Single Payer Radio Dr Murphy Suboxone 5-29-2026 final

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Hello, and welcome to Single Pair of Radio. I'm Paul Hoppey,
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broadcasting from the Haburn Building in Louisville on WFMP one
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six point five Forward Radio Community network, where news, information
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and entertainment is available twenty four hours a day, seven
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days a week. The views and opinions expressed on our
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show are those of the speakers and not the station.
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Single Pair Radio is a project of Kentuckians for Single
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Payer Healthcare in conjunction with Physicians for a National Health
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Program through its Kentucky chapter. We produce this program because
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we believe healthcare is a human right. We advocate for
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a national, not for profit, publicly funded, single payer health
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care system, also known as Enhanced Medicare for all, covering dental, vision, hearing, prescriptions,
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mental health, and long term care covering everyone starting at birth.
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Catch our programs at two pm Monday, seven am Tuesday,
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and eleven am on Wednesday. We'll stream our show on SoundCloud,
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Apple Podcasts, and others, so you can listen anytime. And remember,
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this is an all volunteer radio station and relies on
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your ideas and donations to keep us on the air. Today,
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Doctors Mike Flynn and Genie Shaveley joined me as co
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hosts with their special guest. Let's get started, Doctor Flynn.
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Yeah, this is Michael Flynn, retired surgical oncologist from University
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of Louisville Surgery Department. Let me begin with the usual disclaimer.
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Any comments I may represent my personal views and do
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not represent the views of the Department of Surgery or
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the University of Louisville.
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Jane, this is eu Jane Shaveley. I'm a retired general
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searcher in Cambellsville, Kentucky. I've spent my whole career in
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rural surgery and have had a close relationship to the
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Apartment of Surgery, University of Louisville. Anything I say sent
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my opinion and not to the University of Louisville or
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Taylor Regional Hospital.
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So our topic program topic today is opioid use issues
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and access to bupin norphine, which is a drug used
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to treat opioid used disorder. And we have very special
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guests today, James Patrick Murphy. Doctor Murphy is the CEO
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of the Murphy Pain Center in New Albany. Got his
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medical degree from University of Louisville, did an anesthesia residency
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here at U of L, did a pain management fellowship
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at the Mayo Clinic, and he has a master's in
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medical management from the Marshall School of Business in California,
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and he's been an advocate for the holistic approach to
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addiction issues and increased access to buper norphine. And he's
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going to explain what that drug is and how it's
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used to our listeners before I allow him to make
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whatever comments he'd like to make. Let me challenge our
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listeners to double check the comments that we make. And
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there are multiple source of information sources on Google, Journal
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of the American Medical Association, a New England Journal of Medicine, Wikipedia.
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There are two articles on opioid use and bupenorphine in
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the Journal of the American Medical Association on the seventeenth
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of March and the fifth of May. So Pat thank
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you for coming on. We appreciate your willingness to discuss
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these important issues for our listeners, and as we have
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done in the past, we're going to give you an
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opportunity to make whatever comments you'd like to make for
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as long as you'd like to make them, and Jane
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will begin the conversation, so the floor is yours.
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Well, thank you both, and thank you to the organization
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for allowing me to be on your program today. And
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by the way, I want to tell you that's a
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very dangerous thing to give me a microphone to talk
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as long as I want to. So I've been doing well.
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It's okay. We can always cut you off if we
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need to.
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You have my permission please do that. But I'll try
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to be keep as a salient and as pertinent and
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as brief as I can to the comments so that
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we can get through some questions as well. And I
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do appreciate this opportunity. I am. I want to do
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a disclaimer also. I am a professor GRATIS, which is
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one of the volunteer professors at the University of Louisville
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School of Medicine, and I also serve on the board
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of the American Society of Addiction Medicine. I am doctor
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licensed in Kentucky and Indiana. I'm really a pain specialist,
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but I'm also a specialist in addiction medicine. And I
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want to be clear that the comments I'm making today
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are my own opinions that should not be ascribed or
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given to any other organization. But that's my background. So
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with that being said, I want to talk about this
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issue called butte prinorphine. It's a kind of a fun
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word to say if you've practiced saying it. A bute prenorphine.
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It goes by people call it bube. Some people call
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it by this trade name. Suboxone is one of the
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more common trade names for this, but it comes in
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many forms. There's an injectable version of it. There's a
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once a month injection of it. It's a medication we
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also use for pain management in the operating room sometimes
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and in the emergency rooms. It's a it's kind of
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an opioid, but not a full opioid. It's kind of
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a partial opioid, so it's kind of a morphine type drug,
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but it's got a little bit of a sealing effect
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to it, so it's a bit safer than a lot
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of the other opioids that we know about. The reason
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why it's so important to talk about it now is
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because it is, honestly, by research, if not the best,
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perhaps the best tool we have to treat this condition
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called opioid use disorder, and in fact it's probably the
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best medicine. We have to prevent overdoses from opioids, and
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we have this opioid crisis in this country. We've had
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it for decades. We've had this overdose crisis with deaths
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skyrocketing and around the country and certainly in our state
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as well. Kentucky is one of the most difficult and tragic,
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if you will, opioid crises with overdoses, and this medication
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is extremely effective compared to other measures in terms of
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preventing death and actually treating the disease of addiction. Now,
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the reason why we need to talk about it is
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because it's really underutilized in many states, and certainly in
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Kentucky it's underutilized. And there's some reasons which we'll go
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into as to why that is. And part of the
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reason why I'm on your show today and advocating about
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this is because I'm a Kentuckian. I mean, I know
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people that have had addiction issues. I have some patients
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that have dealt with this medical illness, and people in
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my neighborhood, in my community, and everyone know, every family,
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everyone knows somebody probably or knows of somebody who's had
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an issue with opioids. At some point, it's just very common.
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It's across the board. You're not going to just see
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it in certain communities or inner cities or rural areas
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or certain parts of town. You're going to see it
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everywhere because it's it really affects every every community, every
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walk of life. So it's something we can all get
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behind treating, especially when we have this really effective medicine.
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So before I get into a bit more about how
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about you know why it's why there are barriers to
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getting it. Let me let me explain what it is.
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It's not methadone. We've heard of methodone clinics before, where
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people that have opioid addiction will go typically once a
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day and they'll get a dose of methadone. Methadone is
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a is a very strong potent opioid or narcotic lack medicine.
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It's very long acting, so people with addiction can generally
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take it once a day and it really helps with
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the cravings and the preoccupation and the behaviors that lead
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them to maybe use heroin or other drugs throughout the day.
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So it stabilizes the part of the brain that creates
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that behavior. That's methadone methodone. It's pretty easy to overdose
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on methadone. I mean, opioids can kill you a number
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of ways, but the main way that an opioid will
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kill you is if you take too much of it
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for you and you stop breathing. People, and that's why
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people have narcan. Narcan is the antidote to these opioids.
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It's a very brief medicine that usually people squirt up
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their nose. It's a nasal generally speaking, but you can
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give it other ways. But the narcan will reverse the
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effects of the narcotic or the opioid. So in the
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case of somebody overdosing on an opioid, like whether it
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be methadone or heroin or morphine or anything like that,
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if they overdose and stop breathing, you can give them
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the narcan and that reverses it and they start breathing again.
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If the opioid was the cause of the not breathing,
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it can reverse that. Now, sometimes with the potent opioids
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out there, we've heard of fentanyl being such a problem.
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Fentanyl is a very extremely potent opioid, so even a
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small amount could make somebody stop breathing. Fentanyl is both
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abused and it's also i say secretly clandestinely put into
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the illicit drug supply. So somebody might think they're getting heroin,
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and they're used to heroin, which is bad but not
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as potent as the fentanyl, but they get fentanyl instead,
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or part of the drugs got fentanyl. Now they stop breathing,
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and so you have to if you find these somebody
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like that, you give them a narcan. You can reverse
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it and they can get breathing again. And that's been
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a major important plus for our country and certainly our state.
