Unraveling the Complexities of Opioid Addiction: Insights and Solutions from Experts

Welcome to a riveting journey into the heart of the opioid crisis with our latest podcast episode, “Unraveling the Complexities of Opioid Addiction: Expert Insights and Solutions.” This episode promises a profound exploration into the world of opioid addiction, recovery, and the nuanced challenges of mental health. Join Dwight Hurst, co-host and seasoned mental health professional, as he moderates an enlightening discussion with the esteemed panel from Waismann Method Opioid Treatment Specialists.

In this episode, we delve into the perilous landscape of fentanyl — a drug that has taken center stage in the opioid epidemic. Clare Waismann, a renowned substance use disorder certified counselor and the innovative mind behind the Waismann Method, along with Michael H. Lowenstein M.D., a globally recognized expert in anesthesia, pain management, addiction and anti-aging & regenerative medicine, unpack the complexities of this potent opioid. They distinguish between pharmaceutical-grade and illicit fentanyl, shedding light on the stark differences and lethal implications.

The conversation takes a deeper dive as David Livingston, a clinical director of Waismann Method’s post-detox recovery facility, Domus Retreat, specializing in psychotherapy for long-term addiction sufferers, joins in to explore the daunting challenges of fentanyl withdrawal. The panel discusses the role of medication-assisted treatments, like The role of MAT in opioid addiction treatment, the importance of individualized care, and concerns about long-term use of opioids.

This episode also bravely tackles one of the most controversial questions in the field of addiction recovery: Can opioid addiction truly be cured? Our experts bring their collective experience and knowledge to bear on this topic, offering insights into the multi-faceted nature of addiction, the importance of individualized treatment approaches, and the long-term effects of opioid use.

Whether you’re a healthcare professional grappling with the complexities of treating opioid addiction, a patient seeking answers, or simply someone touched by the opioid crisis, this episode is an invaluable resource. It’s more than just a discussion; it’s an opportunity to gain a comprehensive understanding of the nuances of opioid dependence and recovery. Tune in for an episode that not only informs but also challenges perceptions, offering new perspectives on a crisis affecting millions in the U.S. and worldwide.

Dwight Hurst, CMHC: And we are back. Hello everyone out there. And welcome back to Addiction Recovery and Mental Health, a podcast by Waismann Method Opioid treatment specialists. I’m your co-host, Dwight Hurst, here to have a wonderful, uh, question and answer session with our, uh, esteemed panel of experts, which are I’ve been I’m lucky enough to always be with when we do this show together. We’re joined, of course, by Clare Waismann, who’s the founder and creator of the Waismann Method, Opioid Detoxification Specialists, and the Domus Retreat. Uh, Clare is a renowned substance use disorder certified counselor, also a registered addiction specialist. And she’s been influencing the field of addiction recovery and, uh, opioid detoxification for a long time, let’s say, since there has been such a field, maybe not quite then, but for a long time and a lot of good. Um, David Livingston is a clinical director, an LMFT, a holistic and compassionate expert in the field of psychotherapy. And, uh, David’s particularly known for helping patients who have grappled for a long time with addiction and who have lacked, uh, emotional regulation, uh, challenge, uh, have had emotional regulation challenges and have struggled to find effective tools for healing. So grateful to have him here. And Doctor Michael Lowenstein is a globally recognized authority with board certification in anesthesia, uh, rapid detoxification, uh, pain management and addiction and is known as a world-renowned leader of that. So welcome back to the show, guys. It’s good to all be together again.

Clare Waismann, M-RAS/SUDCC II: How are you?

