15.4 Overdosed: 3rd Wave: Fentanyl Contamination and COVID

[00:00:00] All right. Welcome back for part four of Renegade Psych's maybe even six episode series on the U.S. drug epidemic.

[00:00:07] The worst in history with hundreds of thousands of people dying annually and millions more suffering

[00:00:14] from complications and adverse consequences of illicit drug use. Somebody get this guy some help.

[00:00:29] Renegade Psych, Ethan P. Short, MD We started out in part one by reviewing how the official numbers are underrepresenting and underestimates of the severity of the problem.

[00:00:41] Renegade Psych, Ethan P. Short, MD We reviewed how Purdue Pharma used the pain revolution to somehow convince enough people in the medical community that the use of addictive opiates could somehow be safe and effective in the long term and not addictive.

[00:00:55] Renegade Psych, Ethan P. Short, MD Then in our last episode, part three discussed how the U.S. government's regulatory reaction to the prescription epidemic paved the way for the Jalisco boys of Mexico to introduce potent black tar heroin to American consumers, leading to a massive increase in the amount of intravenous drug use and its resultant infectious complications and leading to them becoming the second most powerful cartel in Mexico.

[00:01:24] Renegade Psych, Ethan P. Short, MD Now today in part four, we're going to talk about the next wave following the prescription epidemic and the IV drug use or heroin part of the epidemic.

[00:01:35] Renegade Psych, Ethan P. Short, MD This massive increase in the availability of fentanyl and its subsequent contamination of the entire illicit drug supply.

[00:01:45] Renegade Psych, Ethan P. Short, MD Just to reiterate how potent fentanyl and its even stronger cousin carfentanyl are is showing you this DEA graphic.

[00:01:55] Renegade Psych, Ethan P. Short, MD It shows the estimated lethal doses of heroin, which is around 20 to 30 milligrams, compared to uncut fentanyl, 1 to 2 milligrams, and uncut carfentanyl, 0.01 to 0.02 milligrams.

[00:02:11] Renegade Psych, Ethan P. Short, MD And this is evidence that even just a couple grains or a sand's worth of fentanyl or carfentanyl especially can lead to a fatal overdose.

[00:02:23] Renegade Psych, Ethan P. Short, MD Oftentimes it takes more than one Narcan or naloxone, the reversal agent for opiate overdose, to reverse the effects of fentanyl overdose.

[00:02:33] Renegade Psych, Ethan P. Short, MD And it may even require a half dozen different administrations of Narcan, which can cause the doctor or the provider in the ER that is treating a suspected overdose to start to call into question their diagnosis and potentially abort giving more Narcan prematurely.

[00:02:55] Renegade Psych, Ethan P. Short, MD So this next graphic shows the number of DEA seizures of fentanyl and its derivatives in the 2000s and into the 2010s.

[00:03:05] Renegade Psych, Ethan P. Short, MD We saw a drastic increase in fentanyl seizures from nearly zero in 2001 all the way through 2013.

[00:03:15] Renegade Psych, Ethan P. Short, MD The one spike you see on there is related to one massive drug seizure in fentanyl-laced cocaine in 2006, I believe.

[00:03:26] Renegade Psych, Ethan P. Short, MD But from having almost no fentanyl all the way through 2013 to over 5,000 seizures in 2014, over 15,000 in 2015, and over 30,000 in 2016.

[00:03:40] Renegade Psych, Ethan P. Short, MD Now, I couldn't find a specific graph to show you from 2017 and on, but from reports and overall numbers,

[00:03:49] it appears the amount of fentanyl flowing into the country has only increased year over year since that time.

[00:03:56] Renegade Psych, Ethan P. Short, MD With DEA reports from 2021 of over 50 million fentanyl-laced fake prescription pills

[00:04:05] and more than 10,000 pounds of fentanyl powder, enough to kill 379 million people.

[00:04:13] Renegade Psych, Ethan P. Short, MD Now, I'll update those numbers for, I believe it's 2023, a little bit later in the episode.

