Rethinking Recovery: Compassionate Harm Reduction with Dr. Taylor Nichols

Dr. Taylor Nichols, an emergency and addiction medicine physician from Sacramento, joins us to unveil the transformative power of harm reduction in addiction medicine. Many of us have been conditioned to think that the path to recovery requires complete abstinence, but this episode promises a fresh perspective. Explore the idea that any positive step towards reducing harm—like gradually cutting back on alcohol—can be a valid and effective part of an individual's recovery journey. Through real-life examples, Dr. Nichols highlights the importance of personalized goals, advocating for progress over perfection.

The conversation confronts the harsh realities of societal stigma and ineffective prohibition-based policies that have long overshadowed pragmatic approaches in addressing addiction. As we challenge these outdated models, the benefits of harm reduction initiatives become clear. From syringe exchanges to overdose prevention sites, these programs offer safe havens for individuals seeking support without judgment or legal fear. We tackle the political and systemic barriers that prevent the expansion of such compassionate programs and discuss the crucial need to combat stigma within healthcare.

Our journey also includes a personal narrative of rethinking harm reduction, sparked by firsthand experiences in San Francisco's healthcare landscape. Witness the evolution from skepticism to advocacy, as we unpack the power of empathy, understanding, and coalition-building in promoting legislative success. Learn how changing perspectives and adopting a compassionate stance can break down barriers and foster recovery. The episode wraps up with insights into innovative approaches to addiction treatment, drawing lessons from global models and exploring the role of community and connection in recovery.

You can find Dr. Nichols
https://www.tnicholsmd.com/

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Episode Transcript

Speaker 1 (00:00):
Hey everybody, welcome to episode.
Ok, I think, yes, no, I knowthe sixty nine minus one.
Yes, yes, you got it.
Oh, yes, all right Episodethat's what yeah?

Speaker 2 (00:10):
Sorry, Taylor.

Speaker 1 (00:11):
We're doing sixty, nine minus and then plus.
Like you know how it's.
Like we set BC, like you know,to that BC, like that's
basically ours is sixty.
Like you know, like people sitaround in armchairs and sip
their whiskey and laugh at, notlike that.
You know basic humor.
You know what I'm saying.
Yeah, of course, good, okay,well, I mean we just, I guess

(00:36):
we'll just jump right into it.
Taylor, why don't you tell us alittle bit about yourself?
Because I feel like in the lastfew weeks, rob, we've kind of
like shot the shit for 20minutes and then we're like oh,
we should probably introduce theguest, or something like that.
We spent a lot of time,probably more time than we
should.
So how about we cut that backdramatically and just let you
introduce yourself here?

Speaker 3 (00:55):
I'm Taylor Nichols.
I'm an emergency medicine andaddiction medicine physician.
I live in Sacramento,california.
I work in a low barrier harmreduction based clinic in
Sacramento and I also work sortof across the continuum of care
for people who use drugs,including for patients who are
hospitalized on inpatientconsult service and in

(01:16):
residential treatment as well.

Speaker 1 (01:17):
Okay, Now I'm very curious, because you say harm
reduction Okay.
So to me that means thereshould be less harm, and that's
about as far as I get Hittingsomebody slightly less with the
baseball bat.
So like yeah, like there's harm, and then you take less of that
and that's harm reduction.
That's pretty much all I know.

(01:38):
Can you tell me like whatactually that might?

Speaker 3 (01:41):
be.
That's a great question.
So harm reduction, the premise,the sort of basis, the original
definition of harm reduction.
It is born of people who usedrugs, created by people who use
drugs, for people who use drugs.
And the idea is simply anypositive step towards whatever

(02:02):
that goal may be.
So I like to use the termrecovery from the context of
like, the verb to recover.
People who are in active usemay have negative consequences
of their addiction or theirsubstance use disorder and from

(02:22):
their use they've lost things,for example, and so to recover
those things is their recoveryprocess.
I don't think of recovery asabstinence only.
Recovery can be whatever peoplewant it to be, and so any
positive step towards that goalto reduce the harm that their
use is causing to themselves ortheir community is harm

(02:45):
reduction.
So it doesn't have to beabstinence, it can be simply
drinking less.
You can be taking one beer awaya day that somebody's drinking.
That is harm reduction and itis supporting them in those
goals, in being able toaccomplish those positive steps
that are helpful to them anddecreasing the harm to them and

(03:09):
to their community.
So, it's really yeah, it's anypositive change.

Speaker 2 (03:14):
I imagine that you know going cold turkey could be
actually more harmful for somepeople.

Speaker 3 (03:19):
Yeah, absolutely, and some people don't want that as
their goal, and my goal inworking with them as a patient
in clinic is just to define whattheir goals are and then help
them accomplish them.
And if it is to remainabstinent from a particular drug
forever, fine, I will supportthem in that.

(03:41):
I'll help them find therecovery spaces that are
abstinence only focused and helpthem achieve those goals.
But say they come to me andthey have a few different
substances that they're using.
Say they want to completelystop using opioids but they also
drink and they don't want tocompletely give that up.
Yet I'll approach that personand say, hey, we have a

(04:03):
medication like buprenorphinethat we can use to help you
manage both the withdrawals andthen the cravings.
That can help you remainabstinent from opioids.
However, we don't have to sayjust stop drinking or manage to
wean you down off of that.
We can say, all right, how muchare you drinking now?
Oh, 12 beers a day, on top ofusing fentanyl.

(04:25):
Say We'll get you off thefentanyl, then we'll work on the
alcohol.
And when we work on the alcoholwe'll say, instead of drinking
a 12-pack, try bringing thatdown a little bit, see if you
can get yourself down.
What's your goal?
Oh, you want to get to asix-pack a day.
All right, let's split thedifference and work on that.
For now you got there, okay.
Then let's keep going down to asix pack.
And then, when you get to a sixpack, what are?

(04:47):
How do you feel?
What are the harms that you'refeeling to yourself?
Or are you still feel thatthere are harms to your
community surrounding your use?
And if you're not, to whereyour recovery goal is and you
say no, I still think I shouldcut back more than we'll work on
that.
But that's the idea is to sortof, you can create those

(05:08):
positive changes through smallsteps and focusing on what is
causing harm and how do wereduce that.

Speaker 1 (05:16):
It seems like kind of better, but not necessarily
perfect, right?
Like we're just trying to focuson better yeah, perfect is the
enemy of good.

Speaker 3 (05:25):
Right, we want good, and perfect is sort of like an
artificial definition, becauseabstinence is not everybody's
goal.
Perfect might not be abstinenceto a person, to society.
Society might say abstinence isthe only option, right, in
which case you're following so asocial definition of perfection

(05:46):
.

