Dr. Stephen Loyd joins Wellness Unmasked and breaks down the current state of the opioid crisis in America, with a particular focus on the deadly impact of fentanyl and the failures of the existing addiction treatment system. He explores how addiction intersects with the criminal justice system, arguing that punishment-based approaches have fallen short while life-saving treatment options remain underutilized.
Dr. Loyd emphasizes the urgent need for systemic reform in addiction treatment, calling for policies that prioritize measurable outcomes over bureaucratic metrics. He also highlights the critical role of community support, leadership accountability, and the widespread availability of overdose reversal drugs like Narcan in preventing unnecessary deaths.
Learn more about Dr. Stephen Loyd HERE
Follow Clay & Buck on YouTube: https://www.youtube.com/c/clayandbuck
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Welcome to Wellness Unmass. I'm doctor Nicole Saffire and we
have a really good guest joining us today. Today we
are talking about sensonyl, not about a political issue, but
as a public health emergency and what we need to
do about it. This synthetic opioid is now the leading
cause of death for Americans ages eighteen forty five, killing quietly, quickly,
(00:24):
and indiscriminately. Just a small dose the size of a
few grains of salt can be fatal. This isn't just
about addiction. It's about poisoned supply chains, failed policies, and
the urgent need for accountability, prevention, and real solutions. So
let's unmask the spental crisis and dive right in well
(00:44):
with the President's war on drugs. Right now, there is
nobody better to be joining us on Wellness Unmass than
doctor Stephn Lloyd, Internal medicine and addiction medicine physician, President
of the Tennessee Medical Board. And he has many more
titles which I'll leave to hand to tell you all about.
But Steven, thank you so much for joining us today.
Speaker 2 (01:03):
Thanks for having me Nicole.
Speaker 1 (01:05):
So I mean big news out of the White House obviously,
President Trump has had a war on drugs, but he's
now declaring fentanyl to be a weapon of mass destruction.
What's your thoughts on that.
Speaker 2 (01:16):
Well, you know, I'm not sure what all that entails,
but from an awareness standpoint thing, Nicole, I'm all for it.
You know, we know that we're losing about two hundred
and twenty Americans today to drug overdoses, and the large
percentage of those are fentanyl. And so you know, if
you look at two hundred and twenty people a day dying,
that's a seven thirty seven crashing and killing everybody on
board every day of the year. And so anytime that
(01:38):
you know, you can raise awareness about that, then I'm
all for it. I think it's the right move. I
don't know what some of the ramifications of that are.
From a military standpoint or a border control standpoint, that's
not my area of expertise, but I am certainly in
favor of because interdiction efforts do help us keeping daily
drugs out of the United States.
Speaker 1 (01:55):
Yeah, I mean, you know, you make an interesting point.
So as physicians, we think of drugs as a medical condition.
It's a physical health issue, but also a mental health issue.
From a physician's perspective, How do you actually feel about
it turning into kind of a criminal justice crisis.
Speaker 2 (02:13):
Well, you know, that's the part that always worries me,
Nicole r. You hang the weapon of mass destruction thing
on there, and then people who are addicted to it
get tied into that. And as you know, stigma is
the biggest thing we have to overcome when we're trying
to help people with any type of substance use disorder.
So I do get worried about that. At the same time,
our partnerships with law enforcement and criminal justice system are key.
We're not going to move the needle on the opioid
(02:35):
crisis in the United States until we address this in
our caarcial setting. I mean, it's just a fact. There's
so many, you know, so many people in there, and
so I think there's pluses and minuses to it, But overall,
I'm glad that he's done it. So it certainly puts
it on the radar, and if our president thinks it's
that important, it certainly raises the level of awareness in
the everyday Americans lives. Except for the people who aren't
(02:58):
going to like anything the President Trump does.
Speaker 1 (03:00):
Well, there are definitely a handful of them. Right, it
doesn't matter what he does. He could cure cancer and
they criticize him somehow, right. You know, President Trump obviously
has emphasized border security and targeting these cartels, and you know,
from a medical standpoint, you know, I think about it,
and the reality is disrupting supply is going to eventually
(03:22):
have to trickle down to a reduction in overdose deaths,
don't you think, yes.
Speaker 2 (03:27):
Ma'am, I mean, yes, Nicole. You know, it's one of
the things that kills me. You know, I hear this.
The war on drugs has been a failure, right, And
from a strictly drug using standpoint, I guess it has been,
But it hasn't been a failure across the board. I mean,
we have stopped a lot of dangerous drugs from entering
the United States. That's a good thing, right, If nothing else,
it drives up the price of what's here, and it
(03:47):
makes it harder for people to access, right. And so
I don't buy into those arguments. Our partnerships with law
enforcement criminal justice are key. They're absolutely key to us
coming out on the other side of this, And so
I don't buy those arguments that interdiction efforts don't matter,
because I think they do, and I think it does
trickle down. As a matter of fact, I think you're
seeing it right now. You know, look in the United
(04:09):
States right now. You know our drug overdose deaths are
going down. In state of West Virginia. They're down over
forty percent year over year, and I think interdiction efforts
have something to do with that. Now, is it one
hundred percent, No, But is it a portion of it? Absolutely?
Speaker 1 (04:23):
So, Now, what do you think the role like narcan
has played in that.
Speaker 2 (04:27):
I think it's been a big, huge role, right. I mean,
if I was in the decision making position to be
able to address this on a national scale, you know,
the first thing I would do is blanket the United
States with narcan or overdose reversal drugs. Because you and
I are physicians, right, and I don't know about you.
I mean, I think you're an anaesthesiologist or a radiologist
or mediologist. Right. You haven't figured out how to treat
(04:47):
dead people. Nicoleon neither, and so so we have to
keep people alive. And so the easiest thing to do
right off the bat is blanket the country with narkann.
But but you know, then you just have people coming
in and out of systems go right back. So you
do have to have that intervention where you actually direct
people towards treatment, and that would be you know, step
two of the process. But I think it's key. I
think overdose reversal drugs have played a big role in this.
Speaker 1 (05:11):
Yeah, but I mean the overdose reversal drugs are for
the FENNOYL and the drugs that are currently in the system.
President Trump's working to try and decrease that supply. But
I'm you know, I still look at our system and
you know, just to bring a little current events to
the conversation, I mean what happened just in California with
the Reiner family. You know, they have a son who
(05:34):
since his mid adolescence has been in and out of rehabs.
I think by the age of twenty two, he had
been in rehab like eighteen times for polysubstance abuse, and
now he's been arrested for murdering his parents. I mean,
at what point do you say if if one of
the most privileged children in our country, I mean, I
(05:57):
would say he's privileged, he obviously was born into a
house privilege. If one of the most privileged children in
this country has failed these multiple rounds of rehab. Like,
is it a system problem?
Speaker 2 (06:09):
Oh, NICOLEE is for sure a system problem. I mean,
it's why I'm on here with you. It is a
system problem. I mean, any other medical condition that we
put that we treated somebody for, you know, and we're unsuccessful.
We have a we have a second you know, we
have a second line treatment option, right, and a third
and a fourth line and a combination of things. Addiction
treatments basically not changed the United States in the last
(06:30):
one hundred years outside of some medications. But they don't
get people into recovery. They quell cravings. They're important for
keeping people alive. But Nicole, we got to change our
fundamental system. You know. I was always I was told
I don't know if you know about my past, but
but I'm recovering from opioid and benzo diazepine addiction for
twenty one years. As a young doctor, I got addicted,
(06:50):
and I stepped into a system of care for doctors
that is very good addressing those underlying drivers of addiction.