[00:04:19] Renegade Psych, Ethan P. Short, MD So, from 2000 to 2012, fentanyl was involved in less than 2% of overdose deaths in New York City.

[00:04:28] Renegade Psych, Ethan P. Short, MD In these 2017 numbers, once fentanyl had contaminated the drug supply,

[00:04:35] it was involved in almost 60% of New York City overdose deaths.

[00:04:41] Renegade Psych, Ethan P. Short, MD Now, most users are not aware that they're using fentanyl.

[00:04:45] Renegade Psych, Ethan P. Short, MD With a 2019 survey of over 300 opioid withdrawal inpatients in Baltimore,

[00:04:52] Boston, and Providence, revealing that only 25% of those people

[00:04:57] sought out fentanyl.

[00:04:59] Renegade Psych, Ethan P. Short, MD What we see in terms of total drug overdose deaths

[00:05:03] is a massive increase year over year.

[00:05:07] Renegade Psych, Ethan P. Short, MD A drug epidemic that was the worst it had ever been in the early 2000s

[00:05:13] just continued to get worse with the emergence of heroin,

[00:05:17] then took somehow an exponentially worse turn with the huge influx of mostly China-produced fentanyl.

[00:05:30] Renegade Psych, Ethan P. Short, MD A drug delivery effect

[00:05:30] in 100,000 Americans every year with an estimated 3 to 4 million years of life lost annually.

[00:05:40] So, according to the DEA, fentanyl flows into the U.S. primarily from China via our neighbors

[00:05:48] mostly to the south but also a little bit to the north.

[00:05:51] The Chinese government actually in 2018 scheduled fentanyl, much as we have our drugs scheduled.

[00:06:00] We'll save that discussion for another day of how horribly we've scheduled our drugs.

[00:06:05] But anyway, China scheduled fentanyl in 2018, which outlawed producers from trafficking it.

[00:06:11] But they simply shifted to trafficking licit fentanyl precursors and analogs and continued sending it either directly into the U.S.

[00:06:24] or vast majority of it comes through Mexico with a little bit coming through Canada,

[00:06:29] where it can be relatively easily smuggled across the border using thousands to tens of thousands of mules every year.

[00:06:38] In recent years, a more strained U.S.-China relationship has likely contributed to a lack of enforcement by the Chinese government.

[00:06:48] But we're also talking about a substance that can be smuggled in microscopic amounts that are extremely lightweight,

[00:07:00] they're odorless, and they're very easily hidden from authorities.

[00:07:05] Now, what follows is the most contaminated drug supply of all time,

[00:07:12] which is scary for other recreational drug users that otherwise would have never used anything IV

[00:07:19] or never would have touched something as potent as heroin or methamphetamine.

[00:07:25] Fentanyl has found its way into powder cocaine.

[00:07:28] With the number of overdose deaths, which was steady around 5,000 for the previous 15 years,

[00:07:35] seeing a stunning and rapid increase in overdose deaths,

[00:07:40] with pretty much the entire increase related to fentanyl and its derivatives.

[00:07:46] Both fentanyl and cocaine are white powdery substances,

[00:07:51] and delineating the two is nearly impossible without a chemical test.

[00:07:55] So these are people that are most likely actively not trying to use fentanyl,

[00:08:02] or even get a drug that acts as a downer.

[00:08:05] But as of most recent numbers, we're seeing north of 20,000 overdose deaths related to cocaine yearly.

[00:08:17] Benzodiazepines like Xanax, Klonopin, Valium, Ativan, and others have seen a similar rise in deaths.

[00:08:24] With very few people dying from benzos alone throughout the last 20 plus years.

[00:08:31] In fact, benzos by themselves do not slow breathing or depress respiration.

[00:08:38] But combined with opioids, they create what's called a synergistic or a multiplier effect.

[00:08:45] So you can see an increase in deaths progressively over the period in the 2000s and into the 2010s

[00:08:56] as the prescription drug epidemic rolled on.

