Breaking Barriers in Addiction Recovery: What 2025 Holds for Healing and Hope

Step into the future of addiction recovery with 2024’s Top Advances in Addiction Recovery: A Year-End Review. In this special episode, Dr. Michael Lowenstein, David Livingston, LMFT, and Dwight Hurst, CMHC reflect on the year’s most impactful innovations and insights. Discover how GLP-1 receptor agonists like Ozempic are revolutionizing addiction care, showing promise in reducing opioid and alcohol use, as supported by groundbreaking studies. Uncover the latest advancements in pain management, the evolving challenges of fentanyl, and the transformative role of comprehensive, medically-assisted detox. Join us as we explore the intersection of medical breakthroughs and behavioral support, offering hope and a path forward for those seeking freedom from addiction. Don’t miss this empowering year-end review!

Podcast Episode Summary:

1. Redefining Recovery: This references the discussion on combining medical and psychological approaches to recovery, emphasizing individualized treatment plans and the importance of addressing both physical dependence and emotional regulation.
2. The Impact of GLP-1 Receptor Agonists: This draws from Dr. Lowenstein’s explanation of how medications like Ozempic are reducing opioid and alcohol use, including the cited study showing reductions in overdose and substance use.
3. Innovations in Pain Management: Reflecting Dr. Lowenstein’s insights into non-opioid pain management options, such as interventional therapies, anti-inflammatory treatments, and physical rehabilitation, aimed at reducing addiction risks.
4. Fentanyl’s New Reality: Highlighting the conversation about fentanyl’s increasing presence, its devastating impact, and how it has redefined both addiction treatment and patient behaviors.
5. Breaking Stigma and Building Support: Tied to discussions on the stigma surrounding addiction, its impact on seeking treatment, and the importance of fostering open, judgment-free support systems.

Transcript:

Dwight Hurst, CMHC: Welcome back, everybody, to a podcast to answer your questions on addiction recovery and mental health, produced by Waismann Method Treatment Center and Rapid Detox. I’m Dwight Hurst, I’m a clinical mental health counselor and honored, as always to be the co-host for today’s program. This is our last broadcast of 2024, for sure to go into the history books. Uh, we’ve had a great year of being able to talk about addiction, mental health recovery, and we’ve had some wonderful guests join us too, which was a new, uh, part of this project we were able to do this year was to have some people join us and tell their stories, and we’re looking forward to continuing that as well as answering your questions about detoxification, the addiction recovery process and mental health. I am joined by our our wonderful panel of experts from here at the Waismann Method. I’ve got David Livingston here. Hi, David.

David B. Livingston LMFT: Hi. Good to be here.

Dwight Hurst, CMHC: A licensed marriage and family therapist. David is the psychotherapist and clinical lead. He’s an expert in the psychological needs that are associated with addiction, with recovery, trauma, and just all sorts of of of good, cool things to help with that recovery. We’re also joined by our medical director, Doctor Michael Lowenstein. Hello.

Michael H. Lowenstein, MPH, M.D.: Hello.

Dwight Hurst, CMHC: Uh, doctor Lowenstein is a globally recognized authority in anesthesiology, pain management, and rapid anesthesia-assisted opioid detoxification. Did I do all the words right?

Michael H. Lowenstein, MPH, M.D.: Yes. Perfect.

Dwight Hurst, CMHC: Okay, good. Just wanted to make sure. Well, um. As always, it’s interesting to me. And I noticed this working in the field, um, to have so many people that are just people we get to meet every single day, and I have very much enjoyed working with throughout the years in this podcast, because there’s such a wealth of knowledge for us to learn from just from each other. So that’s my that’s my gushy end of year comments about you guys. But why don’t why don’t we get into it? We’re going to focus today on some of the trends and some of the elements that we’re seeing in addiction treatment in mental health aspects, as well as pain management and some different things with medications. Um, we’re going to we’re going to talk about how those work together with uh, with recovery. So let’s uh, let’s, you know, dive into this and say, uh, first of all, what do we find to be, uh, when people are getting into this mode of recovery and health building? Um, what are some of the strategies that we like to recommend or that you see work well for people when it comes to that? And I think, you know, we’ve got on both sides. We’ve got the real physiological side of medical, and then we’ve got the psychological side of the medical recovery that people are going through. So where do you want to start with that? What are some good strategies to maintain progress in this area?