And I've got no idea what happened in the Rhiner family.
And I have no insight into it. However, from my
point of view, and I look at this and I see,
you know, young Nick's issues. I wonder, were you just
addressing the drug use or were you trying to get
at some of the underlying drivers that was pushing Nick
(07:12):
in that direction? And then a lot of times it's
untreated mental health issues. And so the system of care
that we have today is not meeting the standard. The
average person with addiction issues takes eight years to get
one year of sobriety, and in that time they go
to five different treatment programs. I mean, come on, the cole,
there's something wrong with that system.
Speaker 1 (07:31):
So what do you think it is?
Speaker 2 (07:33):
Well, I think it's if you're a hammer, everything's a nail. Right.
You know, you come in, you have this problem. This
is what we treat you. You're unsuccessful at it, you
go back out, You come back in, and we hit
you with the same thing that you came back in
with the first time. Right. I learned early on in
recovery that the definition of insanity is doing the same
thing over and over expecting a different result. That's what
we do in addiction treatment. We do it all the time,
(07:54):
and we do it every day. And then when people
are unsuccessful we kick them out. I mean, what if
we treat hard failure that way. You know, the day
after Christmas when Papal was loaded up on country ham
and salt, it gets fluid overload and fills these lungs up.
If we treated him like we do people with addiction,
we'd kick him out of the er.
Speaker 1 (08:11):
That's actually really interesting comparison. You're right, because all the
time we have either non adherence to medications, non compliance
with diets and recommendations, and yet we treat them just
the same. We just give them more diuretics, we up
their medications, and we just move on. But when it
comes to addiction medicine, they lose their privilege for certain things,
they get kicked out of rehabs. That's really interesting. So
(08:33):
that stigma is still there despite how much talk there
is about getting rid of stigma.
Speaker 2 (08:39):
It's the biggest roadblock we have. Nicole. People are always
asking me, Steve, if you know, if you had pixie
dust and you could wave it, you know, spread a
pixie dust, and you'd have one thing in this whole system,
what would you want? And the thing that I want
doesn't cost any money, right, it's just a change in attitude.
And you know, the attitude of which I was approached
back in two thousand and four when I found recovery.
(08:59):
You know, they didn't tell me it was okay. They
didn't tell me that, you know that, you know, what
I've done was great. They did tell me that there's
an avenue here for help, and if you choose to help,
if you choose to follow it, then then we're going
to be beside you the whole way. We're going to
support you, and we're going to help you in your
job as you were in your medicine and and so
you know, those are the type of things that really
helped me going forward. Most people don't have access to that.
(09:22):
Most people, when they come into the system, this is
your last chance. If you mess up, we're going to
kick you out. And it's this tough love approach. And
I'm not above tough love, but I can tell you,
for the most part, it doesn't work. And so we
absolutely have to change our system. And the thing that
we can do first of all is change our attitudes
about addiction and the stigma around it.
Speaker 1 (09:40):
You know, one thing, you know, to bring in a
little bit of health policy and I'm not sure how
familiar you are with it. The one thing that came out,
so the Affordable Care Act, I'm not I'm not going
to ask you your opinion on it. We don't need
to go there. But I have always been not a
huge fan of it. I think there were some good,
good impetus behind it, but the way I'm not a fan.
(10:01):
Let me put it that way, got it? You know,
I think there are significantly more consequences than benefits to it.
But one thing that did come out with the Affordable
Care Act was that addiction treatment was deemed one of
those essential health benefits, and they classified substance use disorder
treatment and mental health care. You know that insurance plans
must cover them detact, detox, impatient rehab, outpatient treatment, medication
(10:25):
assistant treatment. While we also we obviously saw improved in access,
the quality and the continuity didn't necessarily improve in itself. Like,
what do you make of that?
Speaker 2 (10:36):
Well, I think I think we have to work on
the things that you just talked about the quality and
the continuity, and are we using evidence based approaches to
treat addiction. I mean that's you know, from a system standpoint,
you have to do that. But I'm in your corner
with the Affordable Care Act, you know, and it was actually,
you know, I think it was well Stone Diminici Act
of what two thousand and eight or somewhere, the Parity Act.
They said insurance companies have to cover substance use like
(10:58):
they cover everything else. And there's ever been any teeth
in that, and it's really never happened. And so I
think that, you know, we have to We've got some
systems problems we got to look at from a coverage
standpoint here to give people access to care. You know,
if you break your leg, I mean there's certain things
you go through when you break your leg, right, you
see an orthopedis they set your leg, they put you
in the cast. Your insurance come. You know, your insurance
(11:18):
pays for the majority of that. You pay your cope
in deductible. I mean, you have access to care for
that broken leg. If you have addiction, right, which can
kill you much quicker than a broken leg. A lot
of people don't even have access to the care that's
going to help them, and they wind up in the
criminal justice system. And the weird thing, n Cole is
that they get the help once they get into criminal
justice system. How messed up is that?
Speaker 1 (11:40):
I mean it is. And that's an interesting concept in
itself because going back and forth on whether you should
criminalize drug use or not. You know, my thing with
the Affordable Care Act was the ACA expanded coverage for
addiction treatment. And therefore, I know it saves lives in
terms of making sure there's a lot of those medication
assistant treatments, but it obviously created a bloated, bureaucratic system
(12:03):
that prioritizes access over outcomes. And so we may be
treating addiction more often now, but I wouldn't say that
we're treating it better. Yes, we have more medications, but
that's not a result of the ACA. They only care
about the metrics. They care about the number, saying, well,
this many people went to rehab. Okay, well how many
people are now sober?
Speaker 2 (12:22):
So it's so beautiful. I couldn't have said it better.
I mean, this is this is my soapbox. If I
have it, I could I could care less about the metrics, right,
I know those things are important. Right, you've got to
see somebody in this amount of time, and you've got
to do an ASI on this, and those are things
are all Nicole. What I care about is outcomes. Outcomes
are the only thing that matters. You know, in our
current system, if you're getting federal or state dollars in
(12:45):
a lot of our treatment programs, you get the money
you got this year, and then next year, if you
spend all your money this year, then you get you know,
five percent or ten percent more, whatever the budget says.
I don't care about that. I want to know what
your outcomes were. How many people went from having no job,
you know, living on the street, to being in recovery,
having a job, paying into the tax base, getting their
family back, getting their kid. That's what I care about,
(13:06):
right recovery. When are we going to start looking at outcomes?
Because outcomes are the only thing that matters. And I
think that we have to take the third party approach here,
bring them to the table and incentivize people for those outcomes.
And I think there's a way to do that. But Nicole,
it it's the only thing that matters, or the outcome.
Nothing else matters.
Speaker 1 (13:22):
You're listening to wellness and mass, We'll be right back
with more well so. I mean you're not just talking
the talk, you're walking the walk. One you lived it.
You're a professional, but you are chairman of something called
Reach United. Tell us a little bit about.
Speaker 2 (13:41):
That, So Reach you on. It is a nonprofit that
started with some other folks to raise awareness about how
the opioid debatement money is being spent. I was actually
one of the expert witnesses in the cases that you
know secured about fifty five to sixty big dollars for
the United States.
Speaker 1 (13:57):
Hold on. So I know what that is because I
was a part of a lot of the conversations in
here in New Jersey and Jack Chiarelli had he won,
like he had a strong plan as to what to
do with that. But some of our listeners may not
know what that is, so break it down.
