Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Opioid Addiction

Episode Date: August 11, 2017

This week on Sawbones, join Justin and Dr. Sydnee for a sobering look at America's opioid crisis. The bad news: We're all still living in a Sawbones episode. Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy.

I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy.

I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. I'm your co-host Justin McAroy. for the mouth. Wow. Hello, everybody, and welcome to Saul Bones,

a marital tour of misguided medicine. I'm your co-host Justin McAroy. And I'm Sydney McAroy. Hi, Sid. Hi, Justin. How are you doing? I'm pretty good. We had an eventful Thursday, last Thursday.

Last Thursday? Yeah, last Thursday. We, the president of America came here, tiny to us. Virginia. Yes. Uh, we, we, it was, it's my long day at work, Thursdays. I always have a lot extra long days. So the president came on Thursday and Justin and I tried to scramble to leave our respective jobs and get there by the time to protest.

To protest. And then by the time to protest. To protest. And then by the time we left, the motorcade was coming and we couldn't get across how great and actually biceps are entire cities. Exactly. The motorcade path. Yes. The entire city was cut in half and you could not cross from one side to the other. We were stuck on our, at least on the side where our home is.

That's nice. Yeah. But we couldn't get there. Couldn't get there. Uh, but, uh, obviously we were familiar with what was talked about, what was said, it was broadcast here locally, as you can imagine, and many people attended. And one concern that I know I had and Justin, I think probably you two. And most people actually, it was written about the newspaper.

So not just me. This isn't like a novel concern. Is that the president had said he was going to make some kind of special announcement. Right. And a lot of people in this area were kind of hoping it would be opioid addiction related because it is devastating our area. There'd recently been recommendations made to the president by the council on substance abuse that it should actually be declared a state of emergency.

And I appellate West Virginia, this area in general in regard to the opioid epidemic. And I don't know what that would entail. So it's hard for me to say like, absolutely it should because I don't know what resources that brings. Whenever I think of that, like declaring a state of emergency, I think of like tents and water bottles. Not sure that would be like, yeah. And that's not helpful. So I don't know. I'm hoping more resources. FEMA tents. I don't think that's like helpful. Yeah. But anyway, obviously, there was no such announcement made. There was actually no mention of the opioid epidemic

of addiction treatment, recovery of our incredibly limited resources or anything. The word was not mentioned and that was very disappointing to a lot of us especially in the medical profession and in addiction and recovery treatment in this area because we're desperate for help. Yeah. So, I thought in light of that, my mind has been on that topic. We would talk a little bit about the history of opioid addiction and treatment and how we got to where we are now. Now, the Sydney was explaining to me before we got started, not as much in the way of light

stuff with this topic, just because it's the way you put it to me me before we got started, not as much in the way of light stuff with this topic, just because it's the way you put it to me just before we began, is we're still in the solbona episode in with this particular situation. Yeah, that's kind of how I look at it, is that as we kind of get through the history of how the, because it really is an epidemic, as you talk about this stuff, it's hard not to think about it as like the building of an infectious disease as a contagious thing that has spread. As I kind of go through it,

you'll see we're not at a point where we figured out how to turn it around and go in the right direction completely. I mean, people have ideas. People are on the right track, but we're not doing that in mass. Right, and we're not sort of like, it seems like when big things like this are fixed, they're usually a, it's a concerted effort. And it seems like we're still very much divided in, in regards to this.

Exactly. So let's go back. We've done a whole episode on opium before. So I'm not going to go through that. We did the fun side of opium. Yeah. Let's take over the lighter side of opium. The lighter side of opium. But we know that opium, the sticky euphoria producing substance from poppies, it's been cultivated for thousands of years by humans and used recreationally for a very long time. And from it, we derive all of the opiates that I'm going to talk about. It was used for both medicinal and for funsies throughout ancient civilizations. I mean essentially all of them, Sumerian, Desiree, Egyptians, Indians, Arabs, Greeks, Romans, Chinese, everybody, everybody was using this at some point in history for various reasons. Hypocrity's wrote about it noting that it was very helpful, specifically for two things,