Speaker 1 (05:46):
But that may not apply to an individual and
that's kind of like I like that,just because you know we do
that just more on the basis ofnutrition.
Like hey, someone's drinking Idon't know like six sodas a day
and say like, hey, maybe likefive, four, like I feel like
with drugs it's a little bitmore.
Uh, you know it's a littledifferent, maybe a little bit
more extreme, maybe more, maybemore important, but, like you

(06:09):
know, still we kind of try anddo something similar.

Speaker 3 (06:11):
We can look at somebody from a nutritional
standpoint and say, hey, whydon't we use a harm reduction
based approach?
And that's okay.
But when you talk about harmreduction in the context of

(06:35):
drugs, people are like, oh well,they just have to quit.
Like well, that that's notconsistent with harm reduction.
That's not really how we dothings.

Speaker 1 (06:44):
I think the only like harm reduction, uh, like policy
that I have seen and discussedand that I always thought was
interesting, and maybe you canspeak to it a little bit, is
kind of um, I don't know whatthe hell the term is like the
needles uh, basically like safeand just.
But they also hand out likeneedles, like, like you know
syringe exchange, syringe yeahyeah, okay, yeah, let's go
syringe, let's go with needleslike, like you know, syringe

(07:05):
exchange syringe, yeah, yeahokay, yeah, let's go syringe,
let's go with that.
And so you know, because on theone side they'll say like, oh,
you're giving people syringes,basically you're, you're allowed
, you're saying, yes, it's okayto do drugs by giving them these
, these needles.
Is what the the opposing side,I guess would say to that those
policies.

Speaker 3 (07:22):
And I would respond to that by you're taking a
community of people who areusing drugs, you aren't going to
immediately change that and youare reducing the risk of harm,
of bloodborne diseases withinthat community, and so this is
actually speaks to the originsof harm reduction.
So it's very intrinsicallylinked to HIV and AIDS and the

(07:47):
rise of HIV and AIDS as anepidemic or pandemic sort of
globally, where people recognizethat people who use drugs,
people who injected drugs, weregoing to be at very high risk of
HIV as a bloodborne disease, ofHIV as a blood-borne disease.

(08:10):
And so practicing syringe andneedle exchange and I use that
term in the context of, likegiving people needles I will
just want to be careful aboutthat, because syringe exchange
some people say that has to be aone-to-one direct exchange and
that can be harmful because noteverybody is coming in with a
needle to give like somebody who.
It's okay to just give peopleclean syringes and clean needles

(08:32):
, regardless of if they have aprior used syringe or needle.
That may not be the way.
They may not have them, the onesthat they had used, um and and
it's okay just to support safeuse and so that they are also
not giving their needles toother people Say they want more

(08:54):
than they have on hand forthemselves.
They want to be able to givethem to other people because
they're using with somebody else, rather than giving them one so
that they can then share itwith somebody else.
That would defeat the point,and what we've seen with those
is that it did directly impactand reduce the spread of
bloodborne diseases like HIV andhepatitis C.
So when and we also know thatwhen we take those things away,

(09:22):
you know, when people who areantithetic, whose beliefs are
sort of antithetical to that,come into power and they take
away funding for those programs,we see an increase in the
transmission of blood-bornediseases.
Right, and so the idea that youcan just somehow make people
who use drugs stop using themright is like it is fantasy.

(09:46):
Um, that's not how humans work.

Speaker 1 (09:48):
Basically, what seemed to be like the war on
drugs was right.
So, like war on drugs, are youall for it or just mostly for it
, like which?

Speaker 3 (09:55):
well, and I, like to say drugs will always win the
war on drugs.
Every time they you make moreprohibition-based policies,
you're going to lose, but drugswill always win, because that's
part of human nature.
People will seek to alter theirconsciousness, regardless of
whatever policies we create, andso we should create policies
that wrap around that realityand allow people to try to

(10:19):
reduce the harm to themselvesand society in the course of
using drugs, and that's okay.
Like we can't just simply saynobody should ever use drugs
ever and just like cover oureyes and our ears and pretend
like it never happens, which iswhat we try to do more often
than not, unfortunately.

Speaker 1 (10:39):
Yeah, and then you end up with a lot of people in
prison for drugs.

Speaker 2 (10:43):
I feel like this syringe exchange probably acts
as a foot in the door as well,since people aren't likely to go
get help because they want toquit drugs, but they might go
get help to get these cleansyringes and then they get
introduced to things.

Speaker 3 (11:20):
Absolutely.
If people want to pursue anyform of recovery, right?
If they want to, hey, yeah,come into this harm reduction
center, this harm reductionbased clinic, this overdose
prevention site, and where youcan get clean needles, you can
get clean syringes you can use.
I mean ideally right If wecreated, if we allowed overdose
prevention sites which areplaces where people can go, use

(11:42):
their drugs in whatever formthey use, safely and without the
chance of law enforcementpresence, without the chance,
you know, in a non stigmatizingway, where people can come in,
they can use drugs and then theycan leave.
But that's also a place toaccess them.
That's a place to reach themfor health care.
It's a place to reach them forhealth care, it's a place to

(12:03):
check in on them, but it's alsoa place where they have a quote,
unquote responsible person incharge who is at that time, not
under the influence of anythingand can administer Narcan, for
example, to reverse an overdose.
Millions of uses of drugs inoverdose prevention sites, zero

(12:25):
overdose deaths.
If we really wanted to reachpeople where they are and
provide them healthcare andprovide them resources and
access to be able to seekrecovery in whatever version
they want.
Overdose prevention sites are aperfect example of that.
Needle exchanges, harmreduction programs are examples

(12:48):
of having that access in a placethat is trusted by the
community, of people who usedrugs where't want to go to the
hospital because they know thatthey'll be stigmatized.
And, as an ER doc, when I seethat and I see how people are

(13:11):
fearful of seeking care and theyfeel mistreated, they're not
going to come in, they're notgoing to get care when they need
it and it's going to leadpeople to die from simply not
accessing care, right, and so inthat way, we say that stigma
kills.
Because of the stigma that iswithin healthcare, among even my
colleagues, right.

(13:31):
Something that I fight amongstmy colleagues is that seeing
them stigmatize patients who usedrugs.
I have had people who have comein and they say you know, I know
I'm a junkie, I know I, youprobably just think I'm here to
get drugs, but I really needhelp.
And I will pause and I'll sayyou know a little bit of like

(13:56):
gentle redirection here, butlike I don't think of anyone as
a junkie and for fact I preferto not use that term at all, um,
and I prefer you didn't callyourself that.
You can identify yourselfhowever you want, but I've had
people like break down and cryto me over the fact that simply
is like wait, you don't like,you don't care about that, you

(14:17):
don't want to treat me as lessthan, and it's like yeah, I'm,
you're here to for me to provideyou care.
You don't have to humbleyourself before me.
The opposite should be true,like you're here seeking care.

