Why Features of the US HealthCare System Caused the Opioid Epidemic, with Dr. Janet Currie

In this episode of Causes or Cures, Dr. Eeks chats with Dr. Janet Currie about the factors that caused the opioid epidemic. They will discuss her recent research published in The Annals of the American Academy of Political and Social Science, "The Opioid Epidemic was Not Caused by Economic Distress but by Factors that Could be More Rapidly Addressed." In this podcast, she will discuss the history of the opioid epidemic, how it started and explain why prescriptions for opioids and healthcare market policies are what fueled the epidemic, not economic factors.
Dr. Currie is an economist and Professor of Economics and Public Affairs at Princeton University and the co-director of Princeton's Center for Health and Wellbeing. She is also codirector of the Program on Families and Children at the National Bureau of Economic Research. She was named a Nomis Distinguished Scientist in 2019 and 1 of the top 10 women in economics by the World Economics Forum in 2015. She has served as the President of the American Society of Health Economics, The Society of Labour Economics and Vice President of the American Economics Association. She is considered a pioneer in the economic analysis of child development and her current research focuses on the socioeconomic differences in health, access to healthcare, and environmental threats to health.

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SPEAKER_00 0:00

Welcome to the Causes or Cures Podcast, your gateway to understanding health and groundbreaking medical research in a fun and easy to understand way. With Dr. Eats as your host, join us as we sit down with the world's leading doctors and scientists to unravel the mysteries of health. For practical tips on wellbeing to the latest breakthroughs in medical research, we cover it all. Don't forget to subscribe. Now, let's ignite our curiosity and together dive into today's episode.

SPEAKER_01 0:30

Hello, hello everybody, and welcome to Causes or Cures. I'm Dr. Eeks, your host. Thank you so much for joining in for this episode. Hope you guys are doing well. As always, it is great to have you here. So, as some of you know, I have been focusing on a few topics for 2022. Mind you, we talk about everything, but there are some focus points, so to speak. One of them is obesity, the other, the opioid epidemic, and third, industry's influence on health and healthcare and health policy. And this episode hits two of those. Today I will be chatting with Dr. Janet Curry about her recent research that was published in the annals of the American Academy of Political and Social Science. The title of her paper was The Opioid Epidemic Was Not Caused by Economic Distress, but by factors that could be more rapidly addressed. She is going to talk us through the history of the opioid epidemic, how it started, explain why prescriptions for opioids and health policy is what really fueled the epidemic. She will also discuss how economic factors impacted opioid use and overdose and ways we can address the epidemic. You guys might have noticed you'll read articles about states getting money from lawsuits related to the opioid epidemics, and that money is meant for them to address the epidemic. But in order to do that, we need to know what caused it, right? To get the solutions right, we have to know what caused it. Who is Dr. Curry? I, of course, will link to her bio in the podcast description. But she is an economist and a professor of economics and public affairs at Princeton University. And she is the co-director of Princeton Center for Health and Well-Being. She is also co-director of the program on families and children at the National Bureau of Economic Research. She was named a NOMIS Distinguished Scientist in 2019 and was named one of the top 10 women in economics in 2015 by the World Economics Forum. She has served as the president of the American Society of Health Economics, the Society of Labor Economics, and Vice President of the American Economic Association. She is considered a pioneer in the economic analysis of child development, and her current research focuses on socioeconomic differences in health, access to health care, and environmental threats on health, to name a few. So that said, let's connect to Dr. Curry and see what she has to say about the opioid epidemic. One second while I connect. All right, so on the line we have Dr. Janet Curry. Thank you so much for joining us on causes or cures. I guess I read your research paper. There's obviously a lot of interest in the opioid epidemic. But I was curious, how did you become interested in what causes the opioid epidemic? And maybe you can provide a little bit about the work you do.