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I think we've said a lot of lives by having
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narcan and narcan it's kind of like an epinephrin pen
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and EpiPen. When somebody gets a beasting and they're allergic
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to it, you know, you can give them the epinephrine
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and then it kind of treats the anaphylactic shock and
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saves them. So it doesn't treat the allergy, but it
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can save them. Well that's the way narcan. Narcan can
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bring somebody back from near death or certain death, get
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them breathing again, but it does nothing to actually treat
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the disease or what actually caused the overdose. Okay, so
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it's like, also, somebody has a heart attack and you know,
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they drop down in front of you, and you know,
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you call nine one one. Then you get the defibrillator,
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that machine, you put the pads on their chests, on
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their back, you defibrillate them and if things go well,
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you get their heart beating again and you save that person. Y. Okay,
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we've saved somebody's life. Their heart's beating again, But what
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do we do, what do we do to keep it
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from happening again? And the usually they have to have
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follow up care and they get medicines and their heart
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is looked at. And that's kind of the way it
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is with pupern orphine, methadone. And then this disease of addiction,
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this opioid addiction, you know, leads to these critical issues
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where people overdose. But the narcan doesn't treat the cause. Well,
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we have two, actually three FDA approved drugs that can
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treat addiction. FDA approved one is actually a kind of
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a cousin to the narcan. It's a trade named vivatrol.
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It's it's not in a lock zone. It's a it's
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but it's a similar drug to the narcan, and it's
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an injectable once a month injection usually, and that's for
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people that are already in recovery, meaning they're they're they're stabilized,
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they're not using and this helps them herb some of
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the cravings and stay in recovery longer. And it's an
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okay medicine and and for some people it's very very effective,
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but it doesn't hit the receptors like the other two drugs,
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which are methadone and pubernorphine. Those two drugs, methadone and
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pubernorphine are not like narcan. They are actually in the
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opioid family, and they go right to the part of
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the brain that's been damaged by the addiction. They in
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a sense balance that part of the brain that's been
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that's almost had a like having a stroke. It balances
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out the chemicals in that part of the brain. One
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of the chemicals that's important there is dopamine, but there
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are others as well, but it balances it out so
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that now the person with addiction is thinking more clearly.
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They're calmer, they're functioning better, they're they're they're they're able
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to make better decisions. Also, some of these uncom vtible
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side effects to withdrawal syndromes or the cravings, things of
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that nature are taken care of to a large degree.
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So it allows people to go on with their lives
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and function, go to work, have families, attend church, do
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whatever they need to do, go on with their lives.
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So it's a really really important medication that we have available.
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So methadone being very potent, being very powerful, methodone has
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to come from a methodone clinic. They are highly regulated,
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they are certified, and it's a clinic it really does
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methodone and so there's lots of rules and regulations and
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it's very strict about that. We can discuss, you know,
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another time, whether you know those need to be changed
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a little bit, but there's a reason for that. Bupernorphine,
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on the other hand, as I said earlier, is not
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a full opioid. It's a partial opioid, and buper and orphine,
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unlike the other opioids, has what we call a ceiling effect.
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In other words, for somebody who is basically tolerant opioids,
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they've been using them for a while, maybe they've been
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using heroin or whatever. If their body is tolerant to opioids,
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which is a natural occurrent, natural occurrence with people that
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use Then it's almost impossible. I almost sly impossible. But
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it's really hard to overdose on bupern orphine. It's hard
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to stop breathing taking it. Then that means it's like
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perfectly safe. But compared to methadone, buper and orphine is
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so much safer. And by the way, buper and orphine
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doesn't have to come from a pupern orphine clinic. You've
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heard of suboxone clinics or addiction clinics. The DEA has
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lessened the restrictions on buber and orphine because they've seen
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it to be so effective. The federal government has lessened
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the restrictions on pupern orphine. Puper and Orphine is a
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Schedule three drug. Most of the strong europia or the
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Schedule two, meaning they're more potent, But a Schedule three
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drug is considered maybe less addictive, less of a problem.
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It's not always true, but in this case, bupern orphine
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is a medicine that can actually be called in over
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the phone. You can give refills on buper and orphine
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buper and orphine is like any other Schedule three drug
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that your doctor might give you, So it's it really
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can come from a doctor's office. It doesn't have to
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come from a suboxone clinic. Your primary care doctor is
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authorized to prescribe it. In fact, your dentist is authorized
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to prescribe it. Anybody now in this country with a
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DEA license, which you know most physicians and dentists and
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even podiatrists, you know, most people that can prescribe controlled substances.
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In fact, all of them have had to have training
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in how to prescribe or and how to use pubern orphine.
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And the reason they do that is still that at
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the primary care level that your providers would feel hopefully
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comfortable at least starting somebody on this medicine. For example,
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say I'm your primary care doctor and you're coming with
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me a bad back, and I give you I don't know,
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say I'll give you a percocet, which is oxycodone. That's
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a very common opioid that we give people for you know,
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monitors severe pain. It's not for long term use generally,
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But say my patient comes back in two weeks and says, hey,
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I'm out of my meds early. Actually I was chewing
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them and I actually bought some more off the street
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because I was really hurting, and then I kind of
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liked it. I like the effect it had on me.
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While I'm thinking as a primary care doctor, I'm thinking, Okay,
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maybe maybe you have a genetic predisposition to becoming addicted
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to this. Maybe there's other issues going on here. Maybe
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there's a problem with you taking this medicine. But I
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don't want to just cut you off. I think what
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I'll do is perhaps starts you on a medicine that
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maybe help your pain, because pupil orphine does help pain,
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but also something that will maybe calm down that craving
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area of your brain and get you more more of
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a stable aspect. I'm not an addiction specialist doing this,
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but I can understand since I prescribe you the medicine,
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I want to be able to treat it. Okay. And
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this is just like if I was a surgeon, and
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I know you both of you there are surgeons, and
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if you know you have if you you're not infectious,
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I don't think you're infectious disease specialists, but if you
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cut on somebody to try to help them, and they
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come back a week later and they've got some redness
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around the infection and maybe a little bit of pus
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there or whatever. You say, Okay, it looks like you
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got a superficial infection here or something going on. I'm
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gonna go ahead and treat you with some caflex or
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penicillin or ampicillina or whatever I'm gonna treat. I'm gonna
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treat you with Anna see you back and see how
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you did as your surgeon. In other words, you did
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something to help the patient. There was a side effect
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or an outcome that you didn't really want to have happened,
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but you know, you know what happens rarely, hopefully, but
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you're going to be able to treat that complication. Same
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thing with suboxone. If I were to give somebody percoset
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for their low back pain and they were, you know,
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developing what maybe a problem opioid use or maybe an
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early signs of addiction. Not being a specialist in addiction,
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I'd like to be able to treat them. I'd like
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to be able to go and get them started on something.
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Maybe it'll take care of it, maybe it won't, but
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at least I can calm them down and get them
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into more more of a safe use of the medication.
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And maybe they do need counseling, Maybe they do need
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to go to an addiction specialists somewhere and talk about
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why this happened. But it needs to be something available
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at the primary care level. Okay, I hope I've that
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clear enough. So what's the problem in Kentucky? What's the
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issue here? What's the problem? Why are we having in
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this conversation if it makes so much sense, if even
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the Kentucky our government in Kentucky says that the use
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of upern rphine can lower the overdose death rate by
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fifty percent or more and save lives. If that's information
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coming from our very government officials in Kentucky and around
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in federal as well. But Kentucky has said this, why
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is it not so available in Kentucky? Well, that's a
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good cause. That's why we're having this conversation because it
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should be more available. I mean, it's it's if we
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have an epidemic of opioid overuse and death, we should
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have available the medication that we know is best to
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treat it. Right. So the problem is there's a lot
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of stigma out there a lot of people. I've heard
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this a lot. Well, I just don't like trading one
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addiction for another, or one dependency for another. And I
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think what they're saying there is it's not a good
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idea to just take somebody opioids and then put them
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on another opioid. And my comment to that is, well,
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that's not really what we're doing. What we're doing here
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is we're treating the actual disease process. As I mentioned,
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there's a disease process in the brain causing the opioid addiction,
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and we are giving medication that we know from research,
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from years of experience, it's highly effective at treating that condition.
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Pat, let's broaden things a little bit and maybe get
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into some broader issues about opioid use disorder. Gin, you
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want to start the ball.
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Rolling, Yeah, you describe the patient that may need to
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go on to the box on let's say the primary
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care physician starts a patient off the box on how
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long will they have to stay on it? And then
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what's a relapse right of people on the box? All
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I'm going back to opiods like lord tab and other opiods.
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Well, I think that it varies with the individual. Some
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people it might be as little as a week or so.
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It might be just a few a few maybe a
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few days to get them, uh, you know, down off
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the medicine they're taking. So there it treats their withdrawal symptoms.
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It might be longer. It might be months, and so
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for some people it could be years, and for some
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people it could be a lifetime. If you truly have
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the damage to the brain that's causing that addictive behavior,
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then you might need the medicine for a long direction,
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kind of like how we treat diabetes. For example, you know,
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somebody comes into your dock and you've got a high
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blood sugar and your a one sees, you know, really high,
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and they say that you've got diabetes here or pre diabetes.