[00:08:59] As users and even some providers were not aware of the potentially fatal interaction between opiates and benzos.

[00:09:09] Now there was a 2015 Veterans Administration or VA study that showed that veterans who were prescribed both opiates and benzos

[00:09:20] were at a much higher risk of death from drug overdose.

[00:09:24] And found that 27% of 112,000 plus veterans on opioids or opiates were also co-prescribed benzos.

[00:09:34] It also found that half of drug overdose deaths in this population were in patients who were co-prescribed benzos and opioids.

[00:09:44] Now the VA has a policy against co-prescribing the two.

[00:09:50] But you can see the numbers gradually increasing in terms of benzo-related deaths up until 2015.

[00:09:57] And then you see another spike of increasing deaths due to fentanyl after that.

[00:10:05] And again, the same is true for methamphetamine and other psychostimulants.

[00:10:10] But there's a little bit more nuance here.

[00:10:14] While methamphetamine-related deaths have surged from only about 500 per year in 1999,

[00:10:21] and solo methamphetamine overdose was rarely fatal in the late 90s and early 2000s,

[00:10:29] this was a time when meth was primarily being made domestically.

[00:10:33] And the potency of it, of the meth that was made in mom's basement or in the RV by pseudo-chemists,

[00:10:42] was way lower than the meth available today.

[00:10:45] Mexican cartels, which operate much more like Fortune 500 companies than generally believed,

[00:10:53] have also now cornered the methamphetamine market as well.

[00:10:57] And they're producing Walter White-esque, nearly 100% pure methamphetamine.

[00:11:03] So, as you can see, more than half of the almost 25,000 annual meth deaths

[00:11:09] are related to it being cut with fentanyl and other synthetic opioids,

[00:11:13] with a steep increase from 2019 to 2020.

[00:11:17] But the gray line represents a steady increase in psychostimulant deaths

[00:11:23] without any involved opioids, to nearly 10,000 annually in 2020.

[00:11:28] And this is related to a gradually and progressively increasingly pure forms of meth,

[00:11:37] closing in on nearly 100% potency that users are ingesting.

[00:11:42] Leading to deaths from neurologic and or cardiovascular complications,

[00:11:49] such as hypertensive crises, intracranial hemorrhages, seizures, strokes, hyperthermia,

[00:11:58] arrhythmias, and heart failure.

[00:12:00] Not to mention likely deaths due to erratic behaviors and violence.

[00:12:04] For example, I've seen patients come into the ER that have all kinds of paranoia

[00:12:12] that they're being actively followed by drug dealers, police, or others persecuting them.

[00:12:17] I even had a patient come in with behavior as strange as trying to have sex with a light pole

[00:12:23] in between the two sides of a major roadway.

[00:12:27] Interesting.

[00:12:29] That started before COVID, but really picked up steam during and after due to lockdowns,

[00:12:35] the production of counterfeit pills.

[00:12:40] As a father of young children, this is terrifying to me.

[00:12:45] What you see on the top graphic are two 2-milligram Xanax pills.

[00:12:50] What you see on the bottom are two 30-milligram Oxycodone pills,

[00:12:55] the generic alternative to Oxycontin, and when combined with Tylenol called Percocet.

[00:13:02] These are made with pill presses and pill molds.

[00:13:07] And through the internet or from a street dealer,

[00:13:10] most users think they're getting a legitimate prescription drug,

[00:13:15] which again is not necessarily safe, but is a hell of a lot safer than fentanyl.

[00:13:22] What they're actually getting is likely fentanyl combined with a little bit of Xanax

[00:13:28] or a little bit of Oxycodone, or could be marketed as Adderall,

[00:13:34] and they put a little bit of amphetamine or stimulant in there,

[00:13:38] along with a bunch of filler meds or substances like Tylenol or baby laxatives

[00:13:44] or even something like Xylazine,

[00:13:47] which doing this or having these contaminated pills

[00:13:52] magnifies the risk of overdose for multiple reasons,

[00:13:57] including the dangerous benzo-opioid combo,

[00:14:01] as well as users potentially being totally naive to the effects of fentanyl

[00:14:06] and even 1 or 2 milligrams being enough to make them stop breathing for good.