SPEAKER_02 3:48

Okay, sure. Well, thanks for asking me to be here. I guess one reason why I became interested in the topic was, well, obviously it's really important. It's a major cause of death in the US. And that's not happening in other countries. So clearly there's something that's different about the US than in other places. And the narrative that you hear all the time is that it has something to do with economic decline in the US. But when I started looking into that, I thought, well, that doesn't make any sense. It's not like the US is way more depressed than any other place. And in fact, the period of time when the epidemic really took off was a period of great prosperity. You know, it really took off before the Great Recession in 2008 when we had really low unemployment. And then once the economy recovered after 2008, we saw the peak of the epidemic, you know, prior to what's been going on during the pandemic. The peak was in 2017 when we had three to four percent unemployment. So this story that people were telling just didn't make any sense. And I wanted to look into it further.

SPEAKER_01 5:20

And do you you teach at Princeton? You were and then that's where you do your research?

SPEAKER_02 5:25

Yes, I'm a professor of economics and public affairs at Princeton University.

SPEAKER_01 5:31

Very nice. All right, so let's talk about your research. What is the real cause, in your opinion, of the opioid epidemic? And it looked like it went back to the 1970s when people redefined pain and pain was called the fifth vital sign. I was wondering if you could walk us through that and how that led to, I guess, a new approach to pain, new drugs, and then this marketing campaign.

SPEAKER_02 6:00

And so some of that was the realization that there were a lot of patients who were suffering a lot and maybe they didn't need to suffer. And so the idea became popular among doctors that they had a duty to treat pain and to ask about pain and and as you say, to treat it sort of like the fifth vital sign, something that they should always be checking. Around this time also, pain medicine became a specialty. So that's a a recognition that it was important. As I say, that started happening in the late 70s during the 80s, but the opioid epidemic didn't start until companies like Purdue Pharma and some other companies later introduced what they marketed as a new generation of opioids, which they said were not addictive. So OxyContin was marketed as a safe and non-addictive way to treat pain. And Purdue spent millions of dollars aggressively marketing these drugs. These opioids were promoted for things like back pain, which is now thought to be very inappropriate, even though there's still a lot of it going on. Because the thing about opioids is that you build up a tolerance for them. So to get the same amount of pain relief, you have to take more over time. Right, right, right. So eventually, if you have something like lower back pain, what you're going to end up with is you're still going to have lower back pain and you're going to have opioid addiction on top of that. Right. So it was promoted for things like that, for wisdom teeth removal. We still see a lot of opioid prescriptions are from dentists. Yep. You know, and this marketing was very pervasive. So it was targeting doctors, hospitals, medical schools. And even there was a group established called the American Pain Society, which was largely funded by drug manufacturers. It had an academic journal called the Journal of Pain. You know, so there's a lot of promotion of this idea that you should be prescribing opioids to people and that it was safe to do that. But you know, that's turned out to be a lie. And, you know, we see all the lawsuits going on every day. Right? So, and there's so much evidence has accumulated about how dangerous these drugs are. So one famous study looked at people who go to the emergency room, and if they happen to get treated by a doctor who prescribes a lot of opioids, then they're more likely to get an opioid, and then they're more likely to still be taking opioids six months later. Wow. So what that shows you is like a one-time random encounter can lead to people becoming addicted.

SPEAKER_01 9:20

Right. And they knew that these, you know, that's why all the lawsuits, I suppose, are happening right from the get-go, in your opinion, based on your research, they knew that these drugs were more addicting than they were letting on.

SPEAKER_02 9:33

Well, there a lot of evidence has come out as a result of the lawsuits that yes, they they knew all along and that they tried to suppress that information.

SPEAKER_01 9:44

I wanted to specifically ask you you talked a little bit about the the ER doctor and the ER study. But what this aggressive marketing campaign, what did it do to prescriptions? Did they really how like by how much did they increase?

SPEAKER_02 9:58

So they quadrupled between 1999 and 2013. And something I think Americans don't really understand is how different things are in the US than other countries. So the US now consumes about 70% of the world's opioids.

SPEAKER_01 10:19

Wow, 70%?

SPEAKER_02 10:21

Yeah, it's a really big number. So, you know, we have this huge problem, and there's a lot of factors that led up to that. You know, we allow this kind of marketing campaign to go on where it wouldn't be allowed in other countries, you know, just as one example.