David B. Livingston LMFT: You want to go, Michael?

Michael H. Lowenstein, MPH, M.D.: Um, sure. I’ll go first. Um, so as we’ve discussed in the past, uh, patients that are opioid dependent, um, or any substance of dependence, but, you know, my focus is primarily opioid is, um, once you’ve been able to recognize a, the problem, um, and be willing to seek treatment. So the question is, what are the what are some of the options. And, you know, we’ve got traditional options. We’ve got inpatient, outpatient detox. Um, there’s, you know, maintenance drugs like methadone and Suboxone. Um, and then what we do is, um, rapid opiate detox under sedation. So and everybody has different needs and, you know, comes to these decisions differently. So I think the first is to acknowledge that there’s an issue and seek treatment. Um, and then, you know, once we’ve helped to establish medically and there’s no one size fits all for anybody, and a lot of the patients I treat have tried other things and, um, or maybe had short-term success or relapsed. And, um, so we have to figure out what works for the individual. And then, you know, the medical is only works side by side with the behavioral addressing those issues as well. Um, where David kind of comes into the, the picture.

David B. Livingston LMFT: Yeah. Um, so, um, just to add to that, right, you might think of from a more emotional or psychological perspective that a lot of, um, a lot of addiction is just an attempt at affect regulation so that the the opioids, which is, you know, of many different forms that that we treat, um, uh, is an attempt to regulate, um, uh, physiologically and, and emotionally, uh, some form of dysregulation. And it can come from many different things. And we see a lot of people with really chronic sleep problems, which is creates a big form of dysregulation. Doesn’t have to be that. But that’s that’s a common thing that is going on. And usually untreated, some people have attempted at it, um, usually unsuccessfully. So, you know, so that’s just an example of sort of what can cause affect regulation on many levels. So it’s both physiological and of course, then it becomes psychological as you move into perceived helplessness and levels of frustration. And then, you know, the two are pretty intertwined. Um, so I think that there’s been a movement away from so and, and maybe the last thing to say about it is so it’s, it’s often talked about as, as, um, um, that addiction is talked about as a model that is um, uh, I can’t think of the word I’m trying to find right now.

David B. Livingston LMFT: It’s, uh, it’s a, uh, what’s the word I’m trying to find? Disease model. Thank you. Okay. The disease model is not is is right to some degree because it acts upon you. And so what was once thought of as a failure of, um, your character is now seen as problems with affect regulation. So the disease model, which when I hear people talk about it, they usually say it’s a disease. It’s not. It’s not exactly right. There is no pathology that’s being or nor pathogen that is being sort of seen. Oh, this is what’s causing it, but it is a disruption. So the disruption acts upon you. So it is a model that sort of, um, moves in the same way. And then a lot of the treatment that follows both, um, physiologically and emotionally has to do with what is going to help regulate you and sort of move you to a place of better health and, um, and feeling better overall.

Dwight Hurst, CMHC: It strikes me that both of these areas and gesturing to where you guys are on my screen, um, both of those areas relate to, uh, do I regulate and find actual maintenance or curative factors for the underlying reasons why, uh, I might go back to dependance or to to drug use, or maybe why I did it in the first place. In other words, if it was a form of self-medication. Um, do I have attending health problems that could set me up to to get into problematic use? Um, do I treat those right? Am I stabilizing in ways that are more healthy because the needs aren’t unhealthy? It’s just it’s just the addictive, uh, solution for the needs, right?

Michael H. Lowenstein, MPH, M.D.: Yeah, yeah. And I and I would say you do have to address both of what we spoke about. Um, and I’ve always said I’ve been doing this now for 25 years and said, uh, people do drugs for a reason, right? Um, the reason could be the underlying psychosocial issues. Um, it could be chronic pain. Um, but regardless of what the reason is, um, from my perspective, everyone I treat is opioid dependent, right? And opioid dependence is a medical issue. Opioid dependence is a medical issue. Um, and the one thing I didn’t talk about is, you know, the game has changed since I started 25 years ago. Um, you know, there was heroin out there and, um, you know, some of the Vietnam veterans that had come back and were still on heroin, we treated and there were the pills like the Norcos and the Vicodins and things like that. But the fentanyl is really, really changed the game. It’s incredibly potent. The overdoses have gone up significantly. Um, we now find xylazine, you know, tranq in the drugs, which has changed the game and it’s relatively inexpensive. So, um, the amount of drugs that people are taking that come to me are just enormous.

