July 7, 2025 • 42 mins
Discover how stimulating specific points on the ear can dramatically reduce opioid withdrawal symptoms through an FDA-approved device called the ST Genesis. Shelley Halligan, President of Speranza Therapeutics, explains the science behind percutaneous nerve field stimulation and its remarkable effects on patients struggling with addiction.
• The device works by targeting cranial nerves in the ear to activate the parasympathetic nervous system
• Small electrical pulses delivered continuously for five days can significantly reduce withdrawal symptoms
• Clinical applications include shortening the waiting period before starting Suboxone treatment
• The technology may help prevent precipitated withdrawal, a major barrier to recovery
• Patient case studies show dramatic symptom reduction within minutes of application
• Preliminary evidence suggests effectiveness for alcohol and other substance withdrawals
• Research is underway to develop a 10-day version specifically for fentanyl withdrawal
• The device empowers patients by giving them more control over their treatment timeline
• Implementation in emergency settings could transform overdose follow-up care
• Healthcare providers can receive free training to incorporate this technology into practice
Visit speranzatherapeutics.com to learn more about the ST Genesis device and provider training opportunities.
To contact Dr. Grover: ammadeasy@fastmail.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:22):
For 14 years I worked in theemergency department seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
Today we are going to be talkingabout how stimulating the ear
(00:44):
can treat opioid withdrawal.
Now you might be thinking waitwhat?
How does stimulating the eartreat opioid withdrawal?
And I will tell you.
We will go into detail duringthis episode.
Today I speak with ShellyHalligan from the company
Spiranza Therapeutics about adevice that they have which is
(01:05):
FDA approved to treat opioid usedisorder and opioid withdrawal.
It's called the ST Genesis andI have used it in my practice.
Just to be clear, I have nofinancial ties with the company,
but I have used their device totake care of my patients.
Let's go through a fewbackground terms and concepts to
(01:25):
make sure that we are all onthe same page to understand the
discussion that goes on in thisepisode.
First, our body has twoopposing parts of the autonomic
nervous system.
The autonomic nervous system isthe part of our nervous system
that controls our involuntaryfunctions.
We have the sympathetic nervoussystem, and when it's active,
(01:46):
this part of the nervous systemis very stimulating.
It's our fight or flightresponse.
Withdrawal is a fight or flightresponse.
The other part is theparasympathetic nervous system,
and when that one is active it'scalming.
It's the response that our bodyuses when the body needs to
rest and store energy from thefood we eat.
It's often remembered as therest and digest system, and
(02:10):
stimulating the ear, it turnsout, helps us to switch between
these two systems, which is howit helps withdrawal.
Next, shelley mentions a termcalled COWS, and this is an
acronym for Clinical OpioidWithdrawal Scale.
It's how we measure how severea person's withdrawal is.
The higher the number, theworse the withdrawal.
(02:33):
And finally, I am pretty surethat we all know about
precipitated withdrawal, butlet's go over it to make sure
that we're all on the same page.
Precipitated withdrawal is whena medication puts a person into
opioid withdrawal.
Naloxone, also known as Narcan,will do it when it's given to
reverse an overdose, andbuprenorphine, which is in
(02:57):
suboxone and subutex, can alsocause precipitated withdrawal.
People need to wait for aperiod of time after their last
dose of opioid before they areready to take buprenorphine.
Otherwise buprenorphine willcause precipitated withdrawal,
and with that let's learn howstimulating the ear can treat
opioid withdrawal, and it couldalso potentially treat other
(03:20):
withdrawal syndromes too.
Here we go.
Treat other withdrawalsyndromes too, here we go, all
right, well, it's good morningmy time and good afternoon your
time.
Why?
Speaker 2 (03:32):
don't we just start by having you tell us who you
are and what you do?
Absolutely, it's very nice tobe here, dr Grover.
So my name is Shelly Halligan,I'm a board-certified
psychiatric, mental health nursepractitioner and I am the
president of SperanzaTherapeutics.
Speaker 1 (03:44):
How does one become president of a therapeutics
company?
Speaker 2 (03:48):
Well, I have been in the addiction space treating
patients and overseeinginnovations, I would say, for
treatment centers in theaddiction space.
I got introduced to SperanzaTherapeutics in 2019 when I was
the Senior Vice President forAware Recovery Care for Medical
Affairs and Sal Raffinelli, whois the CEO, approached us to use
(04:12):
their ST Genesis device in ourin-home withdrawal management
program.
Speaker 1 (04:17):
I'm always amazed there's such interesting paths
we all take in our careers,absolutely so.
You mentioned the ST Genesisdevice.
I have used it on one of mypatients.
Okay, tell me what it is?
Speaker 2 (04:30):
It is a percutaneous nerve field stimulator that is
applied externally to the earand we have certain locations on
the ear that we target in orderto stimulate the cranial nerves
to address opiate withdrawal.
Speaker 1 (04:45):
How did this technology get discovered?
I mean, I'm going to try to befunny here.
I love the kind of theaccidents of human history Like,
hey, a mold grew and we foundpenicillin.
Right.
Speaker 2 (04:59):
Right.
Well, it's very old medicine ifyou think about acupuncture and
being able to address this.
So it's based in that and it isreally incredible the way that
it works.
I know when I was firstintroduced to the device, I'll
say I was very skeptical and Ithought how this is going to
work on my patients that areexperiencing these extreme
(05:20):
withdrawal symptoms.
This was right.
When we saw a lot of peak offentanyl, the turn from using
heroin to fentanyl and, as youknow, working in addiction
medicine, we were having a verydifficult time treating the
significant withdrawal symptomsand the prolonged withdrawal
symptoms and even startingpatients on Suboxone or other
(05:40):
medications.
So when I was approached withthis device and I was explaining
how it worked, I said, okay,let's see if this thing really
works.
And we tested it out and it did.
Speaker 1 (05:52):
What's the difference between actually just
stimulating an area withacupuncture versus nerve field
stimulation?
Speaker 2 (05:59):
Great question.
So acupuncture usually has asession.
So a patient goes in I'veactually used acupuncture before
for back pain and you're laidon a table and you have
acupuncture and then the noodlesare removed and you leave.
Our device stays on andpulsating for five days.
So real big difference.
A patient with withdrawalsymptoms, as you know, doesn't
(06:21):
have just a moment in time or anhour worth of withdrawal
symptoms.
It lasts for days.
So they're going to need thosesymptoms addressed for a longer
period of time and one sessionof acupuncture.
Although it's helpful and itrelieves a lot of things, it's
not going to give themlong-lasting relief like our
device.
Speaker 1 (06:39):
So make sure I get this right.
There is some sort of nervefield in the ear that, when it's
stimulated, suppresses opioidwithdrawal.
I've heard of auricularacupuncture for withdrawal and
your device uses thisphysiologic state to be able to
provide relief for several daysat a time.
(07:01):
Is that right?
That's correct what?
Speaker 2 (07:03):
is it about the ear?
For several days at a time.
Is that right?
That's correct.
What is it about the ear?
Well, the cranial nerve sitesthat are found on the helix, the
contra and the tragus side ofthe ear stimulate 5, 7, 9, and
10 cranial nerves, majority ofthe vagus nerves.
And how we know that is becausethe response when we put the
device on right I mean you'veseen the device in action and
(07:24):
it's incredible.
So it really you'll see thatthe decrease in blood pressure,
decrease in pulse, theindividuals are able to have a
conversation and reallyunderstand what's going on with
them.
So it's really calming thatautonomic nervous system, being
able to have the restless leg,the pain, all of those things.
I mean it's really incrediblethe way that it works.
(07:46):
I was so impressed with thiswhen we were at AWARE that we
actually did a study with YaleUniversity on this and this
research was published and we'redoing more research now to see
other substances that itaddresses but it's cleared by
the FDA to use on opiatewithdrawal.
Speaker 1 (08:03):
So my former life, before I did addiction medicine,
I was an ER doc and to be an ERdoc you have to know a little
bit about everything, so weoversimplify everything.
So let me see if I can makethis make sense in my former ER
doc brain.
So opiate withdrawal is a statewhere the sympathetic fight or
flight nervous system is inoverdrive and the opposite of
(08:27):
that would be theparasympathetic nervous system,
the rest and digest nervoussystem.
So we are trying to stimulatethe vagus nerve to get the
parasympathetic nervous systemactive to suppress the
withdrawal.
Speaker 2 (08:39):
Is that right?
That is spot on.
Speaker 1 (08:43):
Wow, okay, bravo.
So I've used it on one of mypatients.
He had a very good experiencewith it, except one of the leads
kept coming out.
So talk to me about how yourdevice and your specific
technology, what the devicelooks like, how it's applied and
how a clinician would know thatit's working.
Speaker 2 (09:02):
Okay, the device is very small.
The adhesive is placed on thesoft tissue behind the ear and
then the leads come around andthere's a grounding wire that
goes on the lobe of the ear.
So jewelry has to come out ofthe ear All jewelry does and
then you have a point locatorthat finds the other three sites
and it's placed on.
Just like you said.
Those leads are applied ontothe external part of the ear and
(09:26):
the leads can come out.
We try to do a really good jobof using the adhesive that we
have, as well as other littletricks that we've learned over
the years.
Liquid adhesive is another goodone to be able to keep those
leads on.
We try to instruct individualswith long hair so that they're
not trying to pull their hairout, and we also mark where the
leads go in the ear so that ifthey do come unlodged, we can
(09:48):
have the patient or someone intheir support system reapply
them back onto the site.
That seems to work really well.
Speaker 1 (09:55):
And the leads are basically a very tiny needle and
that it basically punctures theskin and then, because it's
metal, it conducts electricity.
What does the, the deviceitself do?
I mean, I, I saw it on thepatient's neck, it's got
batteries in it, right, and it'sjust electrical, electrical
stimulation that goes throughthose wires and it pulses.