Speaker 2 (14:13):
So multiple states sued industry for the opioid crisis, not
only Purdue Pharma, but the other manufacturers, distributors, macass and
Cardinal Health, a mayor source Bergen, and then pharmacy change
like Walgreens, Walmart and and Kroger some of you know
some of the big pharmacy change. And so when that happened,
the federal court system took those cases and lumped them
(14:34):
in all into one of multi district litigation and then
as a result of that, we won about fifty five
billion dollars to abate the opioid crisis, and abate basically
means to make whole. Now, you're not going to be
able to bring people back from the dead, but the
money is supposed to be spent by these individual states
going forward to build a system of care for the
United States for the next two to three decades. And
(14:57):
that money in a lot of places. Now some places
it's it's going well, but in other places it's sitting
in bank accounts, the process is not transparent, and in
some places it's being used for things that aren't related
to opio debatement. And so that's the whole reason we
started reaching out. It was to shine a light on that,
to advocate that this money be spent to build this
system of care for substitutes and mental health that we
(15:18):
currently do not have.
Speaker 1 (15:19):
Nicole, Yeah, I mean, and you know better than anyone,
there's a lot of money sitting there and if it's
not used, it's going to be misappropriated and it may
go away. So, I mean, it's really been kind of
like the COVID funds. You know, it's people you know
who's not good at managing money the government. I'm sorry,
(15:41):
so well, I mean it's great, So what are some
of the things that you want to see the money
being used for.
Speaker 2 (15:46):
You can even go back further than the COVID funds,
And I know you remember this, the tobacco settlement money.
I mean, it was huge, and very little of that
went to prevent kids from taking up tobacco in the
first place with evidence space programs, and so that's the fear.
And so I think I think that, you know, we
need leadership from a national standpoint on this to ask
(16:07):
mayors and county commissioners across this country how to allocate
these dollars to build a system of care for people
with substance use disorder. I believe that solutions are local
to co I've always believed that. However, this is a
complex issue, and I think we need leadership from the
top down in helping these folks work together to build
a system of care that they need for their communities.
(16:28):
And this is a community issue. The opposite of addiction
is not recovery, it's community and relationship. So where is
the leadership from the top down that's helping form this
system of care that no matter where you touch the system,
you get the help that's right for you. And I
think there's a way to do that. We've got technology,
We've got tools that we've never had in the past.
We have a sense of urgency because you know, we're
(16:50):
losing two hundred twenty Americans a data this, So I
think the timing is perfect. And we actually have funds, right,
we have money. We don't have to go to individual
state legislators and argue for you know, our tax dollars
to be distributed to this. We have a separate pot
of money. My fear is is that we're going to
waste it.
Speaker 1 (17:07):
Well, I mean, I agree with you, because this money
is supposed to be there's legally restricted to opioid remediation
like addiction treatments, medication assistant treatments, NARCAN distributions, housing, prevention, education,
but data tracking and surveillance, which that's an interesting one.
They're not supposed to be used for like the general
budgets or pensions or unrelated projects. But it seems like
(17:31):
sometimes some of it is. But the problem is, as
you're saying, if there's not a cohesive plan and there's
not an evidence based formula, that people are looking at
like we're going to be wasting all of this money
and this it's really going to be a missed opportunity.
And so, you know, is this something that you think,
like President Trump needs to have a task force that
(17:52):
they're looking at to make sure that Trump that the
funds are being used. Is there something that on a
larger scale that they can put out a playbook to say,
this is what needs to happen, this is what will
work so that the money's not just sent piecemeal to
already broken programs.
Speaker 2 (18:10):
You stole my word, nicole, which is a playbook. Yes,
and we already have that mechanism in place in the
federal government's bureaucracy, right. I mean, we have the Office
of National Drug Control Policy, And I get the federal
government saying that these are community issues and the solutions
will be local. And for the most part, I agree
(18:31):
with that. I think this issue is so complex, with
so many moving parts. It's ripped at the fabric of
our families in this country. If you look at our
health care expenditures, and if you will look at this
from a financial standpoint, health care expenditures, the majority of
our health care dollars go to treat chronic disease. You
know that, And the biggest economic burden of any chronic
(18:53):
disease is actually substitute disorder. It's not diabetes, hypertension, or
any of these neurologic diseases that wound up being chronic diseases.
So yes, I do think that there needs to be
a top down plan. And I'm not a big government guy,
but I do think that we need leadership from the
from the top down to help these communities and help
these individual states formulate a system that's going to stick
together and get people the help the need. We don't
(19:15):
get a second bite at this apple on the cole.
Speaker 1 (19:18):
So if part of your playbook, what are some of
the things that you think needs to be done.
Speaker 2 (19:23):
I think the first one right off the bat, you've
already covered, which is, you know, nor kin should be
like you know, it should be in the drinking water. Okay,
it should be literally everywhere. I mean, you shouldn't be
able to walk into a restaurant, a school at any level,
any kind of place where people are in the public,
athletic venues, you know, orchestras, plays on Broadway, whatever, and
(19:43):
not see on the wall overdose reversal drugs. I mean,
that's the first thing you can do to slap a
band aid on it, right off the bat. And then
the next thing that needs to happen is building this
recovery or any system of care that is data driven, right,
data driven. We have access to medical res records, we
have access to technology. We have access to now machine learning,
(20:03):
artificial intelligence. Some of these things I think are going
to be real tools for us to put together individualized
treatment plans for the people that we're trying to help.
And then then last, but not least, you have to
start looking at things like social determinants of health. A
lot of these folks have lost everything, and so it
starts with housing, right and a way to make a living.
You know, every time I ask my son to help
(20:25):
me with something on my phone, right, and you know,
he gives me the old teach a man to fish lecture.
I'm about tired of hearing that, right, But his point is,
let me show you how to do it, and the
next time you won't have to ask me. And so
I think times that we just hand out money instead
of helping people, you know, find a way to be
able to provide for themselves, and I think a lot
most people want to do that. So so Nicole, those
(20:46):
would be my strategies. And then the biggest one for
me is addressing this in the criminal justice population and
then the CARCO setting. I mean, until we address it
in that setting, we're not going to move the needle.
In the United States, numbers are too big.
Speaker 1 (20:58):
So you think that we need more robust programs within
the like the penal system.
Speaker 2 (21:03):
Absolutely we already had what you what are you doing
all day long? Right? I mean you know we could
be using that time to do things that that are
going to help you when you when you're when you
get out of that carceral setting. Ninety five percent of
the people who are incarcerated the United States today will
walk the street again. That's a fact. And so if
they're going to walk the street again, I want them healthy.
And we're missing a golden opportunity and we have leverage, right,
(21:26):
And I'll get killed by the harm reduction people on this,
but I don't care, Nicole. When I went to treatment
as young doc, and you've been through the process right
medical school residency. I was in my chief resident year
when when I got addicted, and when they came to
me and said, Steve, you have a problem, you know,
and here's what we'd like you to do. Nicole. I
didn't have my pom poms out cheering, right. I was
(21:48):
just trying to save my medical license. But they had
leverage and said here's the process and if you don't
do this, then we're not going to let you practice medicine.
That was the leverage and the coll What I got
was recovery. It changed my life, It changed my profession,
It changed me as a father, It changed me as
a husband, It changes me now as a granddad. And
simply using that leverage that we have to hold people
(22:10):
into treatment process when they're already there, and I don't
know why we're not doing it now. We have courts
around the country that are doing it, drug recovery courts,
family treatment courts, veterans treatment courts, and I think it's
a great thing. And I think we need to expand
the use of that leverage to behind the walls in
our car stool setting and start the treatment process while
we still have people, you know, still have the ability
(22:32):
to direct that while they're incarcerated.
Speaker 1 (22:34):
So as someone who's been through it themselves, not just
on the doctor's side of the room with the patient's
side of the room. Any went out here listening, who
may be struggling themselves, or they know someone who is
struggling with any sort of addiction, What is your advice
for them?