SPEAKER_01 10:40

We can do direct-to-consumer marketing here, and that that was part of the opioid marketing campaign, I assume. And there's two two other countries that allow that. A lot of other countries don't, right?

SPEAKER_02 10:52

A lot of other countries essentially don't allow the uh doctors to prescribe opioids except in certain circumstances, right? So here doctors can essentially prescribe anything to anybody. The CDC has put out guidelines saying that opioids shouldn't be used for things like chronic pain. Right. That they shouldn't be prescribed in like 30-day prescriptions. You should give people seven days or 10 days. But those are just guidelines. They're not binding on anybody. Whereas in most other countries, they have pretty strict rules about prescribing them.

SPEAKER_01 11:36

I just read recently their new guidelines that they were thinking about putting out for 2022. And it looked like they were getting some pushback from pain doctors and maybe pain patients.

SPEAKER_02 11:47

Yeah, so one thing I should state, people often talk about cancer patients, and I don't think there's any guideline that would prevent cancer patients from getting access to these drugs. Just before all this marketing took place, most doctors thought that opioids were so dangerous that you should only prescribe them for people who were terminally ill. And it seems like, you know, if if they had stuck to that belief that we would have been better off.

SPEAKER_01 12:27

Yeah. Yeah. One thing I wanted to ask, so there's obviously an over-prescription problem in here in the states. What has been done to curb the over-prescribing of opioids?

SPEAKER_02 12:42

So there's a number of things that have been done. Some of them are the establishment of prescription drug monitoring programs in each state, the passage of naloxone access laws, guidelines about opioid prescribing, as we were just discussing, and also the expansion of health insurance under the Affordable Care Act. So just to talk about those things in turn, so prescription drug monitoring program is a state requirement that pharmacies register every prescription of opioids in a database. And then doctors can check that database to make sure that patients aren't getting multiple opioid prescriptions. And there's been a lot of studies of these which have shown that they do reduce prescribing in states where doctors are required to use them. Okay. So that's one thing. The naloxone access laws allow naloxone, which is an overdose-reversing drug, to be prescribed to third parties, like parents or uh friends, or in some cases they require that naloxone be prescribed at the same time as an opioid so that something has it. And those drug, those laws have also been effective at reducing opioid overdoses, you know, compared to what we would have had without them. The Affordable Care Act has also been important because we know, you know, 10 million people got access to health insurance as a result of the Affordable Care Act. So part of that is that it increased access to drug treatment, which is a really good thing in principle, although in practice drug treatment programs are kind of lightly regulated, and a lot of them don't offer the most effective treatment, which is medication-assisted treatment.

SPEAKER_01 14:57

And I I feel like the situation has changed a little bit recently with um, you know, you hear about fentanyl now. Uh I mean, I know it's always been around, but I feel like I hear about it in the news all the time.

SPEAKER_02 15:08

Yes, it is true. Most of the overdoses now are coming from fentanyl. I guess an important thing to keep in mind is that most people who are using fentanyl started off using prescription opioids.

SPEAKER_01 15:22

So it's interesting. I guess that takes us back to the things that are in place. I always tell people I think they should get the fentanyl testing strips, you know, hand those out too. Yeah, kind of like a harm reduction policy.

SPEAKER_02 15:34

But oh yeah, I'm sure that that would save some lives. But given that you have a bunch of people who are addicted to opioids, and it's a very powerful addiction, it's very, very hard to get off of it, which is why medication-assisted treatment is so important, you know, because it it reduces the cravings and helps people to stay off of them. So what we need, I think, to deal with fentanyl is much wider access to treatment programs. Right now, only about 30% of people who want to get treatment are able to find it. That's just not acceptable.