Speaker 2 (10:18):
And if you were to apply the device to your ear, to
my ear, when and I haveactually used it on myself for
back pain and when I wastraveling and you know, when you
first get it applied to the ear, to my ear and I have actually
used it on myself for back painand when I was traveling and
when you first get it applied tothe ear you can almost feel a
little bit of buzzing and youcan hear that and you can feel
tingling in those small littleneedles.
Sometimes if you get it toodirectly right on the nerve it
can be a little bit painful.
(10:39):
So you want to move that,possibly if the patient is
uncomfortable.
But it stays on for that 120hours or five days and it's an
electrical stimulation from thebattery in the device that stays
on and it turns off after fivedays.
Speaker 1 (10:54):
Why five days?
Speaker 2 (10:56):
Well, that was the determination, from when we were
doing the device, of how to getthrough that first 72 hours,
the first three days, which areusually the most intense, and
five days to be able to get theperson cleared from their
significant withdrawal symptoms.
Speaker 1 (11:12):
Was this device developed before fentanyl was
the dominant drug?
Yes, how has its use changedwhen we went from heroin to
fentanyl?
Speaker 2 (11:21):
How it's changed and that's a great question is that
sometimes patients will need twodevices, and one of the things
that we are looking at makingupgrades to the device because,
as we know, addiction medicinethe beast gets bigger right the
illicit drugs get stronger andstronger because the response we
want to have they want more ofa high.
(11:42):
So if individuals getaccustomed to that, here comes
fentanyl and then we have alarger dose of fentanyl.
I'm hearing from providers nowand I've experienced this myself
that the Suboxone that weprovide just really isn't
answering the fentanylwithdrawal.
I mean, you see that right, andso individuals are coming off
of that using on top of thatmedication.
So what we're seeing is thatwe're looking just to have a
(12:06):
10-day device that stays activefor 10 days to be able to answer
that.
What we're teaching andinstructing providers now and
even patients, is to do theirbest to have a higher CAL score,
meaning a higher withdrawalsymptoms, to be able to start
the device so that you don'thave to use two devices.
We want to be able to respondto the need without increasing
the cost.
That's not our wish.
(12:26):
We want to be able to addressthis and be able to get people
to get better and to be able toanswer that.
So we are looking to create a10-day device because of that
very thing.
Speaker 1 (12:36):
If people put the device on before their last dose
of opioid, does it preventwithdrawal?
Speaker 2 (13:01):
did a study and she actually placed the device on
when people were still activelyusing and she was able to
prevent the withdrawal andprevent precipitated withdrawal
and started her patients onlong-acting Brixati and that's
an incredibly interesting study.
Yeah, exactly, and this waspatients that were very
vulnerable and so they, you know, very difficult coming back.
We see that a lot, right, youknow, patients that are homeless
or are having housing issues,etc.
So she got very creative withthis population as she was
(13:24):
giving them this long-actinginjectable, which actually saved
many of her patients' lives andkept them coming back.
That's genius, right, that isgenius vice you can prevent
precipitated withdrawal, which Ilove as well so I do all
outpatient in my practice so youget the device on and you can
start the patient sooner thanyou would.
(13:45):
You know a lot of patients arenot able to wait that period of
time because of thatprecipitated withdrawal that we
see and they're so fearful of it.
I've had so many patients thathave been placed in precipitated
withdrawal and they end up inthe emergency room and they have
to go out and use, et cetera.
So this gives them theopportunity to be able to
prevent that and she sawincredible results from that.
Speaker 1 (14:10):
So let me ask you a couple of clinical scenarios.
So a person is using fentanyland they want to stop.
As they go into the withdrawal,you put the device on.
How long do you wait before youdose the Suboxone?
Speaker 2 (14:26):
It's going to really depend on the patient, right,
I'm going to let them prettymuch lead the treatment, and
this is another reason I reallylike the device.
So a lot of times in addiction,in early recovery, you have a
lot of people making a lot ofdecisions for the patient, right
, telling them what to do, whento go, what to do.
None of us like that, you know.
None of us enjoy that, butespecially someone who has a
(14:46):
trauma response, that has traumain their life, which is a large
portion of our patients withsubstance use disorder, and so
that control is very important.
Also in experience of seeingthis and working in this field,
also in experience of seeingthis and working in this field,
patients that direct or guidetheir treatment have a better
long-term outcome.
I see that when they're sayingyou know, I want to do this, I
(15:08):
don't want to go inpatient, Iwant to do this, and sometimes
it's not the right decision.
But if they're directing andthey're saying, okay, I want to
do this, it's a great trustingrelationship and that's
important as providers to builda trust with that patient.
So when the patient is sayingI'll put the device on, I will
work with them, I'll say let'sgo as long as we possibly can,
until you can't stand it.
(15:29):
And they're okay, I got it.
And they can call at threeo'clock in the afternoon or 10
o'clock at night and say I'mgoing to use and if okay, let me
just call you in something, letme get you on a Valium for the
night, let me put something inyour system to get you through
until I could see you tomorrowmorning.
Speaker 1 (15:48):
Get them through as long as possible before you can
put the device on.
So I'm currently telling mypatients and I don't know where
three days came from, but thatseems to be the prevailing
wisdom with my colleagues hereon the central coast of
California that from fentanyl tosuboxone, three days waiting is
pretty good to avoidprecipitated withdrawal.
Can you shorten that when theST Genesis is running?
Speaker 2 (16:08):
Absolutely, and that's the thing that we want to
do.
Three days is.
You know, if somebody was totell me, don't eat sugar for the
next three days or don't drinkcoffee for three days, no
problem, I got you.
Three days without using anopiate.
If you're an active withdrawalis like 30 days without a glass
of water.
I mean, it's nearly impossible.
I don't even want to say that Iunderstand it.
(16:29):
I've never been through it, soI certainly don't want to.
But I've seen enough patientsand have enough respect for
withdrawal symptoms to be ableto say that's an impossible ask.
A lot of times, and what we'vealso seen when we ask
individuals to wait that long,they may do 48 hours, and then
48 hours that next night they'regoing out and they're buying an
illicit substance and we'reputting their life on the line
(16:52):
and so it's really verydangerous for our patients and
for their families, et cetera.
So being able to shorten thatwindow by 48 hours if they wait
24 hours to put the device onand you can start them on a
protective medication, you'resaving that individual's life.
Speaker 1 (17:07):
Well said.
Do people ever use the deviceto just get through opiate
withdrawal completely and thenget on naltrexone?
Speaker 2 (17:15):
They do, they do and again I look at the lethality of
what they're using, how muchthey're using, what route
they're using, etc.
And then also their history.
They have an overdose history,you know.
Have they attempted to taketheir life, etc.
Things like that and I will domy best to educate them on the
best medication regime for them.
(17:35):
Again, this is going to betheir recovery and I want them
to make those decisions and theyhave done that and I've done
that.
Actually, I've gone fromSuboxone onto Naltrexone.
I have had patients that havegone from fentanyl use onto
Naltrexone and they've done welland I've been able to do that.
And that can be a delicatedance as well.
As you know.
The device can also be used at,let's say, that you're at the
(18:07):
end of treatment with a patient.
I've had patients that havebeen on Suboxone for eight, nine
years and they want to come offof it.
And I had a woman that she wasactually going abroad to study
and she had been on Suboxone fornine years and she wasn't going
to be able to get it where shewas going.
So we worked with her for threemonths, got her down in her
does and we used the device toget her off completely before
she traveled.
Speaker 1 (18:23):
Yeah, I have the same experience as you do, that it's
very hard to get on naltrexonebecause you have to get all the
way off of opioids to get onnaltrexone.
I only have one patient onnaltrexone for opioid use
disorder because nobody can takethe withdrawal.
Most of them go to methadone orsuboxone.
That is a very interesting idea.
Fentanyl to naltrexone.
I don't think I would havebelieved that if you had told me
(18:45):
, but of course I wasn'tfactoring in using the Genesis
device.
Speaker 2 (18:52):
I wouldn't have believed it either.
I wouldn't have believed thethings that I am saying if I
hadn't have seen this over 300and something times that I've
used the device and our nursethat has applied it.
It's just been.
It's blown me away to see thepatient's response and how well
they do when using the deviceand how they have long-term
(19:12):
recovery.
I got a text yesterday from amother and she's incredible, but
her son.
We used the device on him ninemonths ago and he just
celebrated nine months of hisrecovery and he's on Suboxone.
He's doing very well.
We used the device on him andshe is just such a fan.
You know she's just likenothing else has worked for this
young man because he was ableto not have the significant,
(19:34):
severe withdrawal symptoms thathe's experienced for his whole
entire life of using and that'sbeen about 15 years.
He's almost 40 years old andhe's doing very well.
He's got a job.
He's still living with hisparents, but he's doing great.
Speaker 1 (19:49):
So thinking again back to how this device works,
right, withdrawal is thesympathetic fight or flight
state and we are turning on theparasympathetic rest and digest
state.
Wouldn't that mean it wouldwork for other withdrawal
syndromes besides just opioids?
Speaker 2 (20:05):
That is exactly what we are doing research on right
now.
So we have a very largetreatment center that we are
working with and we are testingthis with alcohol,
benzodiazepines and amphetamines.
I have used it off-label in myown practice for those, as well
as for cannabis withdrawal.
Used it off-label in my ownpractice for those, as well as
for cannabis withdrawal.
Where we are, we have a prettysignificant problem with
individuals using cannabis andcoming off of it and there's not
(20:33):
a lot of resources.
Detox doesn't even reallyaccept that.
So, using this device, I'veused it successfully with
alcohol.
I have never had a patient thatwas solely on benzodiazepines as
an abuse drug to be able to useit on.
I have.
I mean, obviously I've detoxedpatients on benzos, using benzos
on a taper schedule, right, butthe device I haven't had the
opportunity to do that.