Speaker 2 (22:49):
Addictions treatable, treatment works, and people recover. That's a fact.
And so there was a time in my life, Nicole,
where I had all these things, you know, that worked
to put on my wall, my medical degree, all the
stuff that I had won in my academic life, and
income I never imagined as a little boy growing up
in Jonesboro, Tennessee. Right, I had all of those things,
but they didn't matter when I was addicted. The only
(23:10):
thing that mattered was this thing out here I thought
I would have to have or I would die. And
the people that are in that situation right now and
have cravings for that, and they're willing to sacrifice everything
that they have for that. I understand that addiction is
a disorder of the brain. It is about our reward
system and our frontal lobe which gives us insight and judgment,
and our effective treatment programs out there to help you
(23:31):
with the cravings so that you can find long term recovery.
So the people out there who are struggling, I tell
you there is hope and don't give up. The problem is, Nicole,
is that the help that they wind up getting is
dependent upon where they get sent okay, and they get
whatever the place that they get sent to provides. And
that's asinine. Why do we not have individualized treatment plans
(23:53):
that are built on real data? Right? You know, what
have you already failed at? What have you not been
successful at? DNA? What are the markers? What are the
drugs that are most likely to help you with cravings?
What are the things you need to do from a
preventative standpoint, your sleep, your diet. Right, we spend all
these money in the United States on pharmaceuticals and we
keep going further down that rat hole instead of talking
(24:15):
about what we can do from a preventative stand for
standpoint before this happens in the first place, and we
have to treat it as a chronic disease. So taking
all of these factors into consideration, what is the best
treatment profile for you going forward? It gives you the
best chance at recovery. And Nicole, we have that we
actually have the technology and the infrastructure to be able
(24:36):
to do that when we have access to medical data
buried within electronic medical records across this country. Sorry, I
got all the soapbox there for quick, but I feel strung.
Speaker 1 (24:44):
Oh I wanted you on the soapbox. You're the props
big person to talk about it.
Speaker 2 (24:48):
I get so frustrated because we spend all this money
on the back end. You know that the pharmaceutical industry
wants us to be depended on, And it just blows
me away. I don't understand why we're doing more on
the front end. It's like sleep. Sleep is a risk
factor for relapse, Nicole. Right now, I've got a wearable, right,
I've got this this aura ring thing here. I wear
(25:08):
and when I wake up in the morning, I can
see the quality of my sleep. I can see I
got the bed later later last night, and I should have.
I'm a little worn down today, right, So I don't
have my normal energy level because my sleep was disrupted
because me and my wife watched the TV show that
upset me. Right, And so now tonight I've got a
chance to make a correction in that and do better
with my quality of sleep. Now, am I worried about relapsing? Today. No,
(25:30):
I'm not right. I've been in recovery twenty one years.
I know how to handle this stuff, and I've got
friends in recovery. You can help me if I start
to struggle. What do you do when you're three days
out from treatment? Right? And you know what does that
look like? And so we address it not with the
things that I'm talking about. We address it with pharmaceuticals
or oh, you need this sleep eight or let me
write you this annex to help you go to sleep,
(25:51):
or this ambient. Well, by the way, those things have
habit forming potential as well. And now we're giving somebody
who already has known addiction another sub since that they
can become dependent on. And it just blows my mind
that we don't take a different approach looking at some
preventative things our diet, right, our brain, gut access right,
these type of things that the data is out there. Wearables,
(26:13):
the data is out there. We actually know who's at
risk for relapse two weeks before they actually pick up
based on things that can be gleaned right out of
a wearable.
Speaker 1 (26:23):
Here RFK Junior talking about how he loves wearables. I
haven't gotten on the bandwagon for wearables. But you know what,
I'm always behind. My kids don't think I'm very cool.
And even though I'm a radiologist, I'm not the most
tech savvy person you've ever met.
Speaker 2 (26:36):
But you are a radiologist, nic Colon. You all spent
a lot of time in dark rooms, so that could
mess you up with a wearable. But I get it.
Speaker 1 (26:43):
I get it more coming up on wellness and masks
with doctor Nicole Sapphire, I like what you're saying. I mean,
I am for it and for me I talk, you know,
being a Western doctor, obviously I rely on big pharma,
but I also very much into If you know anything
about me, I love natural herbs. I am the one
(27:05):
who tells you to go outside and sit into a
vitamin D. You know, I think that everything that you're
saying makes sense and it should happen. And you'll hear
a lot of people say, well, we just don't have
the money, we don't have the support, but the reality
is we actually do have the money. And you know, again,
the Affordable Care Act, they just looked at how many
(27:25):
people had access to addiction care, but they weren't measuring
the actual outcomes. And same with the opioid settlement money.
You know, spending isn't a success, the outcomes are. So
these monies should be judged by live save, not by
how many programs they get funded. And when you look
at these rehab centers, you're right, like it should be
(27:46):
widely available data. You hear President Trump talking about price transparency.
What about recovery metrics with each rehab center? Like what
if what if they have bad you know, bad track
record that they're our patients don't maintain. You know, I
think this should all be public knowledge.
Speaker 2 (28:04):
Yeah, it's reasonable when you're talking about mortgage in your
house for the third time to send your kid to
the same rehab you've already sent them two twice before. Yes,
and Nicole, I don't want you to hear me wrong.
I am not antip pharmaceutical on everything. I don't want
you to hear that wrong. I'm not. Medications are there,
and they improve our quality of life, and some of
them you have a mortality benefit. We live longer as
(28:25):
a result of treating highpertension or whatever. I'm just saying
that the knee jerk here is as soon as you
have an issue, it's straight to that without some other
things that you could do from a preventative standpoint, and
we start looking at outcomes. You're exactly right, and you
don't even have to start with punishment. Right, Well, your
outcomes are bad and we're going to take your money away.
If my outcomes are bad. As a provider, I'm not
(28:47):
doing the job that I need to do for my
patients who are coming to see me. I want to
know that, and I want to know how I can
use that data to improve my care plan so that
they have better long term outcomes. Right, I mean that's
the reason for it. And so until we start measuring this,
we don't even know what we're doing, if it's successful
or not. And more importantly, we don't know what's successful
(29:09):
for each individual person. We just kind of throw spaghetti
up against the wall and see what sticks.
Speaker 1 (29:13):
Okay, Well, I think these are all amazing and I'm
glad to see everything that you're doing. And you know,
I just I think it's really important that people who
have been on both sides of the exam table have
these conversations, and we need to hold people accountable. And
you know, I can go on my own soapbox and complain, complain, complain,
all day long, but it takes people like you, working
(29:34):
outside of the government to really make sure that these
moneies are being implemented safely. So appreciate all you're doing
and thank you so much for coming on the podcast today.
I'd love to have you back on sometime soon.
Speaker 2 (29:45):
You bet I'd be honored. Nicole. Thank you so much
for shining a lot on it.
Speaker 1 (29:48):
I'm grateful absolutely the functional crisis. It's not abstract. It's
happening in our homes, in our schools, in our emergency
rooms every single day, and we cannot normalize this level
of loss and we can't afford half measures. Real progress
requires prevention, treatment, enforcement, and definitely accountability, all working together.
The lives depend on it. We cannot keep celebrating metrics
(30:11):
like how many people are covered under insurance that have
addiction benefits. That doesn't matter if people are not getting
free from their addictions, if they are not getting clean,
if they are not becoming a productive member of society.