SPEAKER_01 16:18

Right. It won't help solve the problem. I wanted to shift gears a little bit and talk about, you know, this narrative, this popular narrative that the opioid use, opioid overdose are linked to economic factors. And I just wanted to tell you the reason I was so interested in this topic. Um, yes, I work in public health, but I came from like a really small, I come, I grew up in a really small rural town, went to Catholic school. And, you know, you can see the effects of the opioid epidemic at every generation. And so I was just so interested in, you know, was this economic factors, the loss of jobs, the increase in automation, or was it, you know, the prescription factors? You know, it's just just to see it at every level, even from my high school, my sister and I were talking last night with how many people we knew that died of an overdose, or even parents, you know, a kid and a parent both died of an overdose after they became addicted. It was just grandparents going back to work to raise kids because their kids died. So it was just uh one of those things where you didn't know. But that being said, what is the link based on your research between, you know, socioeconomic status and opioid use of opioid deaths?

SPEAKER_02 17:31

So it's actually really interesting the way that you were talking about it, like it's either this or it's that, because it isn't either or. There is a relationship between the sort of long-term economic factors that you were talking about and opioid abuse. It's just that it's not, it's not the whole story, it's not even most of the story. And without the other parts, the widespread prescribing, the lack of access to treatment, and so on, we wouldn't have the public health crisis that we have. But that said, there is some support for the idea that long-term unemployment affects opioid use. So, for example, there was a 2020 study that found that in areas where car plants had shut down, that there was an increase in opioid overdoses sort of five years later. So that's suggesting that it's a long-term unemployment problem that that is linked. Um there's also a lot of work looking at trade shocks. So, you know, places that were strongly impacted, say, by imports from China and experienced loss of manufacturing jobs. And again, there's a link there, but it's relatively small. So one study found that if you moved from the bottom quarter to the top quarter of exposure to trade shocks, that that would explain about 10 to 15 percent of the increases in overdoses. So, yes, there's something there, but it's not the main story. If you think about it from a public policy point of view, that's actually a good thing because it's very hard to reverse long-term economic decline in an area and it would take a really long time. Whereas some of these other things, like reducing prescribing and increasing access to treatment, you could do on a much shorter time horizon and really move the needle in terms of improving things.

SPEAKER_01 19:54

And I thought it was interesting in your research, you looked at employment on both a state level and a county level. Can you explain why you did that and if you saw any differences?

SPEAKER_02 20:06

Sure. So, you know, if you think about a state, like think about a state like California. There's both really wealthy areas and really poor areas. And when we're talking about things like long-term lack of employment, that is going to affect some areas within a state then and not others. Right? So the state is really a very big level to be looking at if you're trying to look at the relationship between employment and opioids. So we looked in our work at the county level, and we could look at counties over a long period of time, so look at changes in employment in the counties and see how are those related to changes in opioid prescribing. And basically, we didn't see any relationship. And again, if you think about it, it's not so surprising. Uh, most of the opioid prescriptions were going to people who are employed, and most of them are actually being paid for by private health insurance. So it's not the case that it's like only unemployed people who are turning to opioids.

SPEAKER_01 21:22

Right. No, that's a great point. So if we address these economic problems, what you're saying is that they will help, but they're not going to solve the problem.

SPEAKER_02 21:33

No, I don't think they well, first of all, we don't really know how to address the problems in a very constructive way. So people, you know, they have economic empowerment zones and all kinds of policies have been tried, you know, but we still have areas of the country that are poor and they stay poor like over decades, right? So if we knew how to fix that. Problem, hopefully we would have done something about it. We'd figure it out by now. Yeah. Yeah. So I feel like that narrative is a very hopeless narrative. So it's just saying, well, there's some places that are poor, and this is what happens when you have people who are poor. And again, it is true that poor people are more at risk of overdoses, but the difference is not as great as you might think. So people in poor households are 1.4 times as likely to overdose as people in non-poor households. Right? So it's not like it's 10 times or 5 times. Right. I was just gonna say it's not like huge, right? Yeah, that's right. There is a bigger difference by education. So people who have less than a bachelor's degree, whether it's a you know community college degree or high school or less than high school, have a risk that's about two and a half times higher than someone with a bachelor's degree. So that is a significant difference. But again, it's maybe not as big as people think. So in other words, there's a lot of people who are, you know, educated, working, presumably have no reason particularly to be in economic despair and yet still have an opioid problem.