I think that's a rarer animal,it's an individual that are just
(20:53):
using benzodiazepines.
I know they exist, but Ihaven't run across that
personally.
Alcohol incredibly successful,incredibly successful using it.
But, as I said, it's FDAcleared for opiate withdrawal,
so it would be off-label and, ofcourse, as a provider, you
could use things off-label.
But we are actually applyingfor it to get approved for more
devices Because, as you said,it's that reward pathway.
(21:15):
It's the same thing, it's goingto work, but I've seen it work
incredibly well with alcoholsame thing.
Speaker 1 (21:21):
It's going to work.
But I've seen it workincredibly well with alcohol.
Okay, so same question Sincethe device turns off that
sympathetic fight or flightresponse and turns up the
parasympathetic rest and digestresponse, can it work for PTSD?
Speaker 2 (21:34):
I have not tried it for PTSD.
I'm going to say that itabsolutely will work with that
because I think majority of ourpatients with substance use
disorder experience PTSD.
Right, I mean active use itselfis traumatic.
You listen to our patient'sstories.
I had a patient not too longago.
He was incarcerated for 32years.
(21:54):
32 years of this man's life hespent incarcerated and you know
the story that he has told wasjust chilling right, of what his
experience was.
So he didn't even realize thathe has PTSD.
But any individual that livestheir life and they spend enough
time using substances alcohol,drugs, whatever it is they're
going to have trauma, right.
(22:15):
And so I absolutely believethat it would work with PTSD.
Speaker 1 (22:20):
I will tell you that I have PTSD from my 14 years as
an ER doc, yeah, and I actuallychatted with my therapist
yesterday about triggering, andit's really weird.
I will be totally fine, andthen, all of a sudden, I am in
fight or flight mode, and mypatients tell me a very similar
story.
I guess the only question withthe device, though, is could you
(22:43):
use it continuously for morethan 10 days?
If it helped with PTSDtriggering?
Are there any major sideeffects?
Speaker 2 (22:51):
No side effects that we know of At this point, though
the battery lasts for five days, so it wouldn't have that
electrical stimulation for along period of time.
The other thing that you justmentioned about you don't know
when it's going to occur, so ifit's something that is more
triggered instead of continuous,we'd have to put it on when
it's happening.
I was in the ER for many yearsmyself.
(23:11):
I understand that.
I think many of us inhealthcare I mean, you're going
to have vicarious trauma, evenif you don't have trauma
yourself.
But when you see someone walkinto your ER with an ax in their
head or a child, if you've doneCPR, which we have on children,
and we've got the stories.
My son-in-law is a statetrooper.
He has PTSD.
So many different areas ofindividuals that could benefit
(23:33):
from this.
I also think that there aresome neuromodulation that occurs
when using the device, so Ithink there's an area that we
could look at that it maybehelps long-term with also pain
and with PTSD.
Speaker 1 (23:47):
And again we're getting a little off topic here,
but I was just imagining beingable to reach back behind your
ear and turn it on whentriggered, Right yeah, and I'm
fascinated to hear that thisalso works for alcohol
withdrawal.
Given the mechanism of actionof the technology, it makes
perfect sense.
Speaker 2 (24:04):
It's incredible, it really is, and I got so excited
using the device and sointerested in seeing what other
things that it worked for.
I'll tell you the first patientthat we used it on was a
26-year-old male it was theheight of COVID right when it
happened and it was a young man.
He was in Connecticut and hewas in his home and no one was
(24:27):
taking patients inpatient.
Everyone was kind of stopped intime and this young man was
using methamphetamines, fentanyland he was using cannabis and
we had a nurse go out and weplaced the device on this young
man.
He had been in 16 treatmentcenters.
I did not feel like this wasgoing to go well at all.
He was combative, the home wasin disarray, his parents were
just beside themselves, he hadattempted suicide A very
(24:50):
significant case, reallysignificant and if it had not
been COVID, I would not havechose this as the first patient
that I used this device on, butwe did and he had a Cal score of
24.
Speaker 1 (24:59):
Wow.
Speaker 2 (25:00):
When we put him in.
I mean it was significantDiaphoretic, he was tachycardic,
I mean everything that you canthink of, just extremely
volatile.
And we placed the device on andin 20 minutes he went outside
to smoke a cigarette with hisfather.
The nurse had got me on a Zoomcall and I was on Zoom watching
this scene and I was thinkingwe're fixing to go to the
(25:22):
emergency room.
That's why I was just about tosay call an ambulance and he
came back in from smoking acigarette and he had a cow score
of six.
I said did he use somethingthere's?
I just can't believe this, butit was the device.
It was the device.
So he ended up doing incrediblywell.
At day three, I was checking inwith this young man for three
(25:44):
days.
That night, after we placed thedevice, he sat down and had
dinner with his family.
His mother called us and saidmy son is sitting down eating
dinner with us.
I couldn't believe it.
He had zero medications onboard.
Now, day two, we did start himon clonidine and gabapentin.
To be completely transparent,he was having significant
restless leg and he was stillfeeling anxious.
(26:04):
So we did put him on clonidine.
We did start him on gabapentinand I think might have put him
on Bentol, but he did very, verywell without any other
medication and he ended up goingon Suboxone after four days and
he did great after four daysand he did great.
Speaker 1 (26:25):
I wonder if some of his impulsivity was PTSD and the
device, in addition to treatinghis withdrawal, suppressed some
of his triggering, which iswhat allowed him to sit down and
eat dinner.
Speaker 2 (26:32):
He did have significant PTSD.
His opiate addiction startedbecause he was a lacrosse player
and he had a significant injury.
His entire future was justerased because of his injury.
So he lost his scholarship, helost his future with that and
then he started this heavyopioid addiction.
He was prescribed Percocet fora year.
A year-long Percocet is aprescription, so after that, you
(26:55):
know, he lost everything.
He was still living at home, hedid not find a job, he did not
find a future and so he hadsignificant, significant trauma.
So absolutely I don't thinkthat that's outrageous to think
(27:17):
of.
As I said before, the patientbeing able to have a voice and
not have everybody else makingdecisions for them is that if
either any of us were in theamount of pain and significant
withdrawal symptoms that ourpatients are in, we would say
yes to anything.
Yes, yes, yes, just get me offof this.
So I think our patients andwhat I see is that they say yes
to things that they don't reallyknow what that means long term.
(27:41):
So the young lady that I wastalking about, that was going
abroad to study, she explainedlike her situation.
She said I said yes to Suboxone.
I didn't even know what thatmeant.
I didn't know that I was goingto have to come in the provider
that she was going to.
She had to come in every weekfor the first two months and
then do groups and thesedifferent things.
(28:01):
She didn't really know what shewas saying yes to.
I think that happens quiteoften with our patients.
They say yes to these things toget them out of that moment and
then they're not really surewhat they've signed up for.
Speaker 1 (28:11):
I would agree with that.
Speaker 2 (28:14):
And it may be a life-saving event at that moment
.
But again, I think, to havelong-term recovery and long-term
the patient is saying yes toit's just like informed consent
we need to be able to reallyexplain.
What does this mean if we'regoing to start you on methadone?
What does it mean if you'regoing to go on Vivitrol, just
any medication that we prescribeWith SSRIs?
(28:36):
We have to do a lot ofeducation, teaching, black box
warning, things like that but alot of times with other
medications we don't do as mucheducation what that's going to
mean for their life.
Speaker 1 (28:47):
So the patient that I used it on was a gentleman that
had been on methadone for painand unfortunately there was an
issue with his methadoneprescription and he couldn't get
it and went into horriblewithdrawal, didn't know what to
do.
So a friend said he had someoxycodone, which of course
(29:07):
wasn't oxycodone, it wasfentanyl.
And so he just was usingfentanyl and came to his next
appointment and got a methadonerefill and didn't think to say
anything because he thought itwas oxycodone.
And then on his urine drug testhe was positive for fentanyl
and he was in withdrawal onmethadone at his old dose
because the fentanyl had broughthis tolerance and dependence up
(29:28):
on him.
And he came into the office andwe did a Zoom call with one of
your nurses.
She was wonderful, helped meput the device on and in an
instant he noticed a difference.
It came on very quickly and theonly issue for him was I
couldn't get one of the leads tostay in place.
(29:48):
And that's probably you know me, never having done this before.
What are you working on interms of innovating the device?
Could you change the technologyso it sticks better, or does it
have to be electrodes?
We're always looking toinnovate as humans.
What are you looking toinnovate with the ST Genesis?
Speaker 2 (30:04):
Yeah, great question and we are looking at several
different things and we areworking on implementation, the
10-day, like I said, the otherthing is making it waterproof
because people want to showerand they want to work out or et
cetera.
It doesn't really become anissue.
You know, we tell people theycould put a shower cap on it or
how to not get it soaking wet,and then the leads, the wires
that come around.
We want them to be lessinvasive, some technology around
(30:27):
that so it doesn't have thatcapability of pulling those
leads out and better adhesive ifthose things can't happen.
As I said, rosemary is who thenurse I think was working with
you.
She's phenomenal and you knowthat's the other thing when you
have somebody that understandsthe technology and also gets so
into it.
I can nerd out on this stuff somuch because it's so
(30:48):
fascinating to me and I lovebeing able to offer patients
these innovations and these newways to be able to treat their
symptoms.
But that can be something thatif one of the leads comes out
again they're going to have areturn of symptoms, and we don't
want that.
Speaker 1 (31:02):
Yeah, the gentleman is now back on methadone and
doing great.
My experience was that he camein, we put it on and literally
as soon as I turned it on, hefelt something and for him, a
couple of unique issues.
He had hearing aids, so weobviously took those out.
Rosemary was exactly the nurseI worked with.
She was awesome, and what Iended up doing is he was doing
(31:27):
great in the office and when hewent to sleep is when the lead
came out.
So he came back to see me thenext day and then I tried to
reinforce it and then he went tosleep again and dislodged it
again the next day.