We have to stop treating the papers and the checkboxes
and actually look at the people. Thanks so much for
listening to Wellness on Mass. I'm doctor Nicole Sapphire. Be
(30:33):
sure to listen to Wellness on Mass with doctor Nicole
Sapphire on iHeartRadio wherever you get your podcasts, and we
will see you next time. Happy holidays,
Welcome to Wellness Unmass. I'm doctor Nicole Saffire and we
have a really good guest joining us today. Today we
are talking about sensonyl, not about a political issue, but
as a public health emergency and what we need to
do about it. This synthetic opioid is now the leading
cause of death for Americans ages eighteen forty five, killing quietly, quickly,
(00:24):
and indiscriminately. Just a small dose the size of a
few grains of salt can be fatal. This isn't just
about addiction. It's about poisoned supply chains, failed policies, and
the urgent need for accountability, prevention, and real solutions. So
let's unmask the spental crisis and dive right in well
(00:44):
with the President's war on drugs. Right now, there is
nobody better to be joining us on Wellness Unmass than
doctor Stephn Lloyd, Internal medicine and addiction medicine physician, President
of the Tennessee Medical Board. And he has many more
titles which I'll leave to hand to tell you all about.
But Steven, thank you so much for joining us today.
Speaker 2 (01:03):
Thanks for having me Nicole.
Speaker 1 (01:05):
So I mean big news out of the White House obviously,
President Trump has had a war on drugs, but he's
now declaring fentanyl to be a weapon of mass destruction.
What's your thoughts on that.
Speaker 2 (01:16):
Well, you know, I'm not sure what all that entails,
but from an awareness standpoint thing, Nicole, I'm all for it.
You know, we know that we're losing about two hundred
and twenty Americans today to drug overdoses, and the large
percentage of those are fentanyl. And so you know, if
you look at two hundred and twenty people a day dying,
that's a seven thirty seven crashing and killing everybody on
board every day of the year. And so anytime that
(01:38):
you know, you can raise awareness about that, then I'm
all for it. I think it's the right move. I
don't know what some of the ramifications of that are.
From a military standpoint or a border control standpoint, that's
not my area of expertise, but I am certainly in
favor of because interdiction efforts do help us keeping daily
drugs out of the United States.
Speaker 1 (01:55):
Yeah, I mean, you know, you make an interesting point.
So as physicians, we think of drugs as a medical condition.
It's a physical health issue, but also a mental health issue.
From a physician's perspective, How do you actually feel about
it turning into kind of a criminal justice crisis.
Speaker 2 (02:13):
Well, you know, that's the part that always worries me,
Nicole r. You hang the weapon of mass destruction thing
on there, and then people who are addicted to it
get tied into that. And as you know, stigma is
the biggest thing we have to overcome when we're trying
to help people with any type of substance use disorder.
So I do get worried about that. At the same time,
our partnerships with law enforcement and criminal justice system are key.
We're not going to move the needle on the opioid
(02:35):
crisis in the United States until we address this in
our caarcial setting. I mean, it's just a fact. There's
so many, you know, so many people in there, and
so I think there's pluses and minuses to it, But overall,
I'm glad that he's done it. So it certainly puts
it on the radar, and if our president thinks it's
that important, it certainly raises the level of awareness in
the everyday Americans lives. Except for the people who aren't
(02:58):
going to like anything the President Trump does.
Speaker 1 (03:00):
Well, there are definitely a handful of them. Right, it
doesn't matter what he does. He could cure cancer and
they criticize him somehow, right. You know, President Trump obviously
has emphasized border security and targeting these cartels, and you know,
from a medical standpoint, you know, I think about it,
and the reality is disrupting supply is going to eventually
(03:22):
have to trickle down to a reduction in overdose deaths,
don't you think, yes.
Speaker 2 (03:27):
Ma'am, I mean, yes, Nicole. You know, it's one of
the things that kills me. You know, I hear this.
The war on drugs has been a failure, right, And
from a strictly drug using standpoint, I guess it has been,
But it hasn't been a failure across the board. I mean,
we have stopped a lot of dangerous drugs from entering
the United States. That's a good thing, right, If nothing else,
it drives up the price of what's here, and it
(03:47):
makes it harder for people to access, right. And so
I don't buy into those arguments. Our partnerships with law
enforcement criminal justice are key. They're absolutely key to us
coming out on the other side of this, And so
I don't buy those arguments that interdiction efforts don't matter,
because I think they do, and I think it does
trickle down. As a matter of fact, I think you're
seeing it right now. You know, look in the United
(04:09):
States right now. You know our drug overdose deaths are
going down. In state of West Virginia. They're down over
forty percent year over year, and I think interdiction efforts
have something to do with that. Now, is it one
hundred percent, No, But is it a portion of it? Absolutely?
Speaker 1 (04:23):
So, Now, what do you think the role like narcan
has played in that.
Speaker 2 (04:27):
I think it's been a big, huge role, right. I mean,
if I was in the decision making position to be
able to address this on a national scale, you know,
the first thing I would do is blanket the United
States with narcan or overdose reversal drugs. Because you and
I are physicians, right, and I don't know about you.
I mean, I think you're an anaesthesiologist or a radiologist
or mediologist. Right. You haven't figured out how to treat
(04:47):
dead people. Nicoleon neither, and so so we have to
keep people alive. And so the easiest thing to do
right off the bat is blanket the country with narkann.
But but you know, then you just have people coming
in and out of systems go right back. So you
do have to have that intervention where you actually direct
people towards treatment, and that would be you know, step
two of the process. But I think it's key. I
think overdose reversal drugs have played a big role in this.
Speaker 1 (05:11):
Yeah, but I mean the overdose reversal drugs are for
the FENNOYL and the drugs that are currently in the system.
President Trump's working to try and decrease that supply. But
I'm you know, I still look at our system and
you know, just to bring a little current events to
the conversation, I mean what happened just in California with
the Reiner family. You know, they have a son who
(05:34):
since his mid adolescence has been in and out of rehabs.
I think by the age of twenty two, he had
been in rehab like eighteen times for polysubstance abuse, and
now he's been arrested for murdering his parents. I mean,
at what point do you say if if one of
the most privileged children in our country, I mean, I
(05:57):
would say he's privileged, he obviously was born into a
house privilege. If one of the most privileged children in
this country has failed these multiple rounds of rehab. Like,
is it a system problem?
Speaker 2 (06:09):
Oh, NICOLEE is for sure a system problem. I mean,
it's why I'm on here with you. It is a
system problem. I mean, any other medical condition that we
put that we treated somebody for, you know, and we're unsuccessful.
We have a we have a second you know, we
have a second line treatment option, right, and a third
and a fourth line and a combination of things. Addiction
treatments basically not changed the United States in the last
(06:30):
one hundred years outside of some medications. But they don't
get people into recovery. They quell cravings. They're important for
keeping people alive. But Nicole, we got to change our
fundamental system. You know. I was always I was told
I don't know if you know about my past, but
but I'm recovering from opioid and benzo diazepine addiction for
twenty one years. As a young doctor, I got addicted,
(06:50):
and I stepped into a system of care for doctors
that is very good addressing those underlying drivers of addiction.
And I've got no idea what happened in the Rhiner family.
And I have no insight into it. However, from my
point of view, and I look at this and I see,
you know, young Nick's issues. I wonder, were you just
addressing the drug use or were you trying to get
at some of the underlying drivers that was pushing Nick
(07:12):
in that direction? And then a lot of times it's
untreated mental health issues. And so the system of care
that we have today is not meeting the standard. The
average person with addiction issues takes eight years to get
one year of sobriety, and in that time they go
to five different treatment programs. I mean, come on, the cole,
there's something wrong with that system.
