>> IF WE ACCEPT THAT PATIENTS WITH DIABETES WILL REQUIRE LIFE LONG TREATMENT AND WE ARE WILLING TO PROVIDE ACCESS TO THAT TREATMENT, THEN WHY ARE WE RELUCTANT TO DO THE SAME FOR THOSE WITH OPIOID ADDICTION DISORDERS.

STAY WITH US AS WE TALK WITH ADDICTION MEDICINE AND PAIN MANAGEMENT SPECIALIST Dr.

JAMES PATRICK MURPHY ABOUT MANAGING THE ADDICTED PATIENT'S ADDICTION.

>> "KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.

♪ ♪ ♪ ♪ THE NATIONAL INSTITUTE ON DRUG ABUSE STATES THAT ADDUCTION IS A CHRONIC, RELAPSING DISORDER CHARACTERIZED BY THE COMPULSIVE SEEKING AND USE OF DRUGS DESPITE THE ADVERSE CONSEQUENCES.

FURTHER, THE N.I.D.A.

SAYS THAT ADDICTION IS CONSIDERED A BRAIN DISORDER BECAUSE IT INVOLVES FUNCTIONAL CHANGES TO BRAIN CIRCUITS INVOLVED IN REWARD, STRESS AND SELF CONTROL.

AND THAT THESE CHANGES MAY LAST A LONG TIME AFTER A PERSON HAS STOPPED TAKING DRUGS.

CLASSIFYING ADDICTION AS A DISEASE TO BE TREATED IS VASTLY DIFFERENT FROM HOW IN THE RECENT PAST, INDIVIDUALS WITH AN ADDICTION WERE CATEGORIZED AS MORALLY FLAWED AND LACKING IN WILLPOWER.

SADLY, THAT LINE OF THINKING STILL INFLUENCES POLICY, AS WE SEE A GREATER EMPHASIS PLACED ON PUNISHMENT RATHER THAN PREVENTION AND TREATMENT.

THE RISK FOR OPIOID USE AND ADDICTION IS, LIKE MOST CONDITIONS, A CONSEQUENCE OF A MULTITUDE OF FACTORS.

THESE INCLUDE GENETICS, ADVERSE CHILDHOOD EVENTS, PEER PRESSURE, COMMUNITY POVERTY, AND AVAILABILITY.

HOWEVER, TO SAY THAT THOSE INDIVIDUALS FROM AFFLUENT AREAS ARE HIGHLY EDUCATED, AND HAVE STRONG SUPPORT SYSTEMS ARE IMMUNE TO DRUG ADDICTION, ONLY PERPETUATES THE LIE THAT THIS ONLY HAPPENS IN "THOSE COMMUNITIES."

TO HELP US GET A BETTER UNDERSTANDING OF WHAT OPIOID ADDICTION IS, THE CAUSES, THE RISK FACTORS AND THE TREATMENT OPTIONS, WE HAVE AS OUR GUEST TODAY Dr.

JAMES PATRICK MURPHY.

Dr.

MURPHY HAS HAD A LONG AND INTERESTING CAREER PATH AFTER GRADUATING FROM THE UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE, HE DID AN INTERNSHIP IN PSYCHIATRY AT THE UNITED STATES NAVAL MEDICAL CENTER IN SAN DIEGO FOLLOWED BY TRAINING AS A FLIGHT SURGEON AT THE NAVAL AEROSPACE MEDICAL INSTITUTE IN PENSACOLA, FLORIDA AND SERVED AS A FLIGHT SURGEON ON BOARD THE USS ENTERPRISE.

AFTER COMPLETING HIS MILITARY SERVICE WHERE HE LEFT WITH THE RANK OF COMMANDER, Dr.

MURPHY COMPLETED A RESIDENCY IN ANESTHESIOLOGY AT THE UNIVERSITY OF LOUISVILLE, FOLLOWED BY A FELLOWSHIP IN PAIN MANAGE MANY AT THE MAYO CLINIC.

HE HAS BEEN PRESIDENT OF THE KENTUCKY SOCIETY OF ADDICTION MEDICINE AND PRESIDENT OF THE GREATER LOUISVILLE MEDICAL SOCIETY.

HE IS THE FOUNDER AND C.E.O.

OF MURPHY PAIN CENTER AND NOW PRACTICES AN AN ADDICTION MEDICINE AND PAIN MANAGEMENT SPECIALIST.

PAT, Dr.

MURPHY, THANK YOU VERY MUCH FOR BEING WITH US TODAY.

>> IT'S MY PLEASURE.

THANK YOU FOR HAVING ME.

>> THIS IS KIND OF AN INTERESTING THING, AND A DIFFERENT TOPIC WHEN WE TALK ABOUT ADDICTION.

WHAT ARE WE REALLY SAYING HERE?

WHAT IS IT?

>> WELL, ADDICTION IS, AS YOU MENTIONED IN YOUR COMMENTS, IS A DISEASE PROCESS.