Is there a way that you tellpeople to sleep to avoid the
device getting dislodged?
Speaker 2 (31:46):
We do.
You know a lot of times if wecan put, like I said, the liquid
adhesive that works really wellto be able to keep it on.
I know when we have had thatproblem or individuals that have
pulled it loose or it comesloose during their sleep.
If we mark that site then theycan push that right back on.
And so it just depends on wherethe site, where you find it.
(32:08):
The ear can be very tricky rightto be able to keep anything on.
It's not a smooth surface,there's no fat tissue there,
it's a very cartil.
Anything on it's not a smoothsurface, there's no fat tissue
there, it's a very cartilagy.
It's a very awkward place.
So those small little needles,if you get it right in the right
place, putting that liquidadhesive on to be able to keep
it on, is the best way to do itDuring the night.
If we can have them lie on theright side instead of on the
(32:29):
left side, if they can avoid itright, if they're sleeping so
soundly they move over, thatmeans the device is working
great.
So I'm actually happy thatthey're saying I didn't even
know what I was doing.
So if they're sleeping, thatmeans the device is working
great.
Speaker 1 (32:41):
I was going to ask and I believe this is true, but
I have not actually fact-checkedthis.
I remember hearing thateveryone's ear shape is unique,
like their fingerprint.
Are there certain ear shapesthat this device it's easier to
use or harder to use.
Speaker 2 (32:59):
I don't know if it's necessarily ear shape, maybe.
So I mean, a very small ear ismore difficult, just like
anything else.
You don't have as muchlandscape right, so that it's
difficult to do Individuals thatare much older adults the skin
is sagging.
It's a little bit moredifficult to adhere If they have
a lot of piercings in their ear.
That also can be difficultbecause they may have moved
(33:21):
things around quitesignificantly.
You know, I think that it'sreally more about making sure
that the person places it in thecorrect way and with enough
adhesive, and finding the rightsites, and that's something that
we do a really good job of.
And, as you've had experiencehaving individuals that are
really knowledgeable about theear, I've never learned so much
about one part of the body in mylife, right so much about the
(33:44):
ear and, like you said, it islike a fingerprint.
I didn't realize either thatevery single person is different
.
It's unique to them and as weage, things in our body move and
shift.
So where my tragus site wasfive years ago, it's probably in
a different location five yearslater.
What if someone has?
Speaker 1 (34:00):
cauliflower ear.
Speaker 2 (34:02):
You would want to use the other ear if they have that
.
So any deformity in the ear.
You would want to use theopposite ear if they have that.
We like to use the left ear,but we can use the right.
Speaker 1 (34:13):
According to WikiHow, we all have different ear
shapes.
That's not peer-reviewed, butthat's what I found on Google in
the last 10 seconds.
Speaker 2 (34:25):
Well, I can send you some journal articles that speak
to that and as well as somecriminal investigations where
they have actually used theperson's ear for criminal things
like that, to be able toidentify the person.
So it's interesting and again,I am not an expert.
I want to clarify that I'venever taken ear imprints.
I don't know, but I do know byusing this device as often as I
(34:46):
have.
It's very unique.
Everyone's ear looks verydifferent.
Speaker 1 (34:49):
What other devices does your company make?
Speaker 2 (34:52):
This is it.
The ST Genesis is the onlydevice that we have.
We are a pharmaceutical companyas well and have some
pharmaceutical medications, butthey're not related to substance
use, and I'm overseeing onlythe ST Genesis and Speranza.
Speaker 1 (35:04):
How did you get interested in addiction medicine
?
Speaker 2 (35:17):
I saw many of our patients that came in with
substance use disordercomplications and it became very
dear to me just because I sawmany of those individuals being
not treated very well,especially in the emergency
department.
And this isn't to say that itwas anyone's fault, necessarily,
but a lot of times in theemergency room we are very, very
busy.
We're working on very seriouscritical emergencies,
life-threatening emergencies,and so individuals that come in
(35:38):
with substance use disorder thatare not in that
life-threatening situation,we're put in the hall, put in
different places, and I justfelt a big soft spot for them
and I thought I want to make adifference.
And when I went back to schoolI found a niche that I felt very
good about.
I really enjoyed it.
I enjoy the population, Iunderstand the disease very,
(35:59):
very well and I'm able to reallyconnect with my patients on a
level that I'm not sure that alot of people really enjoy it.
I really do, I really enjoy it.
I love seeing people get better.
I love seeing people's livescompletely change, and you don't
get to see that in other areasof medicine.
Speaker 1 (36:16):
Lives completely change and you don't get to see
that.
In other areas of medicine.
I've had a very similarexperience to yours, that I got
tired of having people come intothe emergency department and
not knowing what to do and notknowing how to help Right.
So, I've had the same experienceas yours that getting to be an
expert in the field of addictionhas been really enjoyable and
patients are really gratefulwhen they are treated with
(36:37):
respect.
The patient that I put it onmyself felt like a VIP, that he
got to try this device out andhe was very grateful.
And again we finally got himback on his methadone and his
tolerance came down and, yeah,how does it work with insurance?
Speaker 2 (36:54):
Well, we're working with several insurance companies
.
Private insurance does have areimbursement.
We would like to and we'reworking towards getting Medicaid
to be able to reimburse thedevice.
That is the majority of ourpatients and I absolutely know
because of the work that I doand pro bono, I'll work with
patients that don't have fundsto be able to do this, to be
able to place the device.
(37:14):
I know what a difference itmakes in their life.
I know what a difference itwould make in the emergency room
if we had this device.
Imagine all your patients thatcome into the emergency room
that you give Narcan that leaveAMA Massive number of
individuals If you were to placethis device on them, prevent
precipitated withdrawal and beable to give them an injection
before they leave.
It would just be a game changerfor so many individuals and
(37:38):
also save time, save our staffburden.
We have so much burden on staffnurses, physicians, dos, nurse
practitioners that are wantingto be able to address the
problem but can't because oftime and shortage.
This would be able to answer somany of those problems.
Emts out in the field to beable to use this after they if
they Narcan individuals, becausewe know it gives the
(37:58):
individuals their right intoprecipitated withdrawal.
They don't want to stay, theywant to go back out and use and
they want relief of theirsymptoms.
Speaker 1 (38:05):
Yeah, I was just thinking and I realize nothing
in health care in America is,unfortunately ideal.
But I really think the idealcase for what you've described
is for patients with opioidaddiction is placing a device
like this that suppresseswithdrawal and then immediately
starting a long-actinginjectable buprenorphine product
.
What's really ironic is here inCalifornia our Medicaid is
(38:29):
called Medi-Cal.
Medi-cal covers the long-actinginjectable buprenorphine
products.
No issue, right, and thecommercial insurances are a
disaster.
So actually I'm thinking of oneof my patients right now who
his insurance denied hislong-acting injectable
buprenorphine.
I'm going to send himinformation about this to see if
he'd be interested, because hedoes have commercial insurance.
(38:51):
So the one-two punch would beis if we could make it easy to
start a patient on Nerve FieldStimulation in the ear and then
put them on long-actinginjectable buprenorphine.
Speaker 2 (39:02):
Absolutely.
I've written a protocol for it.
It's something that just is avery no-brainer to me,
absolutely.
And you're talking about alarge portion of our population
that again have difficulty withtransportation, with housing,
getting to appointments.
If they have the long actioninjectable on board, they have
an easier time and a largerwindow than if they were to have
an oral Suboxone or tablets,right?
(39:23):
So it's really important thatwe look at how can we save and
help this larger portion of thepopulation that are really in
need.
This is to me, like you said,it's a no-brainer.
But it doesn't always seem tobe a no-brainer in health care
sometimes.
Speaker 1 (39:38):
I was going to try to make a pun and say it's a
no-earer, but that didn't seemto follow.
Speaker 2 (39:44):
We can laugh about it .
Speaker 1 (39:45):
Yeah, I'm sure wherever my daughter is right
now she's rolling her eyes at mybad dad humor.
I tell my daughter once youhave a kid, your humor just
falls apart.
Speaker 2 (39:55):
All you do is dad jokes.
It's horrible.
Well, it's because everythingis funny to you and then I just
became a grandmother.
That's even funnier when youget to see your child raising
their kids.
You're like oh, I'll rememberthat.
Speaker 1 (40:06):
Well, I think we've covered about all of my
questions.
I am so excited to start givingpatients information about this
and I think the issue for me ismost of my patients have
Medicaid.
I have a handful who haveopioid addiction and private
insurance.
So I'm thinking of onegentleman.
I'm going to send himinformation about your product
(40:27):
later today.
Well, regrettably we are at mytime stop because I have to go
get my daughter from Taekwondocamp.
Anything you'd like to leave uswith as we wrap up?
Speaker 2 (40:37):
Yeah, if you're interested, you know, visit us
at spronzotherapeuticscom.
There is a hotline there thatwe can answer any questions.
We are always looking forproviders to get trained.
I just actually contacted youlast week about a patient that
called our hotline.
One thing that you know I wouldreally love is to be able to
train as many physicians,addiction medicine providers as
we possibly can.
Nurse practitioners across thecountry.
(40:59):
We have many, but we need manymore.
So we're always looking totrain.
It's free, it doesn't costanything.
We're a great team, as you'vehad the experience really
enjoyable working with ourproviders.
We partner really more thanjust try to sell a product.
We really want patients to dowell and to be able to expand
your practice.
So if you're interested, visitus at espranzatherapeuticcom or
(41:22):
give us a call and we'll talk toyou about more how to get
trained.
Speaker 1 (41:26):
Well, I have to say, I've learned a ton and, as I
like to say to my podcast guests, I will be a smarter doctor
next week.
So thank you so much and Ireally appreciate your time.
I'm just copied the link foryour website to send to one of
my patients later today.