Speaker 1 (07:31):
So what do you think it is?
Speaker 2 (07:33):
Well, I think it's if you're a hammer, everything's a nail. Right.
You know, you come in, you have this problem. This
is what we treat you. You're unsuccessful at it, you
go back out, You come back in, and we hit
you with the same thing that you came back in
with the first time. Right. I learned early on in
recovery that the definition of insanity is doing the same
thing over and over expecting a different result. That's what
we do in addiction treatment. We do it all the time,
(07:54):
and we do it every day. And then when people
are unsuccessful we kick them out. I mean, what if
we treat hard failure that way. You know, the day
after Christmas when Papal was loaded up on country ham
and salt, it gets fluid overload and fills these lungs up.
If we treated him like we do people with addiction,
we'd kick him out of the er.
Speaker 1 (08:11):
That's actually really interesting comparison. You're right, because all the
time we have either non adherence to medications, non compliance
with diets and recommendations, and yet we treat them just
the same. We just give them more diuretics, we up
their medications, and we just move on. But when it
comes to addiction medicine, they lose their privilege for certain things,
they get kicked out of rehabs. That's really interesting. So
(08:33):
that stigma is still there despite how much talk there
is about getting rid of stigma.
Speaker 2 (08:39):
It's the biggest roadblock we have. Nicole. People are always
asking me, Steve, if you know, if you had pixie
dust and you could wave it, you know, spread a
pixie dust, and you'd have one thing in this whole system,
what would you want? And the thing that I want
doesn't cost any money, right, it's just a change in attitude.
And you know, the attitude of which I was approached
back in two thousand and four when I found recovery.
(08:59):
You know, they didn't tell me it was okay. They
didn't tell me that, you know that, you know, what
I've done was great. They did tell me that there's
an avenue here for help, and if you choose to help,
if you choose to follow it, then then we're going
to be beside you the whole way. We're going to
support you, and we're going to help you in your
job as you were in your medicine and and so
you know, those are the type of things that really
helped me going forward. Most people don't have access to that.
(09:22):
Most people, when they come into the system, this is
your last chance. If you mess up, we're going to
kick you out. And it's this tough love approach. And
I'm not above tough love, but I can tell you,
for the most part, it doesn't work. And so we
absolutely have to change our system. And the thing that
we can do first of all is change our attitudes
about addiction and the stigma around it.
Speaker 1 (09:40):
You know, one thing, you know, to bring in a
little bit of health policy and I'm not sure how
familiar you are with it. The one thing that came out,
so the Affordable Care Act, I'm not I'm not going
to ask you your opinion on it. We don't need
to go there. But I have always been not a
huge fan of it. I think there were some good,
good impetus behind it, but the way I'm not a fan.
(10:01):
Let me put it that way, got it? You know,
I think there are significantly more consequences than benefits to it.
But one thing that did come out with the Affordable
Care Act was that addiction treatment was deemed one of
those essential health benefits, and they classified substance use disorder
treatment and mental health care. You know that insurance plans
must cover them detact, detox, impatient rehab, outpatient treatment, medication
(10:25):
assistant treatment. While we also we obviously saw improved in access,
the quality and the continuity didn't necessarily improve in itself. Like,
what do you make of that?
Speaker 2 (10:36):
Well, I think I think we have to work on
the things that you just talked about the quality and
the continuity, and are we using evidence based approaches to
treat addiction. I mean that's you know, from a system standpoint,
you have to do that. But I'm in your corner
with the Affordable Care Act, you know, and it was actually,
you know, I think it was well Stone Diminici Act
of what two thousand and eight or somewhere, the Parity Act.
They said insurance companies have to cover substance use like
(10:58):
they cover everything else. And there's ever been any teeth
in that, and it's really never happened. And so I
think that, you know, we have to We've got some
systems problems we got to look at from a coverage
standpoint here to give people access to care. You know,
if you break your leg, I mean there's certain things
you go through when you break your leg, right, you
see an orthopedis they set your leg, they put you
in the cast. Your insurance come. You know, your insurance
(11:18):
pays for the majority of that. You pay your cope
in deductible. I mean, you have access to care for
that broken leg. If you have addiction, right, which can
kill you much quicker than a broken leg. A lot
of people don't even have access to the care that's
going to help them, and they wind up in the
criminal justice system. And the weird thing, n Cole is
that they get the help once they get into criminal
justice system. How messed up is that?
Speaker 1 (11:40):
I mean it is. And that's an interesting concept in
itself because going back and forth on whether you should
criminalize drug use or not. You know, my thing with
the Affordable Care Act was the ACA expanded coverage for
addiction treatment. And therefore, I know it saves lives in
terms of making sure there's a lot of those medication
assistant treatments, but it obviously created a bloated, bureaucratic system
(12:03):
that prioritizes access over outcomes. And so we may be
treating addiction more often now, but I wouldn't say that
we're treating it better. Yes, we have more medications, but
that's not a result of the ACA. They only care
about the metrics. They care about the number, saying, well,
this many people went to rehab. Okay, well how many
people are now sober?
Speaker 2 (12:22):
So it's so beautiful. I couldn't have said it better.
I mean, this is this is my soapbox. If I
have it, I could I could care less about the metrics, right,
I know those things are important. Right, you've got to
see somebody in this amount of time, and you've got
to do an ASI on this, and those are things
are all Nicole. What I care about is outcomes. Outcomes
are the only thing that matters. You know, in our
current system, if you're getting federal or state dollars in
(12:45):
a lot of our treatment programs, you get the money
you got this year, and then next year, if you
spend all your money this year, then you get you know,
five percent or ten percent more, whatever the budget says.
I don't care about that. I want to know what
your outcomes were. How many people went from having no job,
you know, living on the street, to being in recovery,
having a job, paying into the tax base, getting their
family back, getting their kid. That's what I care about,
(13:06):
right recovery. When are we going to start looking at outcomes?
Because outcomes are the only thing that matters. And I
think that we have to take the third party approach here,
bring them to the table and incentivize people for those outcomes.
And I think there's a way to do that. But Nicole,
it it's the only thing that matters, or the outcome.
Nothing else matters.
Speaker 1 (13:22):
You're listening to wellness and mass, We'll be right back
with more well so. I mean you're not just talking
the talk, you're walking the walk. One you lived it.
You're a professional, but you are chairman of something called
Reach United. Tell us a little bit about.
Speaker 2 (13:41):
That, So Reach you on. It is a nonprofit that
started with some other folks to raise awareness about how
the opioid debatement money is being spent. I was actually
one of the expert witnesses in the cases that you
know secured about fifty five to sixty big dollars for
the United States.
Speaker 1 (13:57):
Hold on. So I know what that is because I
was a part of a lot of the conversations in
here in New Jersey and Jack Chiarelli had he won,
like he had a strong plan as to what to
do with that. But some of our listeners may not
know what that is, so break it down.
Speaker 2 (14:13):
So multiple states sued industry for the opioid crisis, not
only Purdue Pharma, but the other manufacturers, distributors, macass and
Cardinal Health, a mayor source Bergen, and then pharmacy change
like Walgreens, Walmart and and Kroger some of you know
some of the big pharmacy change. And so when that happened,
the federal court system took those cases and lumped them
(14:34):
in all into one of multi district litigation and then
as a result of that, we won about fifty five
billion dollars to abate the opioid crisis, and abate basically
means to make whole. Now, you're not going to be
able to bring people back from the dead, but the
money is supposed to be spent by these individual states
going forward to build a system of care for the
United States for the next two to three decades. And
(14:57):
that money in a lot of places. Now some places
it's it's going well, but in other places it's sitting
in bank accounts, the process is not transparent, and in
some places it's being used for things that aren't related
to opio debatement. And so that's the whole reason we
started reaching out. It was to shine a light on that,
to advocate that this money be spent to build this
system of care for substitutes and mental health that we
(15:18):
currently do not have.