[00:14:11] The CDC reported that deaths with evidence of counterfeit pill use

[00:14:17] more than doubled from 2% in 2019 to almost 5% at the end of 2021

[00:14:24] and more than tripled from 5% to 15% in Western jurisdictions.

[00:14:29] Let's take a little closer look at how these pills are made.

[00:14:33] By the way, on the top, the Xanax pill on the left is a counterfeit pill,

[00:14:39] and the one on the right is a legitimate and regulated pharmaceutical pill.

[00:14:44] Now, these are pill presses available to buy with a simple internet search.

[00:14:51] Dealers use them to combine fentanyl with other drugs to increase their potency

[00:14:56] due to the low cost and high return by using the fentanyl.

[00:15:01] As you can see in the Customs Clearance Easily tab on this website,

[00:15:08] tabletpresspillpress.com,

[00:15:10] from 2019, they are marketing to buyers how to evade customs,

[00:15:17] stating,

[00:15:18] if our customers have a good capacity for customs clearance,

[00:15:23] we would send the whole machine at once.

[00:15:26] If not, don't worry.

[00:15:28] We'll detach it into three parts and deliver separately

[00:15:32] and be able to pass customs easily.

[00:15:36] And they tout all the countries they've sent pill presses to,

[00:15:39] boasting that rich experience makes us more reliable.

[00:15:44] Oh, you're really doing a fucking great service, pill pressers.

[00:15:51] These pill presses are then paired with specific pill molds.

[00:15:55] On the top right, you can see someone using a pill mold for a Xanax 2 milligram

[00:16:00] next to an oxycodone or Percocet 30 milligram pill mold in the middle.

[00:16:06] This makes the dealer's pills look nearly identical to the real thing,

[00:16:11] but with added fentanyl and non-psychoactive fillers like starch or atropine

[00:16:17] and others previously mentioned that cut costs and or prolong

[00:16:23] or increase the effects of the press pill.

[00:16:26] For those using illicitly bought or dark web-bought pills,

[00:16:30] from working in multiple addiction facilities

[00:16:32] and trying to be curious and asking patients about their use

[00:16:36] and getting their perspectives,

[00:16:38] because they are more expert in a lot of ways than I will ever be,

[00:16:42] many of them report that the counterfeit pills

[00:16:45] tend to crumble more readily than the real pills.

[00:16:50] This is potentially life-saving information

[00:16:53] to dispense to anyone you know

[00:16:56] that uses or ever has used a fake pill.

[00:17:00] It's not just benzos and opioids.

[00:17:02] It's not just Xanax and oxycodone.

[00:17:05] We've seen a massive increase in illicitly produced counterfeit Adderall as well,

[00:17:10] which tends to, if somebody's lucky, be methamphetamine

[00:17:15] or, like the others, can have fentanyl

[00:17:19] and lead to death with one administration.

[00:17:22] You see multiple media reports about deaths on college campuses

[00:17:28] likely related to fake pressed Adderall

[00:17:33] and somebody who's trying to seek out a stimulant

[00:17:38] either to, theoretically, to try to study for their finals

[00:17:42] or to try to stay up,

[00:17:45] whether that be to party or...

[00:17:51] trying to get high on a depressant.

[00:17:55] So, in 2023,

[00:17:59] the DEA, and this is two years after those 2021 numbers,

[00:18:03] the DEA sees more than 80 million fentanyl-laced fake pills

[00:18:07] and nearly 12,000 pounds of fentanyl powder.

[00:18:12] DEA lab analyses revealed that

[00:18:14] two out of every five fake pills with fentanyl

[00:18:18] contained a potentially lethal dose.