Speaker 1 (14:29):
I'm sure that's not always their experience with
other doctors.

Speaker 3 (14:32):
Most of the time I'm sure it's not, and that's the
stigma from doctors, from nurses, from other affiliated health
professionals, right, and sofighting that within society,

(14:52):
within health care, iscritically important to making
sure that, rob, just like yousaid, that people will access
the care, because if you cangive them a trusted place to go,
they'll go there.
And then you can reach them andyou can have those
conversations like hey, how doyou feel about your use?
Is it causing you harm?
Is it causing your family harm?
How are your relationships like?
We can make that better.
We can try to find an approachthat will decrease that harm.

(15:12):
Um, and I guarantee you peoplewill appreciate that approach
more than just shunning them orstigmatizing them or telling
them that they should just what,stop using drugs, like that's
not gonna work so what are the?

Speaker 1 (15:27):
I'm kind of curious like what?
The challenges are because youwere talking about the, these
places people can go and andfeel safe, like.
What are the challenges tocreating more of those places?
Is it the stigma?
Is it policy?
Is it the war on drugs?
Is it a little bit ofeverything like what's you know?
What are the challenges there?

Speaker 3 (15:43):
We have nailed it, though All of those things like
those places are stigmatized.
It is so.
I've had discussions withpeople, with policymakers, about
overdose prevention sites andthat's just a political landmine
that a lot of people don't wantto jump on.
Um it actually so I'm inCalifornia, I work with the

(16:05):
California legislature inadvocacy efforts and because
it's I can walk to the Capitolfrom my house.
The California Assembly andSenate passed a bill to allow to
legalize the creation ofoverdose prevention sites.
Both bodies passed that Right.
So bicameral state legislaturehad to get to the governor's

(16:29):
desk.
The governor, gavin Newsom,decided that that was not
politically viable solution, wastoo much of a political
landmine, and vetoed it.
So that is not legal inCalifornia.
It would be great if thatpassed.
If they open one, I wouldvolunteer to be a medical
director at one because I justbecause I think it's that

(16:52):
critically important.
So that's one step like fromthe top.
It's not even legal Right.
Despite the fact that bars aresafe, consumption sites are for
alcohol.
Consumption sites are foralcohol.

Speaker 1 (17:10):
Um, we have collectively decided as a
society that alcohol as a drugis different than other drugs
and that's always been veryinteresting to me that we just
kind of like I mean, we did tryand and ban it for a little
while, like a hundred years ago,and it went real kind of poorly
.
And then we're like okay, no,it's fine.
And so, like I've always foundthat very interesting, like,
yeah, all right, well, we justlet it go, this is, it is what
it is.
And then we're like okay, no,it's fine.
And so, like I've always foundthat very interesting, like,
yeah, all right, well, we justlet it go, it's it's, it is what

(17:30):
it is and then we don't wantpeople drinking in public.

Speaker 3 (17:33):
So what do we do?
We allow them to drink in bars,and so if we don't want people
using drugs in public, which is,like right now, the big hot
topic, what do we do about thepeople using drugs in public?
Okay, we'll do what we did withalcohol and allow them to have
a space to not use drugs inpublic.
Like there are easy answers tothis that history has already
provided us.
We just need to understand thathistory, and so that is one

(17:58):
factor would be on a on a policylevel.
Say that policy passes, whereare you going to open it?
Well, stigma is going toprevent you from being able to
open it, being able to operate.
There are, they already existin Vancouver, excuse me, in New
York, and Rhode Island isopening one, or just open one?
It is possible, but you have toget people on board with the

(18:22):
idea that there's going to be anoverdose prevention site in
their neighborhood, right, andso stigma is going to be the
problem.
That you's going to be anoverdose prevention site in
their neighborhood, right, andso stigma is going to be the
problem that you'd face there.

Speaker 1 (18:30):
On a on a local political level I bet you get
people like protesting and likewith the, with the little signs
and everything outside.
One of those like they're doingdrugs here.

Speaker 3 (18:41):
We're allowing this we're allowing people to use
safely and responsibly, in a waywhere they don't die or they
could just use, as opposed tojust shooting up in their
backyard.
Right, or in isolation, or youknow in.
You know some of it's publicsome of it's not public.
Some of these people are housedand don't have to use in public.

(19:01):
But they would rather not usein isolation.
They would rather not use alone.
They'd rather go to a settingwhere they can have a
responsible person in charge who, just in case, can check on
them, right?
These are all reasons thatwould be helpful to take people
both out of isolation and out ofthe public and bring it into a
safe space.

Speaker 1 (19:22):
I think that one of the biggest challenges that that
that this is just gonna face,is not to be callous, but I
think we kind of have to justlike talk about it.
People like, oh they're,they're druggy, I don't care
about them.
It's the same thing with, likeprisoners, like, uh, you know,
whenever there's a bill thatlike tries to, you know, reduce
cruel and unusual punishment inprisons, I've always seen like,
oh, fuck it, no, they'reprisoners, they put themselves

(19:45):
there.
Who gives a shit about them?
And now you've got people usingdrugs, which to them, now
you're as a criminal act.
So you know, they're also sortof a criminal and using drugs.
It's kind of this, this, this,this combination for people are
like I just really don't careabout this person, whatever.
So, like I feel like gettingpast, getting people to
understand that like, hey, thisis, you know, a human being.

(20:06):
It could be anyone, it could besomeone you talk to.
They're struggling.
This is, this is a real, thisis addiction.
We need to, we need to treat it, you know, medically.

Speaker 3 (20:14):
That's going to be tough on a systems level.
Stigma works to other peopleand once you can other somebody,
it's easier to then say oh well, you can.
Yeah, oh cal.
Oh, california had aproposition just this year to
eliminate slavery from our stateconstitution, to like because
if you are, if you areimprisoned, you can be forced to

(20:38):
work without pay, right, butliterally that was like under
slavery.
That was sort of.
The idea is like oh, we're notgonna allow chattel slavery,
we're going to allow people whoare prisoners to work for free.
That was like the end aroundfor slavery.

Speaker 1 (20:53):
Yeah, and then we just arrested a bunch of people
for whatever reason and now wehave a bunch of slaves,
basically.