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

Dwight Hurst, CMHC: Well, we are going to be focused. Uh, one of the things we’ve always done in this program is we have a question-and-answer type of format, and we are going to today go through some questions. We’ve decided to, uh, to get into maybe a few more questions per episode as we’re doing these, uh, recordings. And so be interested as people out there, what you think of our format. And also we are always open to receiving questions from those of you who are viewing this video or listening to this on the podcast feed, uh, or just out there. You can always email us at info@opiates.com and or reach out through opiates.com on the website. Uh, contact us and let us know what questions you would like us to answer. Today we’re going to be going over some questions that, uh, that do talk about medication-assisted treatment. And the first couple of those actually are about fentanyl, which we talk about quite a bit on here because of the epidemic crisis and threat that fentanyl is posing. And our first question today is how does fentanyl compare to other opioids, particularly in regards to its level of danger? And I’ll throw that one. That’s a good one to start with. What are we seeing with that?

Clare Waismann, M-RAS/SUDCC II: I think Doctor Lowenstein will be the perfect person to answer that, but I think Dwight, before he answers, is very, very important. When we talk about fentanyl nowadays to deffer illicit fentanyl than pharmaceutical grade fentanyl that is used very safely. Um, you know, by physicians. Uh, we’re dealing with a completely different drug and a completely different level. But, uh, I just want to make sure, Michael, that, you know, we make that clear for the people out there that, uh. Because I have spoken to a doctor actually, this week, and, uh, a lot of people get to emergency rooms right now, and they’re scared of fentanyl because of everything they heard about fentanyl. So it’s really, really important that we make clear to patients, you know, the differences.

Dwight Hurst, CMHC: That’s a great point. Yeah.

Michael H. Lowenstein, MPH, M.D.: And Clare. Yeah, it’s very important to distinguish between the two pharmaceutical-grade fentanyl we’ve used in the operating room. We’ve used to treat chronic or cancer patients for years. And it’s a very successful, very effective drug. And the operating room will use microgram doses though. We’ll use 50 micrograms, 100 micrograms. Um, and so the half-life of prescription fentanyl could be 4 to 5 hours. So you receive it. Um, half of it’s gone in 4 to 5 hours and it’s completely gone in a 24 hour period, whereas, uh, illicit or street fentanyl. Um, we’re talking about grams worth. And again, we don’t know when patients are using the oxy blues or fentanyl powder. We don’t know how much fentanyl is in it, but we’re talking thousands of times greater dosage than we would use in medicine. Um, and prescription, um, medicine. Um, so and then you’re looking at this fentanyl is a very lipophilic drug. So when you use it in small doses for in an operating room or for cancer pain, you use a small dose and it’s gone. Um, the dosages that are being used on the street are enormous amounts, the grams. And so they’re stuck in the tissues and the fat for days and days. Um, and that and we can talk about that later. But the implication that having it in the system for seven to 10 or 12 days after the last dose is enormous. When you’re talking about, um, using medically assisted detox treatments and other things. So, um, it’s very important to understand that the street fentanyl is much more potent. It’s huge dosages, and that’s why it’s so much more lethal. And the fact that you don’t know what you’re actually taking, um, and that’s why we’re seeing, you know, we’re the last stat I saw was 150 deaths a day from this illicit fentanyl.

Clare Waismann, M-RAS/SUDCC II: And I think those I think, um. Actually, uh, the numbers are much higher, Michael. Um, I think the new data shows, uh, more than double that. And I still think that data is, um, not. Does not describe, uh, the amount of deaths that are really happening out there.

Michael H. Lowenstein, MPH, M.D.: Yeah, I agree with you completely. If you look at the CDC data, it’s probably from 2021. And the fentanyl use is growing exponentially since that time. So, um, you’re right.

Clare Waismann, M-RAS/SUDCC II: I think the last data said around 300 plus a day of overdoses nowadays, uh, lethal overdoses.

Michael H. Lowenstein, MPH, M.D.: And and.

Dwight Hurst, CMHC: Always underreported too.

Clare Waismann, M-RAS/SUDCC II: Yeah. And that’s what I’m saying, because really, people don’t know if, uh, it was suicide, if it was overdose, if it was an accident. I mean, there’s so many deaths due to the use of fentanyl, uh, that end up being, you know, uh, the data shows of other reasons, but we don’t know. We weren’t there the last minute.