internal disease. Um, little general, my man. And diseases of women. Okay, I get so, all right. This is, well, and when I say diseases of women, and we've talked about this before, kind of, in our hysteria episode, I don't just mean when a woman is sick, when they say diseases of women. You mean like they're the machinery, the woman machinery? Yes. Hippocrates was probably referencing any kind of menstrual problems, any sort of

mood disorder, anything pregnancy related, child birth related, anything like that. Normally, we try to be really careful when we're talking about anything gender related on this show, but, you know, he was just pretty much wrong all across the board. So we'll just put this one into the buck wild category and we do not need to delve deeper and try to qualify. I mean, it's not, if your thought is so basically if a woman complains he's just saying give her opium. I mean, that's kind of what he's saying. You got it. Opium disappears from European history in the wake of the inquisition.

There's like this moment where it's like, where'd all the opium go? No, no, nobody's writing about it, but it comes back in the 1500s. Mainly Paraselsis brought it back in the form of Lodnam and then Sid and Ham brought Lodnam to the UK about a century later in a very early patent medicine form. So Lodnam was a form of opium that was very popular to take for everything. For everything. And then even nothing at some point, and as you can see, and I guess tombstone features very prominently, right? Yes. Yes. Why are wife is addicted to law and them. And that would be very common. She says she took it for headaches. That's probably exactly what

happened. She went to a doctor said, I'm having headaches. The doctor gave her law and them because she was a woman and she complained. And there you go. This was not uncommon. It made its way to the United States, probably on the Mayflower. Wow. On the Mayflower. That's where the physicians would have carried it in there, in their bags, their doctor bags. And American history and opium history. They're just, it's just tried excited by side on the May the Mayflower. That's, I like that though, because the pilgrims are like, I don't know how this is going to go, but I need to be prepared. It's going to be boring on the boat for sure. I'm probably going to get, I don't know, a headache or something.

I am. Dissenteri. Yeah, I'll get Dissenteri something. It's going to be wack. I'm definitely, are you kidding? I rather, did you pack your Electritude Brush? I did not. I saved it for room for opium, which I definitely needed.

They nearly frozen their pilgrim clothes. Or so the song that I sang in kindergarten about the Mayflower went. Except for one guy who was like, wow, you all look cold. Anyway, I'm gonna to go take it. I'm going to take a map. In 1806, Friedrich Wilhelm Adam, a German chemist gave us morphine, named for Morpheus, not from the matrix. I knew.

Nope. I got him in there. Nope. And that morphine was supposed to be, you know, we already knew that opium could alleviate pain in the form of lardium, but this was supposed to be a more refined version of this. So, you know, that's fine, but it was also associated with smoking opium. I mean, you know, there were opium dens. There was this whole idea that, well, yeah, it might work, but we also kind of knew that it was-

So it's trying to make it dress it up a little bit so it makes it seem more medicinal. Exactly. To give it more of a yes, exactly. So it was used again for anything. So morphine comes out and they're like, great for pain, of course, of a release pain. But then for anything, again, women complaints, and I'm using that again gender term women complaints because that's what it would have been Labeled on the bottle women complaints at the time TB tuberculosis anxiety breathing problems

Does does morphine cause affects on dreams is it are those two tied together? Is it just the idea that you would be chill? It would make you chill and Sleepy and feel good and I mean get high got it perfect probably it also affects your dreams, but Not that was not directly the name So anything it could be prescribed for it was was used for, and then the Civil War happened. And Morphean became a mainstay of a doctor's medical treatment because there were so often that they didn't know what else to do for these awful wounds and injuries, and we didn't

understand infection or infection control or any of that. So you give people Morphean, which is great for pain control, but the result of that is that so many soldiers who managed to survive came home hooked on morphine that actually morphine addiction was known commonly as soldier's disease. So, and that really perpetuated the spread of morphine use and abuse later in this country.

Yeah. And what helped with that was in 1853, the hypodermic needle is invented. Ah. So then all of a sudden, or a whole new world before then. A lot of them are oral preparations. Oh, really? Yeah. But the, but the hypodermic needle is of some sort.