Michael H. Lowenstein, MPH, M.D.: And it’s, um, it’s really made more the traditional treatment options more difficult because the just the drug uses is so high. So, you know, everyone that comes to see me is opioid dependent. And I still think, um, if we can treat that opiate dependence, um, and I use afterwards, use Naltrexone to block cravings so we can treat the dependence and block the cravings. The patient’s ability to address the underlying issues is so much easier than when they’re still dependent. Um, it’s easier for psychiatrists to make diagnoses when the patients are off the drugs, um, and they’re not craving and withdrawing. Um, so I’m still, I still think the medical part it’s important to address whichever way. And I’m, you know, a fan of what I do because we we completely get the patients off opioids, block the receptors with the naltrexone or vivitrol the injectable form. And then, you know, David is then able to start the process of identifying the underlying issue, the wires. Why are patients using drugs. And um I think it’s it’s important.

Dwight Hurst, CMHC: Excellent. Well there’s new trends nowadays in pain management. Um, there’s there’s a lot of different, uh, practices and research that’s been going on with going trying to go beyond opioids to look at that, which hopefully obviously one of the upshots of that would be reducing addiction risks, as well as hopefully finding things that don’t have the eventual, you know, opioid-induced hyperalgesia, things like that that we see. Um, Doctor Lowenstein, can you tell us a little bit about what’s going on there with pain management?

Michael H. Lowenstein, MPH, M.D.: Yeah. So there’s a lot of exciting things going on in the pharmacology world for both pain management and then addiction as well. Um, so with regards to pain management, there’s a the FDA is currently looking at a, a new drug that relieves acute pain, but it doesn’t utilize the opioid receptor. So it theoretically would cause less risk of dependence addiction, things like that. Um, the orthopedic surgeons have gotten very smart. You know, it used to be you’d get a knee arthroscopy and go home with 30 or 60 or 90 Vicodin. Um, they’re now using combinations of anti-inflammatories and local anesthetics that they’re, um, injecting in joints postoperatively. That’s significantly reducing the need for opioid medication afterwards. Um, and so and for the in that arena, in the orthopedic arena, the problem was twofold. One was people that had previously been dependent on drugs. That brain gets a taste of opioids again and there’s relapse. And then, um, you know, some people just like the way that, um, opiates make them feel. It’s interesting. Some people, it causes dysphoria. And, you know, the risk of them abusing is very low. But other people, it’s like, oh, it gives me energy.

Michael H. Lowenstein, MPH, M.D.: I feel so good. And, you know, and that becomes a slippery slope. So, um, after total joints, they’re infusing local anesthetics. Um, so there’s a lot of non-opioid medications. And then in the chronic pain world, um, we’re doing stuff like interventional injections. We can treat facet arthritis by burning the nerves. We can implant spinal cord stimulators, things like that. So for those chronic pain patients, and then there’s really been a push towards more physical therapy, occupational therapy, yoga, pilates, um, things like that. So, um, you know, when I started my career, very few people got opioids, you know, my pain career. Um, and then, you know, with the whole, um, OxyContin, you know, epidemic that changed. And now I think we’re, we’re cycling back to where we’re looking at non-opioid methods. And then in the pharmacologic realm you’re looking at um like ozempic and manjaro, you know, the weight loss drugs. Um the nervous system is very complex. And we’re now finding out that there’s overlap. So these drugs that were prescribed to lose weight and they actually work by.

Dwight Hurst, CMHC: Yeah. That that’s an interesting new trend. You know, that we are seeing that we are seeing with a lot of the weight loss drugs. I know that with Ozempic, I boy, you know, my ads, targeted ads or whatever it is, maybe they know something about me, uh, weight-wise, but I get the targeted ads on social media. They’re just. It’s all over the place. I will now to. Now that we’re talking about it, my phone’s probably listening to me. Um, but a lot of people are using that, even just in the weight loss area. And then to say that there’s been some indications that it can help with addiction. Um, yeah.