A LOT OF PEOPLE THINK OF IT AS A MORAL FLORIDA OR WEAKNESS IN THE-- A MORAL FLAW OR WEAKNESS IN THE CHARACTER BUT IT'S ACTUALLY A DISEASE PROCESS THAT OCCURS IN THE PATIENT'S BODY, PRIMARILY IN THE CENTRAL NERVOUS SYSTEM.

SO IF WE APPROACH IT AS A DISEASE LIKE WE DO OTHER DISEASES, THEN WE HAVE A POSSIBLE WAY TO TREAT IT.

AND WE DO HAVE EFFECTIVE TREATMENTS FOR THIS DISEASE.

>> .

I KNOW THERE ARE A LOT OF DIFFERENT TYPES OF ADDICTION.

BUT FOR TODAY WE ARE GOING TO TALK ABOUT OPIOID ADDICTION.

SO WHAT ARE THE OPIOIDS?

>> AN OPIOID IS A MORPHINE-LIKE DRUG.

MORPHINE CAME FROM THE PLANT OPIUM AND IT IS A NATURALLY OCCURRING SUBSTANCE AND THERE ARE A LOT OF CHEMICALS THAT ARE SIMILAR TO MORPHINE AND ACT THE SAME WAY IN THE BODY AND THEY'RE CALLED OPIOIDS.

AN EXAMPLE WOULD BE OXYCONTIN OR HEROIN AND FENTANYL.

THEY'RE ALL OPIOID-TYPE DRUGS.

>> THEY CAN BE SYNTHETIC OR NATURAL I PRESUME.

>> CORRECT.

>> IS THERE A PREDILECTION FOR OPIOID ADDICTION AMONGST DIFFERENT GROUPS OF PEOPLE OR IT CAN AFFECT ANYBODY?

IS THERE ANYTHING THAT SAYS HEY, THIS GROUP OR AN INDIVIDUAL MIGHT BE MORE LIKELY TO DEVELOP AN ADDICTION?

>> ACTUALLY, NO.

ADDICTION IS SOMETHING THAT HAS BEEN PART OF THE HUMAN EXPERIENCE EVER SINCE WE HAVE BEEN HUMANS.

AND THERE ARE, HOWEVER, RISK FACTORS THAT CERTAIN GROUPS OR COMMUNITIES HAVE THAT MAKE THEM MORE AT RISK FOR ADDICTION.

BUT GENERALLY IT CAN AFFECT ANYBODY IN ANY CIRCUMSTANCE.

>> WHAT ARE SOME OF THE RISK FACTORS?

>> WELL, YOU MENTIONED AGAIN IN THE OPENING STATEMENT, SOME OF THEM.

BUT WE THINK ABOUT IN TERMS OF THE RISK FACTORS IN THE PERSON, AND IN THE SOCIAL ASPECTS OF THEIR LIFE AND ALSO IN THE SUBSTANCE, OKAY.

SO LET'S TALK ABOUT THE PERSON INITIALLY.

WE DO KNOW THAT THERE IS A GENETIC COMPONENT TO THIS.

AND IT MAY BE AS MUCH AS 50 TO 60%.

AND THAT'S HARD TO SAY THAT BECAUSE SAYING IT TENDS TO RUN IN FAMILIES, THERE IS A GENETIC COMPONENT.

IT'S MOSTLY SEEN IN FIRST DEGREE RELATIVES.

SO YOUR FATHER, MOTHER, SISTER, BROTHER, THINGS LIKE THAT.

BUT WE DON'T KNOW EXACTLY WHAT THE GENE IS.

HAVEN'T ISOLATED THAT YET.

BUT YOU MIGHT BE MORE AT RISK OF IT IF IT RUNS IN YOUR FAMILY IN A SENSE.

SECONDLY, IN THE PERSON, ALSO, THEIR EXPERIENCE.

PEOPLE THAT HAVE UNTREATED PSYCHIATRIC DISORDERS LIKE BIPOLAR DISORDER, ANXIETY, THEY TEND TO BE MORE AT RISK FOR USING DRUGS AND TO TREAT THOSE CONDITIONS.

THEY CAN BE MORE AT RISK AND PEOPLE WITH CHILDHOOD TRAUMATIC EXPERIENCES AS WELL.

THOSE ARE RISK FACTORS IN THE PERSON.

AND THEN YOU NOTICE I DIDN'T MENTION, SKIN COLOR OR THINGS OF THAT NATURE OR HOW MUCH THEY MAKE OR WHATEVER BECAUSE REALLY, IT'S, YOU KNOW, A LOT OF IT HAS TO DO WITH JUST THEIR BIOLOGICAL MAKEUP AND THE PERSON AND THEIR LIFE EXPERIENCES.

SECONDLY, LET'S TALK ABOUT THE SOCIAL ASPECTS.

WHEN THERE IS UNREST SOCIALLY OR, YOU KNOW, THERE IS STRESS IN THE COMMUNITY OR THEY'RE AROUND SUBSTANCES A LOT.

THEY'RE AROUND IT.

THERE ARE MORE RISKS.