Dwight Hurst, CMHC: And so that that tells us a lot. Or Doctor Lowenstein, when you’re talking about essentially the answer to that question, that of why it is more dangerous than other opioids that are being that are being used even at the street level. If we’re comparing this to what people maybe think they’re using and they’re not aware of what’s in it.

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

Michael H. Lowenstein, MPH, M.D.: And you know, with opiates we’re looking at respiratory depression and, you know, dying because people just stopped breathing. And then it’s being mixed with other drugs like Xanax. And people aren’t patients or people aren’t even aware of what they’re taking. Um, so it’s just the risk is just extraordinary with this illicit fentanyl and the potency and the combination with other drugs and xylazine.

Clare Waismann, M-RAS/SUDCC II: And xylazine right now, there’s a lot of patients, um, with the fentanyl and xylazine also. Right?

Michael H. Lowenstein, MPH, M.D.: Yeah. And xylazine, which is an animal anesthetic, basically that the combination that it’s already a sedative and an anesthetic agent. And you’re combining it with another very potent, uh, drug that affects, you know, respiration and, um, it just again, we’re talking about we’re talking about exponential increases in deaths and overdoses. It’s just, um, it’s amazing what’s out on the street right now. Um.

Dwight Hurst, CMHC: Well, our next question that we have ties very much into that about one of the differences with other, uh, forms of opiate use or opiate abuse, which is fentanyl withdrawal. Uh, what are some of the uniquenesses, differences and added difficulties with these new strains of illicit fentanyl?

Clare Waismann, M-RAS/SUDCC II: Uh, the reason we put that out there is because more and more in the social media, we see people talking about, you know, people that have used opioids for the last ten, 20 years. And, um, they describe trying to come off the illicit fentanyl that is available right now, and how withdrawal has become nearly impossible. You know how lengthy after days and days and days. Um, they’re still at the height of their withdrawal symptoms. So, um, that’s the reason we have that question out there. People just don’t understand, uh, why this is so different than it ever was.

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

Michael H. Lowenstein, MPH, M.D.: And and traditionally, the duration of withdrawal would be related to the, again, the fast-acting or short-acting opiates versus the long-acting opiates. So a drug like hydrocodone or oxycodone, um, or morphine that have very short half lives, the body will eliminate it faster and the withdrawal will theoretically last for a shorter period. So you would hear people talking about four to 7 or 10 days for a short-acting methadone, on the other hand, that, you know, had a longer half life or it was life or was stored in the in, you know, in the fat and the tissues you would see, um, you know, a little longer duration. Um, but with this fentanyl and the grams that dosages that people are taking in, the whole being lipophilic and stored in the fats, we’re still seeing positive urine drug screens for fentanyl at 7 to 10 days and norfentanyl which is a metabolite. We’re sometimes seeing that positive for 14 or more days. So um, you know the the withdrawal lasts longer. And then again, like I mentioned, that has an implication for introducing a drug like, um, Suboxone or one of the, um, buprenorphine products, where typically you would stop a drug for a day or 2 or 3 and be able to initiate it. I’m hearing stories of just horrendous precipitated withdrawal. When people try to introduce Suboxone to someone who’s taking a large dose of fentanyl, and the patients that I’m treating are telling me these nightmare stories of, you know, their worst experience in their life was this precipitated withdrawal from, you know, introducing Suboxone. Um, so if you have to wait 7 to 10 days, well, you know, by then, you know it. Most people have gone through with the majority of the withdrawal. So it just is a really new and different problem than we’ve experienced in the past.

Dwight Hurst, CMHC: And does that include the, the I’m assuming the, the physical symptoms and even dangers that are usually accompanied that would last much shorter amounts of time. In other words, they’re in pain and having those things the entire time.

Michael H. Lowenstein, MPH, M.D.: Yeah. So though the withdrawal looks the same, it’s still the nausea, vomiting, diarrhea, can’t sleep, can’t eat, restlessness, anxiety, all those things. It just lasts for so much longer. Um, with fentanyl than we’ve seen in the past with the shorter acting, you know, opiates.

