12.1 Safer Drug Use with Stephen Love, MD: INTRO

[00:00:00] Welcome to Renegade Psych, a nuanced podcast dedicated to informing the American public about the

[00:00:05] flagrant shortcomings of our healthcare system. I'm a board certified psychiatrist and along with

[00:00:10] my guests, breakdown interesting and important topics into several segments to appeal to both

[00:00:15] the general public as well as medical and psychiatric students, residents and practitioners.

[00:00:20] My primary motivations are to appreciate nuance in major medical and psychiatric discussions,

[00:00:25] educate listeners on the undo and widespread influence of big business in healthcare,

[00:00:30] and provide accurate and reliable information on relevant mental and medical health topics.

[00:00:36] While I'm still young and have a lot to learn in my career, I cannot continue to stand

[00:00:40] idly by while so many in my field repeatedly fall victim to pharmaceutical interests,

[00:00:45] misinformation and manipulation of existing data at the expense of Americans' health.

[00:00:50] Whether you struggle with your mental health, work in behavioral health or the healthcare system,

[00:00:55] or want to better understand our healthcare systems over promise and under deliver status quo,

[00:01:00] my guests and I hope to provide public education on some of the most pertinent,

[00:01:04] under-reported and controversial issues in psychiatry, mental health and healthcare in general.

[00:01:08] Disclaimer, this podcast is for informational purposes only. The information provided in this

[00:01:12] podcast and related materials are only to educate. This information is not intended as a substitute

[00:01:15] for professional medical advice while I am a medical doctor in many of my guests at extensive medical

[00:01:19] training and experience. Nothing stated in this podcast, norm materials related to this podcast,

[00:01:23] including recommended websites, texts, graphics, images or any other materials should be treated

[00:01:26] as a substitute for professional, medical or psychological advice, diagnosis or treatment.

[00:01:30] All listeners should consult with a medical professional, licensed mental health provider,

[00:01:33] or other healthcare provider if seeking medical advice, diagnosis or treatment.

[00:01:36] Or, put more simply. You need help like this guy, call your own doctor.

[00:01:43] Somebody get this guy some help!

[00:01:52] Today we're going to talk about safer drug use. According to CDC data in 2021,

[00:02:00] we jumped over a hundred thousand deaths for the first time ever in the United States alone.

[00:02:06] What started out as the opiate epidemic has now transformed into a full-blown

[00:02:12] every drug epidemic with a lot of fentanyl contamination, as well as a lot stronger and more potent

[00:02:18] drugs. Overdose deaths in the United States in every drug category are higher than they've ever been.

[00:02:26] In 2021, unintentional injuries which include poisonings for overdoses were the fourth leading

[00:02:33] cause of death in all ages in the United States. That's only behind heart disease,

[00:02:40] cancer and COVID-19, all of which are much more likely to have medical co-morbidities

[00:02:46] that contribute to people's deaths. In fact, the rest of the top 10 includes stroke, chronic

[00:02:54] lower respiratory disease, Alzheimer's disease, dementia, diabetes, chronic liver disease and

[00:03:01] cirrhosis and kidney disease. All of these have significant medical co-morbidities associated with

[00:03:09] them and are much more likely to happen in people over the age of 65. With overdoses,

[00:03:17] we're talking about young people dying sudden and dramatic deaths. Losing so many years of

[00:03:24] compared to these other conditions. Unintentional injury was the number one cause of death in the

[00:03:30] United States for ages 1 through 44, with poisoning or overdose being the number one cause of unintentional

[00:03:39] injury death in ages 25 through 64. Suicide, a major comorbidity in the addiction community,

[00:03:47] was the second leading cause of death in ages 10 through 44 with homicide ranking in the top five

[00:03:55] in ages 1 through 54. There were over 2 million poisonings in 2020 alone,

[00:04:03] with more years of potential life lost than with any other cause of death. In the 2019 National

[00:04:11] Survey on Drug Use and Health in the United States, 50 to 60 percent of non-institutionalized

[00:04:18] Americans older than 12 years old at some point in their life used in illicit substance.

[00:04:23] 13 to 15 percent had used in illicit substance in the past month. The reality is that we are using drugs.

[00:04:32] When we talk about drugs, we're talking about drugs that are most associated with overdose deaths.

[00:04:39] The problem is so severe that life expectancy in the United States is dragging several

[00:04:45] years behind other developed nations. There was one decrease in life expectancy in the U.S.

[00:04:52] from 1950 to 2015. It was associated with the HIV AIDS crisis and a spike in motor vehicle accidents

[00:05:00] in 1993. In 2015, our life expectancy dropped by 0.1 year for the first time since 1993.