ALCOHOLICS ANONYMOUS TALKS ABOUT PERSON, PLACES AND THINGS.

THE SOCIAL ASPECT OF IT.

AND THEN THERE IS THE ACTUAL AGENT ITSELF.

SOME DRUGS ARE MORE ADDICTIVE THAN OTHERS.

WE CULL THAT THEY'RE MORE REINFORCING.

SO WHAT THAT MEANS IS THAT SOME DRUGS CAN ACTUALLY CAUSE A GREATER RELEASE OF THE CHEMICAL DOPAMINE IN THE BRAIN.

AND ONE OF THE THANKS THAT ALL OF THE ADDICTIVE DRUGS HAVE IN COMMON IS THAT THEY RELEASE DOPAMINE IN THE BRAIN TO VARYING EXTENTS.

SO HONESTLY YOU DON'T BECOME ADDICTED TO THE DRUG AS MUCH AS YOU BECOME ADDICTED TO THE DOPAMINE THE DRUG PRODUCES IN THE BRAIN.

>> I'M GOING TO COME BACK TO THAT IN A MINUTE.

LET ME COME BACK TO THE FAMILY, GENETICS YOU SPOKE OF.

THE ARGUMENT IS NATURE VERSUS NURTURE.

SOMETHING THAT IS INHERENT PASSED ON, WOULD BE THE NATURE.

AND NURTURE IS WHAT IS AROUND.

IF I'M AROUND PEOPLE IN MY MEADE FAMILY WHO ARE USING DRUGS-- IN MY IMMEDIATE FAMILY WHO ARE USING DRUGS, IS THAT NOT A GREATER RISK TO ARE ME USING DRUGS AS OPPOSED TO SOMETHING GENETIC OR ARE YOU SUGGESTING IT IS THE GENETICS THAT GETS BACK TO YOUR DOPAMINE RELEASE THAT MAY BE THE FACTOR THAT I MAY USE IT ONE TIME AND GO OH BOY WHERE SOMEBODY ELSE MAY USE IT ONE TIME AND GO NEVER AGAIN.

>> I'LL GIVE YOU AN EXAMPLE.

I COULD BE PERHAPS GENETICALLY PREDISPOSED TO AN OPIOID ADDICTION BUT IF I'M NEVER GIVEN AN OPIOID, NEVER TAKE ONE, I MEAN IT DOESN'T MATTER WHAT MY GENETICS SAY.

I HAVE NO BEEN EXPOSED TO IT.

IF I'M GENETICALLY PREDISPOSED TO, AND I TAKE AN OPIOID AFTER A SURGERY OR INJURY, DOCK DOCTOR GIVES ME A PRECIPITATION, IF I TAKE IT AND LIKE IT WAY TOO MUCH, IT MIGHT BE THAT THE GENE HAS BEEN TURNED O. AND IF I TAKE IT OVER AND OVER AGAIN FOR NON-MEDICAL REASONS AFTER MY INJURY IS HEALED, I MIGHT REALLY TURN THAT GENE ON.

BUT AS FAR AS THE NURTURING ASPECT GOES, YES, CLEARLY BEING AROUND IT AND BEING IN AN ENVIRONMENT THAT WHERE DRUGS ARE PREVALENT, THAT IS CLEARLY A RISK FACTOR.

>> SO IT IS SOMETIMES SAID AND I'M GATHERING YOU DISAGREE, THAT WHEN A PERSON GETS THAT FIRST HIT OF SOMETHING, BE IT LIKE HEROIN, THAT FROM THAT POINT ON, THE INDIVIDUAL IS CHASING, MAYBE NOT SO MUCH THAT FEELING, BUT THE SENSE THAT THEY DON'T WANT TO FEEL BAD WHEN ONE IS WITHDRAWING FROM IT.

ARE YOU SUGGESTING THAT THEY ARE IN FACT CHASING THAT WONDERFUL FEEL FEELING, THE EUPHORIA THAT COMES WITH THE INITIAL HIT OF THE DRUG.

>> IT USUALLY STARTS WITH GETTING A HIGH, STARTS WITH SOMETHING POSITIVE.

GENERALLY THOUGHT OF AS A PLEAS URGE EXPERIENCE.

MAYBE THE MOST PLEASURABLE EXPERIENCE THEY'VE EVER HAD.

AND THEN IF THAT COMPULSE TURNS ON AND THEY'RE NOW SEEKING THAT FOR THAT REASONS, THEY CAN DEVELOP ADDICTION.

NOW THE PROBLEM IS, ONCE THE BODY GETS USED TO THAT DOPAMINE RELEASE, YOUR BODY IS NO THE STUPID.

I TELL PEOPLE, YOU CAN DEVELOP A CALLUS TO IT SO THE SUBCONSCIOUS PART OF THE BRAIN WHERE THE DOPAMINE IS AFFECTED THERE, IF IT GETS TOO MUCH DOPAMINE, IT GETS DAMAGED AND THEN YOU CAN NO LONGER FEEL PLEASURE.