Speaker 3 (20:58):
And so California was trying to.
People in California weretrying to eliminate that from
within our state constitution.
That got voted down.
To eliminate that from withinour state constitution.
That got voted down.
People are okay once someone isothered enough with saying you
can, you can treat them poorly.
It's not me, I'm not a criminal, I'm not going to jail, I'm not

(21:19):
going to have to face this and,yes, you can treat them that
other person badly, and sostigma is really an effective
tool for doing that.
Same thing is true with peoplewho use drugs.
Right, just like you said, liam, like that's, that's spot on is
is people are already sayingwell, that's a criminal act, you
shouldn't be allowed to do that, which, like that, already

(21:40):
becomes a problem because that'sbased on the war on drugs.
And then also, we don't likepeople who use drugs and
therefore you're a criminal andyou're a person who use drugs.
We can treat you poorly and wedon't really care if you live
Like the idea that an overdoseprevention site with zero deaths
is not a good idea is tellingme that you don't care, then

(22:03):
that people who use drugs stayalive.
Right, like if somebody, ifsomebody, if I, if I pitch that
to a person and I give them dataand they're like yeah, but we
had.
You know.
It's like, how many fentanylrelated deaths did you have in
San Francisco just this pastmonth?
Over 40.
That's less than it was a fewmonths ago, where it was like in
the seventies to eighties.
It's coming down.

(22:24):
That's still more of a largenumber than it should be and it
could be zero.
And so if I propose a solutionthat offers zero deaths and
you're like no, we don't want todo that.
What that says is your valuesdon't align with saving the
lives of people who use drugsright.

Speaker 1 (22:42):
I remember one politician I don't remember
which state it was, butbasically their policy was like,
hey, we should allow people toget two doses of narcan and then
after that you don't give themanother one.
Or maybe it was three and youdon't get four.
I don't remember the exactnumber, like I just remember,
and I was like this is just areally kind of wild idea where

(23:03):
you have like paramedics show upand they kind of pull out a
list and they look and they'relike oh, I'm sorry, terry, you
know you've received two of them.
We're just gonna have to sithere and watch you die because
we can't give you a third one.
And people like there waspeople that were like, yes,
totally like three strikes andyou're out or whatever, just
like, and I'm like that's isthat the solution?

Speaker 3 (23:23):
it's like, and it seems like to a lot of people
the solution is just let them,let them die, like, if we're
being honest here, like it is,it's, and I don't feel like
that's gonna do what they thinkit's gonna do well, there are so
many layers to that and and,and it's true if you look at so
many other facets of theconversations we have around

(23:45):
healthcare right, the ideasabout repealing the affordable
care act, the idea that, well,we don't just let people die,
there's the emergency department, like that's not primary care
and like people should know that.
And also, not everybody makesit to the emergency department
for the like massive heartattack that they have.

Speaker 1 (24:05):
They seem to care about price and money and costs
like that's way more cost thecostly than you know what you
the other.
The alternatives right.

Speaker 3 (24:13):
And so those conversations are old, tired
conversations that are had overand over and over again in
different ways about differenttopics, based around the idea
that we can other people oh, youcan't afford health care, oh
you, it's.
It's all around in people'sminds who and what is deserving
enough, and the problem comeswhen people can say that other

(24:38):
person is not deserving enough,regardless of their humanity.
I think you know, and it'salways about, oh, punishing the
other people.
So like, oh, undocumentedimmigrants, they shouldn't get
health care.
They're like why they're like?
You know people will say, well,they don't deserve it, they
haven't paid enough taxes toearn it.
I am as an ER doc.

(25:00):
When I work in the emergencydepartment, I have a mandate to
provide care to anyone,regardless of their ability to
pay.
And again, liam, like youmentioned, that is the most
expensive way to provide care.

Speaker 1 (25:12):
No kidding.

Speaker 3 (25:13):
So you can't say that we truly don't believe people
deserve care, because we'vedecided as a society that
everyone who comes through thedoor in the emergency department
has to be provided care, likewe passed the law.
That's what EMTALA says.
We'll see what the next fouryears brings, because like I

(25:34):
don't know.

Speaker 1 (25:35):
that seems like something that could that some
people would be like, well,let's just get rid of that, then
it's problem solved.

Speaker 3 (25:50):
I mean, that is the you're right, though.
That is the legal safety netthat mandates that emergency
medicine physicians provide careto everyone who comes through
the door.
If you got rid of that, thatwould be a problem.

Speaker 1 (25:56):
That would be.
That would Are some hospitals.
Are they all required, or is itlike some hospitals don't have
to?
I don't know.
I was curious about that.

Speaker 3 (26:04):
Yeah, if you have an emergency department, okay.
So if like say you aren't anemergency department, say you're
in urgent care, you do not faceEMTALA.
Um, so under EMTALA certain,yes, any emergency department.
Or or, frankly, because it'sthe emergency medicine treatment

(26:26):
and uh, emergency medicinetreatment and active labor act,
so anyone in active labor, soyou have.
If you have an obgyn department, if you have a labor and
delivery unit in your hospital,they're also beholden to mtala
for labor and delivery, even ifthey say like didn't have an
emergency department, it's justa obstetric hospital.
Like they're beholden to mALAstandards because of the active

(26:51):
labor part of the emergencymedicine and active labor and so
, yeah, I mean it's the sameidea with harm reduction
principles.
Right, we can reach everyone.
We can save their lives.
We have the tools to do it wecan save their lives.

Speaker 1 (27:11):
We have the tools to do it.
We have to have both thepolitical will and which yeah,
that's a big hurdle, I guess.

Speaker 3 (27:15):
It's just yeah it's a huge, huge hurdle.
I mean that's that'srealistically the biggest hurdle
.
And then and then the practicalimplementation of those tools
is also difficult.
Right On a local level you haveto like, find the place that
allows you to do that and youhave to reach the people you
need to reach.
And so it's sort of twofold fator two factors to achieve, to

(27:40):
be able to accomplish thosegoals.
But we can get there.
We just need the, we needpeople to believe in it.

Speaker 1 (27:45):
How do, how do we get there, Like what?
You've been doing this for awhile.
Do you see anything that worksbetter more often?
Just like kind of on the personlevel, like we're talking to
people right now, like kind ofwondering what, what can, what
can we do?
Like you know, like a vote,sure, like I get that, but like
what is there anything that thatwe can do individually?

Speaker 3 (28:08):
like I get that, but like what?
Is there anything that that wecan do individually?
It's a really good and toughquestion and frankly it requires
a lot of people to do a lot ofself-reflection.
Um, because we can accomplishthese hard political things if
there's the people power and theindividual will to do them
right.
People politicians are beholdento their constituents.

(28:28):
If enough constituents areclamoring for something, then
that politician may change theirmind.
But that requires a lot ofpeople to do a lot of critical
self-examination.
Right, I did not start in it atso, going to medical school, I
was not a believer in in harmreduction, I just I.
To medical school, I was not abeliever in in harm reduction, I

(28:50):
just I, I.
I didn't start from that place.
I grew up, um, as a person witha father who has alcohol use
disorder.
Um, I grew up understanding theAA abstinence only sort of
mantra, and they're sort of thepseudoscience that guides that
threefold model of disease, allof those things.