Dwight Hurst, CMHC: And I can only if I’m putting myself in the shoes of that person. I mean, withdrawal is something that dissuades people from stopping anyway and is dangerous if you aren’t under any kind of medical supervision. But if I go a week into withdrawal from something, I’m more likely to just start using again, and then the next time I want to stop, I’m probably more likely to not try to stop, or I guess less likely to stop is the better way to say that. At least that that’s what I would feel like. Is that what what we’re seeing play out? Does this play into people’s ability to engage with recovering and and getting treatment?

David B. Livingston LMFT: So certainly our maybe I can speak to that a little bit, but, um. You’ll see in communities where, uh. It’s reported to me a lot. Where where, um, people know each other who are using and so forth. And you and I reported to me so often of how many people are overdosing within a small area because, um, they learn from each other, they learn that they can’t get off it often. Many people, as, uh, Doctor Lowenstein was suggesting, will try to move to Suboxone or a different, safer, um, remedy, and they can’t get it done. They go into precipitated withdrawals and so they just can’t get there. And so since persistence is like a muscle and it weakens over time, you add all of the elements that Doctor Lowenstein just mentioned diarrhea. You can’t sleep. Uh, immense anxiety, uh, inability to eat all of these parts of our, uh, physiology get dysregulated simultaneously, and the muscle of persistence just weakens. And then and then even worse, when people go back to take opioids, they usually take more than they did to try to feel better. And the risk of overdose goes up. It’s just an incredibly dangerous cycle.

Speaker3: Um.

Clare Waismann, M-RAS/SUDCC II: And I think the other issue that, um, I’ve been, uh, talking to many patients about is because Suboxone is, um, being allowed to, uh, to be prescribed by, uh, many different levels of health care providers, including, um, through the internet. Um, a lot of the people that are prescribing are not aware of, uh, you know, the fentanyl, uh, response to, uh, or to Suboxone or the length of time that, uh, it stays in your system. So, as David was saying, is, uh, you know, they take the Suboxone and things just escalate from there. And, you know, after 2 or 3 days, desperation hits and they’re out there again trying to use that fentanyl to relieve the symptoms of the Suboxone. And the risks become immense.

Dwight Hurst, CMHC: Um. Yeah.

Dwight Hurst, CMHC: One of the barriers to treatment is tied up with, uh, a question that we received that I think comes up a lot, which is when we’re talking about medication-assisted treatment, people want to ask, is that just replacing one drug with another? Um, what are some responses that are appropriate to tell people? And I should add, this is a question that not only is useful for us to answer, but anybody out there who’s listening, uh, you may get this question if you’re going to enter into treatment or if you have a loved one who maybe tells you, well, I don’t know. Should I go into treatment? Uh, isn’t that just replacing one drug with another or any one of which? Anybody out there listen up. Because you may you may be able to use this for yourself or others.

Clare Waismann, M-RAS/SUDCC II: I, um, just want to say something that I’m going to let the professionals here talk about, um, the medications themselves. But, uh, I think we go back to the situation where, you know, we need to start treating the patient and the reason why that medication is being prescribed. And, um. You know the picture of that patient, uh, what the goal is. So I think if the if the goal is to, uh, temporarily find a, um, answer to, uh, keep the patient safer and, uh, you know, find the right path of treatment, I think is very effective in some cases, uh, I think, uh, prescribing to all people at all times, um, forever. Um, it’s it’s where we find people getting frustrated and hopeless. Um, and again, uh, many, many people feel like it’s almost like a tease. So they are taking the opioids, um, although they are not getting the euphoria they used to get from others. So they’re constantly craving that euphoria. So again, if it is for a short term in most cases, and if it is, you know, with the goal of, uh, making sure the patient is safer and, uh, making sure that the treatment is individualized and the patient is being seen by their unique needs. I think sometimes it’s very effective. But again, again, it’s treating the patient and not the condition because the patient often, uh, feels unseen and they are unseen and untreated.