IN FACT, YOU MIGHT NOT BE ABLE TO HAVE PLEASURE IN LIFE DOING ANYTHING.

YOU MIGHT NOT-- YEAH, YOU LOSE THE ABILITY TO-- IT'S CALLED A PLEASURE DEFICIT.

ANHEDONIA.

IS THE MEDICAL TERM.

THEY'RE TRYING TO NOT FEEL TERRIBLY HORRIBLE.

AND BY HORRIBLE NOT JUST THE PHYSICAL WITHDRAWAL BECAUSE THAT'S BAD ENOUGH.

BUT THAT JUST LASTS A FEW DAYS USUALLY.

SOMETIMES LONGER, BUT FOR THE MAIN WITHDRAWAL SYMPTOMS ARE NO THE THAT LONG.

IT'S THAT IMPENDING SENSE OF I'M NOT-- I'M WORTHLESS AND THAT SUFFERING THAT GOES ON.

THAT'S ALSO PART OF THE ADDICTIVE PERSON'S EXPERIENCE.

AND THAT'S WHAT THEY'RE TRYING TO-- IN MANY RESPECTS, TRYING TO CHASE IS JUST NOT FEELING HORRIBLE.

>> SO WHEN YOU ARE LOOKING AT TREATING A PATIENT, HOW DOES THE BIOLOGICAL, PSYCHOLOGICAL, AND THE SOCIAL ASPECTS AFFECT YOUR TREATMENT PROTOCOLS?

>> WE START WITH-- OKAY, OBVIOUSLY WE ARE A BODY.

WE ARE A HUMAN.

WE'VE GOT ORGANS IN OUR SYSTEM.

IN THIS CASE THE ORGAN IS THE BRAIN AND I MENTION THE MID BRAIN.

THERE ARE RECEPTORS IN THERE FOR THE OPIOID RECEPTORS AND WE HAVE MEDICATIONS THAT CAN TREAT THOSE RECEPTORS, CALM THE FIRE DOWN AND HAVE THE PERSON NOT HAVE THE CRAVINGS OR MUCH LESS OF THOSE WITHDRAWAL SYMPTOMS AND THEY FEEL LIKE A MORE NORMAL PERSON, ON AN EVEN PLAYING GROUND THERE.

WE HAVE MEDICATIONS THAT ARE EFFECTIVE AND USEFUL AND WORK FOR THAT.

SECONDLY, THE PSYCHOLOGICAL ASPECTS OF IT.

WE WANT TO TREAT THE WHOLE PERSON.

SO YOU DON'T-- I MEAN YOU DON'T ALWAYS HAVE TO HAVE THE PSYCHOLOGICAL ASPECT AT THE BEGINNING, BUT IT'S GOOD TO HAVE THAT ON BOARD, THE COUNSELING, THINGS OF THAT NATURE, GETTING YOUR EMOTIONS BACK IN CHECK SO YOU CAN LEAD A PRODUCTIVE LIFE.

AND THEN WE CALL THIS IN THE RECOVERY PHASE, YOU KIND OF HAVE TO HAVE SOMETHING TO FALL INTO.

I MEAN IF YOU DON'T HAVE A JOB OR YOU DON'T HAVE-- OR STILL HAVE THIS TERRIBLE UNREST IN YOUR SOCIAL EXPERIENCE, YOUR RISK OF RELAPSE IS GREAT SO WE WANT TO TREAT THE BIOLOGICAL ASPECT OF THE DISEASE, THE PSYCHOLOGICAL AND SOCIAL ASPECT OF IT BIO, PSYCHO, SOCIAL.

>> INTERESTING.

SO I'M GOING TO SUGGEST OR SURPRISE-- SURMISE THEN THAT THE BIOLOGICAL SIDE WOULD BE THINGS LIKE WHERE NARCAN, WHEN SOMEBODY HAS AN ACUTE OVERDOSE, I WANT YOU TO EXPLAIN THE DIFFERENCE BETWEEN THE MEDICATIONS.

SUBOXONE AND KNOWN AS BUPRENORPHINE.

AND THEN MAYBE EVEN METHADONE.

HOW DO YOU USE THESE DIFFERENT TOOLS AND WHAT, WHEN AND WHY?

>> WE HAVE THREE FDA APPROVED MEDICATIONS THAT ARE EFFECTIVE FOR OPIOID USE DISORDER.

ONE YOU MENTIONED IS METHADONE.

ONE IS BUPRENORPHINE COMMONLY KNOWN AS SUBOXONE.

COMES IN OTHER FORMS AS WELL THOUGH.

AND THEN THE THIRD ONE WOULD BE NALTREXONE WHICH IS AN INJECTABLE FORM CALLED VIVITROL.

VIVITROL IS NOT A CONTROLLED SUBSTANCE.

IT IS VERY SIMILAR TO NARCAN.

IN OTHER WORDS, IT REVERSES THE EFFECTS OF THE OPIOIDS.

LET ME TALK ABOUT NARCAN FIRST BECAUSE NARCAN IS WAY OUT THERE.