(29:10):
And so I in my mind was like,oh well, abstinence is the only
answer and harm reduction isn'thelping anyone and you're not
really saving lives.
And then I finished medicalschool, I went into, started my
emergency medicine residency atUCSF and San Francisco General,
where plenty of people wereusing drugs and seeking care at

(29:31):
the only county hospital in SanFrancisco, which is San
Francisco General, and I had toface it head on and say, oh okay
, I get it more now.
Now I recognize that I am partof a system that is causing harm
to people because they're usingdrugs, and I was recognizing
that people were coming infearful of being stigmatized, of

(29:53):
being looked down upon, ofbeing treated poorly, and that
they were more often than not.
And when you are faced withthat reality, when you accept
that you are part of a systemthat is causing harm, the only
logical answer to that is toseek to reduce that harm.
And so I had to fundamentallyconfront what I believed, and

(30:19):
seeing and trying to understandhow and why people were using
drugs and what that reallylooked like in a practical way,
like on the street, helped me tounderstand that I needed to
change my perspective, not them.
And so that's how I got to thisplace and then I practiced

(30:39):
emergency medicine.
I finished residency, Ipracticed emergency medicine
full-time for years and then sawmore and more of of the same,
saw this as a systemic problemin multiple places where we were
taking the wrong approach tothis and at that point I was

(31:00):
like there's got to be a betterway to do this upstream from the
problem.
Like the emergency department, Iwasn't solving people's
substance use from there, right.
So then it was like this is alarger scale problem that I need
to now go upstream and do thatwork um, outside of the hospital
and try to encourage people toone change their own perspective

(31:26):
within healthcare which I dowhen I'm, you know, working and
when I speak to other hospitalsystems and that sort of thing.
And then the other part is likegetting people into treatment
and trying to change their ownperspective, because there's so
much self-stigma and there's somuch shame within recovery
communities, and trying to getpeople to critically examine

(31:47):
from even within recovery spaces, within addiction medicine,
within you know, people who arein AA and not say, not demonize
AA, but to say, hey, we canreflect a little bit more on,
like where we're at and how wecan help people who are using
drugs, alcohol or other drugs.

(32:09):
I like to just say drugs,because alcohol is a drug, but
people are using all of them,right, and so if, if I can
change my perspective, if otherpeople can change their
perspectives, we could get to aplace where we can advocate more
broadly, form that likecoalition of people who want to
see this change, then you willmake that happen.

(32:31):
You can get to the point where,like we got to the point where
the bill passed both the statelegislature or passed through
both houses of the statelegislature, the assembly and
Senate enough people voted forit.
Right, we have, there's somepolitical will there.
But then you need a coalitionof people who will go to
governor newsom and say youbetter not veto this this time,

(32:52):
like if he believes that it ismore politically viable for him
to to sign that bill than toveto it, he will sign it.
He knows from, like, doing thepolitical calculus, that that's
not going to play throughout theentire state.
Right, and so if you get enoughpeople to to advocate then.

Speaker 1 (33:12):
So then, so we have a solution.
Then what you're saying is wejust need more people to spend
years of their time addressingthe problem directly and seeing
the flaws in the system that wecurrently have in order to
understand how other maybethings that they didn't believe
before might actually be theanswer or maybe we just need to

(33:33):
have more people emergencyresidency yeah, yeah yeah,
totally it's a, it's a very,very easy solution.

Speaker 3 (33:40):
No, I mean on a, on a on a practical level though, if
we can get people to justunderstand right, if it's
there's inertia in change, ifyou, if I can change and I can
change other people's minds,right, the, the downstream
effect, right, say liam say Ichange your mind and rob, I

(34:00):
change your mind.
There's two.
And then if you both change twopeople's minds by actually an
MLM.

Speaker 1 (34:05):
We need an MLM.
We need a pyramid scheme.
We got to get a pyramid schemeof change, people's minds.
Maybe we shouldn't market it asthat, but like that's good
behind the scenes, that's whatwe're doing.

Speaker 3 (34:17):
I mean on a certain level, there's a reason those
are effective, right, becauseyou're magnifying change rapidly
.
Because you're magnifyingchange rapidly, that is a model
of change just in a very sort ofmanipulative way, which isn't
the goal, right, we're nottrying to manipulate people, but
we are trying to changepeople's minds, and if you can

(34:40):
change enough people's minds,then yeah, that is sort of the
answer right there, though, likethat, if you can spread that
message and you can changeenough minds, then you can
achieve that.
And not everybody's gonna gothrough the same process or go
about it the same way, butpeople will get there.

(35:01):
It's just some people.
It may take time.
Some people may take more likedirect experience where they're
confronted with it.
That's how, like deeply sort ofentrenched, my own bias was that
it took years of being exposedto reverse that.
I don't believe that's true foreverybody, and I think we as a
society are starting to dobetter at bringing people to at

(35:24):
least a different starting pointthan where I was at, I hope, at
bringing people to at least adifferent starting point than
where I was at, I hope, and wecan change minds Now.
That isn't the only option,like an MLM isn't the only
option.

Speaker 1 (35:35):
What do you mean?
An MLM isn't the only option.

Speaker 2 (35:37):
It's not the only option, it's just the best
option.

Speaker 1 (35:40):
I was told we need to make a pyramid scheme and I was
all in.

Speaker 3 (35:43):
I mean Liam.
If you want to talk aboutcreating one, I'm all ears.
I was all in.
I mean Liam, if you want totalk about creating one, you
know I'm all.
I'm all ears, I'm sure there'sa model there.

Speaker 1 (35:49):
I mean, like you said , it works.
It works, doesn't it, like youknow, and so you harness
something that's usually usedfor evil for good, and that's
your powers for good.

Speaker 3 (35:59):
Exactly, use your powers for good.
That's the answer.

Speaker 1 (36:03):
Can we?
Say pyramid scheme for good.

Speaker 2 (36:07):
Like pyramid scheme for good, like, yeah, sure, we.
I think we need to put it likeat forefront.
We just need to replace thescheme like pyramid something
else.
No, I think it's kind of evil?

Speaker 1 (36:13):
no, but people want to be part of a scheme like I
think, people like being part ofa scheme, like people want to
be like on the end of something.
You know what I'm saying?
Like wait, what is the scheme?
Why would I want to be part ofthat?
Okay, here's what we're doing.
Actually, that sounds prettycool.
I'm just saying like listen, I,we do social media right.
I know, like short form socialmedia, like the first three
seconds are the most importantof anything.
Right, you just got to hookpeople in, all right, so like

(36:35):
pyramid scheme that hooks peoplein right away, and then we
start talking about, like howwe're actually trying to help
people who are dealing withaddiction.

Speaker 3 (36:42):
You, can call it pyramid scheme for good, like
that could just be the name.