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Let's see if we can treat you here. I'm going
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to give you some insulin, some medications get your blood
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sugar down, but I also want you to lose weight, exercise,
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to eat well those things as well. And then when
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they follow you up, hey, your blood sugar is normalized. Here,
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maybe you can come off some of this medicine. And
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I think that it varies from person to person with
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diabetes sometimes your body just doesn't produce insulin and so
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you're gonna need it really the rest of your life.
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And addiction is kind of the same way. I think
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it just varies from person to person. But generally there's
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two types of people that you use this medication. One
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would be somebody that is that needs to wean or
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taper down off the opia what they're on, and it
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can be helpful for that. The other is the person
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who has truly has the disease of addiction, and that
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could be anywhere from six months, a few years to
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a lifetime on it. And we shouldn't stigmatize people. We
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should allow people to work with physicians and their caregivers.
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And actually, if you're somebody who needs to be on
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this medicine, if you function well on it, if the
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benefits that wagh the harms, then you should be allowed
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to stay on it and not feel guilty about it.
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Can you give our listeners a kind of an overview
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about opioid use disorder one in the country and two
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in the state of Kentucky, just to kind of set
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a little groundwork so everybody has an idea. We was
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just is it getting better getting worse? The same, you know,
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both in the country as well as in the state.
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Okay, well, let's go back to like the nineteen nineties.
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So in the nineties. In the nineteen nineties, we had
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this really push to treat chronic pain. For example, we've
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always had an addiction issue in this country various times
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of the year of the century. It was stimulants like
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methamfetamine or cocaine. Then it became heroin, and it became
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other medications. Well, in the nineties, it was really driven
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by prescription opioids. So there was a you know, you've
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heard about the pharmaceutical companies over marketing these things, and
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this push, this perfect storm of pushing people to treat
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chronic pain because it was so prevalent. Well, there was
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a lot of what we call over prescribing, So there
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was a lot of these pills out in the market
401
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and in the community and people just started you know,
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abusing them, and that created this opioid crisis driven by
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the pills. And then around twenty ten or so, you know,
404
00:25:33.559 --> 00:25:36.720
the evidence was there that the pills were kind of
405
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driving this. So regulations became put into place and they
406
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really worked to lower the amount of pills that were
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prescribed to people. But what happened was as the prescription
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pills became less prescribed, other agents moved into the market.
409
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And I'm talking about heroin and fentanyl. So what happened
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was there was a need or a demand for opioids
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in the for people to abuse or use or whatever.
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And since the pills dropped off, then the the more
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unregulated illicit opioids took over. So and that's carried on
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till today. So the opioid crisis today is really no
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longer driven by the prescribing. The opioid crisis today is
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driven by the illegal fentanyl and heroin that comes into
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the country and comes into our drug system, and that
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it's more potent and obviously more unregulated. So that's where
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we are now. The overdoses have been rising probably for
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the last fifty sixty years that they really spiked up
421
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when interestingly, when the prescribing for pills dropped down, they
422
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dropped like fifty percent, but the overdose death rate doubled
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during that time. I'm talking about the you know twenty
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ten to do that. So why did the overdose death
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rate double when we were actually decreasing the pills prescribed? Well,
426
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it's because we weren't treating the actual disease of addiction.
427
00:27:13.400 --> 00:27:18.000
What we were focusing on is pills the agent, and
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what happened was when the pills dropped off, something else
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moved in and that's kind of where we are now
430
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as well. We are seeing we saw a big peak
431
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during COVID. COVID people lost access to their providers. They
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00:27:31.839 --> 00:27:34.599
couldn't get care, couldn't get prescriptions, couldn't get what they needed.
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00:27:35.079 --> 00:27:36.640
And also it is a lot of stress in this
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country during that time. So the overdose death rate really
435
00:27:40.960 --> 00:27:44.799
really peaked during COVID and then it started to come down,
436
00:27:45.000 --> 00:27:48.039
and in fact, it's come down almost every year in
437
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the last few years. And we had a nice drop
438
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last year as well, almost a thirty percent drop in
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Kentucky and around the country in overdose overdose from opioids,
440
00:27:58.079 --> 00:28:01.599
and it's really unclear exactly why that happened. But unfortunately,
441
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if you think about it, we're still we're still at
442
00:28:04.839 --> 00:28:07.039
a higher level than we were pre COVID, So we
443
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haven't really addressed the underlying cause of the overdose, which
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is the disease of addiction. And that's why we're out
445
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there advocating for this treatment, for the actual disease of addiction,
446
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the opioid use disorder. The best treatment we have is
447
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a medication like pupern orphine. That's the absolute best medication we.
448
00:28:29.240 --> 00:28:32.519
Have, you know, Pat, I've thought a lot about this
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in this data with the opioid desks are coming down,
450
00:28:38.599 --> 00:28:41.079
and so you know, there's really not a good explanation
451
00:28:41.200 --> 00:28:44.079
except only one I can come up with is that
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00:28:44.319 --> 00:28:48.359
narcan is having such an effect today on keeping these
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people from dying.
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Yes, narcan. I remember about ten years ago. I mean
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you couldn't get an arcan without a prescription. I mean,
456
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and it was hard to you know, find it, and
457
00:28:57.720 --> 00:29:01.440
we had harm reduction is trying to give it to
458
00:29:01.440 --> 00:29:04.640
people here and there or whatever. But you know, nowadays
459
00:29:04.640 --> 00:29:06.680
you go to the fair Ducky State Fair and they're
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00:29:06.680 --> 00:29:09.119
given it to you over the counter, handing out to
461
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you at the fair. And it's a good idea. I mean,
462
00:29:11.319 --> 00:29:14.119
you want to have narcan available everywhere, you know, so
463
00:29:14.359 --> 00:29:16.759
if you come across somebody you think it's an I
464
00:29:16.759 --> 00:29:21.079
think it's a possibly, you know, an overdose. I mean,
465
00:29:21.119 --> 00:29:23.640
it's almost not going to hurt somebody. I'm again, there's
466
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no absolutes here, but narkan is essentially a very safe
467
00:29:28.000 --> 00:29:30.440
drug to give somebody, and if it's due to an
468
00:29:30.440 --> 00:29:34.599
opioid the overdose, it'll get them breathing again. Usually Now,
469
00:29:34.640 --> 00:29:38.400
sometimes the fentanyl is so potent that you've got to
470
00:29:38.400 --> 00:29:42.119
redose the narkan, and also so potent that it won't
471
00:29:42.200 --> 00:29:45.839
last long enough, so you don't cure somebody's overdose with narcan.
472
00:29:46.400 --> 00:29:49.839
You may get them breathing again, but you got to
473
00:29:49.839 --> 00:29:52.279
be careful because they might stop breathing again, so you
474
00:29:52.319 --> 00:29:54.119
always call it nine one one. You always do the
475
00:29:54.440 --> 00:29:58.920
emergency efforts there as well. There's also other adulterants, other
476
00:29:59.000 --> 00:30:01.279
drugs in the rug supply now. There's things like a
477
00:30:01.319 --> 00:30:05.319
drug called xylazine, which is like a horse tranquilizer. These
478
00:30:05.359 --> 00:30:07.839
illicit marketers, these people that make this are always looking
479
00:30:07.839 --> 00:30:10.160
for things to put in the drug supply that they
480
00:30:10.279 --> 00:30:14.839
either make it cheaper or more potent, and so xylazine
481
00:30:15.279 --> 00:30:18.799
is a sedative that is not reversed by narcan. So
482
00:30:19.240 --> 00:30:22.119
I might get your breathing again, but you're still passed out.