[00:18:21] And, as you can see above,

[00:18:24] the penalties for buying and importing pill presses

[00:18:26] are way behind the times.

[00:18:29] Though I did see in May of this year

[00:18:31] that Dr. Bill Cassidy,

[00:18:35] an MD and a Louisiana Republican senator,

[00:18:39] as well as Maggie Hassan,

[00:18:40] a New Hampshire Democratic senator,

[00:18:43] have introduced a bipartisan and very important modification

[00:18:48] to the Controlled Substances Act

[00:18:50] that would worsen penalties on those caught with pill presses

[00:18:54] and or pill molds,

[00:18:56] especially in conjunction with illicit substances,

[00:19:01] for up to a 20-year sentence.

[00:19:04] Now, let's pray to the gods

[00:19:06] that corporate entities don't find a way

[00:19:10] that this modification to the Controlled Substances Act,

[00:19:15] that I would guess more than 95% of Americans would agree with doing,

[00:19:22] would reduce their profit margins,

[00:19:25] and somehow try to stifle us making progress on the legal side

[00:19:30] in this fight against addiction.

[00:19:32] The reality is that there are very, very few,

[00:19:36] if any, other theoretical uses for owning a pill press.

[00:19:42] Now, a separate but related problem

[00:19:45] involves what are called designer drugs,

[00:19:48] or street chemists-produced analogs

[00:19:51] of various benzodiazepines, or benzos,

[00:19:56] or what are called synthetic cathinones,

[00:19:59] more commonly referred to as bath salts,

[00:20:02] with one of the more well-known synthetic cathinones

[00:20:05] and media-reported cathinones

[00:20:06] being a drug called Flocka

[00:20:08] that can produce manic-like behavior,

[00:20:12] elevated heart rate or tachycardia,

[00:20:15] and psychosis.

[00:20:16] And I actually remember a media report

[00:20:18] about a not-so-well-known, I think, Florida rapper

[00:20:22] becoming intoxicated on Flocka,

[00:20:26] assaulting his girlfriend,

[00:20:28] and then proceeding to try to eat her face

[00:20:32] or something crazy like that.

[00:20:35] Another way to skirt the legal system

[00:20:38] in terms of possessing or making a designer drug

[00:20:41] is to make something that is not illegal.

[00:20:44] To give a little bit of background,

[00:20:46] the FDA has to give permission

[00:20:48] to pharmaceutical companies

[00:20:50] and FDA approval of prescription medications

[00:20:54] and treatments for use for the American public.

[00:20:57] But that same system does not exist

[00:21:00] for supplements or non-prescription substances,

[00:21:03] which can only be banned by the FDA

[00:21:06] after they cause problems.

[00:21:09] A 2017 study in Europe

[00:21:13] of 9,300 drug-related deaths

[00:21:15] that had a full toxicology report

[00:21:18] found over 1,000 involved at least one NPS,

[00:21:23] or new or novel psychoactive substance,

[00:21:26] with similar trends from 2019 to 2020 seen in the U.S.

[00:21:31] These problems have only gotten worse with time.

[00:21:34] We'll review a similar situation

[00:21:36] with what's called SPICE in our next series

[00:21:38] that focuses more on non-fatal complications

[00:21:42] and consequences of illicit drug use.

[00:21:44] So, the third wave of the epidemic

[00:21:47] is typically considered to be

[00:21:48] the fentanyl contamination wave.

[00:21:51] But again, some consider COVID

[00:21:52] to represent a fourth wave

[00:21:54] with, as mentioned previously,

[00:21:57] another massive uptick

[00:21:58] in the number of different illicit substances

[00:22:01] produced and cut with fentanyl,

[00:22:03] or other novel psychoactive,

[00:22:07] technically illicit substances,

[00:22:09] with a current drug scene

[00:22:11] that reminds me of a line

[00:22:12] from the movie Forrest Gump.

[00:22:14] Life, or the illicit drug scene in America today,

[00:22:18] is like a box of chocolates.