SPEAKER_01 23:24

I think that's really important for people to understand just because of sometimes when people, you know, they get an image of someone who has an addiction, and that's it's this very like stereotypical image, that's not correct.

SPEAKER_02 23:36

That's right. And in fact, uh along that line, you know, the first group of people to really be affected by the opioid epidemic were actually middle-aged white ladies. Oh, interesting. And the reason for that is because middle-aged white ladies go to the doctor more than a lot of other people. And so that put them at risk of getting prescribed to. They go, you know, they go with aches and pains, and then they would get these opioid prescriptions.

SPEAKER_01 24:09

That's interesting. That was the first group to yeah. Wow, I didn't know that. Interesting. So, based on your research and you know, the current state of things right now, I know we just obviously we're still in this pandemic, but we've always had the opioid epidemic. What more can be done to address the epidemic? Like you said, we see all these lawsuits, and I know some states are saying, oh, we're going to use the money for various opioid prevention programs, this and that. But in your opinion, what more needs to be done?

SPEAKER_02 24:45

So I do think we need to do more on the supply side. So we, you know, we shouldn't have doctors giving people, especially new patients, like people who haven't taken opioids before, they shouldn't be going to the doctor with with aches and pains and getting a 30-day supply of opioids. That's just a recipe for creating addicts. So, you know, we could do things like we could use these prescription drug monitoring program registries to investigate doctors who are prescribing a lot of opioids. We could also adopt some of the measures in other countries, like putting restrictions on uh who can prescribe opioids are requiring more training for doctors to be able to prescribe opioids. It's kind of crazy that right now we have any doctor, any dentist, or any veterinarian for that matter, can prescribe any opioids they like, but we have restrictions on who can prescribe medication-assisted treatment. So, in order to treat opioid addiction, a doctor has to have a special license, and there's restrictions on how many people they're allowed to be treating.

unknown 26:11

Right?

SPEAKER_02 26:11

So that seems backwards, yeah. It's crazy, right? So that's definitely something that we we should be doing, is making it harder to prescribe opioids and easier to prescribe treatment.

SPEAKER_01 26:22

Why we do things backwards, I will never understand, but I guess we're we're not very good at prevention overall in general.

SPEAKER_02 26:31

No, it's it's very surprising actually that there's so much resistance to medication-assisted treatment. There are lots of chronic conditions where we prescribe medications for people like diabetics or people with high blood pressure. And, you know, yes, they're gonna have to take medication for the rest of their life, and we're okay with that. But then here we have opioid addiction, which is a life-threatening illness. It's a chronic condition, it's not something people just, you know, get over with willpower. And yeah, people have all sorts of objections to prescribing them medication that has been shown can save their life.

SPEAKER_01 27:19

Is that resistance a like a philosophical one, or is it for some sort of economic reason, or we just don't know?

SPEAKER_02 27:27

It seems to be a sort of philosophical reason. And so part of it I think is philosophical that you know it's wrong to treat drug addiction with other drugs. And part of it I think comes from sort of demonizing people who have drug addiction. So not thinking about them as people that have an illness. And I think that's why it's so important to understand how pervasive it is, and that it's not just you know people of lower socioeconomic status or you know, stereotypical drug users. It's sort of people in all walks of life. And a lot of them did nothing to seek this out. It's not like they had drug-seeking behavior. They went to a doctor with a problem and then they were given opioids and they became addicted. So it really wasn't their fault.

SPEAKER_01 28:24

Right. And I think, you know, just the image people have in their heads, even if we can just change that, maybe it'll help the situation because it can happen to anybody. Absolutely. In addition to those things, do you think the are you optimistic about these lawsuits and what the states might do with this money? And are you optimistic that maybe drug companies will never market stuff like this again or that this will result in a changed marketing strategies?