Speaker 1 (15:19):
Nicole, Yeah, I mean, and you know better than anyone,
there's a lot of money sitting there and if it's
not used, it's going to be misappropriated and it may
go away. So, I mean, it's really been kind of
like the COVID funds. You know, it's people you know
who's not good at managing money the government. I'm sorry,
(15:41):
so well, I mean it's great, So what are some
of the things that you want to see the money
being used for.
Speaker 2 (15:46):
You can even go back further than the COVID funds,
And I know you remember this, the tobacco settlement money.
I mean, it was huge, and very little of that
went to prevent kids from taking up tobacco in the
first place with evidence space programs, and so that's the fear.
And so I think I think that, you know, we
need leadership from a national standpoint on this to ask
(16:07):
mayors and county commissioners across this country how to allocate
these dollars to build a system of care for people
with substance use disorder. I believe that solutions are local
to co I've always believed that. However, this is a
complex issue, and I think we need leadership from the
top down in helping these folks work together to build
a system of care that they need for their communities.
(16:28):
And this is a community issue. The opposite of addiction
is not recovery, it's community and relationship. So where is
the leadership from the top down that's helping form this
system of care that no matter where you touch the system,
you get the help that's right for you. And I
think there's a way to do that. We've got technology,
We've got tools that we've never had in the past.
We have a sense of urgency because you know, we're
(16:50):
losing two hundred twenty Americans a data this, So I
think the timing is perfect. And we actually have funds, right,
we have money. We don't have to go to individual
state legislators and argue for you know, our tax dollars
to be distributed to this. We have a separate pot
of money. My fear is is that we're going to
waste it.
Speaker 1 (17:07):
Well, I mean, I agree with you, because this money
is supposed to be there's legally restricted to opioid remediation
like addiction treatments, medication assistant treatments, NARCAN distributions, housing, prevention, education,
but data tracking and surveillance, which that's an interesting one.
They're not supposed to be used for like the general
budgets or pensions or unrelated projects. But it seems like
(17:31):
sometimes some of it is. But the problem is, as
you're saying, if there's not a cohesive plan and there's
not an evidence based formula, that people are looking at
like we're going to be wasting all of this money
and this it's really going to be a missed opportunity.
And so, you know, is this something that you think,
like President Trump needs to have a task force that
(17:52):
they're looking at to make sure that Trump that the
funds are being used. Is there something that on a
larger scale that they can put out a playbook to say,
this is what needs to happen, this is what will
work so that the money's not just sent piecemeal to
already broken programs.
Speaker 2 (18:10):
You stole my word, nicole, which is a playbook. Yes,
and we already have that mechanism in place in the
federal government's bureaucracy, right. I mean, we have the Office
of National Drug Control Policy, And I get the federal
government saying that these are community issues and the solutions
will be local. And for the most part, I agree
(18:31):
with that. I think this issue is so complex, with
so many moving parts. It's ripped at the fabric of
our families in this country. If you look at our
health care expenditures, and if you will look at this
from a financial standpoint, health care expenditures, the majority of
our health care dollars go to treat chronic disease. You
know that, And the biggest economic burden of any chronic
(18:53):
disease is actually substitute disorder. It's not diabetes, hypertension, or
any of these neurologic diseases that wound up being chronic diseases.
So yes, I do think that there needs to be
a top down plan. And I'm not a big government guy,
but I do think that we need leadership from the
from the top down to help these communities and help
these individual states formulate a system that's going to stick
together and get people the help the need. We don't
(19:15):
get a second bite at this apple on the cole.
Speaker 1 (19:18):
So if part of your playbook, what are some of
the things that you think needs to be done.
Speaker 2 (19:23):
I think the first one right off the bat, you've
already covered, which is, you know, nor kin should be
like you know, it should be in the drinking water. Okay,
it should be literally everywhere. I mean, you shouldn't be
able to walk into a restaurant, a school at any level,
any kind of place where people are in the public,
athletic venues, you know, orchestras, plays on Broadway, whatever, and
(19:43):
not see on the wall overdose reversal drugs. I mean,
that's the first thing you can do to slap a
band aid on it, right off the bat. And then
the next thing that needs to happen is building this
recovery or any system of care that is data driven, right,
data driven. We have access to medical res records, we
have access to technology. We have access to now machine learning,
(20:03):
artificial intelligence. Some of these things I think are going
to be real tools for us to put together individualized
treatment plans for the people that we're trying to help.
And then then last, but not least, you have to
start looking at things like social determinants of health. A
lot of these folks have lost everything, and so it
starts with housing, right and a way to make a living.
You know, every time I ask my son to help
(20:25):
me with something on my phone, right, and you know,
he gives me the old teach a man to fish lecture.
I'm about tired of hearing that, right, But his point is,
let me show you how to do it, and the
next time you won't have to ask me. And so
I think times that we just hand out money instead
of helping people, you know, find a way to be
able to provide for themselves, and I think a lot
most people want to do that. So so Nicole, those
(20:46):
would be my strategies. And then the biggest one for
me is addressing this in the criminal justice population and
then the CARCO setting. I mean, until we address it
in that setting, we're not going to move the needle.
In the United States, numbers are too big.
Speaker 1 (20:58):
So you think that we need more robust programs within
the like the penal system.
Speaker 2 (21:03):
Absolutely we already had what you what are you doing
all day long? Right? I mean you know we could
be using that time to do things that that are
going to help you when you when you're when you
get out of that carceral setting. Ninety five percent of
the people who are incarcerated the United States today will
walk the street again. That's a fact. And so if
they're going to walk the street again, I want them healthy.
And we're missing a golden opportunity and we have leverage, right,
(21:26):
And I'll get killed by the harm reduction people on this,
but I don't care, Nicole. When I went to treatment
as young doc, and you've been through the process right
medical school residency. I was in my chief resident year
when when I got addicted, and when they came to
me and said, Steve, you have a problem, you know,
and here's what we'd like you to do. Nicole. I
didn't have my pom poms out cheering, right. I was
(21:48):
just trying to save my medical license. But they had
leverage and said here's the process and if you don't
do this, then we're not going to let you practice medicine.
That was the leverage and the coll What I got
was recovery. It changed my life, It changed my profession,
It changed me as a father, It changed me as
a husband, It changes me now as a granddad. And
simply using that leverage that we have to hold people
(22:10):
into treatment process when they're already there, and I don't
know why we're not doing it now. We have courts
around the country that are doing it, drug recovery courts,
family treatment courts, veterans treatment courts, and I think it's
a great thing. And I think we need to expand
the use of that leverage to behind the walls in
our car stool setting and start the treatment process while
we still have people, you know, still have the ability
(22:32):
to direct that while they're incarcerated.
Speaker 1 (22:34):
So as someone who's been through it themselves, not just
on the doctor's side of the room with the patient's
side of the room. Any went out here listening, who
may be struggling themselves, or they know someone who is
struggling with any sort of addiction, What is your advice
for them?
Speaker 2 (22:49):
Addictions treatable, treatment works, and people recover. That's a fact.