David B. Livingston LMFT: I mean, I’m hearing that from people who are, are using, uh, those drugs to that they’re actually finding that they’re feeling less, um, compulsive overall towards, you know, uh, any sort of unwanted substance or overeating or things of that nature. So I think as Doctor Lowenstein was saying, we’re just figuring out, I think it’s it’s new and there’s I know there’s research. I’ve been reading a little bit of it, but, you know, I think they’re just beginning to put it together. But it’s promising. And I think that, um, uh, you know what, what drives behaviors in terms of the nervous system, the brain, you know, um, affect regulation and all these components are kind of beginning to sort of come together and, um, and then, you know, pulling them apart and seeing sort of what makes a difference and, and being able to have enough knowledge and access to good treatments where you can try things and see, assuming that it’s indicated, you know, if it’s really useful to you.

Dwight Hurst, CMHC: Yeah. Well, and I know that, um, I have this discussion with people all the time, which is when you do come across research, um, those that write articles love to put this is what we found in the headlines and even in the articles themselves. If you actually talk to researchers, they’re always like.

Dwight Hurst, CMHC: Well… Let’s slow down a little bit there, you know, because they’ll they actually want to answer the questions. And even when we get to the point of doing human trials and having people actually be part of the research studies, it’s always good to keep in mind that it’s like we know that something significant might be going on. That’s it. And until we they don’t make declarative statements very, very quickly. Um, and then at the same time, some of the research is, uh, looking at the effects that it has, whether or not they know what it does. Um, it looks like we’ve got, uh. I’m back. Here we go.

Michael H. Lowenstein, MPH, M.D.: My internet just went down. Do you want me to keep going or.

Dwight Hurst, CMHC: Yeah, well, we were we were actually just talking about some of what people are seeing and the hope that the Ozempic is giving them. I. It’s nice that you jumped right back in. Right as I was, uh, wanted to ask you a little bit about why might… And we were just saying, like research, you know, is one of those things where we can get indicators. But I don’t think we we often don’t know yet. But why, why might the ozempic be helping was in terms of receptors and what it what it done be doing in the body and brain. Yeah.

Michael H. Lowenstein, MPH, M.D.: So it looks like the, the GLP-1 and GIP receptor agonists, um, they actually work on the mesolimbic system, the part of the brain. And again, there’s so many cross cross connections in the brain that I think we’re still at the very tip of the iceberg about discovering how addiction and all these things work. But it’s it looks like it reduces appetite and triggers, um, satisfaction in the brain. Um, and that’s how it actually controls addiction. Um, so as a result, you feel like you’re full or you eat less. And so the weight loss comes through that effect on that, the whole mesolimbic system. And so for that reason, it looks like it’s effective for, um, opioid and alcohol use disorder as well. And there was a recent, um, a recent article that came out in addiction, the Journal of Addiction, that they looked at 500,000 people with opioid use disorder. Um, and the there was about 8000 people that were also on one of these, um, agonists like, uh, manjaro or ozempic. And in that group, they saw a 40% reduction in opioid overdose. And in the alcohol group there was about 800,000 people, and maybe almost 6000 of them were on one of these drugs, and they saw a 50% reduction in, um, in basically, um, intoxication from alcohol. So there’s definitely a cross-reaction. Um, and we see it with naltrexone, right. It’s a pure opioid mu-antagonist? Excuse me. So that’s why we use it after detox to fill the receptors and block the cravings and reduce the risk of overlap. But it also works with alcohol. Um, and they’ve even started using it with weight loss and combining it with Wellbutrin. So there’s definitely a lot of crossover.

