns about that, and then very quickly it led to legislation. Very quickly, that legislation passed out of the state house, um, and it's it's stalled in the Senate. But we saw very quick legislative action as a result of that investigation.

SPEAKER_02 27:09

You know, that's really that's really surprising because, you know, there's been Medicaid cuts in the last two years. And for OUD, Medicaid is the largest provider, and also they pay 80% of the cost of OUD. And it's surprising that they would spend money on a lawsuit, spend money on attorneys to to litigate. That that's so surprising.

SPEAKER_00 27:36

I mean, yeah, I mean, this is the Pennsylvania Department of Health, and that was, I mean, they have their their general counsel, their on-staff counsels, and you know, from their point of view, I think, you know, I think one of the things that um, you know, that first ruling was was helpful. You know, I think it like the first ruling helped clarify that the Commonwealth Court did think that the law said these records should be public, that they were that they were not gonna, nobody was gonna get in trouble for releasing them to us. There were they weren't violating any rules by releasing them to us. And then that precedent helped us get these through mediation the next time, the second time when it came to actual doctors. I think there was some of the language in that that order was sort of explicitly recognizing that the court had ruled that these records were were public, and so it was okay to release these to the other group of records. So, I mean, and that sets a precedent going forward for other reporters and other people. And what's been cool is we've seen academic researchers take some of our data and then go do their own studies um and then you know publish them in like academic journals. And that's that's very cool and gratifying to see. And I should also say the Department of Health, the information they had once fought to keep secret, the the patient qualifications, why they qualify, they now post that publicly. And so we've seen them change their behavior as well.

SPEAKER_01 28:53

That's awesome. And how is how has Governor Shabiro been on this issue?

SPEAKER_00 28:58

So he's he's a supporter of recreational marijuana in Pennsylvania. Um, you know, we have there's he's put he's proposed it, I think, like pretty much every year, uh, sometimes more with more fanfare than others, but it's gone uh not very far in the Republican Senate. The Democratic-controlled House has passed their own plan, but it's basically been the Republican Senate has is not interested in doing this. We have seen we saw little traction and little conversation on it this past session. Last year there was a lot more hope about it. Uh, and this year it's sort of the budget passed without much much uh debate about the recreational issue.

SPEAKER_02 29:40

Yeah, because you know, yesterday or the last podcast, we had a patient that had 17 surgeries, and she was so fearful of opioids that she reduced her opioid load and to replace the opioid load, she used medical marijuana. And you know, when when you think about politicians who make policy for the population, the population isn't an individual, it's a group of people making up a population. And when you try to go drill down all the way to the individual, each individual is different. We don't all wear dresses, we don't all wear pants, and each of us wears uh our the clothes that we like. And some people may like mariju medical marijuana for post-operative pain. And you know, I'm of the camp that, you know, if it works for you and it's legal and you d use it as prescribed, I don't have a problem with it. But I do have a problem with some people who believe that if you have chronic pain and you're on a high dose of opioids, that you should be stopped on opioids for right away. And you but from that you are a opioid use disorder patient. Well, there's a couple things there to unpack. If you have opioid use disorder, you don't actually uh sorry, if you don't have opioid if you have opioid dependency, that does not mean you have diagnostic criteria for opioid use disorder according to the DSM 5. And then when you have opioid use disorder or you have high dose opioids, you should not be rapidly reducing the opioid load. In 2016, the CDC came out and said no one should be on greater than 90 MMEs of morphine. Well, if you look at the death rate, it went up 38%. And then when you look at the tw 2022 uh CDC recommendations to loosen uh the restrictions, the death rate actually dropped in the last two years by nearly 37%. So we've been using opioids for thousands of years. It's the attempt to make things better that I think has made things uh worse. That's interesting. And I hopefully think that politicians will understand that, and all the agencies you mentioned will hopefully see the data out there because everyone talks about oh, we should be practicing evidence-based medicine. Well, there's evidence out there that opioids aren't harming people because it's illicit opioids that are harming people. Illicit opioids combined with xylazine, nidosine, and I know in Pennsylvania they're now being hit with dexmatomidine, which has caused huge problems in jails because people are dying in jail because they're not getting treatment for the withdrawal symptoms. They're dying because of heart attacks and strokes. Wow. Yeah, I mean we keep it, Ed.

SPEAKER_00 33:00

I was saying, yeah, when we just keep we see the drug supply keep changing in Pennsylvania. I mean, like, and there's there are groups out there tracking it as well. Um I'm curious about like I'm curious about you know for for both of you, I mean, what do you think about the recreational marijuana push? I mean, I've heard from heard from some doctors who are um who are like like they wouldn't recommend it, but they'd rather it be just legal than be treated like medicine. Like that, you know, if they if if someone wants to have a glass of wine at the end of the at the end of a long week, like that's fine with them. Just don't call it medicine. And that's sort of how that's one analogy I've heard, but I'm curious what what you all think.

