Fought back. He told me i would not get it. I ended up taking it, had a severe allergic reaction, which i am still so upset, i am in the process of writing a letter to the two doctors that put me in this position. Again, our medical system is a capitalist system, ok . Look at the history of opioids. Handinhandes with the invasion of afghanistan. What is in afghanistan . Opium plants. We went there and took control of the opium. As the earlier caller stated, where our military has turned into a mercenary for corporations, i think it is very clear. Until in america when we start looking at the root cause of all of our problems, rather than constantly trying to run around and put out the fire, we will continue to have these problems. Host leave it there. Guest the capitalism point is important. Where does money get involved with opioids and Pain Medicine . One of the things in the book is i trace a handful of the most obvious ones. One, pharmaceutical companies. Most common narrative, it is too simplistic but it has a kernel of truth. One of the main reasons we are in this mess is the pharmaceutical companies trained an army of marketers, pounded the pavement, told all the doctors that opioids are riskfree and good for all pain. A little too simplistic but a kernel of truth. A lot of misleading marketing. Farm is being sued. Pharma is being sued. Then you have treatment options. What are the most costeffective from a patient and hospital perspective . Morphine are ae penny a dose. Other medications are far more expensive. Acetaminophen, which is complicated, the evidence is mixed, it worked well for me, i wanted more and it was not given to me because it is orders of magnitude more expensive than morphine. When youre dealing with chronic pain at home, a lot of patients ought to hear from their physicians, and have not for 20 years, the best thing for a bunch of Different Things as physical therapy, yoga, mindfulness, acetaminophen and ibuprofen. Especially physical therapy, yoga. Insurance is not paying for yoga. Physical therapy is not covered often. Five dollar copay for opioids or for me, 100 per month for physical therapy. Money is shot through the problem and a bunch of ways. We are only scratching the surface. Doctors who prescribe higher get more funding from pharma. Look at the data sources in the book. It is an important point, as long as money is so shot through the problem, it will be hard to work out. Host paul from new york. Caller quick question. What is the percentage of people prescribed opiates actually get addicted . I listen to stuff on television and i dont actually hear an answer to that. Also, im looking at the cost of intravenous acetaminophen. 40 for 1000 milligrams dosage. I am wondering how that compares to what you were talking about . 1950s,hree, in the they used to send people to a farm in kentucky for about a year to get off opiates. There wouldnt be any around. This was sort of a way of getting them off it. Invariably, in many cases, a huge recidivism rate. I am wondering if you could describe that. I would be interested to hear, what percentage of people prescribed opiates actually become addicted . I was prescribed a bunch of them for a long time. Never got addicted. I did not use them chronically. Im interested in what the data is . Guest important question. Hard to get a singular answer because definitions of addicted vary wildly. We used to use addiction and dependence for Different Things. Now we use opioid use disorder. To 8 ofess than 1 people prescribed opioids develop a new addiction that was not already underlying. This is viewed as a claim that that is a low number, so, as you said, that is most people story. We should be clear. Most people do not get a new bottle, take pills and have this take over their life. The other way to understand it is, look at it from a Population Health perspective. Millions of people being exposed to opioids. If you have 6 chance of developing new addiction, and we prescribe aggressively when they are not needed, 6 of people who never needed to be exposed to this are going to develop this devastating, potentially lethal complication that is addiction. There is more data here. It would take me too long. There are sources in the book about new longterm opioid use, that is not necessarily addiction. That can be harmful in its own right. Do you want me to go on . About the iv a seven minutes and cost. Offend a set admin correct. Phen, 40 is you think it doesnt sound like much. I was asking for daily doses in the hospital. For me, it felt like it was as good as morphine for my traumatic pain. What they had to do, they did not say this, they had to think, as a hospital, if we gave every patient who asked this unlimited doses, to keep it low enough that it would not destroy the liver, what would that cost . There are several papers that say hundreds of millions of dollars over a year if hospitals did this. On the one hand, it does seem them, ii was telling will take morphine if you give me more tylenol. They said, no. That seems absurd. I was angry. It is not obvious. We have to contain costs in the health care system. Someone is