Like, we had needles right before them. We had needles, but we didn't, we couldn't deliver quickly intravenously like that before. Wow. That's why it's, that's so funny. That's that recent. You tend to think that is so essential. So then all of a sudden, we could deliver it quickly to the bloodstream.

And that, of course, anything that you can deliver directly to the bloodstream generally speaking, you're going to get more of a high from. So that euphoria is going to be more intense, and that is more likely to lead to the addiction and cravings and everything else like that, as opposed to something that dissolves slowly in the GI tract. So the problem at this point in history is that even as we know this is happening, right, we call it soldier's disease, we know addiction is happening, is that most of our focus in this area is on alcohol. Alcohol was considered the bigger problem.

Yes, we knew that people were going and using opium, but alcohol was this, I mean, it was very much a moral thing, it was a religious thing, it was evil, it was destroying families, it was destroying men's lives, they were leaving their children, they were abandoning their wives, it was, you know, this was the temperance movement beginning.

It seems like a lot of those are always connected to society. It wasn't societally like encouraged for you to just like do a bunch of morphine with your buddies, but no, but the, but it was much more demonized to do alcohol. So morphine was actually presented initially as a treatment for alcoholism. Oh, good, effective. So you go in to some sort of home for the, you know, an ebriot kind of thing, place a sober living type house,

and they would give you morphine to help you stop using booze. And doctors started prescribing it, honestly, initially. And then a lot of people ended up addicted because of that. And then of course, this is also the same period of time when patent medicines are exploding. And you see, and these are of course are medicines that are made by people who maybe have

no medical background whatsoever. And usually you're just putting together some sort of powder or syrup or tonic that will contain something that will make you feel good. So you'll think it's working. And usually that was either morphine or opium or alcohol or marijuana, whatever. Cocaine. So morphine was an everything from headache powders to diarrhea treatments to, as we've

talked about before, soothing syrup for babies. Your baby's colloquy, if your baby's teething, if your baby just cries, because babies do, and it bothers you, give them some morphine serup. Thank you, modern living. Yeah. So as more and more people became addicted to morphine instead of alcohol, a new, one of the first treatments for morphine addiction, I guess you could say that was advised was cocaine. Wow, we're just not doing great.

No, we're just building on this drain of now. This was not a huge moment where everybody who was first using alcohol became addicted to morphine instead and then shifts to cocaine addiction. It was just kind of a unfortunate sign of hate now now we're going to do cocaine, everyone. Good news. A lot is made of that, especially with Freud, who was recommending this and then treat, and then also using cocaine and then treating people for cocaine addiction. Yeah, I know how to handle your cocaine. I always have said that. Now, when it comes to how to treat this, a lot of it was just trying to pattern after what they were doing for people who were addicted to alcohol.

So the main state of treatment for alcoholism at the time was largely things like asylums and inebriate homes where you would just kind of go lock somebody up, where you didn't have access to alcohol and try to just counsel them. A lot of them could have been religiously focused or just like this moral character-based thing, you're going to stay here and you're going to stay sober and you're not going to use again and that kind of thing. But mainly you were locked up and you couldn't get enough access. So in the mid-1800s, this expanded to include also if you're addicted to other stuff, you can come to these places. But there was no specific like way to treat it. It was just come here and live here and don't do drugs.

Was basically it. At the turn of the century, a big shift in this is the move into private facilities. And a lot of this was heralded by Leslie Keely. Now we've spoken about Keely briefly. I'm pretty sure in our alcohol episode. Yeah, that's okay. Because he invented the Keely cure.

Which was? The Keely cure was, the only thing he would tell you is you would come stay at one of his private treatment facilities. And he'd give you injections of a bichloride of gold is what he would tell you was in it. Mm. Now what was probably also in it,

it's been analyzed later, or strict nine alcohol, atropine and apomorphine and morphine derivative. was in it. Now what was probably also in it, it's been analyzed later, were strict nine alcohol, atropine, and apomorphine and morphine derivative. So he'd give you these shots. Sorry, did you say morphine derivative? Okay. So he'd give you these shots. And he would stay there. And it was a private treatment facility. So this wasn't all these other places I've mentioned were run by the government, you know, almost like a kind of legal treatment center. These were private, for profit.