Speaker 2 (41:41):
I appreciate it so much, dr Grover, and I really do
appreciate you and yourinnovation and thank you for the
kindness and dedication andcompassion that you treat our
patients with.
It's really, really inspiring.
Speaker 1 (41:53):
Before we wrap up, a huge thank you to the Montage
Health Foundation for backing mymission to create fun, engaging
education on addiction, and ashout out to the nonprofit
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdoses.
(42:14):
Word out about how to treataddiction and prevent overdoses
To those healthcare providersout there treating patients with
addiction.
You're doing life-saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together we can make it happen.
(42:35):
Thanks for listening andremember treating addiction
saves lives.
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:22):
For 14 years I worked in theemergency department seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
Today we are going to be talkingabout how stimulating the ear
(00:44):
can treat opioid withdrawal.
Now you might be thinking waitwhat?
How does stimulating the eartreat opioid withdrawal?
And I will tell you.
We will go into detail duringthis episode.
Today I speak with ShellyHalligan from the company
Spiranza Therapeutics about adevice that they have which is
(01:05):
FDA approved to treat opioid usedisorder and opioid withdrawal.
It's called the ST Genesis andI have used it in my practice.
Just to be clear, I have nofinancial ties with the company,
but I have used their device totake care of my patients.
Let's go through a fewbackground terms and concepts to
(01:25):
make sure that we are all onthe same page to understand the
discussion that goes on in thisepisode.
First, our body has twoopposing parts of the autonomic
nervous system.
The autonomic nervous system isthe part of our nervous system
that controls our involuntaryfunctions.
We have the sympathetic nervoussystem, and when it's active,
(01:46):
this part of the nervous systemis very stimulating.
It's our fight or flightresponse.
Withdrawal is a fight or flightresponse.
The other part is theparasympathetic nervous system,
and when that one is active it'scalming.
It's the response that our bodyuses when the body needs to
rest and store energy from thefood we eat.
It's often remembered as therest and digest system, and
(02:10):
stimulating the ear, it turnsout, helps us to switch between
these two systems, which is howit helps withdrawal.
Next, shelley mentions a termcalled COWS, and this is an
acronym for Clinical OpioidWithdrawal Scale.
It's how we measure how severea person's withdrawal is.
The higher the number, theworse the withdrawal.
(02:33):
And finally, I am pretty surethat we all know about
precipitated withdrawal, butlet's go over it to make sure
that we're all on the same page.
Precipitated withdrawal is whena medication puts a person into
opioid withdrawal.
Naloxone, also known as Narcan,will do it when it's given to
reverse an overdose, andbuprenorphine, which is in
(02:57):
suboxone and subutex, can alsocause precipitated withdrawal.
People need to wait for aperiod of time after their last
dose of opioid before they areready to take buprenorphine.
Otherwise buprenorphine willcause precipitated withdrawal,
and with that let's learn howstimulating the ear can treat
opioid withdrawal, and it couldalso potentially treat other
(03:20):
withdrawal syndromes too.
Here we go.
Treat other withdrawalsyndromes too, here we go, all
right, well, it's good morningmy time and good afternoon your
time.
Why?
Speaker 2 (03:32):
don't we just start by having you tell us who you
are and what you do?
Absolutely, it's very nice tobe here, dr Grover.
So my name is Shelly Halligan,I'm a board-certified
psychiatric, mental health nursepractitioner and I am the
president of SperanzaTherapeutics.
Speaker 1 (03:44):
How does one become president of a therapeutics
company?
Speaker 2 (03:48):
Well, I have been in the addiction space treating
patients and overseeinginnovations, I would say, for
treatment centers in theaddiction space.
I got introduced to SperanzaTherapeutics in 2019 when I was
the Senior Vice President forAware Recovery Care for Medical
Affairs and Sal Raffinelli, whois the CEO, approached us to use
(04:12):
their ST Genesis device in ourin-home withdrawal management
program.
Speaker 1 (04:17):
I'm always amazed there's such interesting paths
we all take in our careers,absolutely so.
You mentioned the ST Genesisdevice.
I have used it on one of mypatients.
Okay, tell me what it is?
Speaker 2 (04:30):
It is a percutaneous nerve field stimulator that is
applied externally to the earand we have certain locations on
the ear that we target in orderto stimulate the cranial nerves
to address opiate withdrawal.
Speaker 1 (04:45):
How did this technology get discovered?
I mean, I'm going to try to befunny here.
I love the kind of theaccidents of human history Like,
hey, a mold grew and we foundpenicillin.
Right.
Speaker 2 (04:59):
Right.
Well, it's very old medicine ifyou think about acupuncture and
being able to address this.
So it's based in that and it isreally incredible the way that
it works.
I know when I was firstintroduced to the device, I'll
say I was very skeptical and Ithought how this is going to
work on my patients that areexperiencing these extreme
(05:20):
withdrawal symptoms.
This was right.
When we saw a lot of peak offentanyl, the turn from using
heroin to fentanyl and, as youknow, working in addiction
medicine, we were having a verydifficult time treating the
significant withdrawal symptomsand the prolonged withdrawal
symptoms and even startingpatients on Suboxone or other
(05:40):
medications.
So when I was approached withthis device and I was explaining
how it worked, I said, okay,let's see if this thing really
works.
And we tested it out and it did.
Speaker 1 (05:52):
What's the difference between actually just
stimulating an area withacupuncture versus nerve field
stimulation?
Speaker 2 (05:59):
Great question.
So acupuncture usually has asession.
So a patient goes in I'veactually used acupuncture before
for back pain and you're laidon a table and you have
acupuncture and then the noodlesare removed and you leave.
Our device stays on andpulsating for five days.
So real big difference.
A patient with withdrawalsymptoms, as you know, doesn't
(06:21):
have just a moment in time or anhour worth of withdrawal
symptoms.
It lasts for days.
So they're going to need thosesymptoms addressed for a longer
period of time and one sessionof acupuncture.
Although it's helpful and itrelieves a lot of things, it's
not going to give themlong-lasting relief like our
device.
Speaker 1 (06:39):
So make sure I get this right.
There is some sort of nervefield in the ear that, when it's
stimulated, suppresses opioidwithdrawal.
I've heard of auricularacupuncture for withdrawal and
your device uses thisphysiologic state to be able to
provide relief for several daysat a time.
(07:01):
Is that right?
That's correct what?
Speaker 2 (07:03):
is it about the ear?
For several days at a time.
Is that right?
That's correct.
What is it about the ear?
Well, the cranial nerve sitesthat are found on the helix, the
contra and the tragus side ofthe ear stimulate 5, 7, 9, and
10 cranial nerves, majority ofthe vagus nerves.
And how we know that is becausethe response when we put the
device on right I mean you'veseen the device in action and
(07:24):
it's incredible.
So it really you'll see thatthe decrease in blood pressure,
decrease in pulse, theindividuals are able to have a
conversation and reallyunderstand what's going on with
them.
So it's really calming thatautonomic nervous system, being
able to have the restless leg,the pain, all of those things.
I mean it's really incrediblethe way that it works.
(07:46):
I was so impressed with thiswhen we were at AWARE that we
actually did a study with YaleUniversity on this and this
research was published and we'redoing more research now to see
other substances that itaddresses but it's cleared by
the FDA to use on opiatewithdrawal.
Speaker 1 (08:03):
So my former life, before I did addiction medicine,
I was an ER doc and to be an ERdoc you have to know a little
bit about everything, so weoversimplify everything.
So let me see if I can makethis make sense in my former ER
doc brain.
So opiate withdrawal is a statewhere the sympathetic fight or
flight nervous system is inoverdrive and the opposite of
(08:27):
that would be theparasympathetic nervous system,
the rest and digest nervoussystem.
So we are trying to stimulatethe vagus nerve to get the
parasympathetic nervous systemactive to suppress the
withdrawal.
Speaker 2 (08:39):
Is that right?
That is spot on.
Speaker 1 (08:43):
Wow, okay, bravo.
So I've used it on one of mypatients.
He had a very good experiencewith it, except one of the leads
kept coming out.
So talk to me about how yourdevice and your specific
technology, what the devicelooks like, how it's applied and
how a clinician would know thatit's working.
Speaker 2 (09:02):
Okay, the device is very small.
The adhesive is placed on thesoft tissue behind the ear and
then the leads come around andthere's a grounding wire that
goes on the lobe of the ear.
So jewelry has to come out ofthe ear All jewelry does and
then you have a point locatorthat finds the other three sites
and it's placed on.
Just like you said.
Those leads are applied ontothe external part of the ear and
(09:26):
the leads can come out.
We try to do a really good jobof using the adhesive that we
have, as well as other littletricks that we've learned over
the years.
Liquid adhesive is another goodone to be able to keep those
leads on.
We try to instruct individualswith long hair so that they're
not trying to pull their hairout, and we also mark where the
leads go in the ear so that ifthey do come unlodged, we can
(09:48):
have the patient or someone intheir support system reapply
them back onto the site.
That seems to work really well.
Speaker 1 (09:55):
And the leads are basically a very tiny needle and
that it basically punctures theskin and then, because it's
metal, it conducts electricity.
What does the, the deviceitself do?
I mean, I, I saw it on thepatient's neck, it's got
batteries in it, right, and it'sjust electrical, electrical
stimulation that goes throughthose wires and it pulses.
Speaker 2 (10:18):
And if you were to apply the device to your ear, to
my ear, when and I haveactually used it on myself for
back pain and when I wastraveling and you know, when you
first get it applied to the ear, to my ear and I have actually
used it on myself for back painand when I was traveling and
when you first get it applied tothe ear you can almost feel a
little bit of buzzing and youcan hear that and you can feel
tingling in those small littleneedles.
Sometimes if you get it toodirectly right on the nerve it
can be a little bit painful.
(10:39):
So you want to move that,possibly if the patient is
uncomfortable.
But it stays on for that 120hours or five days and it's an
electrical stimulation from thebattery in the device that stays
on and it turns off after fivedays.