Michael H. Lowenstein, MPH, M.D.: Yeah. And I would I agree with Clare there completely. Um, the fentanyl on the street right now is incredibly dangerous, and the risk of overdose is enormous. So if drugs like Suboxone or buprenorphine provided an alternative to, um, stabilize the patient and get them on, you know, a nice, stable dose of a prescription opioid and reduce the risk or eliminate the risk of using street drugs, then I think there’s definitely a place but long term opiate use, whether it’s for chronic pain or, you know, for to treat addiction has effects on the body. It affects neurotransmitters, it affects hormone production. It affects gut function. Um, it can cause hyperalgesia, which makes people’s pain worse. So, um, while it plays a role, I think there are long-term issues just from a medical physiologic standpoint. So, um, yes, I think there’s a place for it, but there are patients who do not want to be on opiates anymore. And that’s when you have to figure out, you know, what are the treatments available. Um, and, you know, detox under sedation or rapid detox is a very effective, um, way to treat the dependence. And then once the dependance is treated, then you can really address the other issues, um, whether it’s chronic insomnia or depression or anxiety or bipolar disorder or social issues, um, I think there is a place for it for people. But, um, there’s got to be options for when they want to get off of those meds as well.

Clare Waismann, M-RAS/SUDCC II: Dwight. Uh, doctor Lowenstein can tell you more about that. You know, we often see patients, uh, especially, uh, pain patients, um, that were taking five Norco’s a day, six Norco’s a day, and suddenly they’re giving eight, 16mg of Suboxone. And it is so unfair because you would be so much easier for them to come off the medications they were originally taking, and now they just multiply their dependence and the withdrawal becomes so much higher. And so all the effects of it. Right, Michael?

Michael H. Lowenstein, MPH, M.D.: Yeah. So I and that comes that goes back to educating people that are prescribing um Suboxone. So I’ll see somebody who was taking, say maybe 80mg of oxycodone or hydrocodone a day. And you know, by a calculation, 2 to 4mg of Suboxone probably should have been enough to control them. And they’re coming with 16 plus milligrams a day. So and obviously the higher the dose of Suboxone, the harder it is to get off of it. Um, so there’s, there’s I think there’s a lack of education. So these, some of these conversion dosages are just, um, huge. And you know, and I think that’s causing a problem in itself. Um, there’s one other thing I wanted to point out about fentanyl while we’re discussing this, is that it’s interesting when, you know, I’ve been doing this for 25 years now. And so people’s dosage used to escalate at, you know, kind of a consistent pace, the increase in use. And usually it’s they get tolerant to the effect, the euphoric effect of the opiate. So when they get tolerant to that they increase the dose to maintain that euphoria. The escalation in dosages with fentanyl is unlike anything I’ve ever seen before. You know, patients will say, I was taking 1 or 2 and then it’s six and then it’s 12, and then it’s 20 to 40 of these oxy blues or whatever. It’s just it’s an extraordinary acceleration. Um, so there’s something so addictive about, um, the drugs that are out there right now that it’s, um, it’s really unprecedented in the 25 years I’ve been doing this.

Dwight Hurst, CMHC: It’s interesting, the, uh, comparison that just occurred to me, as you guys are saying these things, is we talk a lot on here about the importance of individualized treatment and never, you know, not treating people like they are just all the same, individualizing according to their needs. There’s also, along with that, a need in our education and understanding to sort of individualize between what are the differences between different drugs. I think, especially if people aren’t really educated in that issue of addiction. You think of drugs is like a big umbrella terms, and these things fall under it. And historically, one of the big problems with that is that there have been people in recovery or sober-based environments who have been nervous to take antidepressants, and that’s a good example of like, those are so different than what you may be abusing as far as what they actually do in the brain. They are different medications. And we’re talking about amongst the illicit drugs, understanding the differences of illicit fentanyl, uh, prescribed fentanyl overdose and then withdrawal, and then also the medications used to treat those. There’s an individualization of what it is we’re putting into our body, which is is part of healthy living. If that makes sense. There’s a weird, uh, maybe a weird comparison to make, but not having blanket judgments of all drugs, I guess. Well, uh.