Mm-hmm. And this concept people latched onto, as you can imagine, because it's still very prominent today. We are also the... Expensive, private, boutique, addiction treatment centers. Right. It's a very fashionable addiction to try to treat. This is this is the beginnings of this. This is where this kind of started. Now, it is he did believe that alcohol addiction and drug addiction later were

medical conditions. So that is very important. Progressive. Yes, it was very progressive. That concept. Now the treatments for it, probably not so progressive. So anyway, this concept spread to drug use as well as alcohol use. And a lot of people who were trying to seek treatment couldn't at this point in history because as these kind of government run treatment centers started shutting down and these private centers took over, you couldn't afford them. You know, just like today, a lot of people can't afford those treatment centers. And so they ended up instead in jail or on the street instead of actually in a treatment

program. Seems like the, especially, I know this is true nowadays, but certainly back then I mean we were so hard up to cure diseases people didn't want to have I would say I mean and that's not to say that You know people don't want drug or alcohol addiction, but you know They seem a lot more optional than a lot of other diseases And I was seeing if society is gonna put pressure on something to throw its weight behind curing It's probably more focused on the stuff that it has no idea how to treat as opposed to, you know, just stop doing drugs, which is a lot easier said than done, obviously. Absolutely.

Right. I mean, that's a big part of it at this point is that there still is no widespread acceptance of addiction as a disease. It's very much still seen as a moral or character issue. And as such, people were pretty comfortable with leaving it to the legal system, as opposed to the medical establishment to take care of. Now, at this point, so many people are getting addicted to morphine. By 1898, somebody comes up with a better, safer alternative.

Oh, thank goodness. I was starting to get worried there. It seems so dire. We can prescribe people for all these different conditions and it will be safer than morphine and we won't have so many people addicted. And so that is when heroin is introduced. Okay, come on, guys. Seriously, really, this is the best we can do? Just inventing worse things.

Yeah. It was thought to be non-addictive initially. We didn't understand addiction very well. We didn't understand anything very well, apparently. Bear as an aspirin bear began marketing it to people who had problems with morphine who were addicted to morphine as an alternative for pain and also as a cough suppressant by the way, which I mean most most opioids do work as a cough suppressant by the way, which I mean most most opiates do work as a cough suppressant. Well, at least heroin's got that going for it.

People always want to rush to the bad side of heroin and so rarely we'll talk about all its pluses. Yeah, that's true. I mean these things will definitely stop your diarrhea and your cough. Perfect. This is also a moment, this side note, there was a society called the St. James Society. It was like a altruistic, religiously-based trying to help do good charitable organization. In an effort to help at this point with the introduction of heroin, they began sending free

samples of heroin through the mail to morphine, people addicted to morphine to try and help them quit. I mean, you can't beat the convenience of mail order heroin. Mail order heroin, to try to help you quit your morphine addiction. Now, this was, like I said, this was in 1898 that this is introduced. By 1910, we have documentation of someone walking

into Bellevue Hospital and asking for help because they believe they were addicted to heroin. No that broke bad fast It took about a decade and then the numbers just started growing By 19 that's the least kind of that it took 10 years because that means for 10 years arrows like listen of that it took 10 years. Because that means for 10 years, era is like, listen, heroin is great. This is working so good for me that I don't even want morphine anymore. I just want heroin and the thing is, it's really easy to stick to. Like, I just want it and actually I want more.

I actually want more of it because it's so effective in treating my morphine addiction that I stopped doing seven years now. I mean, you probably did stop doing morphine. Yeah, yeah, yeah, it's perfectly effective. Now, as we began to see this, again, doctors finally began kind of in larger numbers by 1914, talking about addiction as a disease and not a moral issue. And I think in large part, like, when you see this kind of thing happen, like we're trying to help you get unaddicted to morphine and we came up with something new and that within, you know, a decade, people are already seeking treatment for addiction to that.