Speaker 1 (36:46):
Yeah, like I, social media messaging fg like pyramid
scheme for good, like I don'tknow, we'll act, we'll
acrimonize it.
You know I I was just sayingit's.
It's maybe not the best option,but it's an option.
That's all I'm saying.
I mean the whole thing withlike I will say like the whole
thing with like drugs.
I've always found it reallyinteresting, especially like
looking at other countries andlike the completely different

(37:08):
ways they'll go about it.
Like I don't, I don't know allthe ins and outs of everything,
like I know just stuff to bedangerous, all this stuff.
But like you, look at one placelike the philippines which is
like basically just anyone who'sseen a drug is murdered, like
they, they, they have theharshest laws of like anything
right, like I'm sure you'veprobably seen some of this stuff
right, like um, and then on theon, yeah, on the flip side, you

(37:29):
have portugal, who?
I was just gonna say likeactually portugal and I've seen
like switzerland even have donelike, not made drugs legal, but
they've decriminalized drugsright and so they've made it.
So, like you, it's easier toseek treatment.
It's more see it's.
It's seen more right as like asa medical issue, right, so that

(37:49):
that needs to be treated, thanit is a crime that we have to
lock you in prison for manyyears for Correct In.

Speaker 3 (37:55):
Portugal.
So Portugal put their entiresort of money and effort behind
this idea that decriminalizationcould work in hand in hand with
, rob, like you mentioned, theidea of improving access to
treatment and that if peoplecome and you give them a safe
space, they may want to pursuetreatment and you need to have

(38:16):
the availability there.
And so I know when I talk aboutPortugal and that they
dramatically rate they spentabout 20 years doing this.
I think now they've cutoverdose deaths down to
essentially like negligiblecompared to our over 100,000 for
a couple of years.
Yeah, the people willpotentially point to Oregon, and

(38:41):
Oregon decriminalized smalldose possession of all drugs for
a brief period over the lastcouple of years, but they didn't
put the money and the sort ofenforcement ability to create
all the treatment spaces and thebed availability and all that

(39:01):
to low barrier treatment whichis kind of necessary.
That's the key part, and so they, they people will say it failed
because they repealed it aftera couple of years, two or three,
because they're like oh,there's public drug use has
gotten way up and now the policesay they can't do anything
about it.
Blah, blah, blah, well, peoplecan't access treatment.
It blah, blah, blah, well,people can't access treatment.

(39:22):
Then, like, what good are youdoing?
If you are just like oh, yeah,sure, anybody can use drugs
anywhere and it's legal.
Well, it's decriminalized, soit's not illegal, we're not
going to necessarily take themto jail for it, but you like,
well, you can't help.
Then what are you then?
What are you doing?
Right?
So the difference betweenPortugal and Oregon was that

(39:45):
Portugal, like, invested heavilyin this idea and it worked.
And if you don't invest heavilyand that may be part of the
political will problem is,people want to take that half
measure.
They want to say, well, it'sdecriminalized, at least, but
they don't put any money into it.
Then that's because we see,these people as criminals

(40:06):
already.

Speaker 1 (40:07):
So you know, it's basically like hey, let's spend
a bunch of money to help peoplethat you've already othered.
Yeah, you know that's a hardsell.
That's like you know.
You know selling whatever Idon't know, one of those
analogies You're selling thesand to someone in a desert,
whatever I don't find.
I don't do analogies, I don'tknow.
But like I don't feel, likeit's not gonna go super well,

(40:27):
right, like that's all, that'shard that's hard and and that is
part of the political problemis you.

Speaker 3 (40:35):
You have to be able to overcome that and that is as
much more complex or politicalanswer than than just just like
hey.
We need to help decrease stigmafor towards people who use
drugs and help support thepolitical will towards allowing
things like overdose preventionsites.

(40:56):
We could do that we could dothat and that could still work
without sort of decriminalizingeverything and then requiring
treatment beds and all that.
Uh, that would be sort ofanother layer to that, that
piece of the puzzle.
Um, but I think we can getthere, we.
We just have to, we have tostart somewhere.

Speaker 1 (41:18):
Right, I was just gonna say, like I think the way,
maybe one of the one of theways to try, besides a pyramid
scheme, is to try and tellpeople like the situation we
have now is, but like it's notgood, like we have we, our
system is literally set up tocost basically the most amount
of money where people have to goto the emergency room and

(41:39):
that's incredibly expensive.
And we're constantly talkingabout how much we spend on, you
know, medicine in general.
Right, like, because we do, wespend like a crazy amount.
This isn't the only reason, butit's just not not helping.
So, like I, I feel like maybeone of the best ways to go about
it's just like hey, this iswhat we have right now and it's
terrible.
So, like, would you be willingto try something else that would

(42:00):
maybe also save money, becauseyou like that sound?

Speaker 3 (42:03):
probably, yeah I mean , and that's the thing, they
will save money and they likeyou can save money, you can save
lives and you can take peopleaway from using in public.
Like that.
It seems like a win, win winyeah you have to say doing drugs
is okay.

Speaker 1 (42:21):
I feel like that's the one that it's like for some
people.
There's like they're neverthought the war on drugs has
gotten too deep into their skull, or just like.

Speaker 2 (42:30):
Just say no, like reagan said, and then it's not a
problem well, another thing weneed to do is rehumanize these
people that are yeah and likethat's not going to work for the
people who are far right andthey only care about the money.
But I mean, like it wasmentioned earlier, we get them
with the money, Like just thosepeople.

Speaker 1 (42:49):
we just focus on the money, but everybody else we try
to humanize.

Speaker 2 (42:51):
There we go.
It was mentioned earlier thatthese people, a lot of them, are
probably going throughstressful times and stuff.

Speaker 3 (43:07):
And the more you beat them down, the more that they
are going to withdraw fromsociety and rely on drugs to get
by.
I use the term.
You know people use drugs tosave their life, right, like.
Ask a person who uses drugs whythey use drugs and you will
hear many people say drugs savedmy life for a variety of
reasons.
But if you are in a situationthat is deeply uncomfortable,

(43:29):
traumatic, stressful, what haveyou just?
Like you said, rob, like peopleare going to use drugs as a
means of escape, as a means offinding some level of whether
it's tuning out or finding somelevel of joy, whatever it might
be that like saves their life,that prevents them from dying or

(43:52):
dying by suicide or whatever itmay be.
When you have people say drugssaved my life, like, it's hard
to look away from that and saybut we should never allow people
to use them I find itinteresting you say I used to
say, like you said, die bysuicide.

Speaker 1 (44:08):
I feel like that's it's a change that I actually do
, like I try and say, instead ofsaying committed suicide, as
everybody says, because when youcommit something, generally you
commit, you know, arson,burglary, a crime, whereas like
did you really you took your ownlife, is that we, we
criminalize even the act oftaking your own life.
That seems, boy, that seemsreal rough, like so you die by

(44:29):
suicide.
So I think it is a nice thingif people could start saying
that in the future.