483
00:30:22.599 --> 00:30:26.640
And so it's really a more complicated overdose crisis now
484
00:30:26.920 --> 00:30:29.640
than we've had in the past because of the adulterants
485
00:30:29.680 --> 00:30:32.240
in there. But that's kind of where we are. And
486
00:30:32.279 --> 00:30:37.240
I think that the fentanyl honestly has been noted to
487
00:30:37.279 --> 00:30:41.319
be less potent in the drug supply now, So I
488
00:30:41.359 --> 00:30:44.440
think that maybe the people that supply this to our
489
00:30:44.720 --> 00:30:47.440
neighborhoods and the drug dealers and the people that make this,
490
00:30:47.920 --> 00:30:50.720
they've decided that they want to quit killing off all
491
00:30:50.759 --> 00:30:53.799
of their customers in a sense, so they've made the
492
00:30:53.880 --> 00:30:58.400
fentanyl less potent, but still, you know, potent enough to
493
00:30:58.400 --> 00:31:02.039
where it can kill you in one dose. But you know,
494
00:31:02.119 --> 00:31:04.000
I think that's part of the reason. And I think
495
00:31:04.039 --> 00:31:07.000
there is more We are making progress in terms of
496
00:31:07.119 --> 00:31:10.440
access to care. There are more clinics, more people that
497
00:31:10.480 --> 00:31:13.000
are being open to this. Part of the reason why
498
00:31:13.000 --> 00:31:15.559
I'm on here today with this you know, this program
499
00:31:15.640 --> 00:31:18.839
is that I'm just trying to hopefully people like myself,
500
00:31:19.960 --> 00:31:24.039
in my you know, the professional groups that I work with,
501
00:31:24.880 --> 00:31:28.319
we want to reduce the stigma of this and if
502
00:31:28.319 --> 00:31:31.440
we can make the treatment of over the opioid use
503
00:31:31.440 --> 00:31:35.880
disorder similar to how we treat other medical illnesses, reverse
504
00:31:35.960 --> 00:31:38.359
the stigma understand that this is something that nobody wants
505
00:31:38.359 --> 00:31:41.440
to be an addict Nobody wants to be addicted to
506
00:31:41.480 --> 00:31:44.319
these things, but they want treatment, they want care for
507
00:31:44.400 --> 00:31:48.200
this disease. If we approach our patients like we would
508
00:31:48.400 --> 00:31:51.960
approach any other disease, I think that we would really
509
00:31:52.079 --> 00:31:55.680
make the progress we need. Currently, there's a lot of
510
00:31:55.720 --> 00:31:58.480
stigma behind it. There's a lot of misunderstanding about what
511
00:31:58.519 --> 00:32:03.240
this medicine really does. And that's again, that's a that's educational,
512
00:32:03.319 --> 00:32:05.680
and this program is an example of how we get
513
00:32:05.720 --> 00:32:06.720
over that barrier.
514
00:32:07.680 --> 00:32:11.279
Let me ask a question about the people who have
515
00:32:11.599 --> 00:32:18.079
opioid use disorders and other uh they have psychiatric illnesses.
516
00:32:19.519 --> 00:32:25.079
Should a primary care physician be uh treating someone with
517
00:32:25.119 --> 00:32:28.880
the opioid use disorder? And then if they have a
518
00:32:28.920 --> 00:32:33.799
patient who has severe depression or uh uh, let's say
519
00:32:33.799 --> 00:32:38.279
they are schizophrenic or pop polar, should they be Should
520
00:32:38.319 --> 00:32:44.640
they add other medicine psyche antidepressants and drugs for schizophrenia
521
00:32:44.640 --> 00:32:48.680
and bipolar Should they do that? Or should a psychiatrist
522
00:32:48.759 --> 00:32:50.519
or a specialty clinic do that?
523
00:32:51.279 --> 00:32:53.359
You know, I think that depends upon the comfort level
524
00:32:53.839 --> 00:32:58.960
of the provider. Some some you know, internal medicine, primary
525
00:32:59.000 --> 00:33:04.039
care providers, pain specialisty. Even so, they understand and they
526
00:33:04.039 --> 00:33:08.279
feel more comfortable treating those conditions, but we call those
527
00:33:08.440 --> 00:33:11.400
co occurring conditions. You know, for example, a lot of
528
00:33:11.400 --> 00:33:16.720
people that have lung problems COPD, they also have heart problems.
529
00:33:16.759 --> 00:33:19.720
You know, the lung bone is connected to the heartbone.
530
00:33:19.759 --> 00:33:23.480
You know, they're two different conditions. And you know, I
531
00:33:23.519 --> 00:33:27.400
might feel comfortable treating the pulmonary the lung problem, but
532
00:33:28.000 --> 00:33:29.720
as a primary care doctor, I might say, well, I
533
00:33:29.799 --> 00:33:31.920
need I need a cardiologist to help me with the
534
00:33:32.559 --> 00:33:35.440
with the heart issue here so that you get the
535
00:33:35.640 --> 00:33:41.319
best care possible. So we like for our primary care
536
00:33:41.400 --> 00:33:45.400
physicians and nurse practitioners and providers to feel like they
537
00:33:45.440 --> 00:33:49.640
can work within the level of their comfort zone and
538
00:33:50.119 --> 00:33:53.160
they can decide if they feel like they can treat
539
00:33:53.160 --> 00:33:54.640
it there in the clinic or if it needs a
540
00:33:55.160 --> 00:33:58.759
it needs a referral someplace else. It shouldn't be something
541
00:33:58.759 --> 00:34:02.279
that's mandatory or worse to by law or whatever, because
542
00:34:02.279 --> 00:34:04.839
a lot of this is I mean, honestly, everyone's different,
543
00:34:05.240 --> 00:34:08.480
and you should be able to have a conversation or
544
00:34:08.519 --> 00:34:11.599
a relationship with your with your doctor or your nurse
545
00:34:11.639 --> 00:34:14.480
practitioner or somebody, and then you come up with a
546
00:34:14.519 --> 00:34:18.159
plan that works for you, not everybody is going to
547
00:34:18.320 --> 00:34:20.559
want or even be able to go to counseling or
548
00:34:20.599 --> 00:34:24.280
go to a psychiatrist. So you know, if it's available
549
00:34:24.280 --> 00:34:26.840
to me, great, if I can get you in there,
550
00:34:26.920 --> 00:34:29.119
But what if your interns doesn't cover it, well, if
551
00:34:29.119 --> 00:34:32.400
you don't have transportation, what if you're actually living under
552
00:34:32.400 --> 00:34:35.159
a ydoct you know down in the you know, Shawnee
553
00:34:35.159 --> 00:34:38.159
Park down by there. You know, that's that's where your
554
00:34:38.199 --> 00:34:41.000
life is right now. You have to meet people where
555
00:34:41.000 --> 00:34:45.719
they are and treat the most important, most life threatening
556
00:34:45.760 --> 00:34:49.440
issues first, and then once you get that stabilized, move
557
00:34:49.480 --> 00:34:52.800
on to other things. But the scenario that you mentioned
558
00:34:52.800 --> 00:34:56.559
here with somebody has a severe psychiatric illness along with
559
00:34:56.599 --> 00:35:00.079
the opial use disorder, you're probably not going to be
560
00:35:00.119 --> 00:35:03.480
successful in either one unless you are treating both.
561
00:35:04.440 --> 00:35:05.519
Paul's got a question.
562
00:35:05.880 --> 00:35:08.280
Yeah, well, you know, we had to cancel this program
563
00:35:08.320 --> 00:35:13.119
a week ago for unforeseen reasons. But I wouldn't have
564
00:35:13.159 --> 00:35:16.800
this story to tell if that hadn't happened. So this
565
00:35:16.920 --> 00:35:20.480
past Saturday, I visited a young fellow that I know
566
00:35:21.320 --> 00:35:24.840
who's incarcerated, and I believe I contacted you about this
567
00:35:25.000 --> 00:35:28.119
about this fellow because it was announced to him that
568
00:35:28.320 --> 00:35:33.440
the facility that he's at is going to have a
569
00:35:33.480 --> 00:35:40.400
suboxone program running. And I told him that, you know
570
00:35:40.480 --> 00:35:43.239
that I knew you, and I've heard your your story
571
00:35:43.440 --> 00:35:45.920
a couple of times, and I think it would be
572
00:35:46.000 --> 00:35:49.760
great for him to do that if it's available to him. Well,
573
00:35:49.840 --> 00:35:53.079
when I visited him, he is now on that program.
574
00:35:53.360 --> 00:35:55.480
First of all, I maybe you can give me some
575
00:35:55.519 --> 00:36:02.119
background on why there is a program at these But secondly,
576
00:36:02.239 --> 00:36:04.440
he told me he's been on it a week now
577
00:36:05.239 --> 00:36:09.840
and he feels completely different, which warmed my heart. And
578
00:36:11.000 --> 00:36:12.760
so that's why I think it was a good idea
579
00:36:12.800 --> 00:36:15.239
that maybe we did have to cancel the program last week.
580
00:36:15.480 --> 00:36:17.360
So I'd like to just hear your thoughts on that.
581
00:36:19.199 --> 00:36:21.920
First of all, I'm really happy that he's getting better,
582
00:36:22.159 --> 00:36:24.960
and that points out that he's getting the proper medical
583
00:36:25.000 --> 00:36:29.199
treatment for his medical condition. And you know, people that
584
00:36:29.280 --> 00:36:31.360
are in the throes of addiction or if they're in
585
00:36:31.599 --> 00:36:35.679
you know, withdrawal from stuff they've been using, their brain's
586
00:36:35.719 --> 00:36:40.360
on fire. Their brain's on fire, and you can't think
587
00:36:40.440 --> 00:36:43.159
properly or even you know, you feel decent at all.