And I think that doctors at least be able to be included in that there's something else happening here. These aren't bad people. These aren't people who are fundamentally flawed. There's something else medically that we're missing. And we need to figure out what it is. That's been a frustrating meeting though when they were all like, listen bad news, y'all, we've got to come up with something worse than heroin. I know, I know. But people kept trying. And by 1916 with heroin clearly being more of a problem than a solution, it was

no longer manufactured widely by bear. But another German company came in and said, we got something else that we've just synthesized that we think we could get ready for the market to replace it. And that is oxycodone. And the story continues. Right after this. After the billion department. Let's go. Why should I not follow sleep first at a slumber party? How do I be flea? Is it okay to break up with someone using emojis? And sometimes we talk about buzz! No, we don't. Nope. Find out the answers to these important questions and many more on still buffering a sister's guide

to teens through the ages. I am a teenager. And I was to... But, but, butt, butt, butt, butt. So Sid, we had just synthesized Oxycodone, is that right? That's right. So, Oxycodone has been made. Now this is going to play a larger part as the story continues. But just so that you kind of know what happened with heroin, because obviously

it's illegal now. So, so something happened in the interim. Well, in the in 1914, the Harrison Narcotics Act is a big in terms of like opiate legislation. This was a big deal. This was passed in order to clamp down on opiate use, especially by like patent medicines and people who were just kind of handing it out by making it through taxes. Basically, if you're getting it any way other than with a prescription, it was impossible. So this was an attempt to make it something that only doctors could prescribe. Now at the same time, one side result of this was that it criminalized doctors who were prescribing like opiates for addiction. So it made it impossible to try to treat opiate addiction with opiates. And the problem is that at this point in history, there were a lot of morphine

maintenance clinics, which were a lot of morphine maintenance clinics, which were similar to what you might think of as a methadone or suboxone clinic today. Now, of course morphine is not ideal for this, but it was what they had. So they were trying to run a morphine maintenance clinic where you would go, you'd get your dose, and then you would try to continue to live in society, have a job, have a family and function. You know, well, they basically shut all these down because they became illegal.

Doctors weren't allowed to be involved in this anymore at this point in history. And so a lot of doctors just said, forget it then. I'm not treating addiction anymore. I'm done. This is too hard. The government is making it impossible. And at this point, people start arguing, okay, well, doctors aren't part of the conversation anymore.

The medical establishment has walked away. So what is causing the heroin? And in general, opiate addiction problem. And you start to get into different theories. Is it a moral issue? Perhaps it's just a temperance problem. All we need to do is make it not available. All humans are gonna use it if it's there. And we'll make it not available. It's been effective.

Make it not available and then everyone will stop. Maybe it's a character thing. Maybe we should work on character building and parenting. Or maybe it's behavioral. Maybe we could just like negative reinforcement, slap people in the face every time they use it and then they'll stop. It's definitely not. Things like this we're actually trying with alcohol and drug addiction. Really? Maybe it's just educational. Maybe we just sent everybody to better schools.

They wouldn't use heroin. Oh, I thought you meant like they didn't know it was bad for them. Well, that too. Obviously, all these theories were not helpful or progressive. And it took until 1924 when the aptly named heroin act made heroin. It's locked into the point. Yes. But at this point, I think the cat was kind of out of the bag.

The FDA was established in the next decade. There was a lot more oversight. Physicians were allowed to prescribe opiates at this point, although, like I said, not for addiction specifically, but, you know, for other, but it was more regulated. And, and this is where we see heroin kind of move underground and spread like wildfire. Throughout the 20s, 16, maybe harder to get. Didn't pick the problem.

Yeah. Somehow banning it didn't stop everyone from using it. That just never works. It's popularity grew. Although, I mean, for, and usually it was in different, like, you can look through different populations that spread it. Like, it was cool because of this group or because of this trend or this fad, but it didn't go away. In 1970, the controlled substances act made it schedule one, meaning you couldn't prescribe it anymore. Hopefully, it wasn't being prescribed, but it probably was.