[00:05:10] But in 2020, it dropped by 1.8 years. Now some of this is absolutely due to COVID,

[00:05:18] but the reality is that COVID deaths 90 percent of them were in people over the age of 55

[00:05:25] while with overdose deaths 90 percent of them are in people younger than 65. So how have we done

[00:05:32] in the last several years in treating our drug epidemic? Well between 2019 to 2021,

[00:05:38] we had an increase in overdose deaths of 40 percent. The estimated cost is over $1 trillion

[00:05:48] to the American economy. Now we'll do another episode on the evolution of the opiate and

[00:05:54] drug epidemic, but we'll give you a brief overview now. So the current epidemic started with an

[00:06:00] increase in prescribing most notably of oxycodone produced by Purdue Pharmaceuticals. In 1996,

[00:06:08] oxycodone sales were estimated at 40 million. By 2001, oxycodone sales were over 1 billion

[00:06:18] to the point where it outperformed biagra the top earning drug of the late 90s and very early 2000s.

[00:06:26] By 2009, we were approaching 40,000 overdose deaths per year in the United States and the federal

[00:06:33] government instituted prescribing limitations to try to combat the rising rates of prescription

[00:06:39] opiate addiction. This unintentionally led users, especially young ones, to seek out elicit

[00:06:45] forms of opiates. Around this same time, Mexican cartels had taken over the heroin trade and

[00:06:52] transport into America was relatively easy. Americans became heroin addicted and within a few years,

[00:07:00] the drug supply became contaminated with fentanyl, mostly produced in China and shipped to the

[00:07:06] United States and Mexico. Covid is sometimes considered the fourth wave of our current drug epidemic

[00:07:12] and contributing heavily to the increase in overdose numbers over the last three to four years.

[00:07:18] When we talk about deaths, the vast majority of them are related to opiates or other drugs

[00:07:23] less with opiates, most notably fentanyl. We are seeing the numbers of drug overdose deaths

[00:07:30] with cocaine rising from 2014 where there were about 5,000 cocaine related deaths all the way up

[00:07:37] to 2020. Both of those are white powdery substances, fentanyl doesn't have any odor to it,

[00:07:47] can't be easily identified in the illicit drug supply. We're talking about psychostamulence

[00:07:54] mostly methamphetamine. 2015 methamphetamine was attributed to about 5,700 deaths as of 2020

[00:08:04] that number jumped up almost to 25,000 deaths. Benzo Dazapines, 2009, about 5,000 overdose deaths

[00:08:13] attributed to Benzo's as of 2020, almost 12 and a half thousand overdose deaths. But

[00:08:21] complications of illicit drug use don't just include death.

[00:08:26] Intervenous drug users or IV drug users are 22 times more likely to get HIV. Almost half

[00:08:34] of IV drug users test positive for hepatitis C with 90% of new cases related to IV drug use.

[00:08:42] The prevalence of endocarditis or infection of the heart valves related to IV drug use in 2003

[00:08:50] was estimated at 5%, but 2016, this estimate increased to 16% and was exponentially increasing

[00:09:00] from 2013 to 2016. Other complications include osteomyolitis, abscesses, the complications that

[00:09:09] come from non-fatal overdose such as anoxic or hypoxic brain injury where somebody maybe

[00:09:16] doesn't completely stop breathing, but they're not breathing enough to oxygenate parts of their

[00:09:22] brain or parts of their other vital organs. Potentially causing kidney failure, liver failure,

[00:09:29] lung failure, heart failure, spinal cord abscess and injury. And those are just a few examples

[00:09:35] of non-fatal complications of illicit drug use. As a society our current reality is that we are

[00:09:44] in accumulating medical and psychiatric comorbidities at astronomical rates because of drug use.

[00:09:51] What we have been doing, what we are doing, what we've done in the past is not working.

[00:09:58] Now the only safe way to use drugs is to not use drugs. And we certainly recommend abstinence

[00:10:06] from people using illicit substances especially due to the high risk of fentanyl contamination

[00:10:12] and so many other complications that we'll talk about today. Stigmatizing and admonishing users

[00:10:19] in waiting for them to be quote unquote ready for treatment instead of educating them,

[00:10:24] encouraging them and engaging them in potential treatment even if they are at the pre contemplative

[00:10:31] stage of change. Maybe by engaging them we can move them to the contemplative phase or we can

[00:10:39] move them from contemplative to preparing for change or preparing for change to acting on change.