David B. Livingston LMFT: Right, that if as as, um, it’s been pointed out, um. You have to get off the street fentanyl. You have to because it’s just it’s so addictive. It’s so dangerous. You have to get off it. And um, but then to distinguish whether or not what you want is to get on to a safer drug because you’re still vulnerable, you really need an interim period of being able to be on something like a Suboxone, which is, which is safe. And um, uh. But a lot of a lot of times people will go back and forth to just, you know, that is that’s reported to me a lot. But also if you’re really ready to get off of it and one out of the whole cycle, that’s another option. And I think that’s the thing we’re we’re talking about and isn’t always what I hear reported to me is generally whatever the program is or what, uh, is what is recommended. So it’s not really taking the time to find out how vulnerable a person is. Um, it’s really harm, uh, based. And while that makes sense from, you know, uh, um, you can’t die and you have to get off the drug, but a lot of people don’t want, don’t need to and don’t want to. And they what they really want is just to be off it altogether. So, um, and, and I think we see a lot of people who come through who are just tired of being on opioids altogether and went off it and, and, um, and there’s a, there’s a big group of people who benefit from that.

Dwight Hurst, CMHC: Um, yeah. It’s a great point you bring up, which is, are we meeting the needs of a patient, or are we meeting the needs of a program at the cost of what we require a patient to do? Uh, one question that comes up a lot that I think we are leaning into here, naturally, is, uh, can opioid addiction be cured? Those that meet a diagnosis for opioid dependence? Uh, and I know this is a this can be almost kind of a dicey question in a way, because there’s a lot of emotion and, and history and tradition involved in this question. But as we’re talking from that medical, uh, standpoint, can it be cured?

Clare Waismann, M-RAS/SUDCC II: I, uh, and I’m going to let, uh, Doctor Lowenstein talk about the medical side of it, but I, I think the word cured, it’s, uh, almost a mystical word that is used, uh, on advertising and is very misleading. I think you’re talking about about, uh, multifaceted condition that affects every part of a human being. So when you say cured, what does that mean? That means, uh, putting a patient, uh, in the medical box and curing everything that is wrong with them emotionally, physically, you know, chemically. Um, but is it a treatable condition? Yes. Do I, I personally don’t like to call it a disease. I think it’s a condition. I think it’s treatable, but I think it’s, uh. There’s a difference between dependence. That is very easily treatable. And that’s what we do. And addiction that comes with behavioral, emotional, social and all the others that has to be, again, is not going to be done in 24 hours or 30 days or 90 days. You know, mental health is something that, uh, you know, can be prolonged. It doesn’t need to be a lifetime, uh, commitment. And, uh, every patient is, is different in what they need in order to treat all those multi-level aspects of the condition. Uh, is very different. So we got to stop, um, you know, generalizing addiction as if it’s, you know, a human with, uh, blood running veins. It’s not. It’s a condition. It’s a multifaceted condition that, again, um, affects patients in. Different areas.

Michael H. Lowenstein, MPH, M.D.: Yeah. If you look at the, you know, the definition of addiction or, you know, with opiates as being a chronic relapsing disorder. So if you want to measure cured by I think we want to avoid relapse. Right. And so if we can avoid relapse then uh, can you say it’s cured. Um, but we’re really trying to avoid relapse. So there’s like Clare said, there’s so many important components. So you have to deal with any underlying social issues, you know, is there PTSD, is there previous trauma. So mental health is, you know, probably long-term terme the maybe one of the most important things people have to take drugs because they can’t sleep. They’re anxious. You have to address all the different components. And that’s why when you talked about individualizing treatment, everybody’s different. You know the reason they all everyone I treat is opiate dependent. Um, and you know, I can treat their opiate dependence with detox. Um, but the way they’re going to be successful long term is to address all the underlying issues the psychosocial, the mental health, the the medical, the insomnia, the anxiety. Um, so if you can adequately address all of those, the risk of relapsing becomes much less. And so from that perspective, like Clare said, then we’re treating, um, the issue. Um, I think it’s a it’s a much healthier approach to, you know, what’s what what how do you measure success in this, you know, with, um, opiate treatment?