[00:22:20] You just never know what you're going to get.

[00:22:24] So, with COVID,

[00:22:25] we saw a nearly 40% increase

[00:22:28] in overdose deaths alone

[00:22:29] during a two-year period

[00:22:31] from 2019 to 2021,

[00:22:33] in what was already

[00:22:35] the worst drug epidemic

[00:22:36] in human history,

[00:22:37] in 2019.

[00:22:40] 2019's numbers of overdose deaths

[00:22:42] represented more than 400% increase

[00:22:45] when compared to 2000.

[00:22:47] And I've got to reemphasize,

[00:22:49] this is a period of time

[00:22:51] where intuitively,

[00:22:53] you would have expected

[00:22:54] the numbers to drop

[00:22:55] due to isolation,

[00:22:57] stay-at-home mandates.

[00:22:58] What we saw instead

[00:23:00] was a worsening

[00:23:01] of the substance use problems,

[00:23:02] evidenced by

[00:23:04] emergency department numbers

[00:23:06] from early in the pandemic

[00:23:07] from this JAMA psychiatry article.

[00:23:11] Here, you can see

[00:23:12] the total number

[00:23:13] of mental health-related

[00:23:14] U.S. emergency department

[00:23:16] or ER visits,

[00:23:18] aka the gray vertical bars

[00:23:20] in the graph,

[00:23:21] including mental health conditions

[00:23:23] or MHCs,

[00:23:25] suicide attempts or SAs,

[00:23:28] overdoses,

[00:23:29] and violence outcomes,

[00:23:30] which at the start

[00:23:32] of the pandemic

[00:23:32] in April of 2020

[00:23:34] dropped precipitously

[00:23:36] with 7 to 9 million

[00:23:38] psych-related ER visits

[00:23:39] in the first three months

[00:23:40] of 2020,

[00:23:41] then a huge drop

[00:23:43] to less than 5 million

[00:23:44] in April of 2020

[00:23:45] and remaining lower

[00:23:47] than the prior year

[00:23:49] through September of 2020.

[00:23:51] But, despite a 38% drop

[00:23:55] in overall mental health-related visits

[00:23:58] in the first month

[00:23:58] of the pandemic,

[00:23:59] we actually saw more people

[00:24:02] seeking help

[00:24:03] for drug overdoses

[00:24:04] in May through September

[00:24:06] of 2020

[00:24:07] than we did

[00:24:08] during the same period

[00:24:09] in 2019.

[00:24:10] From March to May of 2020,

[00:24:14] we saw nearly double

[00:24:15] the number of drug-overdose-related

[00:24:18] ER visits.

[00:24:19] We also saw more intimate

[00:24:21] partner violence,

[00:24:23] suicide attempts,

[00:24:24] and suspected child

[00:24:25] and adolescent neglect.

[00:24:27] Hell,

[00:24:28] it's almost like

[00:24:29] shutting down the country

[00:24:31] had some serious

[00:24:32] unintended consequences

[00:24:34] on those struggling

[00:24:36] with their mental health.

[00:24:37] In Kentucky,

[00:24:39] despite a significant decrease

[00:24:41] in total ER visits

[00:24:42] from March to September,

[00:24:44] comparing 2019 to 2020,

[00:24:46] we actually saw the rates

[00:24:48] of overdose-related ER visits

[00:24:50] out of total ER visits

[00:24:52] nearly triple

[00:24:53] in the first two months

[00:24:55] of the pandemic

[00:24:55] and remained nearly double

[00:24:58] their 2019 rates

[00:24:59] through September

[00:25:01] for heroin and opioids

[00:25:03] with an even more alarming increase

[00:25:06] in stimulant overdose-related visits.

[00:25:09] So, in summary,

[00:25:11] for this week,

[00:25:12] we've reviewed the scope

[00:25:14] of the overdose fatality problem

[00:25:16] and the likely underrepresented

[00:25:19] number of deaths

[00:25:20] related to all complications

[00:25:23] of illicit drug use.