[00:10:47] As a medical community we would never treat people with other diseases like diabetes,

[00:10:54] for COPD or high blood pressure. Like we do, folks with addiction, some people with uncontrolled

[00:11:01] diabetes have neglected to make changes in their diet, neglected to make changes in their

[00:11:07] activity level. Our non-compliant with medications meant to lower their blood sugar. People with

[00:11:12] severe COPD continue to smoke 10, 20 cigarettes a day. People with high blood pressure are

[00:11:19] non-compliant with their medication, non-compliant with diet and exercise change. We don't

[00:11:24] wait for these people to be ready for change to treat them. We do what we can to help them.

[00:11:30] So why is it that we treat addiction differently and not like the chronic medical condition

[00:11:38] that it is? We can continue to set boundaries within this population while offering support

[00:11:45] an encouragement. If somebody breaks the law for example, regardless of whether or not they're

[00:11:51] intoxicated on a substance they should face legal consequences. But the reality is that there

[00:11:57] are a lot of good people out there who are addicted and when you hear their stories,

[00:12:04] you have a lot more compassion for them. You have a lot more willingness to try to engage them in

[00:12:11] treatment. Addiction is not always the root cause of the problem. Sometimes there are deeper,

[00:12:19] rooted psychological issues. Histories of trauma that contribute to people's

[00:12:25] addictions or simply addiction may be the only way for some people to fit into their environment,

[00:12:33] to their family, to their community. So the reality is that we've got to do something different.

[00:12:39] We've got to find a way to reach people where else our overdose numbers are going to continue

[00:12:46] to climb higher and higher as they've done for the last 25 years. A hundred thousand deaths

[00:12:54] is absurd. That's one in five of the world's drug overdoses occurring in the United States.

[00:13:04] As a psychiatric professional, that's embarrassing for our field. We've got to do something different.

[00:13:11] And that's why we're here today to talk about safer drug use. So today I've got with me,

[00:13:21] one of my best buds, one of my cohorts in my psychiatric residency at U of L. Steven Love,

[00:13:28] MD and psychiatrists. Somebody that I've got a lot of intellectual respect for,

[00:13:33] I don't know if I would have survived residency without him on a very personal note.

[00:13:39] See that I both grew up in a very opiate afflicted part of the country in northern Kentucky and

[00:13:46] Louisville, Kentucky right around Appalachia is where the opiate epidemic really started. It still has

[00:13:52] the highest number of overdoses. HIV hepatitis C. We share a lot of similar views and have a lot

[00:13:59] of productive and unproductive arguments. Sometimes threatening our friendship, other times perpetuating

[00:14:07] our friendship, Steven gives us a little background about what you're doing and where you're at.

[00:14:13] How you view psychiatry in the world as a whole? Oh man, you can't even go for a chat.

[00:14:19] I'm a simple man. Now I'm personally passionate about the philosophy of psychiatry

[00:14:24] and how we are incredibly misguided. As a field in our current approaches, our current systems,

[00:14:33] our current diagnostic classification and our current quote unquote algorithms. So,

[00:14:39] I'm on board with anything that is talking about things that need to be talked about but

[00:14:44] aren't talked about enough. So what do you think are some of the biggest problems with the way

[00:14:50] that we approach addiction in this country? Because the reality is that we're not doing it correctly

[00:14:57] or else maybe we would have numbers that would reflect an improvement in our outcomes surrounding

[00:15:04] addiction. I mean to me, I know we live in the day and age of medicalizing addiction but

[00:15:09] I see addiction through the lens of a societal problem more than anything else on one hand

[00:15:15] and then the other hand from an individual perspective. I think we live in a day and age where it is

[00:15:21] increasingly difficult for an individual human being to find meaning and purpose that they can

[00:15:27] hold on to. And I think that drugs are as accessible as they've ever been and lots of drugs

[00:15:35] provide artificial meaning and purpose and it's hard to argue with that when the world's fucked up.