Speaker 3 (44:34):
But like, still, sometimes I'll catch myself
saying it because it's just soingrained in us, you know
absolutely, and, and, and itspeaks to the whole point about
humanizing, right, you're justlike trying to humanize people's
lived experiences of whateverthey are experiencing, um, and,
and sometimes it's, you know,deeply difficult, and it's okay

(44:56):
that we reconcile that with theability of drugs to create
opportunities for people tocontinue living, um, and, and
that is okay right like, like.

Speaker 1 (45:08):
I think we collectively agree that people
continuing to live is generallya good for the most part, I feel
like we can come together on afew things and be like you know
less people dying.
Can we all give a thumbs up?
What do we do?
How do we feel about this?
I would hope most people wouldbe on board.

Speaker 2 (45:28):
I imagine another potential benefit to these harm
reduction sites is just theability for, or the potential
for people to find others insimilar situations and feel less
alone.

Speaker 3 (45:43):
Yeah, absolutely.
Drug use and substance usedisorders in general are
surrounded with shame and stigmaand internalizing social stigma
, and so people often end up insituations where they're using
alone, they're using inisolation, they don't understand
that there are other people inthe same place where they are

(46:04):
and finding that community canbe incredibly.
I mean not only can be anincredible relief, but is
incredibly important to thembeing able to form a self
identity, to be able to moveforward, regardless of whether
they want to be, you know,become abstinent in their you
know, in their like recoveryprocess, or if they want to be,
you know, become abstinent intheir you know, in their like
recovery process, or if they'rejust like oh man, this is

(46:26):
getting out of hand and I needsomebody to hold me accountable,
to moderate my use, or whateverit may be.
That is incredibly helpful.
I mean just community buildingin general.
We are social beings, rightLike that's useful for any of us
but that.
But I think that is a specificthing.

Speaker 1 (46:43):
That is like isolated right and stigmatized what you
said, though, like really getsto the heart of the issue.
We with the drugs are anescapism, you know, like there's
the the people have are dealingwith their lives and things are
shitty, and you know you turnto drugs.
It makes sense, right, likethat's what humans have been
doing, that since we've haddrugs.
Right, like we've, like yousaid, you've been doing drugs

(47:05):
since we've discovered drugs.
Like you know, we find, oh,this frog, if I lick it, if
things go weird, then I'm gonnakeep doing that.
Like it's kind of tough to justbe like, ah, don't do that.
So, like I think you know, justoverall, just trying to improve

(47:25):
people's lives.
You know it's got to be likeone of the answers there.
And like you know you look atany like drug treatment facility
, center, rehab, whatever it is.
They try, and you know, showthe people dealing with
addiction like other things,right, like there's just like,
hey, what there's, there's thisand that and there's other
reasons, and you know that's, Imean, that's when you're
fighting.
You know heroin, that's gottabe really hard, man, I should

(47:45):
for anybody dealing withaddiction.
I'm so sorry, like that justhas to be.
So the absolute, fuckingterrible.
I'm just going off on a tangenthere, but it's you know, just
basically yeah, we're trying toimprove people's lives.
I feel like it's one of thebest things you can do certainly
and certainly a worthwhile goal, in my opinion you know.
But then it gets into the likeokay, how do we do that, this
and that like you know?

(48:06):
That's you know when you'relooking more for like, what can
we do in the you know right now?
I think you know, like you said, creating these places people
can go that are safe seems to beone of the better things we can
do, as opposed to, you know,again, having a terrible system
that we have now.

Speaker 3 (48:22):
That it's just, it's awful yeah, it's tough, but I
appreciate you guys having me onto to talk about this.
I mean that is one of theanswers.
Right is like trying to spreadthis idea.
It's the, it's the mlm.
Uh, if you will, I still listen, I like the pure.

Speaker 1 (48:41):
Why don't?
We could also call it a cult.
It's a cult we're trying to getpeople into and then people are
very confused and they find outwhy and they're happy.
Then they're like, yes, lessyou know, less, less deaths from
drugs, that's good.
I like that.
I'm part of this pyramid scheme.
Now I'm just saying it's notthe worst idea.
It's not the worst idea, ohshit.

(49:02):
Well, I mean also, I guess like, do you have any?
We?
But here we talk a lot aboutnutrition.
Do you have anything to mentionabout, like, drugs and
nutrition?

Speaker 3 (49:11):
here I need a combination I think nutrition in
in addiction context is reallyinteresting.
Framing um, speaking of sort ofhow nutrition relates, there
are things that also leveragethe same things that cause
addiction to drugs, that causeaddiction to food, right, like

(49:32):
food can be an escape, it can bepleasurable, it drives dopamine
release.
People can use food in a waythat helps them with that escape
and release, and so people candevelop sort of eating disorders
or disordered thinking aroundfood, the same way that they
develop substance use disorders,disordered use of drugs, right.

(49:56):
So it's something to thinkabout and be mindful of as we
seek to approach addictions islike food can be used as an
addiction.
Food can be addictive in thatsense.
And so I don't and I use thatword a little bit cautiously
because I don't I don't thinklike drugs themselves are the

(50:17):
addiction forming problem.
Like the vast, vast, vastmajority of people who use drugs
don't develop an addiction Um,same thing is true with food.
So it's not the like substanceitself, it's the way that it's
used, it's the context with theyou know I.
So substance use disorders formin people in sort of like a

(50:38):
three fold um model.
I guess you'd say like thereare three factors.
It would be like.
We know there's some geneticcomponent that people are more
predisposed to developaddictions or substance use
disorders.
They have to have anenvironment that creates the
necessary circumstances wherethat drug becomes that creates

(51:01):
that positive feedback.
Circumstances where that drugbecomes that creates that
positive feedback.
And then you have to have theexposure.
And so, even though I amgenerally on the side of like
reducing harm, I'm not on theside of like let's make
everything legal and increaseexposure.
I'm okay with providing peopleinformed consent and putting
warning labels on things andlike telling people that smoking
can kill them.
Like people are like, oh, butwhat about you know?

(51:23):
Like, isn't that part of?
Like harm reduction is likejust letting people use drugs?
It's like, well, I mean, yes,in so far as we should provide
people help where and when theyneed it, the way they want help.
But we know that if the later,the more people delay their
exposure to drugs, the lesslikely they are to develop

(51:43):
substance use disorder.
So the same thing is true withfood.
Right, Like all of those things, from a nutritional standpoint
that matters, we should bethinking about how we label food
, how we approach food, how weallow people to be exposed to it
.
Because I'm sure, if you brokeit down and I'm not like an
expert on the on the, you know,nutrition side, I'm not like a

(52:08):
dietician, but like I'm surethere are other ways to approach
exposure, in the same way thatwe approach exposure to drugs
and and and yes, I'm all for theideas of like, if something is
found to truly be harmful orhave potential negative
consequences, we should labelthat, we should provide warnings
for that, we can ban things.