Speaker 1 (10:54):
Why five days?
Speaker 2 (10:56):
Well, that was the determination, from when we were
doing the device, of how to getthrough that first 72 hours,
the first three days, which areusually the most intense, and
five days to be able to get theperson cleared from their
significant withdrawal symptoms.
Speaker 1 (11:12):
Was this device developed before fentanyl was
the dominant drug?
Yes, how has its use changedwhen we went from heroin to
fentanyl?
Speaker 2 (11:21):
How it's changed and that's a great question is that
sometimes patients will need twodevices, and one of the things
that we are looking at makingupgrades to the device because,
as we know, addiction medicinethe beast gets bigger right the
illicit drugs get stronger andstronger because the response we
want to have they want more ofa high.
(11:42):
So if individuals getaccustomed to that, here comes
fentanyl and then we have alarger dose of fentanyl.
I'm hearing from providers nowand I've experienced this myself
that the Suboxone that weprovide just really isn't
answering the fentanylwithdrawal.
I mean, you see that right, andso individuals are coming off
of that using on top of thatmedication.
So what we're seeing is thatwe're looking just to have a
(12:06):
10-day device that stays activefor 10 days to be able to answer
that.
What we're teaching andinstructing providers now and
even patients, is to do theirbest to have a higher CAL score,
meaning a higher withdrawalsymptoms, to be able to start
the device so that you don'thave to use two devices.
We want to be able to respondto the need without increasing
the cost.
That's not our wish.
(12:26):
We want to be able to addressthis and be able to get people
to get better and to be able toanswer that.
So we are looking to create a10-day device because of that
very thing.
Speaker 1 (12:36):
If people put the device on before their last dose
of opioid, does it preventwithdrawal?
Speaker 2 (13:01):
did a study and she actually placed the device on
when people were still activelyusing and she was able to
prevent the withdrawal andprevent precipitated withdrawal
and started her patients onlong-acting Brixati and that's
an incredibly interesting study.
Yeah, exactly, and this waspatients that were very
vulnerable and so they, you know, very difficult coming back.
We see that a lot, right, youknow, patients that are homeless
or are having housing issues,etc.
So she got very creative withthis population as she was
(13:24):
giving them this long-actinginjectable, which actually saved
many of her patients' lives andkept them coming back.
That's genius, right, that isgenius vice you can prevent
precipitated withdrawal, which Ilove as well so I do all
outpatient in my practice so youget the device on and you can
start the patient sooner thanyou would.
(13:45):
You know a lot of patients arenot able to wait that period of
time because of thatprecipitated withdrawal that we
see and they're so fearful of it.
I've had so many patients thathave been placed in precipitated
withdrawal and they end up inthe emergency room and they have
to go out and use, et cetera.
So this gives them theopportunity to be able to
prevent that and she sawincredible results from that.
Speaker 1 (14:10):
So let me ask you a couple of clinical scenarios.
So a person is using fentanyland they want to stop.
As they go into the withdrawal,you put the device on.
How long do you wait before youdose the Suboxone?
Speaker 2 (14:26):
It's going to really depend on the patient, right,
I'm going to let them prettymuch lead the treatment, and
this is another reason I reallylike the device.
So a lot of times in addiction,in early recovery, you have a
lot of people making a lot ofdecisions for the patient, right
, telling them what to do, whento go, what to do.
None of us like that, you know.
None of us enjoy that, butespecially someone who has a
(14:46):
trauma response, that has traumain their life, which is a large
portion of our patients withsubstance use disorder, and so
that control is very important.
Also in experience of seeingthis and working in this field,
also in experience of seeingthis and working in this field,
patients that direct or guidetheir treatment have a better
long-term outcome.
I see that when they're sayingyou know, I want to do this, I
(15:08):
don't want to go inpatient, Iwant to do this, and sometimes
it's not the right decision.
But if they're directing andthey're saying, okay, I want to
do this, it's a great trustingrelationship and that's
important as providers to builda trust with that patient.
So when the patient is sayingI'll put the device on, I will
work with them, I'll say let'sgo as long as we possibly can,
until you can't stand it.
(15:29):
And they're okay, I got it.
And they can call at threeo'clock in the afternoon or 10
o'clock at night and say I'mgoing to use and if okay, let me
just call you in something, letme get you on a Valium for the
night, let me put something inyour system to get you through
until I could see you tomorrowmorning.
Speaker 1 (15:48):
Get them through as long as possible before you can
put the device on.
So I'm currently telling mypatients and I don't know where
three days came from, but thatseems to be the prevailing
wisdom with my colleagues hereon the central coast of
California that from fentanyl tosuboxone, three days waiting is
pretty good to avoidprecipitated withdrawal.
Can you shorten that when theST Genesis is running?
Speaker 2 (16:08):
Absolutely, and that's the thing that we want to
do.
Three days is.
You know, if somebody was totell me, don't eat sugar for the
next three days or don't drinkcoffee for three days, no
problem, I got you.
Three days without using anopiate.
If you're an active withdrawalis like 30 days without a glass
of water.
I mean, it's nearly impossible.
I don't even want to say that Iunderstand it.
(16:29):
I've never been through it, soI certainly don't want to.
But I've seen enough patientsand have enough respect for
withdrawal symptoms to be ableto say that's an impossible ask.
A lot of times, and what we'vealso seen when we ask
individuals to wait that long,they may do 48 hours, and then
48 hours that next night they'regoing out and they're buying an
illicit substance and we'reputting their life on the line
(16:52):
and so it's really verydangerous for our patients and
for their families, et cetera.
So being able to shorten thatwindow by 48 hours if they wait
24 hours to put the device onand you can start them on a
protective medication, you'resaving that individual's life.
Speaker 1 (17:07):
Well said.
Do people ever use the deviceto just get through opiate
withdrawal completely and thenget on naltrexone?
Speaker 2 (17:15):
They do, they do and again I look at the lethality of
what they're using, how muchthey're using, what route
they're using, etc.
And then also their history.
They have an overdose history,you know.
Have they attempted to taketheir life, etc.
Things like that and I will domy best to educate them on the
best medication regime for them.
(17:35):
Again, this is going to betheir recovery and I want them
to make those decisions and theyhave done that and I've done
that.
Actually, I've gone fromSuboxone onto Naltrexone.
I have had patients that havegone from fentanyl use onto
Naltrexone and they've done welland I've been able to do that.
And that can be a delicatedance as well.
As you know.
The device can also be used at,let's say, that you're at the
(18:07):
end of treatment with a patient.
I've had patients that havebeen on Suboxone for eight, nine
years and they want to come offof it.
And I had a woman that she wasactually going abroad to study
and she had been on Suboxone fornine years and she wasn't going
to be able to get it where shewas going.
So we worked with her for threemonths, got her down in her
does and we used the device toget her off completely before
she traveled.
Speaker 1 (18:23):
Yeah, I have the same experience as you do, that it's
very hard to get on naltrexonebecause you have to get all the
way off of opioids to get onnaltrexone.
I only have one patient onnaltrexone for opioid use
disorder because nobody can takethe withdrawal.
Most of them go to methadone orsuboxone.
That is a very interesting idea.
Fentanyl to naltrexone.
I don't think I would havebelieved that if you had told me
(18:45):
, but of course I wasn'tfactoring in using the Genesis
device.
Speaker 2 (18:52):
I wouldn't have believed it either.
I wouldn't have believed thethings that I am saying if I
hadn't have seen this over 300and something times that I've
used the device and our nursethat has applied it.
It's just been.
It's blown me away to see thepatient's response and how well
they do when using the deviceand how they have long-term
(19:12):
recovery.
I got a text yesterday from amother and she's incredible, but
her son.
We used the device on him ninemonths ago and he just
celebrated nine months of hisrecovery and he's on Suboxone.
He's doing very well.
We used the device on him andshe is just such a fan.
You know she's just likenothing else has worked for this
young man because he was ableto not have the significant,
(19:34):
severe withdrawal symptoms thathe's experienced for his whole
entire life of using and that'sbeen about 15 years.
He's almost 40 years old andhe's doing very well.
He's got a job.
He's still living with hisparents, but he's doing great.
Speaker 1 (19:49):
So thinking again back to how this device works,
right, withdrawal is thesympathetic fight or flight
state and we are turning on theparasympathetic rest and digest
state.
Wouldn't that mean it wouldwork for other withdrawal
syndromes besides just opioids?
Speaker 2 (20:05):
That is exactly what we are doing research on right
now.
So we have a very largetreatment center that we are
working with and we are testingthis with alcohol,
benzodiazepines and amphetamines.
I have used it off-label in myown practice for those, as well
as for cannabis withdrawal.
Used it off-label in my ownpractice for those, as well as
for cannabis withdrawal.
Where we are, we have a prettysignificant problem with
individuals using cannabis andcoming off of it and there's not
(20:33):
a lot of resources.
Detox doesn't even reallyaccept that.
So, using this device, I'veused it successfully with
alcohol.
I have never had a patient thatwas solely on benzodiazepines as
an abuse drug to be able to useit on.
I have.
I mean, obviously I've detoxedpatients on benzos, using benzos
on a taper schedule, right, butthe device I haven't had the
opportunity to do that.
I think that's a rarer animal,it's an individual that are just
(20:53):
using benzodiazepines.
I know they exist, but Ihaven't run across that
personally.
Alcohol incredibly successful,incredibly successful using it.
But, as I said, it's FDAcleared for opiate withdrawal,
so it would be off-label and, ofcourse, as a provider, you
could use things off-label.
But we are actually applyingfor it to get approved for more
devices Because, as you said,it's that reward pathway.
(21:15):
It's the same thing, it's goingto work, but I've seen it work
incredibly well with alcoholsame thing.
Speaker 1 (21:21):
It's going to work.
But I've seen it workincredibly well with alcohol.