Michael H. Lowenstein, MPH, M.D.: Um, and it’s interesting, even naltrexone in the dosage we use to block opioid receptors, if you use it in very low dose, like one-tenth the dose, um, they show that it increases, um, inflammation in the, in the body, um, effect, by the way, it affects glial cells. And so it’s being used now for MS. It’s being used for fibromyalgia pain. It’s being used for um, all of these, a lot of these chronic pain states. So, um, you know, naltrexone is a pure mu opioid antagonist. So it’s a very pure reaction, but it seems to be working by other mechanisms in so many other body systems that I think hopefully they’ll be able to design drugs that are more specific because, you know, like these have side effects nausea, vomiting, you know, GI issues. Um, so, but you know, somebody who’s overweight, it’s interesting that people that I’ve treated with fentanyl, which are now about 80% of the patients I treat, are all fentanyl. The amount of weight gain in the past two years, because I asked that question, what was your weight two years ago and what is it now? And a significant number of gained 20 to 50 pounds in the past two years or while they’ve been on fentanyl. So if you can get the weight loss which will have positive health impacts and you can block, um, reduce, you know, the risk of relapse or cravings, things like that, and there’s a lot of potential. I’m not sure I would use it primarily for to reduce, you know, overdose and things like that because of the side effects. But if it can provide benefits, you know, for both, that’d be excellent.

Dwight Hurst, CMHC: Yeah, there’s a balance there that happens when people have the. And this happens with detox in general. Right. When people have a reduction or a success with the chemical underpinnings and the dependance issues that way. Um, and those kind of chemically induced cravings. Then on the other hand, there’s the habitual and the way we think and the way we go to problem solve with intoxicants. And David, do you see do you what’s the relationship there when that ratio starts to shift and the chemical cravings are down, how much do you see people’s just habits and their either behavioral or cognitive habits kick in to where I’m used to going to this for help. You know.

David B. Livingston LMFT: I think it’s I think when there is positive reinforcement, there’s positive reinforcement. So when if you if you want to lose weight and you’re having success, it tends to, um, help you feel better overall. Both, you know, in terms of your goal of losing weight and then also emotionally, you feel like you’re you feel better about things and and whatever the importance of the losing the weight means to you, you also kind of feel like you’re regaining control of your life in a way, in a sense. You know, I’ve talked about perceived helplessness and frustration as being one of the triggers, big psychological triggers for moving people into compulsive states. So when you’re having success, you’re moving out of a state of of compulsivity because frustration is going down because you’re having success and you also don’t you’re not in a sense of perceived helplessness because you’re having success and things are working. So the more things work and the and the better things go for people, they more they want to continue that and also keep rewarding themselves. It tends to create that sort of a positive spiral. Um, And in that way I think it’s heavily correlated.

Dwight Hurst, CMHC: Speaking you had brought up fentanyl just a minute ago. Doctor Lowenstein and we’ve talked a lot about how the overdose crisis. And as we like to differentiate here on the show there’s, there’s overdose increased overdose deaths. Um but then we could also we also like to point out that a lot of those are actually poisoning deaths. Right. Where where people are being given things that are poison. So we don’t want to ignore that. And I think we’re very, very conscious here about victim blaming or patient blaming. Uh, when it comes to the language that we use. So I just want to throw that out there. Uh, but as far as with the fentanyl crisis of fentanyl being present in so many drugs, I was curious about the trends in how is that affecting the way people, um, the way people act, the way that they, uh, avoid drug use or the way that they, you know, relapse or do or don’t relapse. Um, we thought it’d be worth a mention here. One of the things that I’ve noticed is that there are times where people that I’m working with, they may have strong relapse cravings, and they may actually relapse to intoxicant use and overuse. Um, but some of them, even if they have an opiate dependence, shy away from street, uh, purchased opiates or heroin, uh, because of the fear of fentanyl. And they may go to other things thinking that they’re safer. Uh, I mentioned as we were setting up the recording, I’ve had some people I’ve talked to who have tried to use kratom, thinking that it would be safer than taking a chance. You know, something you get at a smoke shop or something in some states, um, or, or over use of alcohol sometimes to, to avoid what they think of as the risk of fentanyl. I’m curious if you guys are seeing that anywhere.