NARCAN HAS BEEN A GREAT MEDICATION THAT HAS SAVED SO MANY LIVES AND PROBABLY ONE OF THE MAIN REASONS WHY THE OVERDOSE DEATH RATE HAS DROPPED RECENTLY BECAUSE MORE NARCAN IS AVAILABLE.

NARCAN WILL REVERSE THE EFFECTS OF AN OPIOID VOADZ OVERDOSE.

>> REALLY?

>> IT DISPLACES THE OPIOID, THE HEROIN, THE FENTANYL, KNOCKS IT OFF THE RECEPTORS IN THE BRAIN THAT ARE MAKING YOU NOT BREATHE.

SO THE PATIENT CAN THEN WAKE UP AND START BREATHING, BUT THEY WILL BE IN WITHDRAWAL.

SO THEY'RE GOING TO FEEL THAT WITHDRAWAL SYNDROME FROM NOT HAVING THE OPIOID IN THEIR BODY.

>> LET ME STOP YOU BECAUSE YOU SAID SOMETHING THAT WAS INTERESTING.

I DON'T WANT YOU TO SLIDE BACK.

OVERDOSE DEATH RATE ARE DROPPING?

>> YES.

THEY'VE DROPPED.

WHAT HAPPENED WAS, THEY HAVE BEEN GOING UP, UP, UP, AND UP.

>> YEAH.

>> THEN COVID HIT AND PEOPLE DIDN'T HAVE ACCESS TO CARE AND THINGS OF THAT NATURE AND THEY SKYROCKETED.

THEY WENT UP A TREMENDOUS AMOUNT DURING THE TWO OR THREE YEARS DURING COVID AND THEY HAVE KIND OF STARTED COMING DOWN AND LAST YEAR THEY CAME DOWN IN MANY COMMUNITIES IN THIS COUNTRY, ALMOST 30% IN A LOT OF PLACES.

>> NARCAN MAY BE A BIG REASON FOR THAT.

>> NARCAN IS A BIG REASON FOR THAT AND COMING OUT OF TATES CREEK ROAD.

BUT WE, IF YOU LOOK AT THE OVERDOSE DRETH RATE PRE-COVID TO WHERE IT IS NOW, THE DEATH RATE, WE ARE STILL RISING.

SO WE STILL HAVE A BIG PROBLEM WITH THIS.

AND NARCAN WILL SAVE PEOPLE'S LIVES.

IT WILL REVERSE THE OVERDOSE SO THEY CAN BREATHE AGAIN BUT IT DOES NOTHING TO TREAT THE ACTUAL DISEASE OF ADDICTION.

>> GOTCHA.

>> THAT'S WHERE THE METHADONE AND BUPRENORPHINE COME IN AND IN SOME RESPECTS, THE NATIONAL ELECTRONICS NALTREXONE, VIVITROL.

>> METHADONE CLINICS, METHADONE IS A VERY POWERFUL OPIOID VERY GOOD FOR PAIN BY THE WAY.

>> REALLY?

>> IT'S A TRICKY DRUG AND IT'S GOT SOME ISSUES.

YOU HAVE TO KNOW EXACTLY HOW TO TAKE IT FOR PAIN BUT IT HELPS PAIN AS WELL.

BUT IT'S FOR ADDICTION, IT'S ONLY ALLOWED TO BE PRESCRIBED OR GIVEN IN A METHADONE CLINIC AND IT'S HIGHLY REGULATED BECAUSE METHADONE IS A VERY POTENT DRUG.

BUPRENORPHINE, HOWEVER, SUBOXONE, IS NOT A FULL OPIOID.

IT'S NOT COMPLETELY LIKE METHADONE.

IT'S A PARTIAL OR HALF OPIOID.

>> WHAT DO YOU MEAN BY THAT?

>> IT HAS A CEILING EFFECT.

IT GOES INTO THE BODY AND COVERS THOSE RECEPTORS IN THE BRAIN, TREATS THE DISEASE PROCESS CAUSING THE ADDICTION, BUT FOR MOST PEOPLE, THERE IS A CEILING EFFECT AND BEYOND A CERTAIN LEVEL, THEY DON'T GET ANYMORE EFFECT FROM IT.

IN OTHER WORDS, IT'S HARD TO STOP BREATHING FROM TAKING BUPRENORPHINE.

IN FACT, IF YOU-- IT'S ALMOST IMPOSSIBLE FOR SOMEONE WHO IS TOLERANT ON OPIOID TO OVERDOSE ON IT.

IT'S NOT IMPOSSIBLE AND NOT A COMPLETELY SAFE DRUG BUT COMPARED TO MORPHINE-- COMPARED TO METHADONE, IT'S SO MUCH SAFER THAT THE DEA LASTER YEAR OR I THINK IT WAS LAST YEAR-- >> DRUG ENFORCEMENT AGENCY.