588
00:36:43.199 --> 00:36:47.440
You feel horrible. But that medication is like putting water
589
00:36:47.639 --> 00:36:50.480
throwing water on the fire. It calms it down. It
590
00:36:50.480 --> 00:36:53.199
doesn't cure you right away, but it's treating the cause
591
00:36:53.599 --> 00:36:57.199
of how you feel that way. And I don't want
592
00:36:57.239 --> 00:36:59.360
to say it's a magic pill, but I've had paces
593
00:36:59.360 --> 00:37:01.960
before that I almost tell them like, Okay, you're ready
594
00:37:01.960 --> 00:37:03.639
for this. This is going to be like a magic trick.
595
00:37:04.000 --> 00:37:06.840
You're going to immediately feel better. And if you do it,
596
00:37:07.400 --> 00:37:09.679
if you certain ways you do it. And there's various
597
00:37:09.719 --> 00:37:14.079
ways of initiating sybox own or this medication, puper and orphine,
598
00:37:14.159 --> 00:37:16.840
but if you do it properly in the context of
599
00:37:17.280 --> 00:37:19.920
what you know about that patient, usually you can get
600
00:37:19.920 --> 00:37:23.119
a really good response right away. And I think that's
601
00:37:23.159 --> 00:37:26.480
important because that gets the patient then has confidence and
602
00:37:26.480 --> 00:37:28.440
they go, oh, there is hope for me. Oh I
603
00:37:28.480 --> 00:37:32.719
feel normal again or the first time in forever. The
604
00:37:32.840 --> 00:37:37.719
reason why the jails are having it now, part of
605
00:37:37.760 --> 00:37:40.599
the reason is because there was a lawsuit by the
606
00:37:40.599 --> 00:37:45.039
federal government and the issue was that OPIOI use disorder
607
00:37:45.199 --> 00:37:49.079
is considered a medical illness. It's a disability protected by
608
00:37:49.079 --> 00:37:53.519
the Americans with Disabilities Act. And so if somebody goes
609
00:37:53.559 --> 00:37:56.000
into a jail or a prison and they have a
610
00:37:56.119 --> 00:37:59.760
medical condition, then they have to be treated for that condition.
611
00:38:00.280 --> 00:38:04.039
That's the law. So a lot of jails then are
612
00:38:04.960 --> 00:38:07.320
bringing these programs in, not all of them, and it's
613
00:38:07.320 --> 00:38:09.239
still a lot of stigma. There's still a lot of
614
00:38:09.239 --> 00:38:12.159
issues with this, still a lot of understanding. But is
615
00:38:12.400 --> 00:38:18.159
that is that's humane, that's proper, and that actually decreases
616
00:38:18.639 --> 00:38:24.519
their recidivism, It decreases the crime when the person is released.
617
00:38:24.519 --> 00:38:26.639
If they can stay on this and have continuity of
618
00:38:26.679 --> 00:38:31.280
care that the relapses are less, the crime is less,
619
00:38:31.760 --> 00:38:34.280
the all of the benefits you would see to society,
620
00:38:34.360 --> 00:38:37.719
so there's a really great return on that investment from
621
00:38:37.760 --> 00:38:41.599
a society standpoint. The problem is that people get out
622
00:38:41.639 --> 00:38:44.880
of prison where they're actually now getting some treatment, and
623
00:38:44.920 --> 00:38:49.239
they can't find somebody in their community to continue it.
624
00:38:49.559 --> 00:38:51.880
So they have to go, you know, one hundred miles
625
00:38:52.039 --> 00:38:54.159
to find a clinic that will give them this medicine
626
00:38:54.159 --> 00:38:56.320
which they were getting while they were in prison, and
627
00:38:56.360 --> 00:38:58.960
eventually maybe they can't make it or they miss an appointment,
628
00:38:59.000 --> 00:39:01.079
and then they get they get least from the clinic
629
00:39:01.800 --> 00:39:04.880
and now they're back where they were. That's why it's
630
00:39:04.960 --> 00:39:09.679
so important that we have access to this medication. This
631
00:39:09.840 --> 00:39:14.320
treatment legally in all of our communities in Kentucky.
632
00:39:14.559 --> 00:39:19.599
Pat give us an example of how access to this
633
00:39:19.760 --> 00:39:25.880
treatment as influenced by their coverage with either Medicare, Medicaid
634
00:39:26.920 --> 00:39:33.119
or private health insurance. Does that affect the degree of
635
00:39:33.199 --> 00:39:36.519
access to care? Or is it not an issue?
636
00:39:37.119 --> 00:39:40.320
It's a major issue. It's gotten better over the years.
637
00:39:40.559 --> 00:39:44.159
There's a thing called prior authorization that most people understand.
638
00:39:44.599 --> 00:39:47.519
It's really annoying because if a doctor or prescriber wants
639
00:39:47.519 --> 00:39:50.199
you to have something, the insurance company is going to say, wait,
640
00:39:50.639 --> 00:39:53.599
we want to be authorized before we pay for it.
641
00:39:53.840 --> 00:39:56.239
And so the doctor or the prescriber or the nurse
642
00:39:56.280 --> 00:39:59.679
practitioner they have to send in all of this information
643
00:40:00.159 --> 00:40:04.199
and hope that the insurance reviewers who've never seen you ever,
644
00:40:05.199 --> 00:40:07.639
hopefully they will allow you to have this what is
645
00:40:07.920 --> 00:40:11.239
actually life saving medicine. And it could take days to
646
00:40:11.280 --> 00:40:13.599
get that back. Well, what's going to happen in those
647
00:40:13.719 --> 00:40:16.679
days you're waiting to get the medicine. Certainly if you
648
00:40:16.719 --> 00:40:21.559
had chest pain, they wouldn't, you know, with withhold nitroglycerin
649
00:40:21.639 --> 00:40:23.760
from you, hopefully to treat the chess pain. But if
650
00:40:23.760 --> 00:40:27.039
you have addiction and I'm ready for treatment, and I'm
651
00:40:28.199 --> 00:40:31.280
I'm finally decided, I'm ready to try this, and now
652
00:40:31.280 --> 00:40:33.800
I've got to wait three days or a week or longer.
653
00:40:34.559 --> 00:40:37.599
I'm probably going to go to the street and you know,
654
00:40:38.159 --> 00:40:40.199
use again. That's what happens a lot of times. So
655
00:40:40.519 --> 00:40:43.800
the prior authorizations is an issue. It's still there. Also,
656
00:40:43.880 --> 00:40:46.280
there's limits on the amount of medicine that we're able
657
00:40:46.320 --> 00:40:49.800
to give people and the dosage. As I told you earlier,
658
00:40:50.280 --> 00:40:53.079
fentanyl's out there now. Fentanyl is so potent that you
659
00:40:53.159 --> 00:40:56.679
might need a higher dose of the buper and orphine.
660
00:40:57.000 --> 00:41:00.320
Then your insurance company is going to allow because I
661
00:41:00.400 --> 00:41:03.679
don't know, because of whatever reason they have, and you
662
00:41:03.760 --> 00:41:08.000
have to work around that. Also, the formulation they may not.
663
00:41:08.280 --> 00:41:11.320
You might be a perfect candidate for the injectible version
664
00:41:12.360 --> 00:41:15.440
that lasts a week or a month, and then the
665
00:41:15.480 --> 00:41:17.800
interance doesn't cover that, but they'll give you the pill
666
00:41:17.920 --> 00:41:20.519
or the sometimes it comes in a film under your tongue,
667
00:41:21.719 --> 00:41:24.679
but they might only give you certain formulations of it.
668
00:41:24.760 --> 00:41:27.800
I may want a patient to be on twelve milligrams
669
00:41:27.840 --> 00:41:32.199
of the medicine, well Medicaid doesn't cover a twelve miligrand
670
00:41:32.239 --> 00:41:34.159
so I got to give them an eight and a four.