Michael H. Lowenstein, MPH, M.D.: Yeah, I’m actually I am seeing a lot more kratom. Um, and kratom is interesting. You know, it’s a plant that comes out of Southeast Asia, and a lot of times the workers in the fields will chew the leaves of the plant because it has opioid like effects and it also has stimulant effects. And so the amount that I think you get from just chewing a leaf, it allows them to be functional and things like that. And the internet, there’s been more and more, um, information that kratom can be used to help people get off of more serious opioids like fentanyl. Um, I’ve recently had a patient who used it to stop alcohol. Um, where it becomes a problem is because it does have opioid-like properties, is that they use more and more and more to try to, when they discontinue the opiates, to try to treat the withdrawal symptoms. Um, and you can become opioid-dependent on kratom. And you know what? What’s available out there by internet or in smoke shops is there’s more and more concentrated, um, liquids that are being produced that just have higher and higher, um, quantities of the chemical that’s in kratom. And so people when they stop the kratom develop opioid withdrawal symptoms. And, um, you know, especially as you take more and more and more of the really highly concentrated elixirs or liquids, and then you’re dealing with opioid dependence, but from kratom. Um, so, you know, yes, there and I have heard of people being successful, but it also everyone has to be aware that it can lead to dependence itself. And then when you withdraw, you’re dealing with, you know, another opioid that you’re need to be potentially treated for.

Dwight Hurst, CMHC: The fact that it leads to dependence and withdrawal is one thing that I think is a is a big. Well, it doesn’t seem like everybody knows that going into it that they’re that they should expect that that’s going to be part of it.

Michael H. Lowenstein, MPH, M.D.: Yeah. And I that’s definitely not advertised.

Dwight Hurst, CMHC: Sure. Yeah. That’s not they don’t have little sign by the cash register at the smoke shop that may.

Michael H. Lowenstein, MPH, M.D.: May cause dependance and withdrawal when you discontinue it. Yes.

David B. Livingston LMFT: And from what you were saying, Dwight, that you know of people who’ve overdosed from it, too. So, I mean, with that in mind, it’s, you know, so it can become, you know, at a certain level, really dangerous as well.

Dwight Hurst, CMHC: Yeah. I think that sometimes the legality of something will lead people to think it’s okay, or the fact that you can go on Reddit and someone will say, hey, here’s how I got off of opiates using kratom, and you’ll see comments that are really, really like, yeah, this stuff’s fine because it’s not talked about very often maybe.

Michael H. Lowenstein, MPH, M.D.: Um, and it’s not and it’s over the counter. Right. So it doesn’t require a prescription. So oftentimes, um, you know, it’s kind of like anti-inflammatories. The number of people that die from GI bleeds from using over-the-counter Advil or Aleve is, is significant or, you know, Tylenol toxicity and liver damage. Um, so kratom is available in smoke shops, you know, over the internet. So it’s got to be safe, right? Because it’s over the counter.

Dwight Hurst, CMHC: Right. That’s the perception. A lot of times I also I wonder, I wonder if you’ve seen this, uh, in your work with people. Uh, both of you, that one of the elements that I see as a psychological risk factor for continued addiction or sliding back into more addictive behaviors is the desire for, oh, let’s say, control maybe over things that in a sense of like, if I can just go buy something and take care of it myself, whether I take care of it, you know, in air quotes here. Um, then I’m going to do that rather than go and talk to someone and get something that’s maybe medically approved and has some studies and some work and, um, you know, shying away from asking for help and support or having a community orientation around the problem that I have. Um, I’m not saying everybody with addiction has this, but I just see it as a risk factor that exists is I just gotta do everything myself.

David B. Livingston LMFT: So a big risk factor, I think. Um, um, that one of the things that you’ll see a lot with, um, someone struggling with a substance abuse or, or dependency is that there’s been gaps in healthy dependency where they’ve reached out to, um, well, there’s problems maybe earlier in their life or in other ways and, or they’ve gone in for treatments and haven’t been successful either because it wasn’t the right fit or they got medications or help that wasn’t successful initially, and there was a lack of persistence. And underneath that is kind of this vulnerability towards reliance anyways, for usually there’s deeper issues around that. Um, so you know, and, and um, so they’ll, they’ll quit, they’ll don’t kind of go to whatever it is that has been successful for them or helps them initially. And if it if their dysregulation gets severe enough, then they can really turn towards things that are more dangerous. But there’s a huge correlation. I think one of the things that I when people say, well, what does it take to get better and be successful? One of the things I say is, well, find people that, um, that you have confidence in that you can count on, that are going to work with you and build a relationship with them and then stay at it.