>> THE DEA NOT KNOWN TO BE EASY ON DRUGS BY THE WAY, THEY CAME OUT AND SAID THE EVIDENCE IS SO GREAT THAT BUPRENORPHINE LOWERS THE OVERDOSE DEATH RATE, THAT WE WANT DOCTORS TO BE ABLE TO PRESCRIBE IT BY PHONE.

SO YOU ACTUALLY, A DOCTOR, SINCE 2022, FEDERALLY, DOES NOT HAVE TO HAVE A SEPARATE DEA REGULATION X WAIVER OR REGISTRATION TO PRESCRIBE SUBOXONE FROM THEIR OFFICE.

DOCTORS CAN PRESCRIBE AND NURSE PRACTITIONERS CAN PRESCRIBE SUBOXONE IN MOST STATES FROM THEIR OFFICE.

>> NOW WAIT A MINUTE.

I DON'T KNOW ABOUT HOW,-- I DON'T KNOW ABOUT YOU.

YOU AND I BOTH CAN PRESCRIBE INSULIN FOR DIABETICS.

I DON'T WANT TO MANAGE A DIABETIC PATIENT.

YOU MAY.

NOT BECAUSE I DON'T LIKE THEM BUT I'M NOT EQUIPPED TO DO THEM.

ARE WE ALL EQUIPPED TO MANAGE THE PATIENT WITH BUPRENORPHINE OR SHOULD YOU HAVE THAT LEVEL OF EXPERTISE THAT YOU BRING TO THE TABLE?

>> WELL EVERYONE IS EQUIPPED TO A CERTAIN DEGREE.

NOW I'M A PAIN SPECIALIST AND ADDICTION SPECIALIST SO I PROBABLY SHOULD KNOW MORE ABOUT IT THAN A LOT OF PEOPLE AND I BELIEVE I DO.

I TRY TO STAY UP ON THESE THINGS.

IT'S MY SPECIALTY.

BUT BEGINNING IN 2023, EVERY DOCTOR, EVERY NURSE PRACTITIONER THAT HAS A DEA LICENSE MUST TAKE EIGHT HOURS OF TRAINING, GOVERNMENT CERTIFIED TRAINING IN ADDICTION MEDICINE.

AND THAT ALLOWS THEM, EVERYONE, TO HAVE WHAT THEY NEED TO PRESCRIBE THIS MEDICATION.

IT'S A SIMPLE MEDICATION TO PRESCRIBE.

IT'S NOT HARD TO PRESCRIBE IT.

IT'S A RELATIVELY SAFE MEDICATION COMPARED TO A LOT OF THE THINGS WE HAVE AND EVERYONE THAT IS INVOLVED IN THIS FIELD WANTS MORE ACCESS TO THIS MEDICATION BUPRENORPHINE BECAUSE THE EVIDENCE THAT IT SAVES LIVES AND LOWERS THE OVERDOSE DEATH RATE IS SO ROBUST AND SO CONVINCING THAT REALLY THIS BECOMES OUR NUMBER ONE AGENT, OUR NUMBER ONE TREATMENT THAT WE HAVE TO LORE-- TO LOWER OVERDOSE IN THIS STATE AND IN THIS COUNTRY IS BUPRENORPHINE.

ACCESS TO BUPRENORPHINE IS OUR BEST AGENT OUR BEST TREATMENT TO LOWER THE OVERDOSE RATE.

>> I MAY BE WRONG BUT INFERRING FROM WHAT YOU ARE SAYING AND THE WAY IN WHICH YOU ARE SAYING, THERE ARE OBSTACLES IN THE WAY OF HOW WE ARE TREATING PATIENTS.

>> ALSO I THINK PTSD FROM THE OPIOID CRISIS FROM THE 1990S AND FIRST PART OF THE CENTURY WE TALK ABOUT OXYCONTIN WAS EVERYWHERE AND WAY TOO MUCH PRESCRIBING AND OTHER MEDICINES CAME IN, HEROIN, FENTANYL AND THINGS OF THAT NATURE, WE HEAR ABOUT THE OPIOIDS AND WE ARE WORRIED IN THIS SOCIETY TRADING ONE OPIOID ADDICTION FOR ANOTHER.

WHY PUT THEM ON SUBOXONE.

ISN'T THAT LIKE OXYCONTIN WAS?

THE DIFFERENCE IS AS I MENTIONED SUBOXONE OR BUPRENORPHINE, ICE NOT A MEDICATION THAT IS DESIGNED TO DO ANYTHING OTHER THAN TREAT ADDICTION.

I MEAN THERE IS-- IT IS AVAILABLE IN SOME FORMS FOR PAIN AND IT IS EFFECTIVE PAIN MEDICINE BUT BY AND LARGE WHEN I TALK ABOUT SUBOXONE OR BUPRENORPHINE, IT IS TO TREAT ADDICTION, WHICH WAS CAUSED, IN A SENSE, BY OXYCONTIN, THE OVERPRESCRIBING AND THE OTHER OPIOIDS.

SO THE THING IS, PEOPLE NEED TO UNDERSTAND THAT'S BY LOCHING BUPRENORPHINE WITH THE OTHER OPIOIDS, IT'S A TRAGIC CASE OF MEDICAL MISIDENTIFICATION.