David B. Livingston LMFT: Uh, just to add to all of that, that I couldn’t agree more. So, um, uh, you don’t um, you can’t. Our need to sleep persists forever. Our need to eat, persists forever. If you don’t, you get hungry. If you don’t sleep, you get, uh, all kinds of problems. So those needs persist forever. So if you think opioids are ultimately a coping mechanism for most people, there are some people who will say they do it recreationally. And I would say, uh, even then it’s a coping mechanism for a lack of imagination, for other ways to, um, uh, recreate and enjoy yourself. And that needs to expand. So it is it is a coping mechanism. And the goal in life isn’t to cope, it’s to live a full life that is right for you and to cope as little as possible. Now we all have to cope at times. We all don’t sleep great. There’s, you know, life brings what it brings. Um, so if you’re struggling from chronic loneliness, which is a big issue in our culture, that has to get solved. Um, and so whatever these needs are that, that the, uh, opioids are often being used and uh, uh, to cope with has to get solved.

David B. Livingston LMFT: And the better it gets solved, the less vulnerable you are, the less vulnerable you are, the less chance of relapse. And the more you have the life you like and want, you know, and I’m not talking about an, you know, an entire, uh, ideal, but largely right. It feels good enough, then your chances of being vulnerable are much less. And one of the problems with opioids is it, as Doctor Lowenstein and Clare both talked about, is it regulates so many things that people actually forget what they need. And so I’m talking to them and they and the only thing that comes to mind is an opioid because they’ve forgotten the complexity of their needs, the, um, their imagination and ways to get the needs met, uh, has decreased or doesn’t even come to mind. So when a treatment is, as we’re talking about, all these things get addressed and they can get addressed. Um, and when you bring it up, people recognize it usually pretty quickly. There has to be enough support to get them there to be able to sort of sustain and build, uh, what I’m talking about.

Dwight Hurst, CMHC: Yeah, it comes a lot comes to that concept of being cured. And it is interesting how many times that that concept in all medical care can be a destructive concept, because we don’t know what it means. And there are after-effects and ongoing effects of managing our health. That will always have to be there. I can get my dentist can do as much work as he wants, but I still have to brush my teeth. I’m waiting for that procedure that will allow me to not have to do that anymore. Um, and that actually that all builds into our final question today, which is what are the long-term effects of opioid use? You get into treatment, you get into sobriety, you get into you’re not, you know, maybe even using anymore. And we still are going to see effects that might be there. What are what are those? What should people be aware of?

Michael H. Lowenstein, MPH, M.D.: You want me to. I’ll. I’ll take on that one to start with. So, um, we know that opiates affect many different parts of the body. Um, you can affect the gut and you can affect, you know, pain and things like that. And those tend to reverse themselves more quickly. Um, you do definitely get changes in the production of neurotransmitters, the production of hormones. Um, there are changes, um, in receptors. And so a lot of the brain physiology has changes. Um, you know, it’s it’s up for discussion whether or not there are things that are irreversible. Um, I think the majority of these things can, um, correct themselves over time. You know, your receptors are proteins in the brain. You will make new receptors, you will make new neurotransmitters, your body will rebalance. Um, there’s, you know, you have to do things like good sleep, good exercise, nutrition, all those things need to take place to optimize. Um, you know, we know with alcohol that there can be genetic changes that are passed on to future generations. Um, I’m not sure that’s as clearly defined with opiate use, um, whether or not there are permanent genetic changes. But, um, I think the majority of the changes that take place from long-term opiate use can be at least improved over time, if not reversed. Um, but, you know, it is what it is. So we got to do all the things to optimize, um, recovery, um, both from a mental health as well as a physical standpoint. And then, you know, whatever you’re left with, you’re left with. It’s kind of like, you know, if you look at functional medicine, we can’t change our genes, but we can change how our genes express themselves. So healthy lifestyle, good nutrition, good sleep, all those things. There’s definite science to document that you can influence how your genetics express themselves. And so we have to do all of those things to optimize our, our function once the opiates are eliminated and um, going forward.