[00:25:25] Then we trace the evolution

[00:25:27] of the U.S. drug epidemic

[00:25:28] from the increase

[00:25:29] in prescription opiates,

[00:25:31] the first wave,

[00:25:32] to the emergence

[00:25:33] of black tar heroin

[00:25:34] and a large increase

[00:25:36] in IV drug use,

[00:25:38] to the third

[00:25:39] and or fourth waves

[00:25:40] representing fentanyl

[00:25:41] contaminating the drug supply

[00:25:43] and then an even bigger surge

[00:25:45] in deaths

[00:25:46] and contamination

[00:25:47] along with the creation

[00:25:49] of novel psychoactive substances

[00:25:51] that are becoming

[00:25:52] increasingly difficult

[00:25:53] for the legal system

[00:25:54] to regulate

[00:25:55] and increasingly difficult

[00:25:57] for providers

[00:25:58] to manage medically

[00:25:59] and predict their psychiatric

[00:26:01] and medical consequences

[00:26:02] all emerge.

[00:26:03] Next,

[00:26:05] we'll review

[00:26:05] a plethora

[00:26:06] of other complications.

[00:26:09] You thought we were finished

[00:26:10] with the complications,

[00:26:11] but we're not.

[00:26:14] To really try to emphasize

[00:26:16] the millions upon millions

[00:26:18] of people

[00:26:19] suffering

[00:26:20] from severe

[00:26:22] but mostly non-fatal

[00:26:24] complications

[00:26:25] related to their drug use.

[00:26:27] Tune in again next week

[00:26:28] and thanks for listening.

[00:26:31] Disclaimer.

[00:26:32] This podcast is for informational purposes

[00:26:33] only.

[00:26:34] The information provided

[00:26:34] in this podcast

[00:26:35] and related materials

[00:26:35] are meant only to educate.

[00:26:37] This information is not intended

[00:26:38] as a substitute

[00:26:38] for professional medical advice.

[00:26:39] While I am a medical doctor

[00:26:40] and many of my guests

[00:26:41] have extensive medical training

[00:26:42] and experience,

[00:26:42] nothing stated in this podcast

[00:26:43] nor materials related

[00:26:44] to this podcast

[00:26:45] including recommended websites,

[00:26:46] text, graphics, images

[00:26:47] or any other materials

[00:26:48] should be treated

[00:26:49] as a substitute

[00:26:49] for professional,

[00:26:50] medical or psychological advice,

[00:26:51] diagnosis or treatment.

[00:26:52] All listeners should consult

[00:26:53] with a medical professional,

[00:26:54] licensed mental health provider

[00:26:55] or other healthcare provider

[00:26:56] if seeking medical advice,

[00:26:57] diagnosis or treatment.

[00:26:58] Or put more simply,

[00:27:00] if you need help like this guy,

[00:27:02] call your own doctor.

[00:27:02] Call your own doctor.

[00:27:03] Call your own doctor.

[00:27:04] Thanks again for watching

[00:27:05] and or listening.

[00:27:07] If you're passionate

[00:27:08] about the subjects

[00:27:09] that I discuss on the channel,

[00:27:11] do me a favor

[00:27:12] and like, comment, subscribe.

[00:27:15] Do whatever you can

[00:27:17] to make your voice heard

[00:27:19] that these are problems

[00:27:20] that must be addressed

[00:27:22] in our society.

[00:27:24] If you have any questions,

[00:27:26] comments or concerns,

[00:27:27] I want to hear them.

[00:27:30] Feel free to reach out

[00:27:31] on social media

[00:27:32] or email us at

[00:27:34] renegadesyke at gmail.com

[00:27:36] and if you'd like to be

[00:27:38] a guest of the show

[00:27:39] or you have a connection

[00:27:40] to somebody that you think

[00:27:41] would be a good guest,

[00:27:43] let us know.

[00:27:45] Thanks again for listening.