OR, YOU KNOW, I TELL PEOPLE IT'S LIKE WHEN THE OPIOID CRISIS HAPPENED AND THEY BROUGHT ON REGULATIONS TO STOP DOCTORS FROM PRESCRIBING SO MUCH, THEY KIND OF ROUNDED UP ALL THE PERPETRATORS AND THEY ROUNDED UP BUPRENORPHINE ALONG UP WITH IT AND THEY PROBABLY SHOULD NOT HAVE BECAUSE BUPRENORPHINE WAS AN INNOCENT BYSTANDING TRYING TO HELP OUT.

WELL NOW SINCE 2000, WE'VE GOT 25 YEARS OF ROBUST EVIDENCE AND WE KNOW THAT BUPRENORPHINE IS INNOCENT AND BUPRENORPHINE IS ACTUALLY THE HELPER.

SO WE NEED TO SET BUPRENORPHINE FREE, LIKE A PRISONER WITH THE DEA ON IT NOW.

SO WE NEED TO UNDERSTAND THAT BUPRENORPHINE IS SO EFFECTIVE, THE EVIDENCE IS CLEAR.

EDUCATE PEOPLE LIKE YOU ARE DOING WITH THIS SHOW.

EDUCATE PEOPLE THAT THIS MEDICATION CAN BE PRESCRIBED VERY SAFELY BY PRIMARY CARE DOCTORS.

IT DOESN'T HAVE TO BE A SPECIALTY CLINIC AND WE CAN TREAT THE BASELINE OF PEOPLE WITH THIS MEDICATION.

WE CAN GET INCREDIBLY EFFECTIVE MEDICATION INTO THE BODIES OF PEOPLE THAT NEED IT.

AND IT WOULD BE LIKE, IF WE HAD AN EPIDEMIC OF DIABETES AND, YOU KNOW, WE REALLY JUST NEED TO GET THAT BLOOD SUGAR UNDER CONTROL.

THAT MAY NOT CURE YOUR DIABETES, OBVIOUSLY, IT'S NOT ALL THAT YOU NEED TO DO BUT MAN, YOU WILL BE ABLE TO LIVE AND NOT HAVE A DIABETIC COMA OR WHATEVER.

YOU WILL BE ABLE TO GO ABOUT YOUR LIFE.

SO IF YOU LOOK AT IT THAT WAY, LIKE WE HAD THIS HEALTH CRISIS.

IT'S A DISEASE PROCESS.

IT'S NOT A MORAL FAILING.

THERE SHOULDN'T BE STIGMA GETTING IN THE WAY.

IF WE TREAT IT LIKE THE DISEASE CRISIS THAT IT IS, AND ALLOW THE TREATMENTS THAT WE KNOW WORK, WE KNOW THIS MEDICATION WORKS, IF WE ALLOW IT FOR PEOPLE TO HAVE ACCESS TO IT, I THINK WE CAN MAKE A REAL IMPACT.

>> PATIENTS WHO HAVE HAD A HISTORY OF ADDICTION TO PAIN MEDICATION, STILL GET OPERATED ON AND PEOPLE HAVE AFTER SURGERY HAVE PAIN.

HOW DOES THAT GET HANDLED?

IS THAT A WHOLE NEW CONUNDRUM?

I HAVE SEEN WHERE THE PATIENT IS AFRAID OF GETTING ADDICTED AGAIN, THE PHYSICIANS ARE AFRAID TO WRITE SOMETHING BECAUSE THE PATIENT IS GOING TO GET ADDICTED AGAIN.

IS THAT A SIMPLE PROCESS TO HANDLE THESE PATIENTS?

>> NO, IT'S NOT REAL SIMPLE BUT IT DOES START WITH JUST LETTING YOUR SURGEON OR LETTING YOUR ANESTHESIOLOGIST, THE PERSON CARING FOR YOU UNDERSTAND YOUR FEAR AND YOU HAVE HAD THIS BACKGROUND.

YOU MAY BE MORE AT RISK AND MAYBE YOU SHOULD BE SOMEBODY THAT YOU LOOK AT OTHER OPTIONS.

AND IT MAY BE THAT YOU DO NEED AN POIP SHORT-TERM.

-- A OPIOID SHORT-TERM.

MONITORED VERY CLOSELY TO HELP WITH YOUR PAIN.

MAYBE BUPRENORPHINE, WHICH AGAIN TREATS ADDICTION, BUT ALSO IS A GOOD PAIN MEDICINE, MAYBE THAT CAN BE USED FOR YOUR POST-OP PAIN BUT THERE ARE THINGS LIKE PHYSICAL REMEDIES, THE ICE PACKS, THINGS OF THAT NATURE.

NERVE BLOCKS, NUMBING OF THE EXTREMITIES, MOST MODERN AND WELL TRAINED ANESTHESIOLOGISTS UNDERSTAND A NUMBER OF WAYS TO GIVE YOU POST-OP PAIN CONTROL THAT DON'T INVOLVE THESE REINFORCING OR ADDICTING MEDICATIONS.