SPEAKER_02 33:35

Will you want to go first? Because I can give a soliloquy about this.

SPEAKER_01 33:40

We're almost out of time, so we don't have a time for that. But go ahead, John. Yeah, yeah. Give us your give us your thoughts.

SPEAKER_02 33:46

Okay, well, I practice multimodal pain therapy, which means that I use other modalities to treat pain, which means that I do ultrasound guided pain blocks. I also use other medications, anti-seizure medications, antidepressants, anti uh uh uh anxiety medications, anti-nause, anti-vomiting. But I also use acupuncture, acupressure, tens units. I do uh I asked my patients to do physical therapy. There's a lot of things that can be do it that can help with pain. One of the patients uh that we spoke to who had 17 surgeries, she uses ice packs and heat packs. She bought a massage chair and she uses uh a jacuzzi. Well, if it's you know, m if it's regulated and they call in a medicine or don't call in a medicine, you know, and it helps somebody with pain and they use it properly and they don't abuse it, I think that's reasonable. In fact, when I was I I started multimodal pain therapy about well, I didn't start it, but I followed it and I started using it in 1999. When I started bringing it up, there was a colleague of mine that accused me of practicing Chinese medicine on American patients because I was putting needles in places that shouldn't shouldn't go. I was injecting local anesthetic to reduce pain postoperatively. And you know, it's stigma within the healthcare care facil uh environment, stigma that patients have. And I believe, bottom line, finally, if America if mer if marijuana works, you know, and they they can get it, it's okay with me. As long as they tell me, because one of the things about medications is that 75% of people don't take their medications properly. And if they tell me they take it properly, then I'm gonna give them a treatment that's incorrect. But if they tell me they use pot, okay, then I'll adjust my medications and or not adjust my medications, but to see how they're doing first. Yeah. I need to be able to know everything about my patients, know all the medications they're taking to actually individualize care so I can make it successful. I really care about my patients, I want them to get better.

SPEAKER_01 36:19

Yeah, absolutely. Absolutely. For sure. Yeah. Well, you know, I we're just we're just about out of time. So um this has been conversation's been awesome. Uh and I really appreciate it. It's really trying to I appreciate all that you're doing, first off, and shining a light on this issue in Pennsylvania. Um, you know, it's it's obviously we're still it's still a crisis. You know, we're talking, as John mentioned, another guest, and you know, in the United States right now, there's about they estimate around 25% of Americans suffer from chronic pain. Chronic pain, right? Pain that they have, they've had for more than three months. And at the same time, we have this massive addiction crisis going on, right, where almost 50 million Americans have some form of a substance use disorder. So the balance of that, of trying to treat chronic pain and then manage addiction, is a big challenge. It's a big challenge for caregivers, a big challenge for doctors, a big challenge for government and the agencies. And so I love that what you're doing there in Pennsylvania and shining a spotlight on this. Maybe we'll just wrap it up and um, you know, give you sort of the last word. And, you know, anything else you want to mention about what's going on, issues, what people should be thinking about, how people can get involved, uh, how people can make a difference. Just any sort of final thoughts about this particular issue.

SPEAKER_00 37:32

Yeah, no, that's thank you so much for having me on. I really appreciate this. Again, yeah, I'm at edmathenspotlightpa.org. You can check out our work here. You know, one of the things we've done with this opiate coverage is I would say two things, opiate set on money in particular, is where's the money going, but also who gets a say and how it's being spent. And we spent a lot of time giving a platform to people who are often don't have a platform. You know, people in government have their platforms, and that's fine, that's appropriate. But people who have been through this might not have a platform. So we've spent a lot of time. We had a voices of the epidemic series of events last year. We've continued that work uh to elevate voices of people who are directly affected by these issues. And that's the biggest thing I would say is you know, we we want to give, we want to make sure, or we want to just understand those voices. We want to make sure that we understand it. Because if you don't understand all the voices, if you don't understand all sides to an issue, you might be missing problems and you might be missing solutions. So thank you again for having me on. I really appreciate it.

SPEAKER_01 38:30

Yeah, thank you so much. I appreciate all that you're doing. God bless you for doing this work. It's good, you are saving lives and impacting. Thank you so much for joining us. We are we'd love to have you back. You know, obviously, maybe sometime in the future to hear updates on what's going on in PA and some of the investigative work. We'll certainly stay following you like we are and um you know on this conversation. For our listeners, thank you so much for listening to us today. Hope you've got a lot out of this conversation, like I know I have and Doctors too have. So thank you so much. If you like what you heard, please like it, subscribe it, follow it. Whatever, whatever uh format you're listening to, please do that. We really appreciate you being here today. And we look forward to seeing you on our next episode of the Saving Dose Podcast.