[00:15:41] So most of my hot take views on addiction are really about societal ills then they are about

[00:15:47] approaching them in a particular way in a clinical setting. So I always have an existential bet

[00:15:52] when it comes to all things addiction. It almost seems like you might draw a parallel between

[00:15:59] the meaning that you would get out of purchasing a new product like a new car and the rush

[00:16:06] that you would get from having that new sexy kind of silver bullet that's going to make you

[00:16:13] happy and make everything better compared to the feeling that you get. If you do a drug that causes

[00:16:21] a strong release, those same rewarding pathways, I'll bite at a much more rapid rate without nearly as

[00:16:30] much work but what do you make of that parallel? I don't necessarily disagree that there's

[00:16:35] something there but I think where I'm coming from is less of a like I consume this and I get a rush

[00:16:41] perspective and more a hey all my problems are solved by this and I think it's getting more

[00:16:49] difficult to solve one's problems nowadays speaking very broadly and generally just commentary

[00:16:55] on the society that we live in and so drugs are just a more and more attractive alternative than

[00:17:02] telling the line and trying to find the American dream in a country that doesn't necessarily

[00:17:08] offer it like it used to. Yeah and I mean in terms of that conscious moment by moment experience that

[00:17:14] we all live within like you said it does offer really for those moments and when people are

[00:17:21] intoxicated on a drug or on alcohol, it kind of sets aside so many of the problems that you have.

[00:17:27] Obviously the big issue with that is that the problems don't go away they come back in full

[00:17:33] force when that feeling or that intoxication wears off and then you're stuck in a deeper hole

[00:17:39] and that kind of vicious cycle continues. Dr. Love tell us a little bit about your professional journey.

[00:17:47] My father's a physician he's an emergency medicine doc grew up in a quote unquote medical

[00:17:52] household my mom worked in a lab in a hospital as well so it was always known that it was an opportunity

[00:17:59] and then my oldest brother went into medicine and my other brother went into veterinary medicine

[00:18:04] so I just figured out get into the family business. But once a Notre Dame for undergrad

[00:18:09] they actually have a pre-med major there pre-professional studies major so it did that

[00:18:14] then went to University of Louisville for medical school. Hold on while you're in Notre Dame.

[00:18:18] The word on the street is that you started a club that was maybe a little bit against the Notre Dame

[00:18:24] philosophy. You told us a little bit about that. You can look it up in USA today. I was a

[00:18:31] 1718, 19 year old kid lost in the world and was questioning religion. I'd been questioning it

[00:18:37] for a while but it was the flavor of the time that militant atheism was in the air. I latched onto

[00:18:44] it at some point and so a couple of buddies and I decided to start a club called the atheist

[00:18:49] agnostic and questioning students club at the most prestigious Catholic University in the world

[00:18:54] and they didn't like it very much but we met underground for a couple of years. Had 40, 50 members

[00:19:00] we would basically just get together and try to discuss other ways to approach life that didn't

[00:19:04] have religion being at the center of it because you know the Catholic University it's always there so

[00:19:10] we would do things like discuss ethics talked about existentialism with out God and try to figure

[00:19:17] out how one could and should live one's life. Do you think our society would be more progressive

[00:19:25] or less progressive if religion did not take the whole that it did so many centuries ago?

[00:19:33] I don't know man humans are savages like more murders have probably been committed in the name of

[00:19:39] religion in the past several centuries but also like we would probably would be doing it anyways

[00:19:44] just under the guise of something else. I do think it's been a moderating and tamely experience

[00:19:49] or sorry, taming influence so we would probably be more savage without it although I think we need to

[00:19:56] evolve beyond its at this point because God is dead and we have killed him and we need to figure out a

[00:20:02] different way to fill that gap and bring people together without engaging in holy wars.

[00:20:09] Yeah I agree with you. I think it probably did serve a very formidable role for humans for

[00:20:17] a long time but with where we're at now evolutionarily and having a grasp of so many different

[00:20:24] elements of history that we're now able to combine together in our learning of history. It's not

[00:20:30] presented from some monotheistic point of view we have access to so many different religions or religious

[00:20:39] history that as an intellectual in 2023 it's becoming harder for us to grapple with some of the

[00:20:50] contradictions and hypocrisies about any certain religion. I just have a hard time understanding how

[00:20:59] any learned individual could believe in the religion of yesterday. I get it if you believe in a

[00:21:06] God and I don't know if I'm agnostic or atheist to this day because I do think that there are

[00:21:12] elements of our reality that contain a spiritual component that just cannot be explained by modern

[00:21:19] science it might just be that we don't have the ability to explain it scientifically yet. It's very

[00:21:25] difficult for a thinking person in the 21st century to believe in the Judeo Christian religions

[00:21:31] in their offshoots and good faith. So you went to Notre Dame and did you go straight from Notre Dame

[00:21:39] into medical school? It took a little sabbatical that a gap year after undergrad to just get some

[00:21:47] other real-world experience outside of academia always wanted to work at a factory so I didn't work

[00:21:52] at a factory so I learned my lesson and went to med school and then took another sabbatical

[00:21:58] for a couple of years. I decided I wanted people to describe as blue collar work. I just

[00:22:05] still wanted that experience. I wanted to scratch that edge so I went and worked at a printing

[00:22:09] press for a year and then returned to med school and stayed the course through residency.