SO IF YOU HAVE A CONCERN ABOUT THAT, TALK TO YOUR SPECIALIST, TALK TO YOUR DOCTOR ABOUT THAT AND THEY CAN DO SOME RESEARCH AND THEY CAN PROBABLY FIND YOU A GOOD WAY TO AVOID, YOU KNOW, EXPOSURE TO THE MEDICINES YOU ARE WORRIED ABOUT.

>> AS YOU THINK ABOUT THINGS, LAST MINUTE AND A HALF THAT WE HAVE, WHAT ARE THE THREE BIG POINTS, IF YOU HAD TO SAY I WANT TO MAKE SURE PEOPLE AFTER HEARING YOU TALK HERE TODAY, THIS IS WHAT I WANT TO MAKE SURE PEOPLE UNDERSTAND ABOUT ADDICTION AND MANAGEMENT ADDICTION.

>> NUMBER ONE.

THIS IS NOT A MORAL FAILING.

THIS IS A DISEASE PROCESS THIS IS SOMETHING A DISEASE PROCESS THAT NUMBER 2 WE HAVE TREATMENT FOR.

IT IS TREESABLE.

AND-- IT IS TREATABLE.

WE HAVE MEDICATIONS THAT TREAT IT THAT WE KNOW ARE VERY EFFECTIVE.

AND I MENTIONED METHADONE, METHADONE CLINIC, BUPRENORPHINE, HOPEFULLY FROM YOUR PRIMARY CARE DOCTOR OR A BUPRENORPHINE CLINIC.

AND THEN VIVITROL, THAT MEDICATION AS WELL.

AND THIRDLY, THAT WE, AS A SOCIETY NEED TO APPROACH THIS AS A PUBLIC HEALTH CRISIS AND NOT A CRIMINAL CRISIS.

IT'S A PUBLIC HEALTH CRISIS LIKE WE APPROACH OTHER HEALTH EMERGENCIES.

WE NEED TO IMPROVE ACCESS TO THESE TREATMENTS, THEY'D MEDICATIONS THAT WE KNOW WORKS.

AND ONE OF THEM IS BUPRENORPHINE AND WE NEED TO DO WHAT WE CAN TO ALLOW PEOPLE TO HAVE ACCESS TO THIS MEDICATION.

WE NEED TO LOOK AT THE REGULATIONS WE HAVE ON THE BOOKS, MAKE THEM SO THEY DON'T SCARE DOCTORS INTO SAYING I CAN'T PRESCRIBE THIS.

AS I MENTIONED TO YOU EARLIER.

EVERY DOCTOR WITH A DEA LICENSE HAS THE TRAINING THEY NEED AND THEY CAN PRESCRIBE THIS MEDICATION.

ARE SOME AFRAID WHEN THE REGULATIONS THEY WILL LOSE THEIR LICENSE.

WITH THE FUNDING KIND OF CHANGING IN TERMS OF, YOU KNOW, MEDICAID AND WHERE YOU CAN GO, ACCESS TO SPECIALTY CLINICS ARE GOING TO BE MAYBE TENUOUS.

WE NEED TO HAVE THIS TREATED ON THE PRIMARY CARE LEVEL.

AND WE CAN DO THAT WITH BUPRENORPHINE.

>> PAT, THANK YOU VERY MUCH.

I DON'T WANT TO GIVE A SHORT, BUT IN THE PSYCHOLOGICAL WORK ALSO COMES INTO PLAY.

>> YES.

>> THANK YOU VERY MUCH FOR BEING WITH US.

AND THANK YOU FOR BEING WITH US TODAY.

WE DON'T GET MEDICINE WHEN A PERSON WITH PNEUMONIA CONTINUES TO COUGH DESPITE OUR ATTEMPTS TO TREAT THEM.

RATHER, WE SEEK OTHER MEANS OF TREATMENT.

THE SAME CAN AND SHOULD BE SAID FOR THE PATIENT WITH ADDICTION.

ADDICTION IS A COMPLEX PROBLEM WITH MANY SOCIAL, POLITICAL AND MEDICAL NUANCES THAT TO EFFECTIVELY TREAT THE PATIENT MUST BE ADDRESSED.

IF IT TAKES A VILLAGE TO RAISE A CHILD, IT MAY WELL TAKE THE EFFORTS OF THE ENTIRE COMMUNITY TO TREAT OPIOID ADDICTION.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR ARCHIVED VERSION OF PAST SHOWS PLEASE GO TO ket.org/HEALTH.

IF YOU HAVE A REQUESTY OR COMMENT ABOUT THIS OR OTHER QUESTIONS.

WE CAN BE REACHED AT KYHEALTH AT ket.org.

I LOOK FORWARD TO SEEING YOU ON THE NEXT "KENTUCKY HEALTH."

IF YOU HAVEN'T DONE SO, LEARN HOW TO ADMINISTER NARCAN.

SEE YOU NEXT WEEK.

>> "KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.