David B. Livingston LMFT: Persist. Right. Just you, you know, things aren’t going to always I mean, if you go in and you’re trying to get help with sleep, you may try a few different things that won’t work, maybe even make you feel worse initially, but there’s a good chance you can figure it out over time. So and then. But it’s hard because I think on our own we have blind spots. We tend to overestimate or underestimate things. So we constantly need feedback in order to kind of get to where we need to go. I think it’s a human thing, and if we have good help, um, uh, it helps in, uh, you know, getting us where we need to go. And also we’re we’re better off when we’re accountable to other people. Not because we have to, but because we want to be, because there’s a good relationship. And that accountability is also a strengthening factor. Right. That, you know, um, so all of that, I think helps.

Dwight Hurst, CMHC: Goes back to that reinforcement you mentioned before, healthy behavior can reinforce more healthy behavior.

David B. Livingston LMFT: You bet.

Michael H. Lowenstein, MPH, M.D.: Yeah. You know, another thing that’s become much more prevalent, which I don’t think we’ve ever talked about previously, is the fact that, um, a lot of the physicians that practice during this whole, um, OxyContin, the whole opioid epidemic, are now starting to retire. So there’s a lot of patients out there that have been on, you know, their 6 or 8 Vicodin or Norco or Percocet for years and years and years. And now the doctors who have a good relationship with these patients and know the patients and know that there’s, you know, they’re dependent, but there hasn’t ever been an issue. Um, now they’re all of a sudden they’re retiring. Um, and the younger group of physicians that grew up being aware of the opioid and, you know, being afraid to prescribe opiates because of all the, you know, the crackdown on physicians prescribing opiates and everything else are not comfortable with prescribing. So all of a sudden, these group of patients, um, are now looking for new physicians who are not wanting to prescribe opiates. And a lot of times rightfully so. Right. Because, you know, if you look at the recent studies that show, you know, opiates are great after accidents and after surgery, but long-term opiates like, um, you know, studies show that they’re probably doing more harm than good. So now we have this entire population of patients whose doctors are retiring and nobody’s going to prescribe for them. So what do they do? Um, they don’t want to be sick, so they end up going to the street. And fentanyl is very available. Um, and you’d be amazed at people you’d never in a million years think would be going to the street to buy fentanyl, you know, people with families and jobs and, um, you know, not your stereotypical drug addict. Um, and I don’t like that term, but someone you’d never expect?

Dwight Hurst, CMHC: Right. There’s an air quotes there, too, for anyone who’s just listening to the audio. Yeah.

Michael H. Lowenstein, MPH, M.D.: These people that, you know, they they can’t they don’t want to be sick. They’ve got a family, they’ve got jobs, they’ve got responsibilities. And now these are the people going to the street to buy fentanyl. Um, so that’s something we also have to address. So going back to the behavioral, I think we have to recognize that they are dependent and that they probably need to be off these opiates if no other reason is to reverse the opioid-induced hyperalgesia and determine what their real pain is. But then they need the behavioral support to deal with whatever underlying issues there are, and then they need good medical treatment to treat the dependence. Um, so there is, there is that as well that we’re, we’re facing now.

Dwight Hurst, CMHC: Yeah. And I think that the new crop, so to speak, is you’re seeing medical professionals who have also grown up, hopefully in a field and a world that has a little bit less stigma. And we still see that stigma, as you just put. Right. People have a perception. If you say, picture a drug deal happening on the street, there’s an image, right, that people have of what that looks like and maybe who they think that looks like. And there’s probably a range of what people think. But the more exposure you have to the world of addiction, you might find that your idea of who that person looks like that is purchasing is much more wide and varied. Uh, and also that stigma kills people because then we don’t turn to our neighbor, our friend or a loved one and say, are you okay? Because they would never, you know, they would. They’re not. I mean, you know, yeah, they seem a little problem, but they would never get heavily enmeshed in that world. And how would they even. And it’s like, oh, you know, you can and we do when we get into that. So that stigma going down also I think helps over time. Yes.