crunching the numbers saying, is the data there to support the expenditure . Dependenceological on opioids is not the same thing is addiction. Addiction involves something else. What precisely . It turns out this is hard to answer. Why is that . Guest this goes back to my response about how many people report addiction. People hear my story and say, boy, that is too bad you got addicted after a short amount of time. That is not a great description. Addicted, i i was would talk about it, i think we should destigmatize addiction. It is important we do not confuse physiological dependence on addiction. There is what happens to every persons brain if they are on opioids long enough. The brain tries to readjust. That is called the formation of tolerance and dependence. Because the brain has tried to readjust and doesnt want to go crazy every time you get a shot of morphine, if you take that morphine away, they going to really terrible withdrawal. The longer they have been on, the higher doses they have been on, the worse the withdrawal is. That is not a sign of addiction. It happens to every single person. How may people get addicted . If withdrawal was evidence of addiction, the answer would be 100 . That is not helpful. Something else is present with addiction. Maybe they lose a family, their job, they cannot keep their life together, even if they are holding down a job. They chase this reward to the exclusion of all else they should find meaningful by their own life. Even in the face of negative consequence, they impulsively chase this thing and crave it all the time. That is the behavioral aspect. We should think about someone as addicted if they have this aspect. Does away with this dependence and addiction and puts it all under Substance Use disorder. They can be moderate or severe. We have to teach this. When you see someone in withdrawal, you do not necessarily see someone addicted. It has different policy locations. Every single one of us needs dependence treatment if we are on opioids long enough. A smaller number, which is more costly, need Addiction Treatment. Host eric from pennsylvania, next for our best, travis. Go ahead. Caller travis, this is interesting. I was ahead of the curve. I became a convicted felon because of this stuff in 2001. Theve gotten introduced, in 1980s as a migraine patient, and it went from there. Assumptions and presumptions about who gets caught up in this, what is your Research Bear out regarding the changing phrasing and attitude, now that there is welltodo suburban white kids getting caught up in it, it is an epidemic, it is a medical problem, but not too many years ago, you are seeing, if you were involved in the stuff, you are seeing it as a common drug, criminal with potential for violence and all manner of criminality just because of the class of drug it was. Guest yeah. Super important question. I am grateful to talk about it. I say at the end of the book, you cannot responsibly have this conversation without saying explicitly a bunch of the things you just said. Serious drug problem in this country for decades before anyone was calling it a crisis. 1990s,ned starting mid 19992010, overdose rate from prescription opioids quadrupled, same time that prescribing quadrupled. Where we shifted the kind of patient that was seen with addiction, Substance Use disorder, but it is really on us that, who was getting hit by that change . We had this older opioid epidemic, largely heroin in inner cities, disproportionally affecting minority communities and when it switched to white,ption, it affected rural and suburban patients. We are now in a third wave. Everyone is a victim. There is no discrimination among demographics anymore, partially because there is a huge amount of prescriptions, there is heroin everywhere and it is laced with fentanyl, which is super potent. It is everywhere now. The story is important. If we act like, this is only worth tackling now because a bunch of white people and people who have more power, politicians are now personally have family members and friends who have died from overdose, if react like that is the only reason to address the crisis, then shame on us. Were are just admitting our response is shot through with racism classism. That means, looking forward, one, we have to own it looking backward and looking forward, when we devise policy solutions, we cannot be thinking only about the kind of patient we like for the kind of victim we like. If you think, oh, this is worth it because the white suburban High School Football player gets addicted and dies, we cannot devise only prescription restrictions. We have to do something more comprehensive. Host they viewer on twitter saying imperative that government contribute to Pain Research. Is anything happening . Guest there is Research Money going into Pain ResearchAddiction Research new interventions, something called the heroin vaccine, using the bodys immune system to respond. There is Research Money going in. The person is online, the person is correct. It is imperative. Im not 100 sure this is the best use of resources. We have a ton of things we can do now on the pain side and