Okay, so same question Sincethe device turns off that
sympathetic fight or flightresponse and turns up the
parasympathetic rest and digestresponse, can it work for PTSD?
Speaker 2 (21:34):
I have not tried it for PTSD.
I'm going to say that itabsolutely will work with that
because I think majority of ourpatients with substance use
disorder experience PTSD.
Right, I mean active use itselfis traumatic.
You listen to our patient'sstories.
I had a patient not too longago.
He was incarcerated for 32years.
(21:54):
32 years of this man's life hespent incarcerated and you know
the story that he has told wasjust chilling right, of what his
experience was.
So he didn't even realize thathe has PTSD.
But any individual that livestheir life and they spend enough
time using substances alcohol,drugs, whatever it is they're
going to have trauma, right.
(22:15):
And so I absolutely believethat it would work with PTSD.
Speaker 1 (22:20):
I will tell you that I have PTSD from my 14 years as
an ER doc, yeah, and I actuallychatted with my therapist
yesterday about triggering, andit's really weird.
I will be totally fine, andthen, all of a sudden, I am in
fight or flight mode, and mypatients tell me a very similar
story.
I guess the only question withthe device, though, is could you
(22:43):
use it continuously for morethan 10 days?
If it helped with PTSDtriggering?
Are there any major sideeffects?
Speaker 2 (22:51):
No side effects that we know of At this point, though
the battery lasts for five days, so it wouldn't have that
electrical stimulation for along period of time.
The other thing that you justmentioned about you don't know
when it's going to occur, so ifit's something that is more
triggered instead of continuous,we'd have to put it on when
it's happening.
I was in the ER for many yearsmyself.
(23:11):
I understand that.
I think many of us inhealthcare I mean, you're going
to have vicarious trauma, evenif you don't have trauma
yourself.
But when you see someone walkinto your ER with an ax in their
head or a child, if you've doneCPR, which we have on children,
and we've got the stories.
My son-in-law is a statetrooper.
He has PTSD.
So many different areas ofindividuals that could benefit
(23:33):
from this.
I also think that there aresome neuromodulation that occurs
when using the device, so Ithink there's an area that we
could look at that it maybehelps long-term with also pain
and with PTSD.
Speaker 1 (23:47):
And again we're getting a little off topic here,
but I was just imagining beingable to reach back behind your
ear and turn it on whentriggered, Right yeah, and I'm
fascinated to hear that thisalso works for alcohol
withdrawal.
Given the mechanism of actionof the technology, it makes
perfect sense.
Speaker 2 (24:04):
It's incredible, it really is, and I got so excited
using the device and sointerested in seeing what other
things that it worked for.
I'll tell you the first patientthat we used it on was a
26-year-old male it was theheight of COVID right when it
happened and it was a young man.
He was in Connecticut and hewas in his home and no one was
(24:27):
taking patients inpatient.
Everyone was kind of stopped intime and this young man was
using methamphetamines, fentanyland he was using cannabis and
we had a nurse go out and weplaced the device on this young
man.
He had been in 16 treatmentcenters.
I did not feel like this wasgoing to go well at all.
He was combative, the home wasin disarray, his parents were
just beside themselves, he hadattempted suicide A very
(24:50):
significant case, reallysignificant and if it had not
been COVID, I would not havechose this as the first patient
that I used this device on, butwe did and he had a Cal score of
24.
Speaker 1 (24:59):
Wow.
Speaker 2 (25:00):
When we put him in.
I mean it was significantDiaphoretic, he was tachycardic,
I mean everything that you canthink of, just extremely
volatile.
And we placed the device on andin 20 minutes he went outside
to smoke a cigarette with hisfather.
The nurse had got me on a Zoomcall and I was on Zoom watching
this scene and I was thinkingwe're fixing to go to the
(25:22):
emergency room.
That's why I was just about tosay call an ambulance and he
came back in from smoking acigarette and he had a cow score
of six.
I said did he use somethingthere's?
I just can't believe this, butit was the device.
It was the device.
So he ended up doing incrediblywell.
At day three, I was checking inwith this young man for three
(25:44):
days.
That night, after we placed thedevice, he sat down and had
dinner with his family.
His mother called us and saidmy son is sitting down eating
dinner with us.
I couldn't believe it.
He had zero medications onboard.
Now, day two, we did start himon clonidine and gabapentin.
To be completely transparent,he was having significant
restless leg and he was stillfeeling anxious.
(26:04):
So we did put him on clonidine.
We did start him on gabapentinand I think might have put him
on Bentol, but he did very, verywell without any other
medication and he ended up goingon Suboxone after four days and
he did great after four daysand he did great.
Speaker 1 (26:25):
I wonder if some of his impulsivity was PTSD and the
device, in addition to treatinghis withdrawal, suppressed some
of his triggering, which iswhat allowed him to sit down and
eat dinner.
Speaker 2 (26:32):
He did have significant PTSD.
His opiate addiction startedbecause he was a lacrosse player
and he had a significant injury.
His entire future was justerased because of his injury.
So he lost his scholarship, helost his future with that and
then he started this heavyopioid addiction.
He was prescribed Percocet fora year.
A year-long Percocet is aprescription, so after that, you
(26:55):
know, he lost everything.
He was still living at home, hedid not find a job, he did not
find a future and so he hadsignificant, significant trauma.
So absolutely I don't thinkthat that's outrageous to think
(27:17):
of.
As I said before, the patientbeing able to have a voice and
not have everybody else makingdecisions for them is that if
either any of us were in theamount of pain and significant
withdrawal symptoms that ourpatients are in, we would say
yes to anything.
Yes, yes, yes, just get me offof this.
So I think our patients andwhat I see is that they say yes
to things that they don't reallyknow what that means long term.
(27:41):
So the young lady that I wastalking about, that was going
abroad to study, she explainedlike her situation.
She said I said yes to Suboxone.
I didn't even know what thatmeant.
I didn't know that I was goingto have to come in the provider
that she was going to.
She had to come in every weekfor the first two months and
then do groups and thesedifferent things.
(28:01):
She didn't really know what shewas saying yes to.
I think that happens quiteoften with our patients.
They say yes to these things toget them out of that moment and
then they're not really surewhat they've signed up for.
Speaker 1 (28:11):
I would agree with that.
Speaker 2 (28:14):
And it may be a life-saving event at that moment
.
But again, I think, to havelong-term recovery and long-term
the patient is saying yes toit's just like informed consent
we need to be able to reallyexplain.
What does this mean if we'regoing to start you on methadone?
What does it mean if you'regoing to go on Vivitrol, just
any medication that we prescribeWith SSRIs?
(28:36):
We have to do a lot ofeducation, teaching, black box
warning, things like that but alot of times with other
medications we don't do as mucheducation what that's going to
mean for their life.
Speaker 1 (28:47):
So the patient that I used it on was a gentleman that
had been on methadone for painand unfortunately there was an
issue with his methadoneprescription and he couldn't get
it and went into horriblewithdrawal, didn't know what to
do.
So a friend said he had someoxycodone, which of course
(29:07):
wasn't oxycodone, it wasfentanyl.
And so he just was usingfentanyl and came to his next
appointment and got a methadonerefill and didn't think to say
anything because he thought itwas oxycodone.
And then on his urine drug testhe was positive for fentanyl
and he was in withdrawal onmethadone at his old dose
because the fentanyl had broughthis tolerance and dependence up
(29:28):
on him.
And he came into the office andwe did a Zoom call with one of
your nurses.
She was wonderful, helped meput the device on and in an
instant he noticed a difference.
It came on very quickly and theonly issue for him was I
couldn't get one of the leads tostay in place.
(29:48):
And that's probably you know me, never having done this before.
What are you working on interms of innovating the device?
Could you change the technologyso it sticks better, or does it
have to be electrodes?
We're always looking toinnovate as humans.
What are you looking toinnovate with the ST Genesis?
Speaker 2 (30:04):
Yeah, great question and we are looking at several
different things and we areworking on implementation, the
10-day, like I said, the otherthing is making it waterproof
because people want to showerand they want to work out or et
cetera.
It doesn't really become anissue.
You know, we tell people theycould put a shower cap on it or
how to not get it soaking wet,and then the leads, the wires
that come around.
We want them to be lessinvasive, some technology around
(30:27):
that so it doesn't have thatcapability of pulling those
leads out and better adhesive ifthose things can't happen.
As I said, rosemary is who thenurse I think was working with
you.
She's phenomenal and you knowthat's the other thing when you
have somebody that understandsthe technology and also gets so
into it.
I can nerd out on this stuff somuch because it's so
(30:48):
fascinating to me and I lovebeing able to offer patients
these innovations and these newways to be able to treat their
symptoms.
But that can be something thatif one of the leads comes out
again they're going to have areturn of symptoms, and we don't
want that.
Speaker 1 (31:02):
Yeah, the gentleman is now back on methadone and
doing great.
My experience was that he camein, we put it on and literally
as soon as I turned it on, hefelt something and for him, a
couple of unique issues.
He had hearing aids, so weobviously took those out.
Rosemary was exactly the nurseI worked with.
She was awesome, and what Iended up doing is he was doing
(31:27):
great in the office and when hewent to sleep is when the lead
came out.
So he came back to see me thenext day and then I tried to
reinforce it and then he went tosleep again and dislodged it
again the next day.
Is there a way that you tellpeople to sleep to avoid the
device getting dislodged?
Speaker 2 (31:46):
We do.
You know a lot of times if wecan put, like I said, the liquid
adhesive that works really wellto be able to keep it on.
I know when we have had thatproblem or individuals that have
pulled it loose or it comesloose during their sleep.
If we mark that site then theycan push that right back on.
And so it just depends on wherethe site, where you find it.
(32:08):
The ear can be very tricky rightto be able to keep anything on.
It's not a smooth surface,there's no fat tissue there,
it's a very cartil.