(52:28):
I'm okay with all those things.
But to try to reduce people'sconsumption of harmful things.
I think, like in Rob, to yourpoint also about community, like
there are community supportgroups for these things.
Right, Forming community andrecognizing that you're not
alone in your own, like foodaddiction, is also valuable in
terms of forming thatself-identity and decreasing the

(52:51):
self-shame and stigma.
All of that, all of that isimportant, and so we can view
them sort of through the samelens.
Like food is not inherently badbut it can be used in harmful
ways, drugs are not inherentlybad, but it can be used in
harmful ways.
Drugs are not inherently bad,but they can be used in harmful
ways and they can lead people todying.
Just like food can lead peopleto die, like poor nutrition can

(53:12):
lead to bad outcomes, drugs canlead to bad outcomes.
We can recognize those thingsbut also, try to, like improve
the lives of the people who usethem In moderation.

Speaker 2 (53:22):
Brad Bobby Reduction Center coming soon to a city
near you.
Reduction Center to likeimprove the lives of the people
who use them in moderation.
Brand bobby reduction centercoming soon to a city near you
reduction set.

Speaker 1 (53:27):
I think we have to spend our money a little more
wisely.
But like we'll throw it on thelist, um, that's how successful
that mlm is.
Yeah yeah, and that's the thingyou know with people, with food
, you know you're surrounded byfood all the time, like you need
to eat, you need food.
So when you have it around you,you know you always have that
exposure right to it which, yeah, for a lot of people can be
really difficult.

Speaker 2 (53:48):
Yeah, absolutely so.
If we have somebody in ourlives that could use going to a
harm reduction center orsomething, yeah, what would be a
good way to approach that toget them?

Speaker 3 (54:03):
That's a great question.
So one thing I will say tostart is, like I generally think
of interventions in the contextthat like the sort of classical
context that we think of asinterventions like sit down and
everybody's going to likebasically shame this person,
tell them how bad they are andthey need to seek help, as

(54:23):
inherently problematic.
Are there ways to do that moreethically?
Sure, um, but I think you canjust approach the conversation
and say hey, here's an issuethat I see, right, um, I've seen
that you struggled with food.
I've seen that you struggledwith your heroin use getting out

(54:43):
of control.
Are you interested in talkingabout that?
And if they're like, yeah, Iknow I'm really having a problem
then you can say hey, like,would you be open?
I know that there's a place thatit's not going to shame you or
stigmatize you about your use,but they'll be willing to talk
to you about this.
They're they might be betterthan me at having this
conversation about how we can goabout helping you in terms of

(55:08):
your use so that it's not out ofcontrol, so that your life
doesn't feel out of control.
I think driving like isolatingthem more and shaming them more
is just going to be moreproblematic and they're going to
reflexively basically want totell you to f off and and like I
can do it myself or whatever itis, or I don't want to do it

(55:28):
your way because, like you'remaking me feel ashamed, you're
making you're an asshole, yeah,um, and so if you can approach
it just from like a friendly,like hey, I want to help, tell
me if you want help and if andthey may say no and then you

(55:50):
just kind of like beat that druma little bit, say like I'm, or
even offer like hey, you know, Itook another friend to this
place and like they seem likethey really have these
conversations well, or whateveryou want, however, you want to
approach it, but like not aconfrontational way, right, um,
I like to think about thosesorts of things in the like,

(56:13):
like I I I'm not a person with asubstance use disorder but like
I have a problem with using myphone too much and using social
media too much, and I've had tohave conversations about, like
you know, like with my wife,like hey, um, I like this is a
time that, like I need you toreally like not use your phone.

Speaker 1 (56:34):
It's like okay.

Speaker 3 (56:35):
If that was presented in like a super confrontational
way, like hey, you're a dick,um, and you're ignoring me or
whatever.
Like I'm not going to respondto that, well, um, but just
approaching it from like hey,this is a thing that I think is
an issue right now and we cantalk about it more later if you
want.
But, like, I would like to seethis happen this way because of

(56:57):
and frame it in the context oflike this is how I feel about it
, not about them, not about likehey, not, I feel like your life
is out of control, but like Ifeel like I've seen this happen
to you and I want to help.
Can I can't, like can you allowme to have a conversation with
you about that?

Speaker 2 (57:14):
so not last semi-charmed life and then be
like hey, speaking of drugs forthose of you who don't realize
it yet, uh, semi-charmed life isabout doing crystal meth yeah
you go back and listen to thatsong, you're like, holy shit.

Speaker 1 (57:30):
I listened to this when I was younger and I was
just like singing along with thelyrics.
But now, god damn, what is this?
Was this lyrics always likethis?
Yeah, yeah, everybody afterthis episode is gonna go listen
to semi-charmed life.

Speaker 2 (57:42):
Yeah, huge spike in listeners.

Speaker 1 (57:43):
I know Spotify it's a bunch of listeners Well, is
there anything else you want totouch on that we didn't mention,
or anything that you want toget across to people?

Speaker 3 (57:53):
Uh, if you're interested in this kind of
discussion, um, I host a podcastwith a friend and colleague, um
Macaulay Sexton, calledRecovery Reform and basically is
all about reframing the way wetalk about recovery and talking
about it in a non-abstinent,non-stigmatizing way and wanting

(58:14):
to support people where theyare in their journey and
recovery.
So, yeah, plug that.

Speaker 1 (58:23):
Where else can people find you Do all the pluggables,
all the plugs.

Speaker 3 (58:28):
I don't use Twitter anymore.
I'm on X or not on X?
I'm off of X.

Speaker 1 (58:33):
I'm not on Twitter.
Elon Musk is happy that youcalled it X.

Speaker 3 (58:37):
I'm on Blue Sky and my profile is tnicholsmcom.
Um, I don't know.
That's pretty much it.
I stopped using social media.

Speaker 1 (58:48):
In general, I get it, oh yeah.

Speaker 3 (58:50):
Yeah, it's a.
It's not great right now,anyways.

Speaker 1 (58:53):
Uh yeah.
Well, don't worry, the nextfour years will be a lot better.
It's fine.

Speaker 3 (58:59):
Thank you guys.
I appreciate you.
Thank you for having me and,yeah, I look forward to more of
these conversations.

Speaker 2 (59:06):
And I look forward to us organizing our MLM.

Speaker 1 (59:10):
MLM.
I want pyramid scheme.
I want to have a pyramid scheme.