671
00:41:34.639 --> 00:41:38.920
Now it's two prescriptions. It's just issues that are really
672
00:41:39.280 --> 00:41:43.480
burdensome in terms of allowing prescribers to give patients what
673
00:41:43.519 --> 00:41:47.199
they actually need. And by the way, that titration phase
674
00:41:47.320 --> 00:41:50.519
early on is crucial. I have to be able to
675
00:41:51.000 --> 00:41:54.519
adjust the dosages to your nees. I might start you
676
00:41:54.559 --> 00:41:56.320
on a lower dose, but immediately want you on a
677
00:41:56.400 --> 00:41:59.199
higher dose depending on how you're doing. But like any
678
00:41:59.239 --> 00:42:02.000
other critical care medicine, we have to be able to
679
00:42:02.039 --> 00:42:05.559
adjust the dots. I'm an antithesiologist, whether you know it
680
00:42:05.679 --> 00:42:09.239
or not. When you're having surgery and I'm, you know,
681
00:42:09.280 --> 00:42:11.960
fixing your blood pressure or helping you out under surgery,
682
00:42:12.400 --> 00:42:14.920
I give you a medication and then I immediately look
683
00:42:14.920 --> 00:42:16.639
at the vital signs. I look at what's going on,
684
00:42:16.920 --> 00:42:21.400
and I can adjust what's happening depending upon what happened
685
00:42:21.440 --> 00:42:23.800
with the medication. And that's kind of what we have
686
00:42:23.880 --> 00:42:26.239
to do in addiction. We have to be able to
687
00:42:26.280 --> 00:42:28.559
give the medication and be able to adjust it. But
688
00:42:28.719 --> 00:42:32.440
these these regulations that we have in Kentucky, these insurance regulations,
689
00:42:32.440 --> 00:42:37.199
these pharmacy regulations that we have, really make it challenging
690
00:42:37.480 --> 00:42:39.639
for doctors to do that with their paces.
691
00:42:39.840 --> 00:42:43.960
Well, these insurance companies are not in business to provide healthcare.
692
00:42:44.000 --> 00:42:47.559
They're in business to make money, and healthcare is just
693
00:42:47.679 --> 00:42:52.480
the vehicle for them to make their money. Uh, let
694
00:42:52.480 --> 00:42:54.079
me ask you go ahead.
695
00:42:55.039 --> 00:43:00.559
Medicaid, that issue is coming up the end of the year.
696
00:43:00.800 --> 00:43:04.360
You know the great beautiful bill. They designed it to
697
00:43:04.639 --> 00:43:11.000
cut back medicate the first of January twenty twenty seven,
698
00:43:12.760 --> 00:43:16.320
and it's gonna be a dramatic cut for Kentucky. There's
699
00:43:16.360 --> 00:43:20.159
more money coming in from medicate than a whole budget
700
00:43:20.239 --> 00:43:23.400
of the state of Kentucky. How is that going to
701
00:43:23.480 --> 00:43:27.480
affect a treatment of people who are addicted to drugs
702
00:43:27.480 --> 00:43:31.760
and their access to care, and particularly with subox on.
703
00:43:32.400 --> 00:43:37.800
Well, from one perspective, Kentucky has a high number of
704
00:43:37.960 --> 00:43:41.880
beds in these in these facilities that when there was
705
00:43:41.920 --> 00:43:45.199
a lot of money available Medicaid and government money to
706
00:43:46.199 --> 00:43:49.320
treat addiction in Kentucky, a lot of it was devoted
707
00:43:49.360 --> 00:43:54.880
to these facilities that are maybe impatient or residential or whatever,
708
00:43:54.920 --> 00:43:57.199
and they have these beds. You would go there for
709
00:43:57.280 --> 00:43:59.800
two weeks or whatever till the money ran out, I guess,
710
00:44:00.079 --> 00:44:02.760
and then you would be let go back into the
711
00:44:02.760 --> 00:44:06.119
community without the continuity of care. What's going to happen
712
00:44:06.159 --> 00:44:10.519
now is that the Medicaid funding will be cut for
713
00:44:10.840 --> 00:44:13.719
a lot of these centers, so they will go out,
714
00:44:13.760 --> 00:44:16.000
they will go out of business. So now we're not
715
00:44:16.039 --> 00:44:18.719
gonna have the beds or the ability to pay for
716
00:44:18.840 --> 00:44:22.880
these centers that otherwise were open in communities and out
717
00:44:22.880 --> 00:44:27.360
in rural areas. So we have to have our primary
718
00:44:27.400 --> 00:44:30.280
care doctors to pick up the slack. And that's why
719
00:44:30.280 --> 00:44:33.440
we really want them to feel comfortable doing that, because
720
00:44:33.639 --> 00:44:36.079
you should be you should not have to go to
721
00:44:36.360 --> 00:44:39.199
a residential center every time you have an issue with
722
00:44:39.239 --> 00:44:42.079
an opioid problem. You should be able to go to
723
00:44:42.280 --> 00:44:45.400
your primary care doctor and get some treatment there. And
724
00:44:46.360 --> 00:44:48.239
as far as I know, you're still going to be
725
00:44:48.280 --> 00:44:51.760
covered for ed your primary care doctors. That's gonna be okay.
726
00:44:51.800 --> 00:44:54.639
And medicaids not. I don't think they're going to stop
727
00:44:54.719 --> 00:44:58.760
covering puper and orphine in certain you know, formulations. So
728
00:44:58.920 --> 00:45:02.599
there's gonna be treatment available, it's gonna shift. It's going
729
00:45:02.679 --> 00:45:05.800
to need to shift from these centers that we're inpatient
730
00:45:05.880 --> 00:45:11.400
to the primary care And again another analogy here, everyone
731
00:45:11.480 --> 00:45:14.119
with a cough and a fever doesn't need to go
732
00:45:14.159 --> 00:45:17.800
to the ICU for treatment. They usually go to their
733
00:45:17.840 --> 00:45:21.039
primary care doc and they get assessed and they treat
734
00:45:21.079 --> 00:45:23.400
them based upon what they need at the time. So
735
00:45:23.440 --> 00:45:26.880
they might give you a penicillin shot and some cough
736
00:45:26.960 --> 00:45:29.360
medicine and check back with you. They don't admit you
737
00:45:29.400 --> 00:45:33.239
to the ICU. It's very expensive, unnecessary. So that's the
738
00:45:33.280 --> 00:45:37.800
way with addiction. Most addiction can be treated initially at
739
00:45:37.840 --> 00:45:40.920
the primary care level, and that's why we need to
740
00:45:41.000 --> 00:45:45.880
lower those barriers. Have enough funding so and regulatory barriers
741
00:45:45.920 --> 00:45:50.719
removed so our primary care force can feel comfortable and
742
00:45:50.880 --> 00:45:53.559
motivated to treat this medical disease.
743
00:45:53.840 --> 00:45:59.239
Now, whether primary care physician or addiction specialists decide which
744
00:45:59.360 --> 00:46:03.840
patient needs syum injection, which costs a lot more versus
745
00:46:03.960 --> 00:46:08.440
a po injection, I mean medicine, well.
746
00:46:08.280 --> 00:46:11.159
A lot of it's based upon where you are in
747
00:46:11.280 --> 00:46:15.079
terms of your recovery. If if generally speaking, you have
748
00:46:15.119 --> 00:46:18.400
to demonstrate that you are doing well or you can
749
00:46:18.519 --> 00:46:22.360
take the sybox owned the uperen orphine orally or of
750
00:46:22.400 --> 00:46:25.920
that nature, and if you're doing okay that in that
751
00:46:25.960 --> 00:46:29.320
way and say say you're somebody who just can't go
752
00:46:29.440 --> 00:46:31.840
to the pharmacy, you live in an area where you
753
00:46:31.880 --> 00:46:34.719
can't get there once a week to get your medicines refilled.
754
00:46:34.960 --> 00:46:38.360
You or you know you are also maybe you're working
755
00:46:38.400 --> 00:46:40.760
somewhere you can't take off work to go to all
756
00:46:40.760 --> 00:46:43.519
these visits and go to the pharmacy and get these
757
00:46:43.559 --> 00:46:46.960
pills over and over again. Maybe somebody just doesn't do
758
00:46:47.079 --> 00:46:52.559
well taking pills, but it's based on the individual characteristics.
759
00:46:53.079 --> 00:46:55.599
You might be somebody that will do really, really well
760
00:46:55.840 --> 00:46:58.840
with a once a week or once a month injectable.