Michael H. Lowenstein, MPH, M.D.: And hopefully this new, this new crop of physicians as well, they’ve had more training in functional medicine and behavioral medicine. And when I trained, you know, if you had a pain, you took it, you were prescribed a pill. So hopefully they’ll be able to utilize the other things that they’re being trained with now as far as functional medicine. And, um, and they’ll be able to utilize some of those skills to help deal with the issues better than when we were first trained in, you know, the the model where everything requires a prescription medication to deal with.

David B. Livingston LMFT: Yeah. And if you are, if you are, um, unable if your doctor is retiring or there’s a reason that you’re unable to be prescribed, uh, prescribed the medications that you’ve been getting, possibly for many, many years, um, it’s critical that you not feel ashamed to ask for help. And a lot of people do that, that there’s this they’re afraid of being, you know, that there’ll be a stigma or and the medical profession, you know, can do that, too. I know a lot of people are afraid to tell their doctors what is going on, because if they if they find out they’re on, um, an opioid or something like that, they, they move them into a different category. And I think that, um, you know, I think there needs to be a different philosophy. I understand the fear of that. A lot of doctors have, like, you’re talking about Doctor Lowenstein of sort of continuing prescribing and that it’s often not indicated. Um, the same time, I think there has to be some process of helping people sort of move to a safer and better, um, way to go. Uh, and there haven’t been great options for that. Mostly it’s been either Suboxone or methadone and, um, but that’s really, really hard to get off of and sometimes much harder to get off of than the opioids that are on if they’re particularly if they’re on a small amount. So it’s a complex thing. And I and I don’t think that, um, it’s talked about very well and I’m glad we’re talking about it because of that. Uh, so, um, you know, and I think part of why, you know, what we do is we get people off of it, all of it. So, you know, there’s that option. It isn’t just moving to something else. And that is also very hard to get off of. And as I said, often harder to get off of, but safer than than being on fentanyl, that’s for sure.

David B. Livingston LMFT: Absolutely.

Michael H. Lowenstein, MPH, M.D.: Yeah. And that is one of the beauties of rapid opiate detox, is that the patients will call up and say, you know, my doctor is retiring. I have this many pills left. I don’t want to be sick. I, you know, what are my options? So they come and we treat the dependence and they’re done. And then they can move on. And you know, they can, for the first time in a lot of years, figure out what is my true underlying pain. I’ve been on pain meds for so long. My surgery was ten years ago and I’m still on pain. Do I do I still have I mean pain meds? Do I still have pain? Do I need opiates? Um, so, you know, that’s a that’s a very viable option in this case.

David B. Livingston LMFT: Well, and for people who are really just have been on them long term, like the group we’re talking about have been maybe helping with some, um, some sort of pain issue, uh, who don’t want to move on to something like Suboxone or another medication, um, which is usually what’s, what’s suggested. It’s I, you know, I, um, occasionally someone will say just wean down. People usually are unsuccessful with that. Um, occasionally I hear of someone being able to do it, but not usually. Um, so I think that the idea that you can actually get off it completely is, um, um, it’s a, it’s a good thing for many, many people, um, that they don’t need that interim phase of, of being on a different medication.

Dwight Hurst, CMHC: Well thank you, gentlemen. And also thank you everybody out there who has been, uh, been listening. We’re really, really grateful for everybody who’s become a part of our little listener, uh, family out there who follows us and is nice enough to share some of the things that we share. And hopefully, you find it useful to share with those that you know and care about as well? That is our goal. Obviously on this show is to spread information and support. So you know you’re not alone and you know that there’s hope to be had. As we always like to say, we want to hear from you and your questions about mental health, about addiction recovery, also about detoxification, especially rapid detox. It’s an area that there’s lots of interesting information, but not always a lot of knowledge about where to find and look for it. You can always hit us up with any of those things at info@opiates.com, or go to our website opiates.com to to call or contact us as well. We’re also very active on social media. We’re #WaismannMethod on all the big platforms. And we’re just we’re just grateful to be here with you. Remind everyone out there that you should keep asking questions. If you ask questions, you can find answers. And when you find answers, you can find hope. Thanks again everybody. Thank you.