Clare Waismann, M-RAS/SUDCC II: I think. Dwight, um, I think I think this is great, you know, talking about the physiological side, but because we treat so many, um, patients, um, a lot of them, um, between 20 to 35 years old. I would like David to talk about the long-term side effect, because I think, um, in a way, it stunts your emotional growth. And I think that becomes a huge issue. Um, if you’re looking at the long-term side effects, especially when they’re coming off, uh, opioids and they’re like 32, 33 and the parents are expecting them to be this, you know, productive, strong, uh, adult when you know, their development, emotional development has been delayed. So I think if David could talk a bit about that, I think that’s a huge side effect that is often unseen.

David B. Livingston LMFT: So if you’re relying on opioids consistently as, um, a mediating process, your ability to develop, your capacity to tolerate ambivalence, to tolerate frustration, to recognize ongoing needs, um, in a variety of ways, from social needs to, uh, uh, occupational needs and other areas of your life can, um, not be developed. And you’ll also see that relationships kind of suffer and there’s less of an ability to negotiate, uh, in all areas of your life, if you will. So when I see, uh, when you talk about kind of, um, a stunted ness, often it’s in that area now. Um, but not always. I see a lot of people also who have very developed lives who have been on opioids for one reason or another, um, uh, and are able to sort of sustain that. And they’ve already developed the capacity for the things we’re talking about. So it really does vary in terms of, uh, what the person is able to and has already developed and needs to develop. So, um, it’s not at all one size fits all. It isn’t even at all that people sometimes you’ll see someone come through as exceedingly developed. In fact, they’re so developed that one of the reasons they’re using opioids is because, um, uh, they’re tolerating more frustration and more ambivalence and more responsibility than they can handle. And they use opioids to cope with it because they don’t want to let anyone down or something like that. So it really varies. Um, with younger people, there is a much, you know, because you’re developing as you as you get older, there is a greater chance, as you’re suggesting, Clare, that, you know, there are areas that are just unattended to that need time and patience to develop.

Clare Waismann, M-RAS/SUDCC II: Like maturity.

Dwight Hurst, CMHC: It’s it’s an interesting component to, to say, you know, time we tend to think of it even though there is, uh, a delayed emotional growth and development during the times of that. There are implications for that. We do still exist during the years or time that we have addiction problems and we change that too. Also, I’ve noticed that people when they, uh, go through treatment and they’re having success and they are no longer dependent on those things, they they are sometimes addressing their mental health more openly and more in a healthy way than they were before they started using. So you may not recognize that your loved one is actually a better version, healthier version, I should say, of themselves than you saw before, because they were hiding things before. That’s why they, uh, that’s why they were self-medicating, right? So well. Wonderful feedback and information. I want to, uh, just just commend this information to anyone who is out there. And please continue to tune in to, uh, monitor what we are sharing so that you can share that with others. Please consider going on to if you’re listening on a Podcatcher program, Apple or Spotify or one of those, please share and uh, and rate the show as well. It helps us to get the message out there. We’re so grateful for you listeners. So grateful when people reach out and we really do want to hear your questions once again and send it to us at info@opiates.com. And I just want to once again thank our panel for being here as always and always taking so much time to do this, this outreach and public education. Uh, this podcast is a product of Waismann Method Opioid Treatment Specialists. And, uh, more information, of course, can be found at the website that I gave before, uh, opiates.com, uh, for, uh, David and Clare and, uh, Doctor Lowenstein. I’m Dwight Hearst and want to remind everyone to keep asking questions because if you ask questions, you can find answers. And whenever you can find answers, you can find hope. We’ll be back with you again soon. Thanks.