SPEAKER_02 28:53

Well, I guess I'm sort of more optimistic in the short term than the long term. We have the example of the tobacco settlement, where states got a lot of money for tobacco remediation. And in the short run, they did do a lot of tobacco remediation with that money. Over the longer term, the money sort of got shifted to other purposes. Uh, so we don't see right now very much of that money being spent on tobacco remediation. I fear it may be somewhat similar for the for opioid mitigation. And the other thing is that I'm not sure that states have a very clear idea about what it is that they should be doing to address the problem. Well, for example, uh in uh New Jersey, where I am, there's was a lot of discussion under Governor Chris Christie that, well, what we need is residential treatment beds. And that's really not at all clear that that's what we need to combat this epidemic. It's kind of one of the more expensive things that you could do. But there are a lot of cases of people being in residential treatment for say 30 days and then they leave residential treatment, there's no outpatient support, and they go out and immediately overdose and die. Right. So in those cases, the treatment that they got may have actually made them more vulnerable to an overdose instead of less.

SPEAKER_01 30:36

That's interesting. So states are getting a bunch of money, but I guess they're they just don't know what to do with it.

SPEAKER_02 30:43

Yeah, I think that's right. They think they should be doing something and they don't have a very clear idea about what they should be doing, and the sort of this pervasive narrative about how it's all due to unemployment is just not helpful, right? In directing states to what might be effective. As they say, they could use the prescription drug monitoring registries to identify pill mills. They could put money into medication-assisted treatment and make it more available, they could expand outpatient support programs so that people had someplace to go and were able to maintain their jobs and so on while they were getting treatment. So I I think there's a lot that states could do. Whether they will do that, that's another matter. Right, right.

SPEAKER_01 31:39

Well, I maybe I'll send them this podcast after I put it on. I mean, this would be an evidence-informed, at least, you know, research informed, evidence-based. That's the word I was looking for. I gosh, I say that word all day long. Evidence-based policies.

SPEAKER_02 31:57

Yes.

SPEAKER_01 31:57

That could work. Are you doing any more research in this area?

SPEAKER_02 32:02

I'm I'm actually not right at the moment working on this. I I'm doing a little bit of work on prescription drug monitoring registries, just trying to look. Most of the work that's been done is looking at sort of state-level data, as we were discussing. But it is possible to look at individual level data and see whether there's evidence of patients doctor shopping, for instance, or whether there's evidence of doctors doing questionable prescribing. And so just sort of trying to quantify what's going on with the prescribing, I think could be helpful in the debate.

SPEAKER_01 32:51

Definitely. And you can get it down to an individual level. That's interesting.

SPEAKER_02 32:55

You you can get data about retail prescriptions at the individual level, which doesn't have people's names on it or anything like that, but allows you to track a patient over time. So you can see a patient who wasn't taking opioids, you can see their prescription, and then you can see what happens to them after that. That's interesting.

SPEAKER_01 33:15

Well, maybe when you get that research done, if you want to come back on causals or cures, I really wanted to try to focus uh this year on opioids. Also, I'm focusing on obesity and the influence of industry in in healthcare policy and that kind of thing. Those were my three topics for 2022. So I really appreciate you coming on and sharing your expertise with us and your research. I think it's really interesting and I think it's really helpful and timely.

SPEAKER_02 33:43

Oh, well, thank you very much. I guess we hit two out of three of your priorities thinking about how industry affects things and opioids.

SPEAKER_01 33:52

Yes. Well, I tell a lot of people, you know, I always say this when they talk about, you know, misinformation, and we've seen a lot of people just don't seem to trust as much. And then I said, well, you know, I think too, we have to look at the influence of industry and maybe I just have a whole different, you know, a theory that if we have to start talking about that and how to make the system better for people to rebuild that trust. And I think the whole opioid epidemic ties into that, you know, what happened and what's being done to rebuild trust and to hold people accountable, you know?