But it took till 1970 to say that. A schedule one stuff has no medical benefit. Okay. That means you can't prescribe it at all, period. You can't do anything with it. You can't even study it. Shouldn't exist. Well, marijuana's schedule one, so.

Oh. So it's a whole other topic. So it's not actually true when they say that it has no medical benefits, right? It varies. Cool. Maybe not across the board. I'd say heroin we're fine with, but yeah, but maybe marijuana shouldn't be in there. That's a different episode.

By the end of Vietnam, it was with that episode though. We did marijuana. We did marijuana. I said this. It shouldn't be schedule one. Let's keep banging that drum though. We had to be schedule one. Let's study it and see what it can do.

We're already using it for medical benefit. Like, let's prove that it actually does that. It also says psychedelics as long as we're here. Okay, let's stick with opiates right now. I'm right about this. By the end of Vietnam, it was estimated that 10 to 15% of soldiers had become addicted to opiates during the war. And at this point, the Control Substances Act soldiers had become addicted to opiates during the war.

And at this point, the controlled substances act was actually amended, but it was called the Narcotic Addict Treatment Act. And we are reallowing doctors to get involved in addiction treatment using substances. So like actually using opiates to help wean people off of opiates. So methadone clinics are established. That's where this comes in. So these like government run legally mandated, not mandated, but legally regulated.

Sure. Methadone clinics are started. We are so far behind at this point on like a medical model for addiction. We have begun to understand it somewhat for alcohol. There's been a lot more progress made. We're about in the 70s at this point in history with alcohol, then with drug addiction, where we are still just beginning to become accustomed to the idea that maybe it has nothing to do with how many times your parents took you to church or something like that. Believe it or not.

So, and by the way, on a side note, the 1960s also brought us naloxone or narcan, which a lot of people have heard of now. They give that to you if you OD, right? Exactly. So it blocks the opiate receptors and it will save you from an overdose. It doesn't help in the long run, but in the moment, it can save your life. By the 80s heroin is a huge problem, but this is when a new player comes on the stage. And I've already mentioned we've had oxycodone around since the early 1900s, but that was just the beginning. Perkidan, which was oxycodone plus aspirin. I don't think anybody uses that anymore.

Was already out there, Vikidan, which is hydrocodone and Tylenol. You might still know it by Lord Tabernorco. Came along in the late 70s. But in the 80s, doctors are still pretty biased against the idea of using these narcotics for anything other than like terminal diagnoses, like cancer pain

or surgical management or something like that. You didn't go and get narcotics for chronic back pain at this point in history. Doctors were very biased against that. Okay, that seems good. But a couple things turned the tide. First of all, there were some pain management specialists who began writing very persuasive articles

arguing that we were under treating pain as a nation. Doctors are not taking care of pain. And the same specialist began arguing that the rate of addiction among people who actually have pain is extremely low, basically negligible. So this should not be a reason to stop yourself from prescribing opiates, basically saying, feel free. As long as the patient really has pain, feel free to prescribe. This was based on, in a lot of cases, a letter to the editor, a five sentence letter to the editor that was published in the New England Journal of Medicine in 1980 by Jane Porter and Dr. Hersheljick, which referenced a brief survey of their in-patients, patients that they had in the hospital that they did on their own a verse-torture period of time where they went along around and said, have you had opiates yes,

are you addicted, yes or no? And they said like, oh, like 1% are addicted. Based on this letter to the editor, this is not a study, this is not double-blinded, this is not, this is a five sentence letter to the editor. 608 times this letter has been cited in papers arguing that we under treat pain and that you are unlikely to become addicted to opiates if you have pain and are treated with them. That's staggering. This is completely unscientific. This letter to the editor, and this was not their intention when they wrote this letter. I mean, I don't want to put Jan Jay in her salon blast here, y'all. But, but this letter has been blown completely out of proportion

in terms of medical evidence. And, and from here, the race was on. This is when you start hearing this phrase, pain is the fifth vital sign. You may have heard this. I have not. So this was mandated that we needed to start asking patients, are you in pain and treating it just the same as we would a derangement in their heart rate or blood pressure or oxygen

level, just the same as we would do that. We need to start treating pain just as aggressively. So we start getting new extended release versions of morphine, fentanyl, oxycodone, hydro morphone, all these different opiate derivatives, Purdue rolls out oxy cotton, which is built as a brand new, non-addictive, long-acting opiate that will give your patients back their quality of life, and it is totally safe to use. Excellent. End of episode.