the addiction side using resources we already developed. For Pain Medicine, we could educate physicians. That would go along long way and does not require new research technology. We can scale up Addiction Treatment facilities, using methadone, the Gold Standard for Addiction Treatment, introduce Harm Reduction services where they do not exist. We know how to do those things and we could start them now. Research, absolutely. That is a longterm plan. There is stuff we can do now efficiently. Host what was the experience for your wife and daughter . Guest traumatic. Ought, she wants to, this is something she could do, to family members going through this. It was traumatic for me in a particular way that i have this personal view. It was traumatic for her in a completely different way that she had to watch this happen to me. She knew i could recover, that i could be whole again. She couldnt convince me of that. She watched me believe i was dying. She was trying to raise our 1. 5yearold. She could not leave her job. She is a research scientist. She had to hold down a job. I am grateful my daughter was only 1. 5, because she does not remember it. I said to her, every day, god, i hope you dont remember this. It is secondary trauma. Us, howd remind, all of lucky i was that i only wrestled with withdrawal for one month and two months of exposure. There are people whose lives are destroyed and the trauma must be orders of magnitude greater. Host when did you know you were off opioids . Week we stuck to the 4 weaning plan because we never got better advice. I didnt know that if i change anything, it would get better. No one would tell me that. I believed if i would go back on the meds, i would never get myself to do it again. Month100 free after one of the medication and the acute stage of withdrawal lasted a week. Up, mye acute phase let life started to recenter and i started to think, i will survive this. Withdrawal symptoms can flareup for months, postacute withdrawal symptoms. That is a scary thing. If you have been traumatized like this, months later you can get tremors again. Host do you still have pain from the accident and how do you manage that . Guest i do. It was a limb salvage situation. You dont fully heal. It depends on how bad it is. I will need another surgery eventually. Surgeonve an orthopedic clear out some of the painful components. I sometimes use ibuprofen. I try not to use it everyday. All drugs have side effects. First rule of pharmacology. Ibuprofen and a set a minute for they work really well for me. Things like physical therapy, shame on me if i dont put this into practice. Over the course of six months, as i was finishing the book, i ramped up my regimen and it is borderline magic for me. The kind of pain i have in my foot responded well to exercise. If i am too busy and i neglect myself, the pain goes up. Host williamsburg, virginia, randy. Caller good morning, america. My condolences to the families of the tragedies this past weekend. , good morning dr. , that is wonderful youre bringing up exercise as a recovery tool. In anlf was injured industrial farm accident in 1998. I was thrown from a roof and broke my neck. Ended up with seven screws, two plates of steel and part of mybutt and neck. When i was well enough to volunteer, i did so on the pediatric injury for an brain injury. 2000, that is when i saw how well, how, not only, there was little equipment for children to get back some of their physical abilities. I also found out how in school, we dont teach fitness so much. That is what really saved my life. I was an endurance athlete. I knew the difference between injury pain and training discomfort. That is what i relied on for the first two years out of the hospital, which i spent 10 weeks in. They said i would be there six months at least. Sir, i will get right at this and that is what i did. Stationary bike is what brought my lower extremities back. More andn, more and more and more work in the gym and i was able to separate the discomfort of improving my health from the discomfort of the injury itself. We are not teaching that in school. As a result of that, please let me finish, ive built a mobile fitness facility which i have been sharing on cspan for 20 years now. This murderwith all and mayhem on these blocks, psychologically and physically, fitness is a great respite for those directly affected or for those in the community. Host thanks. Right to is exactly talk about the importance of fitness. One of the interesting things i learned in my research was we have these tools we recognize because we use them. Another one is breathing. The first thing i thought when i read about this was, no, how can breathing be that important . Doctors said, your wife gave birth, right . Yeah. What did they teach her to do in the pain of childbirth . Pain management and focused techniques. One of the interesting things i found was evidence for things chi combined tai elements of good recovery techniques. You strengthen the body with exercise and do mindfulness meditation, focusing on your breathing and all of those, it can sound hokey if you are not on board but a lot of those are