SPEAKER_02 34:26

Yeah. Well, I mean, the other thing is that the it is sort of frustrating because we have the highest level of opioid prescribing in the world. It's kind of leveled off since people noticed that it was so high, but it hasn't gone down. And so we're still prescribing at very high levels. And now, you know, as I say, there's this sort of narrative about how it's all due to unemployment. We really have to attack unemployment before we can do anything else, you know, leaving aside the fact that we have a 4% unemployment rate now. But then, you know, then people will say, oh, it's not the prescribing anymore, it's fentanyl, right? So anything about prescribing is irrelevant. But it's not, right? It's still opioids are still being prescribed at a very high level. A lot of the people who die with fentanyl in their blood also have prescription opioids in their blood. And so, you know, there's still this on-ramp into addiction, which we haven't really done very much to curb. And that is something that is certainly under control of public policy. And in other countries, they do do a much better job, and they haven't had this horrible death from opioids that we have.

SPEAKER_01 35:50

Right. No, and that's a great point because I even I now when you talk about the opioid epidemic, the next word is often fentanyl, and you lose sight of that, the whole prescription side of things. So I think that's a great point to make.

SPEAKER_02 36:03

Well, that's right. And there's a reason for that, which is because nobody likes to say that doctors got people addicted to opioids, right? The doctors don't like it, the companies don't like it. So nobody likes it, and so they just ignore it and focus on other things.

SPEAKER_01 36:23

Yeah, no, it's I agree. It's one of those statements you just don't want to make you'll get criticized for it, I suppose. I have been criticized for it. Yeah. Oh, really? Have you received quite a bit of criticism?

SPEAKER_02 36:37

Like, yeah, I I would say, you know, doctors are not thrilled with this general line of research.

SPEAKER_01 36:44

I mean, but it's not really, it's not blaming doctors, it's just saying what happened. Right? There's a difference.

SPEAKER_02 36:51

Yeah, but you know, doctors like to perceive themselves as being benevolent and helping people. And so you know in many cases they cause people to die. And, you know, that's very upsetting.

SPEAKER_01 37:06

Yeah, yeah. Well, I mean, and I think that's a lot of getting back to the industry influence. A lot of some of the other researchers that I've been bringing on are really focused on how industry um influences, you know, prescription prescribing patterns in general or what drugs people use. And I think just being aware of that influence can be helpful. I just feel like a lot of people just, you know, they're too busy doing their day job. They don't think about what's driving the system. Do you know what I mean? So that's kind of what I would hope to. I don't like, I hope I certainly don't want to use this podcast to like play the blame game or anything like that. I just like to understand things and how to make things better. Obviously, there's an opioid epidemic. So I mean, we have to try to see what the root causes are. But that's a shame that uh you get that kind of pushback. I don't know. Well, but it's good that you're still continuing to research the topic and letting your voice be heard. I'm sure there's some people who are receptive, some doctors who are receptive to it.

SPEAKER_02 38:09

Yeah, I think that's right. I mean, that's a big group, right? Doctors. So some of them are kind of leading the charge in terms of you know, trying to push for more medicated, medication-assisted treatment, um, trying to come up with more rational guidelines for prescribing. Yeah. Many hospitals have actually changed the default in their system, so that the default is that you get a seven or a 10-day prescription of opioids, say after surgery, instead of 30 days. So that actually that kind of thing can make a big difference because now if the doctor in the hospital wants to order opioids, it comes up and says 10 days. They have to actually override it if they want to give 30 days, and they don't do that. So just these things like defaults can make a difference.

SPEAKER_01 39:04

Yeah, little things. Absolutely. I mean, I was prescribed opioids after a dental surgery. And I mean, I didn't get addicted, but I was like, man, these feel pretty good. So I I totally get it's sort of like this, it starts out very benign, and then whether you want to or not, it can lead to a problem for sure.

SPEAKER_02 39:24

That's right. And actually, there's research now suggesting that combinations of other types of painkillers can do just as good a job. So it's not even true that opiates are the only game in town.