Anything on it's not a smoothsurface, there's no fat tissue
there, it's a very cartilagy.
It's a very awkward place.
So those small little needles,if you get it right in the right
place, putting that liquidadhesive on to be able to keep
it on, is the best way to do itDuring the night.
If we can have them lie on theright side instead of on the
(32:29):
left side, if they can avoid itright, if they're sleeping so
soundly they move over, thatmeans the device is working
great.
So I'm actually happy thatthey're saying I didn't even
know what I was doing.
So if they're sleeping, thatmeans the device is working
great.
Speaker 1 (32:41):
I was going to ask and I believe this is true, but
I have not actually fact-checkedthis.
I remember hearing thateveryone's ear shape is unique,
like their fingerprint.
Are there certain ear shapesthat this device it's easier to
use or harder to use.
Speaker 2 (32:59):
I don't know if it's necessarily ear shape, maybe.
So I mean, a very small ear ismore difficult, just like
anything else.
You don't have as muchlandscape right, so that it's
difficult to do Individuals thatare much older adults the skin
is sagging.
It's a little bit moredifficult to adhere If they have
a lot of piercings in their ear.
That also can be difficultbecause they may have moved
(33:21):
things around quitesignificantly.
You know, I think that it'sreally more about making sure
that the person places it in thecorrect way and with enough
adhesive, and finding the rightsites, and that's something that
we do a really good job of.
And, as you've had experiencehaving individuals that are
really knowledgeable about theear, I've never learned so much
about one part of the body in mylife, right so much about the
(33:44):
ear and, like you said, it islike a fingerprint.
I didn't realize either thatevery single person is different
.
It's unique to them and as weage, things in our body move and
shift.
So where my tragus site wasfive years ago, it's probably in
a different location five yearslater.
What if someone has?
Speaker 1 (34:00):
cauliflower ear.
Speaker 2 (34:02):
You would want to use the other ear if they have that
.
So any deformity in the ear.
You would want to use theopposite ear if they have that.
We like to use the left ear,but we can use the right.
Speaker 1 (34:13):
According to WikiHow, we all have different ear
shapes.
That's not peer-reviewed, butthat's what I found on Google in
the last 10 seconds.
Speaker 2 (34:25):
Well, I can send you some journal articles that speak
to that and as well as somecriminal investigations where
they have actually used theperson's ear for criminal things
like that, to be able toidentify the person.
So it's interesting and again,I am not an expert.
I want to clarify that I'venever taken ear imprints.
I don't know, but I do know byusing this device as often as I
(34:46):
have.
It's very unique.
Everyone's ear looks verydifferent.
Speaker 1 (34:49):
What other devices does your company make?
Speaker 2 (34:52):
This is it.
The ST Genesis is the onlydevice that we have.
We are a pharmaceutical companyas well and have some
pharmaceutical medications, butthey're not related to substance
use, and I'm overseeing onlythe ST Genesis and Speranza.
Speaker 1 (35:04):
How did you get interested in addiction medicine
?
Speaker 2 (35:17):
I saw many of our patients that came in with
substance use disordercomplications and it became very
dear to me just because I sawmany of those individuals being
not treated very well,especially in the emergency
department.
And this isn't to say that itwas anyone's fault, necessarily,
but a lot of times in theemergency room we are very, very
busy.
We're working on very seriouscritical emergencies,
life-threatening emergencies,and so individuals that come in
(35:38):
with substance use disorder thatare not in that
life-threatening situation,we're put in the hall, put in
different places, and I justfelt a big soft spot for them
and I thought I want to make adifference.
And when I went back to schoolI found a niche that I felt very
good about.
I really enjoyed it.
I enjoy the population, Iunderstand the disease very,
(35:59):
very well and I'm able to reallyconnect with my patients on a
level that I'm not sure that alot of people really enjoy it.
I really do, I really enjoy it.
I love seeing people get better.
I love seeing people's livescompletely change, and you don't
get to see that in other areasof medicine.
Speaker 1 (36:16):
Lives completely change and you don't get to see
that.
In other areas of medicine.
I've had a very similarexperience to yours, that I got
tired of having people come intothe emergency department and
not knowing what to do and notknowing how to help Right.
So, I've had the same experienceas yours that getting to be an
expert in the field of addictionhas been really enjoyable and
patients are really gratefulwhen they are treated with
(36:37):
respect.
The patient that I put it onmyself felt like a VIP, that he
got to try this device out andhe was very grateful.
And again we finally got himback on his methadone and his
tolerance came down and, yeah,how does it work with insurance?
Speaker 2 (36:54):
Well, we're working with several insurance companies
.
Private insurance does have areimbursement.
We would like to and we'reworking towards getting Medicaid
to be able to reimburse thedevice.
That is the majority of ourpatients and I absolutely know
because of the work that I doand pro bono, I'll work with
patients that don't have fundsto be able to do this, to be
able to place the device.
(37:14):
I know what a difference itmakes in their life.
I know what a difference itwould make in the emergency room
if we had this device.
Imagine all your patients thatcome into the emergency room
that you give Narcan that leaveAMA Massive number of
individuals If you were to placethis device on them, prevent
precipitated withdrawal and beable to give them an injection
before they leave.
It would just be a game changerfor so many individuals and
(37:38):
also save time, save our staffburden.
We have so much burden on staffnurses, physicians, dos, nurse
practitioners that are wantingto be able to address the
problem but can't because oftime and shortage.
This would be able to answer somany of those problems.
Emts out in the field to beable to use this after they if
they Narcan individuals, becausewe know it gives the
(37:58):
individuals their right intoprecipitated withdrawal.
They don't want to stay, theywant to go back out and use and
they want relief of theirsymptoms.
Speaker 1 (38:05):
Yeah, I was just thinking and I realize nothing
in health care in America is,unfortunately ideal.
But I really think the idealcase for what you've described
is for patients with opioidaddiction is placing a device
like this that suppresseswithdrawal and then immediately
starting a long-actinginjectable buprenorphine product
.
What's really ironic is here inCalifornia our Medicaid is
(38:29):
called Medi-Cal.
Medi-cal covers the long-actinginjectable buprenorphine
products.
No issue, right, and thecommercial insurances are a
disaster.
So actually I'm thinking of oneof my patients right now who
his insurance denied hislong-acting injectable
buprenorphine.
I'm going to send himinformation about this to see if
he'd be interested, because hedoes have commercial insurance.
(38:51):
So the one-two punch would beis if we could make it easy to
start a patient on Nerve FieldStimulation in the ear and then
put them on long-actinginjectable buprenorphine.
Speaker 2 (39:02):
Absolutely.
I've written a protocol for it.
It's something that just is avery no-brainer to me,
absolutely.
And you're talking about alarge portion of our population
that again have difficulty withtransportation, with housing,
getting to appointments.
If they have the long actioninjectable on board, they have
an easier time and a largerwindow than if they were to have
an oral Suboxone or tablets,right?
(39:23):
So it's really important thatwe look at how can we save and
help this larger portion of thepopulation that are really in
need.
This is to me, like you said,it's a no-brainer.
But it doesn't always seem tobe a no-brainer in health care
sometimes.
Speaker 1 (39:38):
I was going to try to make a pun and say it's a
no-earer, but that didn't seemto follow.
Speaker 2 (39:44):
We can laugh about it .
Speaker 1 (39:45):
Yeah, I'm sure wherever my daughter is right
now she's rolling her eyes at mybad dad humor.
I tell my daughter once youhave a kid, your humor just
falls apart.
Speaker 2 (39:55):
All you do is dad jokes.
It's horrible.
Well, it's because everythingis funny to you and then I just
became a grandmother.
That's even funnier when youget to see your child raising
their kids.
You're like oh, I'll rememberthat.
Speaker 1 (40:06):
Well, I think we've covered about all of my
questions.
I am so excited to start givingpatients information about this
and I think the issue for me ismost of my patients have
Medicaid.
I have a handful who haveopioid addiction and private
insurance.
So I'm thinking of onegentleman.
I'm going to send himinformation about your product
(40:27):
later today.
Well, regrettably we are at mytime stop because I have to go
get my daughter from Taekwondocamp.
Anything you'd like to leave uswith as we wrap up?
Speaker 2 (40:37):
Yeah, if you're interested, you know, visit us
at spronzotherapeuticscom.
There is a hotline there thatwe can answer any questions.
We are always looking forproviders to get trained.
I just actually contacted youlast week about a patient that
called our hotline.
One thing that you know I wouldreally love is to be able to
train as many physicians,addiction medicine providers as
we possibly can.
Nurse practitioners across thecountry.
(40:59):
We have many, but we need manymore.
So we're always looking totrain.
It's free, it doesn't costanything.
We're a great team, as you'vehad the experience really
enjoyable working with ourproviders.
We partner really more thanjust try to sell a product.
We really want patients to dowell and to be able to expand
your practice.
So if you're interested, visitus at espranzatherapeuticcom or
(41:22):
give us a call and we'll talk toyou about more how to get
trained.
Speaker 1 (41:26):
Well, I have to say, I've learned a ton and, as I
like to say to my podcast guests, I will be a smarter doctor
next week.
So thank you so much and Ireally appreciate your time.
I'm just copied the link foryour website to send to one of
my patients later today.
Speaker 2 (41:41):
I appreciate it so much, dr Grover, and I really do
appreciate you and yourinnovation and thank you for the
kindness and dedication andcompassion that you treat our
patients with.
It's really, really inspiring.
Speaker 1 (41:53):
Before we wrap up, a huge thank you to the Montage
Health Foundation for backing mymission to create fun, engaging
education on addiction, and ashout out to the nonprofit
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdoses.
(42:14):
Word out about how to treataddiction and prevent overdoses
To those healthcare providersout there treating patients with
addiction.
You're doing life-saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together we can make it happen.
(42:35):
Thanks for listening andremember treating addiction
saves lives.
Popular Podcasts
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
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.