[00:22:13] Is that when you went to Thailand? I actually went to Thailand in med school while I was actually

[00:22:19] still enrolled over summer break to study Buddhism. I could do a little bit of yoga and then

[00:22:25] got punched in the head once and I was like, I think it would be more time to that's

[00:22:29] need to hear it all there. If I was religious I would be a Buddhist. Buddhism though some people

[00:22:35] would fairly make the argument that does not a religion per se it's just a system of ethics to orient

[00:22:44] one to existence but of course there's organized Buddhism which is different than the

[00:22:50] spiritual tenants of Buddhist philosophy. So you finish medical school at UML and then did

[00:22:59] your residency at UML with me? This is true. Without me you'd probably be dead. That's also true.

[00:23:07] It tells about what you're doing now. I am trying to take another sabbatical.

[00:23:13] Now I just finished up a year stint at a state hospital in Indiana and I'm taking a couple

[00:23:19] months to do some travel and some reading and sort of reassess where I am in my life personally and

[00:23:25] professionally so I can engage in the type of work that's a fine most meaningful. Would you say you're

[00:23:31] trying to figure out what you want to be when you grow up? It's pretty much it. I have not made a lot

[00:23:37] of progress. Any young listeners out there you may never figure out what you want to be when you grow

[00:23:43] up. It's not about figuring out what you want to be when you grow up. It's about continuing to figure

[00:23:49] out what you want to be when you grow up. Man is a constant project. It goes right back to the

[00:23:55] destination fallacy. The Miley Cyrus? It's the climb. I got that for me. There are a lot of songs about it.

[00:24:04] Yeah, being processed oriented is always important. Hey once I get through residency then I can

[00:24:11] start living my life. Yeah. Once I finish medical school then I'll start living my life.

[00:24:17] There's always something else. Once I pay all my bills then I can start doing the things that I want.

[00:24:24] No, no. Start doing the things that you want. You may get to the destination you may not and you

[00:24:31] can always just take more sabbaticals whenever you get lost. There's actually no rules. Don't listen

[00:24:35] to anybody who says otherwise. Well they're shy. I mean you know don't kill people. There's

[00:24:40] you said at the best right. Life moves pretty fast. If you don't stop and look around once in a

[00:24:46] while you can miss it. That's right. Great line. Fairest people are existentialist. So you are about

[00:24:54] to go to Thailand for a couple of months. I'm jealous and figure out what your next steps are after that.

[00:25:02] What in your ideal world would you be doing 5 or 10 years from now? If we had a camera

[00:25:09] it would surely staring blankly into the abyss right now. I have no idea.

[00:25:16] No you know I personally and professionally in a transition period after residency when you get to

[00:25:22] the other side of all the hard-earned training and finally had the ability to be gainfully employed

[00:25:28] with some financial resources and theory more free time. So trying to figure out in which realm

[00:25:36] of the field I want to contribute to. See that I worked in an addiction facility that

[00:25:43] we don't work at anymore but we would talk about running a camp where we go out in nature. We

[00:25:50] disconnect from the world and we establish a sense of community while also focusing on helping

[00:25:57] people to get sober. It was going to be a commune. Essentially a commune helped people find the

[00:26:02] meaning that they're lacking in life and figure out their values and what direction they want

[00:26:08] their life to go, what things create meaning for them and then finding behaviors or actions

[00:26:15] that will move them towards those things that matter all at the same time developing resilience

[00:26:22] to the things in life that are uncomfortable or that we all try to actively avoid at times.

[00:26:29] But we're in so much fucking debt right now that we are a slave to the system and have to make

[00:26:35] enough money to support our lifestyles, payback our debts, raise all these kids that I keep having

[00:26:45] etc etc and hopefully even save a little bit of money for them in the future.

[00:26:53] Somebody get this guy some help!

[00:27:02] Thanks for listening. For more social media content, check us out on all social media

[00:27:06] platforms at RenegadeSight. If you have any comments, questions, or challenges to the information we

[00:27:10] present it here, or if you'd like to be a guest of the show, feel free to email us RenegadeSight at

[00:27:15] Gmail.com. Follow the link in the show notes to our website for source material, transcripts and

[00:27:18] additional links for my guests. And if you feel passionate about our message and what we're trying to do

[00:27:23] and you'd like to donate, you can also follow the link in the show notes to our website. Thank you.