SPEAKER_01 39:40

Yeah, I just think, you know, I think they're so addicting. Like I remember when I post a lot about, you know, the lawsuits because I want I'm just interested in in that kind of thing. And they're all coming in now and large amounts. And I have talked to people who have pain issues, and they'll be like, hey, you know, opioids are the only thing that controls my pain. And all these laws, the opioid epidemic is making it harder for me to get my medication. So I'm always I'm aware of that too, you know, and I don't know what their exact health issues are, but I guess that's part of this issue too. How do you make sure that those people are able to access their medication? I recently had a conversation with a veteran uh who runs weed for warriors, and he's trying to make weed more accessible to veterans. And he was talking about how a lot of veterans are, you know, turned to that and stopped using opioids and they wanted to stop using opioids because there was a problem with addiction. But I guess it's like little aspects like that, like the that can be very sensitive.

SPEAKER_02 40:44

Yeah. Well, it is very hard once people are addicted to to get them off. Like, you know, how do you know when somebody says, oh, opioids are the only thing that control my pain? How do you know that that's true, right? It is true that if they stop taking opioids, they would have withdrawal and they would feel terrible.

SPEAKER_01 41:04

Yeah. Right. I mean, but how do you argue with them too? You know, like that's that's such a sensitive topic. Um, but I agree with you. I guess you don't really know, but and they're powerful, so they do work. And they probably do work, you know, well. But and yeah, and then trying to switch to another thing and going through that withdrawal would be tough for sure. For sure. Well, I don't I don't have any of the answers, but I do know. I hope that uh our country can wrap its collective head around this issue.

SPEAKER_02 41:34

Yeah, I hope so too. I hope that uh treatment can be improved.

SPEAKER_01 41:39

Yeah, no, definitely. And thank you so much for your time this evening. It was very interesting. And I look forward to sharing this with my listeners and getting their feedback. Everybody usually emails me after they hear an episode. And there's been a lot of recent uh chatter about opioids. So this should be a good one. This podcast is for discussion and no blame games or anything like that. So if I get hate mail for it, well, whatever. I'm just trying to have discussions. It's it's hard today to have discussions about controversial topics, isn't it? I I find it's hard. Sometimes I find myself it's you know, trying to use my word so carefully that it's stressful.

SPEAKER_02 42:22

Yeah, no, that's true. It is really very difficult. We never know. I would expect that you'll probably always get somebody objecting to something in your podcast, right?

SPEAKER_01 42:32

I mean, oh yeah, all the time. All the time.

SPEAKER_02 42:34

You're always going to. So trying to figure out how representative that is of anything.

SPEAKER_01 42:39

100%. And I just tell people, listen, I'm a curious person. I can talk to anyone. I love hearing from smart people. You're obviously very smart. You did this research. We want to hear from people like you. I mean, that's how I view it. But that's me.

SPEAKER_02 42:53

Yeah. Well, I'm sure you'll get a fair share of like, oh, she doesn't know what she's talking about.

SPEAKER_01 42:58

Yeah. Yeah. I mean, I get that about myself too. But I mean, if you say anything, like you said, if you say anything today, you're gonna get that. So that's just the way it is, I guess.

SPEAKER_02 43:09

Yeah. All right. Well, thanks very much.

SPEAKER_01 43:12

Yes, thank you. And enjoy the rest of your evening. And I'm proud of my dog. He wasn't too bad. He was he got a little restless, but uh he was pretty good the rest of the majority of the podcast. The bone worked. Yes, the bone worked exactly. All right. Bye then. Bye-bye. Take care. You too. All right, you guys. Thank you so much for joining in for this episode of Causes or Cures. I'm glad you were here. And you know, let me know what you thought. You can reach me at bloomingwellness.com or find me on Instagram, Facebook, Twitter. I sometimes post there. And uh I enjoy getting feedback from you guys and hearing what you thought. If you are so inclined, if you like causes or cures. Please share the episodes. Tell your friends. The more the merrier. This is a totally grassroots independent podcast. So I appreciate all the shares and all the comments that you guys provide. That said, definitely check out some of the other episodes that are posted and subscribe. If you do subscribe, stay tuned, and new episodes will be posted shortly. I have some great guests coming on. So I hope you guys stick around. Alright, talk to you soon. Take care of yourselves. Bye bye.