761
00:46:59.320 --> 00:47:02.679
So if we find somebody that we determine that that's
762
00:47:02.679 --> 00:47:04.760
a good option for you, we should be able to
763
00:47:05.239 --> 00:47:10.440
offer that to somebody. And right now it's almost I mean,
764
00:47:10.480 --> 00:47:13.639
it's very, very difficult to get an insurance company to
765
00:47:13.679 --> 00:47:17.559
approve those injectibles. Part of the reason because they're not
766
00:47:17.599 --> 00:47:21.119
generic at this point. They're all out there there to
767
00:47:21.159 --> 00:47:25.519
my knowledge, they're all branded trade name that may change
768
00:47:25.519 --> 00:47:28.280
in a few years. But they're kind of expensive. But
769
00:47:29.440 --> 00:47:33.119
it's also very expensive to have somebody relapse. It's also
770
00:47:33.400 --> 00:47:37.639
very expensive to our community, to our society to have
771
00:47:37.719 --> 00:47:41.280
somebody in the throes of addiction, somebody who's functioning well,
772
00:47:41.599 --> 00:47:43.559
who's able to go about their life, take care of
773
00:47:43.599 --> 00:47:46.119
their family, go to work, not feel like they have
774
00:47:46.199 --> 00:47:49.119
to steal things or commit crimes to support their addiction.
775
00:47:49.760 --> 00:47:53.320
Not have the medical illnesses deliver damage, all those things,
776
00:47:53.320 --> 00:47:56.519
the infections they go along with with opial use disorder.
777
00:47:57.159 --> 00:48:00.559
If you can have somebody that's getting well, the return
778
00:48:00.599 --> 00:48:03.679
on that investment is so great and just we need
779
00:48:03.679 --> 00:48:05.880
to understand that and allow that to happen.
780
00:48:06.480 --> 00:48:12.079
Are our nurse practitioners and physician assistants are able to
781
00:48:12.159 --> 00:48:18.039
give these medications or are they prevented from it? You
782
00:48:18.039 --> 00:48:20.800
know in Kentucky and in other states.
783
00:48:21.119 --> 00:48:23.960
Well, technically they're able to do it. There are. The
784
00:48:24.039 --> 00:48:29.480
regulations in Kentucky are very very strict in there. We
785
00:48:29.599 --> 00:48:32.480
call them onerous. They're they're way overkilled in terms of
786
00:48:32.480 --> 00:48:36.880
what they require the doctors and our spectitioners, the physicians
787
00:48:36.960 --> 00:48:40.719
assistants to do. There's and Kentucky's an outlier. The rest
788
00:48:40.760 --> 00:48:42.400
of the country for the most part, has done away
789
00:48:42.400 --> 00:48:46.480
with these regulations. But ten years ago Kentucky created a
790
00:48:46.559 --> 00:48:49.960
regulation for up and orphine that is very similar to
791
00:48:50.280 --> 00:48:54.960
methodone regulations, and frankly, that's absurd because it is not
792
00:48:55.039 --> 00:48:58.719
the same Medicine's methodone. It's so much safer. The DEEA
793
00:48:58.880 --> 00:49:01.599
the federal government allowed to be prescribed out of out
794
00:49:01.639 --> 00:49:05.320
of clinics, your your family, your family practice clinic. But
795
00:49:05.519 --> 00:49:11.199
Kentucky's regulations restricted in some respects harsher than methadone. It
796
00:49:11.320 --> 00:49:15.719
just doesn't make any sense from a public health standpoint.
797
00:49:16.079 --> 00:49:17.920
But I think there's a lot of fear in terms
798
00:49:17.920 --> 00:49:22.000
of like, we don't want to lessen any regulation on
799
00:49:22.119 --> 00:49:26.559
any opioid. Well, it's it's a case of mistaken identity.
800
00:49:27.639 --> 00:49:33.079
Ten years ago, they viewed bupern orphine as just another opioid,
801
00:49:33.159 --> 00:49:36.320
and they rounded it up with oxycon and everything else,
802
00:49:36.400 --> 00:49:39.400
and they say we're gonna we're gonna restrict this, and
803
00:49:39.440 --> 00:49:43.079
they overly restricted the sebox zone and the bupern orphine.
804
00:49:43.960 --> 00:49:47.119
It's it's ten years now, it's time to let that
805
00:49:47.199 --> 00:49:51.400
restriction be much less. It doesn't mean that we're going
806
00:49:51.480 --> 00:49:55.440
to let anybody prescribe buper and organ without any any guardrails.
807
00:49:55.480 --> 00:49:59.119
We have regulations that cover all of the controlled substances,
808
00:50:00.119 --> 00:50:03.400
saying it would be nice if we could prescribe pubert
809
00:50:03.519 --> 00:50:08.199
orphine at least as easily as we can prescribe OxyContin.
810
00:50:08.400 --> 00:50:10.440
I mean, come on, that makes that makes sense.
811
00:50:11.039 --> 00:50:15.519
I know personally some doctors who refuse to do that
812
00:50:15.679 --> 00:50:19.079
because of all the regulations. And I know some doctors
813
00:50:19.079 --> 00:50:25.840
who've gotten into trouble with the box on and it's
814
00:50:26.519 --> 00:50:31.199
hurt them personally and hurt the community personally because of
815
00:50:31.679 --> 00:50:32.719
the overregulation.
816
00:50:33.920 --> 00:50:35.599
Right, I think there are something you know, there's obviously
817
00:50:36.119 --> 00:50:38.679
been some doctors and some prescribers that have done poorly
818
00:50:38.679 --> 00:50:43.440
and done it wrongly, and by doing that, they I mean,
819
00:50:43.559 --> 00:50:45.800
they make it back for everybody else. But by and large,
820
00:50:46.440 --> 00:50:51.079
most physicians, most nurse practitioners, most pas, they're doing it
821
00:50:51.119 --> 00:50:53.719
for the right reasons. They're trying to help people, and
822
00:50:53.960 --> 00:50:56.800
they should not be penalized just because there are a
823
00:50:56.840 --> 00:51:01.320
few bad apples out there. And the doctors I know
824
00:51:01.719 --> 00:51:04.199
of other doctors that have tried to do it just
825
00:51:04.239 --> 00:51:06.480
the right way, exactly the way that they've been taught
826
00:51:06.480 --> 00:51:08.440
to do it, and have gotten in trouble with the
827
00:51:08.440 --> 00:51:12.400
medical board. That gets out in the community, and when
828
00:51:12.440 --> 00:51:14.960
we find out about that in the community, that makes
829
00:51:15.039 --> 00:51:17.440
everyone say, I'm not going to risk my medical license
830
00:51:17.960 --> 00:51:19.760
to prescribe this. I'm sorry, I'm just not going to
831
00:51:19.800 --> 00:51:23.559
do it. That is so sad and we can make
832
00:51:23.599 --> 00:51:25.599
a change on that. And there was a bill in
833
00:51:25.800 --> 00:51:28.719
Frankfurt last year that made it all the way to
834
00:51:28.760 --> 00:51:31.800
the last day, and it's going to come up again
835
00:51:32.559 --> 00:51:36.239
in twenty seventeen, twenty twenty seven. It's going to come
836
00:51:36.239 --> 00:51:38.920
out up again this next session. So we all need
837
00:51:38.920 --> 00:51:41.559
to get behind that and get that regulation for uber
838
00:51:41.679 --> 00:51:45.639
rphine lessons so that our primary care docs and the
839
00:51:45.639 --> 00:51:48.159
docks in Kentucky and the mercht practitioners and the pas
840
00:51:48.559 --> 00:51:52.559
can treat this epidemic in the most effective way possible.
841
00:51:52.880 --> 00:51:59.400
How much of an issue is a drug eusediction in
842
00:51:59.440 --> 00:52:04.239
the homeless population? And then the question next question is
843
00:52:05.840 --> 00:52:09.880
how do they get treated? You know, is there is
844
00:52:09.920 --> 00:52:13.679
there a way to get access to care for these
845
00:52:13.719 --> 00:52:17.039
homeless people who are living under bridges and sleeping in
846
00:52:17.199 --> 00:52:18.719
parks and places like that.
847
00:52:19.159 --> 00:52:21.800
Yeah, well, I think that a lot of the reason
848
00:52:21.840 --> 00:52:24.920
why people are there in that condition is because there
849
00:52:24.920 --> 00:52:27.960
are there's untreated illness and a lot of it is
850
00:52:28.039 --> 00:52:32.159
untreated psychiatric illness and untreated or poorly treated addiction for example.
851
00:52:32.599 --> 00:52:36.960
So if it's addiction, I you know, we need to
852
00:52:37.000 --> 00:52:41.039
take the treatment to them, and there are programs, there's
853
00:52:41.079 --> 00:52:43.960
there was a pilot program in this state in Louisville
854
00:52:44.119 --> 00:52:46.559
in fact, for a while. It's I think it's stopped now,
855
00:52:46.639 --> 00:52:49.400
but in other states where they have had even vans
856
00:52:49.719 --> 00:52:52.679
or you know, medical facilities that have gone to these
857
00:52:52.719 --> 00:52:56.119
areas and assessed people decide if they're a good candidate
858
00:52:56.159 --> 00:52:58.519
for it, if they're willing to try it, and start
859
00:52:58.519 --> 00:53:02.000
them on the sabbox owne right there or at that point.