For everything. They marketed it to patients. They had videos playing in waiting rooms. They went to naive doctors who didn't really know how to use opiates to the first place, didn't know how to prescribe them because they hadn't really been. And basically said, listen, use this. Patients are pain-free, no risks. The number of... After this was introduced, the number of patients on chronic opiates jumped by 11 million in this country. And by the time we started to figure out as physicians that, hey, maybe this was wrong.

And at the same time, pharmaceutical companies started making pills that weren't so easy to crush and snort and inject. It was too late, obviously. Right. People were already addicted. It is estimated now that for chronic non-cancer pain, opioid addiction may be as high as 26%. So if we start you on opiates long term for something other than cancer,

you got about a one and four chance of developing addiction. And one in 550 patients started on chronic opiate therapy die of opiate related causes within two and a half years of starting it. Y'all. These drugs were never benign. Y'all be careful because people, doctors are still, I've seen so many times I'm sure Sid has a way more experience with that this idea, but here's so many times that people just casually

getting prescribed this stuff. Just remember that number in your head, one in four. Like how bad is the pain? Seriously, because there's a one in four chance of addiction. That's wild. America uses 99% of the world's hydropower. I'm sorry, no, we're not supposed to give medical advice to people, but I'm just some chump

with the microphones. So I can say whatever I want, be careful, sheesh. I mean, this is the thing. We are just now preaching this. Why are doctors whack at this? I'm asking seriously. Why are doctors still so ready to gamble on this stuff? I think part of it depends on what era of medicine you were trained.

Prior to the 80s, if you were trained before then, you probably still are pretty reluctant to give pain medication. But if the 80s hit you hard in terms of the pain is the fifth vital sign, patient suing doctors and hospitals over under treating pain, I think that that stuck in a lot of physicians' mind. And that was, you know, the years that I trained, that was still told to me, like, listen, these drugs are addictive and they're dangerous and you want to be careful. But if you under treat pain, you can get sued. So you've got to treat that pain and you've got to find a way. And if your patient is hurting, it doesn't matter if you think all of your studies

are negative and I can't see the pain and you treat them until they're not hurting anymore. And sometimes, if, especially of addiction is part of the problem, that's not possible. That's, I mean, it's impossible. But I, and I think, I think the other thing is that we now are training medical students a lot better on the consequences of these substances and the risks. But I don't think we were for a long time. Like I said, America uses 99% of the world's hydrocodone. We have 5% of the world's population.

It's a crazy number. In West Virginia, overdose deaths are the highest in the nation. We had over 800 last year and we're growing. We're on rate to beat that this year. We lose someone every 10 hours, at least, to opiates. In West Virginia, yes. And of course, as the pills have become harder to get or to use because doctors are getting wise and prescribing them less, they're becoming more expensive to buy on the street. And they're harder to, they've made them so that instead of being like powdery, make you if you crush a tablet and it turns into powder, you can cook it up and inject it.

They've turned into stuff like their ones that are kind of like skittles. If you think about it that, how hard would that be to crush and inject? So they've changed them to try to make them harder to abuse, but the result has just been heroin has taken over. Heroin's cheaper, it's easier to get. It's easier to use. So it's filled the void. Well Jamie, I'll fix this one.

You know, he fixed the eating thing. I just wish Jamie would come fix the open addiction. I need it. We've had substances, medications, to treat these things since about the 80s, Naltrexone, which is vivitrol, has been around since the 80s. It's been highly, like, touted

by the Secretary of Health and Human Services. I will tell you that it does not have the long history of efficacy in treating opioid addiction that other substances do. I don't know why there are certain like political figures that get really hung up on Vivitrol as the solution to everything.