And so there was a time in my life, Nicole,
where I had all these things, you know, that worked
to put on my wall, my medical degree, all the
stuff that I had won in my academic life, and
income I never imagined as a little boy growing up
in Jonesboro, Tennessee. Right, I had all of those things,
but they didn't matter when I was addicted. The only
(23:10):
thing that mattered was this thing out here I thought
I would have to have or I would die. And
the people that are in that situation right now and
have cravings for that, and they're willing to sacrifice everything
that they have for that. I understand that addiction is
a disorder of the brain. It is about our reward
system and our frontal lobe which gives us insight and judgment,
and our effective treatment programs out there to help you
(23:31):
with the cravings so that you can find long term recovery.
So the people out there who are struggling, I tell
you there is hope and don't give up. The problem is, Nicole,
is that the help that they wind up getting is
dependent upon where they get sent okay, and they get
whatever the place that they get sent to provides. And
that's asinine. Why do we not have individualized treatment plans
(23:53):
that are built on real data? Right? You know, what
have you already failed at? What have you not been
successful at? DNA? What are the markers? What are the
drugs that are most likely to help you with cravings?
What are the things you need to do from a
preventative standpoint, your sleep, your diet. Right, we spend all
these money in the United States on pharmaceuticals and we
keep going further down that rat hole instead of talking
(24:15):
about what we can do from a preventative stand for
standpoint before this happens in the first place, and we
have to treat it as a chronic disease. So taking
all of these factors into consideration, what is the best
treatment profile for you going forward? It gives you the
best chance at recovery. And Nicole, we have that we
actually have the technology and the infrastructure to be able
(24:36):
to do that when we have access to medical data
buried within electronic medical records across this country. Sorry, I
got all the soapbox there for quick, but I feel strung.
Speaker 1 (24:44):
Oh I wanted you on the soapbox. You're the props
big person to talk about it.
Speaker 2 (24:48):
I get so frustrated because we spend all this money
on the back end. You know that the pharmaceutical industry
wants us to be depended on, And it just blows
me away. I don't understand why we're doing more on
the front end. It's like sleep. Sleep is a risk
factor for relapse, Nicole. Right now, I've got a wearable, right,
I've got this this aura ring thing here. I wear
(25:08):
and when I wake up in the morning, I can
see the quality of my sleep. I can see I
got the bed later later last night, and I should have.
I'm a little worn down today, right, So I don't
have my normal energy level because my sleep was disrupted
because me and my wife watched the TV show that
upset me. Right, And so now tonight I've got a
chance to make a correction in that and do better
with my quality of sleep. Now, am I worried about relapsing? Today. No,
(25:30):
I'm not right. I've been in recovery twenty one years.
I know how to handle this stuff, and I've got
friends in recovery. You can help me if I start
to struggle. What do you do when you're three days
out from treatment? Right? And you know what does that
look like? And so we address it not with the
things that I'm talking about. We address it with pharmaceuticals
or oh, you need this sleep eight or let me
write you this annex to help you go to sleep,
(25:51):
or this ambient. Well, by the way, those things have
habit forming potential as well. And now we're giving somebody
who already has known addiction another sub since that they
can become dependent on. And it just blows my mind
that we don't take a different approach looking at some
preventative things our diet, right, our brain, gut access right,
these type of things that the data is out there. Wearables,
(26:13):
the data is out there. We actually know who's at
risk for relapse two weeks before they actually pick up
based on things that can be gleaned right out of
a wearable.
Speaker 1 (26:23):
Here RFK Junior talking about how he loves wearables. I
haven't gotten on the bandwagon for wearables. But you know what,
I'm always behind. My kids don't think I'm very cool.
And even though I'm a radiologist, I'm not the most
tech savvy person you've ever met.
Speaker 2 (26:36):
But you are a radiologist, nic Colon. You all spent
a lot of time in dark rooms, so that could
mess you up with a wearable. But I get it.
Speaker 1 (26:43):
I get it more coming up on wellness and masks
with doctor Nicole Sapphire, I like what you're saying. I mean,
I am for it and for me I talk, you know,
being a Western doctor, obviously I rely on big pharma,
but I also very much into If you know anything
about me, I love natural herbs. I am the one
(27:05):
who tells you to go outside and sit into a
vitamin D. You know, I think that everything that you're
saying makes sense and it should happen. And you'll hear
a lot of people say, well, we just don't have
the money, we don't have the support, but the reality
is we actually do have the money. And you know, again,
the Affordable Care Act, they just looked at how many
(27:25):
people had access to addiction care, but they weren't measuring
the actual outcomes. And same with the opioid settlement money.
You know, spending isn't a success, the outcomes are. So
these monies should be judged by live save, not by
how many programs they get funded. And when you look
at these rehab centers, you're right, like it should be
(27:46):
widely available data. You hear President Trump talking about price transparency.
What about recovery metrics with each rehab center? Like what
if what if they have bad you know, bad track
record that they're our patients don't maintain. You know, I
think this should all be public knowledge.
Speaker 2 (28:04):
Yeah, it's reasonable when you're talking about mortgage in your
house for the third time to send your kid to
the same rehab you've already sent them two twice before. Yes,
and Nicole, I don't want you to hear me wrong.
I am not antip pharmaceutical on everything. I don't want
you to hear that wrong. I'm not. Medications are there,
and they improve our quality of life, and some of
them you have a mortality benefit. We live longer as
(28:25):
a result of treating highpertension or whatever. I'm just saying
that the knee jerk here is as soon as you
have an issue, it's straight to that without some other
things that you could do from a preventative standpoint, and
we start looking at outcomes. You're exactly right, and you
don't even have to start with punishment. Right, Well, your
outcomes are bad and we're going to take your money away.
If my outcomes are bad. As a provider, I'm not
(28:47):
doing the job that I need to do for my
patients who are coming to see me. I want to
know that, and I want to know how I can
use that data to improve my care plan so that
they have better long term outcomes. Right, I mean that's
the reason for it. And so until we start measuring this,
we don't even know what we're doing, if it's successful
or not. And more importantly, we don't know what's successful
(29:09):
for each individual person. We just kind of throw spaghetti
up against the wall and see what sticks.
Speaker 1 (29:13):
Okay, Well, I think these are all amazing and I'm
glad to see everything that you're doing. And you know,
I just I think it's really important that people who
have been on both sides of the exam table have
these conversations, and we need to hold people accountable. And
you know, I can go on my own soapbox and complain, complain, complain,
all day long, but it takes people like you, working
(29:34):
outside of the government to really make sure that these
moneies are being implemented safely. So appreciate all you're doing
and thank you so much for coming on the podcast today.
I'd love to have you back on sometime soon.
Speaker 2 (29:45):
You bet I'd be honored. Nicole. Thank you so much
for shining a lot on it.
Speaker 1 (29:48):
I'm grateful absolutely the functional crisis. It's not abstract. It's
happening in our homes, in our schools, in our emergency
rooms every single day, and we cannot normalize this level
of loss and we can't afford half measures. Real progress
requires prevention, treatment, enforcement, and definitely accountability, all working together.
The lives depend on it. We cannot keep celebrating metrics
(30:11):
like how many people are covered under insurance that have
addiction benefits. That doesn't matter if people are not getting
free from their addictions, if they are not getting clean,
if they are not becoming a productive member of society.
We have to stop treating the papers and the checkboxes
and actually look at the people. Thanks so much for
listening to Wellness on Mass. I'm doctor Nicole Sapphire. Be
(30:33):
sure to listen to Wellness on Mass with doctor Nicole
Sapphire on iHeartRadio wherever you get your podcasts, and we
will see you next time. Happy holidays,
The Clay Travis and Buck Sexton Show News
Hosts And Creators
Clay Travis
Buck Sexton
Show Links
WebsiteNewsletterPopular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
The Bobby Bones Show
Listen to 'The Bobby Bones Show' by downloading the daily full replay.