860
00:53:02.480 --> 00:53:04.599
And if the if you again, if you can treat
861
00:53:04.639 --> 00:53:08.840
the illness that is causing the behavior, then the thinking
862
00:53:08.920 --> 00:53:12.480
becomes more rational and reasonable, and then they can make
863
00:53:12.559 --> 00:53:16.039
better health care decisions for themselves. So there's I think
864
00:53:16.079 --> 00:53:19.440
there's a dual issue here. A lot of psychiatric issues
865
00:53:19.480 --> 00:53:21.119
that need to be treated and then a lot of
866
00:53:21.119 --> 00:53:22.960
addiction and they so a lot of them go together.
867
00:53:23.440 --> 00:53:26.440
But if they're not going to come to a clinic,
868
00:53:26.440 --> 00:53:28.480
and they're not going to come down to Floyd Street
869
00:53:28.559 --> 00:53:30.599
and go to the U of L, for example, the
870
00:53:30.719 --> 00:53:34.159
Family of Medicine clinic, we have to go to them
871
00:53:34.639 --> 00:53:37.400
because there's a benefit to society for doing that. We're
872
00:53:37.440 --> 00:53:40.199
not just treating the individual, which is the compassionate and
873
00:53:40.320 --> 00:53:42.840
humane thing to do, and nothing wrong with treating the individual,
874
00:53:43.079 --> 00:53:46.639
but by doing that, we're actually helping solve the problem.
875
00:53:46.800 --> 00:53:51.800
We're helping solve the death, the disease, the homelessness problem,
876
00:53:52.039 --> 00:53:56.079
the houseless problem by going to them. And I really
877
00:53:56.079 --> 00:53:59.239
think that that's the benefit outweighs the risk and the
878
00:53:59.559 --> 00:54:03.039
return of that investment is great.
879
00:54:03.400 --> 00:54:06.519
Okay, this is a five minute warning, so we're getting
880
00:54:06.559 --> 00:54:09.400
close to the end of the program here, Gene, do
881
00:54:09.440 --> 00:54:11.480
you want to ask a question or two and then
882
00:54:11.599 --> 00:54:14.760
Paul pat We're going to give you an opportunity to
883
00:54:14.800 --> 00:54:17.880
make whatever final comments you might want to make, and
884
00:54:17.920 --> 00:54:19.519
then Paul is going to take us out.
885
00:54:20.559 --> 00:54:21.679
Yeah.
886
00:54:21.039 --> 00:54:26.519
I question bugged me for a long time. Is you
887
00:54:26.679 --> 00:54:30.559
remember back in the nineties, some joint commission I had
888
00:54:30.559 --> 00:54:34.280
this big deal that pain is a vital sign and
889
00:54:34.320 --> 00:54:39.840
that high emphasis on treating and pain. All the nurses
890
00:54:39.920 --> 00:54:42.480
had to That was one of the first questions they asked,
891
00:54:42.519 --> 00:54:46.960
how much pain are you having? Do you think that
892
00:54:46.960 --> 00:54:52.079
that effort, what's overtone and contributes it to some of
893
00:54:52.119 --> 00:54:53.840
our addiction problems that.
894
00:54:53.800 --> 00:54:58.000
We have today. Yes, definitely, I think that for one,
895
00:54:58.599 --> 00:55:01.400
pain is not a vital sign. Is subjective. Pain is
896
00:55:01.400 --> 00:55:07.119
an individual's person's level of misery or discomfort. So you know,
897
00:55:07.159 --> 00:55:09.440
putting a number on your pain is really not a
898
00:55:09.519 --> 00:55:12.239
vital sign like a blood pressure or whatever. But the
899
00:55:12.599 --> 00:55:14.960
idea that we do need to take pain seriously though,
900
00:55:15.079 --> 00:55:17.280
is very important. So I think you can you can
901
00:55:17.840 --> 00:55:21.679
have a movement where you're addressing pain. But when they
902
00:55:21.760 --> 00:55:24.760
called it a vital sign, I think that they opened
903
00:55:24.760 --> 00:55:28.480
it up to miss interpretation of what that number really means.
904
00:55:28.639 --> 00:55:31.079
And then it was also hijacked in a sense by
905
00:55:31.320 --> 00:55:33.559
some of the marketing companies and things of that nature.
906
00:55:33.599 --> 00:55:39.079
In fact, the Joint Commission would penalize hospitals if they
907
00:55:39.079 --> 00:55:42.360
didn't get those pain scores down and that so that
908
00:55:42.440 --> 00:55:45.840
contributed to overprescribing. So I think that was an initially
909
00:55:45.880 --> 00:55:49.480
an attempt to do the right thing, but again they
910
00:55:49.480 --> 00:55:53.840
were they kind of overdid it and it led to overprescribing.
911
00:55:54.159 --> 00:55:56.599
Pat do you want to make any last minute comments
912
00:55:56.599 --> 00:55:59.840
to our listeners before Paul winds this?
913
00:56:00.760 --> 00:56:04.199
Well, the most important thing I think that people need
914
00:56:04.239 --> 00:56:07.320
to know is that this is addiction with opioids is
915
00:56:07.360 --> 00:56:10.800
a medical issue. It's a medical disease, and there is
916
00:56:10.920 --> 00:56:15.639
medicine that is proven to be very effective for this
917
00:56:15.760 --> 00:56:19.480
medical illness. We have to have people get access to
918
00:56:19.519 --> 00:56:22.000
this medicine. Otherwise we are not going to get on
919
00:56:22.079 --> 00:56:24.159
top of this epidemic like we really need to. It's
920
00:56:24.199 --> 00:56:27.960
never going to go away unless we get people access
921
00:56:28.000 --> 00:56:31.159
to the treatment that's available that's effective. We need to
922
00:56:31.159 --> 00:56:34.039
remove as many barriers as possible. There are insurance barriers,
923
00:56:34.280 --> 00:56:37.639
there are stigma barriers, there are other social barriers, and
924
00:56:37.679 --> 00:56:40.199
there's regulatory barriers. So if you want to know more
925
00:56:40.199 --> 00:56:43.360
about it, I would say go to a couple of
926
00:56:43.360 --> 00:56:47.920
websites that are good about Kentucky issues. The Kentucky Society
927
00:56:47.960 --> 00:56:51.079
of Addiction Medicine has a lot on this, so you
928
00:56:51.119 --> 00:56:55.800
can look that up. The group called dream dot org.
929
00:56:56.639 --> 00:56:59.800
They are very active in this, and I would recommend
930
00:56:59.840 --> 00:57:06.119
that organization also pr people advocating recovery. They have a
931
00:57:06.119 --> 00:57:08.280
lot of information on this too. But please learn more
932
00:57:08.320 --> 00:57:11.960
about it, Please ask questions about it, and then and
933
00:57:12.000 --> 00:57:15.119
then when the time comes to have this bill again
934
00:57:16.079 --> 00:57:21.719
about the regulation in twenty seventeen, please contact your your
935
00:57:21.840 --> 00:57:25.000
legislator and tell them that you support the bill to
936
00:57:25.480 --> 00:57:26.719
lessen these regulations.
937
00:57:27.079 --> 00:57:29.679
Pat, thank you again for coming on. This is really
938
00:57:29.719 --> 00:57:32.239
an excellent program, Paul Yep.
939
00:57:32.280 --> 00:57:34.920
Pat you might give a nod out to your website,
940
00:57:34.960 --> 00:57:36.840
which is a very good resource.
941
00:57:37.559 --> 00:57:40.480
Oh okay, well it's James P. Murphymd dot com, so
942
00:57:40.559 --> 00:57:44.719
that's a James James P. Murphymd dot com.
943
00:57:45.119 --> 00:57:47.840
I tuned in there quite often. You know, I kind
944
00:57:47.880 --> 00:57:50.800
of adopted your cause here when a few programs back,
945
00:57:50.840 --> 00:57:53.559
and I'm still behind you.
946
00:57:54.000 --> 00:57:57.639
Great work. Thank you, and thank you listeners for tuning
947
00:57:57.679 --> 00:57:59.119
in to today's program.
948
00:57:59.360 --> 00:58:01.960
Join us the next time for a single pair radio
949
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