It's been used a lot more in alcohol addiction than opioid addiction and with some success. So I'm not saying it's useless, but probably the route to go is methadone and maybe a little better now, your pranorphine, which is subutex or suboxone. Although both are shown to be efficacious, I think that there is less of a stigma with suboxone

and subutex. And the other thing is it is an agonist and antagonist so you don't get, you're less likely to have the sedating effect that you do with methadone, which is good because the truth is if we can have a patient who's stable on one of those medication-assisted therapies as replacement opioid replacements, you're more likely to be able to have a job, have relationships, retain custody of your children. I mean, be part of society, you know, and have a life back, give you your life back.

The problem is really complicated. We've already talked about it. Money and stigma are probably two of the biggest barriers. There's lots of them. It's treatment programs are expensive. The ones that are cheap are too few. They're very hard to get into. And a lot of them aren't long term.

So we might detox you and then put you in like a 28-day program. And then that's it. And then what? And then we tell you to go to NA and hope that that's enough. And NA is great. I'm not saying narcotics and otomus is a bad thing. It's just a lot of these patients need more intense treatment than just that. We still treat treat people with addiction as if it's a moral failing. I mean, I see that in my professional life. People treat it as if like, well, if you weren't such a degenerate, you wouldn't have this as opposed to someone who has a chronic disease.

And we need to treat it medically. So now we've got detox, we've got behavioral therapy, we've got counseling, we've got medication assisted therapy, treat the comorbidities to somebody having anxiety, to somebody have depression. Treat that too. But how do we get it to people? Well, this is the part, this is always my fair bar of substance because this is when Sydney's like, but the good news is we've got things a little more figured out these days. And then you say that. Okay, I will give you good news. We don't have it all figured out. This is a complicated problem.

But there are smart people who are doing this research. I went to a heroin summit. That sounds like a really weird thing to go to. It's actually the National Prescription Drug Abuse and Heroin Summit. I went to back in May, April, sometimes. And there are very smart people researching this and working on this all over the country, all over the world, but this was focused on our country. And there are answers to these problems.

What we need though is a coordinated effort that's got to start from the government. It has to be funded. that's got to start from the government. It has to be funded. And we have to aggressively treat this chronic disease of opioid addiction the same way that the government decided they were going to aggressively support people who had renal failure and needed dialysis.

You know, the government pays for everybody to get dialysis who needs it. Okay, well, this is a chronic disease with devastating consequences. Let's take care of it too. We need that coordinated effort because there are smart people with answers. It's just getting those answers turned into action that is the problem right now.

But it's not hopeless. It's not hopeless. We just all have to work together a lot harder to make it happen. Folks, that's gonna do it first. This this week on Sob bones. We hope you have... If you've not enjoyed yourself, at least feel... If you want to know about it. If you want to know about this stuff, a better person to than me,

the book Dreamland by the offer Sam Kenones is a wonderful book that documents the whole history of this. And a lot of the story i'm telling you i read his book. I got from him as well as a lot of other resources but i would highly recommend that book if this is something that interests you and that you might want to look into how you can help with. say thank you to the taxpayers for letting us use their song Medicines is the intro and outro of our program. And thank you to the maximum fun.org network for having us as part of their extended podcasting family. There's a ton of great shows you can listen to. I'd like to recommend a favorite of mine. It's called Stillbuffering. It's a show Sydney makes with her sisters Taylor and Riley. Thank you, honey. And this week they have an ask a teen Teen episode which is

our our wait, would you say this one's educational or entertaining which is it or like a delicious blend. I think it's both. I think it's both. We definitely learned some things from Riley that were scary. Keep your keep your keep your finger on the pulse of teen life with still buffering and all the great max fun shows But folks that is gonna do it for us and we hope you'll join us again next week for solbones Until then my name is Justin McRoy. I'm Sydney McRoy and as always don't drill a hole in your head Alright! Maximumfund.org Comedy and Culture, Artistone Listener Supported comedy and culture, artist owned.

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