15.5 Overdosed: Other complications and consequences of Drug Use

[00:00:00] Hey, I'm back again talking about the worst drug epidemic in history. To today review a bunch of other complications related to illicit drug use, let's just jump right into it.

[00:00:15] Somebody get this guy some help!

[00:00:24] So just to quickly bring this slide back to the forefront of your mind, it is not just overdose deaths we're trying to avoid.

[00:00:33] It's the fact that so many of those who present to the emergency department for a non-fatal overdose end up dying in the first year after.

[00:00:42] With the expected death rate in the general population hovering around 0.2%, but this population of non-fatal overdosers having 5,200 deaths out of 75,000 patients.

[00:00:58] Almost 7% or 35 times the risk of death in that first year compared to the general population.

[00:01:08] But we've reviewed that it's not just deaths either.

[00:01:13] So let's start looking at some of the non-fatal complications that contribute to years of life and years of meaningful life reductions.

[00:01:23] So let's start out by talking about how opiates cause fatality.

[00:01:28] Well, what they do is they tell the person's brain to slow and eventually stop breathing.

[00:01:36] A normal number of respirations per minute is as low as five or six in an endurance athlete to up to 15 to 20 in someone who has some sort of respiratory or lung pathology.

[00:01:48] The brain, which has very high energy requirements and low energy reserves, is one of the first organs affected by decreased oxygen.

[00:01:58] And with a brain sensing low oxygen and too much carbon dioxide, which we're trying to get rid of, it is toxic to us.

[00:02:08] It prioritizes providing oxygen and nutrients through the blood to areas like the brain stem first.

[00:02:16] Regions critical to survival and managing unconscious processes like telling your heart when and how hard and how fast to beat, telling your kidneys to filter blood, your liver to detoxify substances and make proteins, etc., etc.

[00:02:34] The most sensitive areas of the brain include what are called watershed areas.

[00:02:40] So what happens when you slow your breathing to two or three or four times a minute or to any decrease that is abnormal for you, but don't completely shut off oxygenation of your blood and subsequently the vital organs?

[00:02:59] Well, you can get complications in various brain regions as well as other vital organs.

[00:03:06] As this British Columbia study of roughly 2,500 admissions for accidental opioid overdose between 2006 and 2015 shows, 3 to 4% developed what's called encephalopathy or in layman's terms, brain dysfunction.

[00:03:25] The longer the decrease in oxygenation, the longer the decrease in oxygenation, the brain persists, the more severe the encephalopathy is and the more likely it is to become permanent.

[00:03:36] Another study on anoxic or anoxic brain injury or a brain injury related to going without oxygen out of Quebec, Canada showed a 2020 rate of 4.2% of more than 4,400 opioid related poisoning.

[00:03:54] I will quickly scroll through some images of a condition called delayed post hypoxic leucoencephalopathy, which is caused by a non-fatal overdose, not getting enough oxygen to those watershed areas that was not initially apparent, but became obvious on CT or CAT scan and other radiographic images over time.

[00:04:20] This was in a 51-year-old female with chronic pain who was on a fentanyl patch and was found comatose in her home, resuscitated and intubated on site and then transferred to the hospital.

[00:04:35] She had no immediate obvious neurological deficits, but later brain imaging showed hypo-intense regions that indicate a lack of oxygen in one of those watershed areas mentioned earlier in a brain region called the globus pallidus, which has elements of controlling conscious involuntary movement, motivation and cognition.

[00:04:58] So three weeks into her hospitalization, she developed progressively worsening neurologic and psychiatric symptoms.

[00:05:08] She was getting agitated, had really odd delirious-like behaviors, including urinating in a trash can, urinating in other patients' beds, gross, followed by decreased movement, apathy and eventually mutism.

[00:05:25] She had muscle rigidity and what's called spontaneous myoclonus, which are sudden involuntary uncontrollable muscle contractions in one muscle or group of muscles.

[00:05:37] And her MRI at three weeks out showed bilateral basal ganglia, which includes the globus pallidus, necrosis, or areas with evidence of cell death.

[00:05:50] At five weeks, an MRI showed additional areas of dysfunction, including more watershed areas of the brain and including significant frontal lobe and parietal lobe on top of the brain damage.

[00:06:04] This is scary shit.

[00:06:05] And I've seen plenty of patients in the hospital after overdoses, whether that be on an illicit drug or on their prescription drugs, especially if you throw into the mix of an opiate, a benzo, and you throw a little alcohol into there.

[00:06:23] I have had more than one older female patient on that cocktail that was found in their bed for two, three days just laying there.

[00:06:38] And then so in the hospital, you know, psychiatry gets consulted for altered mental status or abnormal behaviors days after the overdose and not always related back to the brain damage from the decreased oxygenation.

[00:06:53] But there's a lot more ways than not breathing that can cause lung pathology or at the worst death.

[00:07:03] This is a really interesting study done on 234 deceased opioid users.

[00:07:10] 42% of them were found to have aspirated stomach contents.

[00:07:17] 13% were found to have fulminant aspiration.

[00:07:22] And fulminant means sudden and severe.

[00:07:25] And interestingly, those 13% were found to have lower concentrations of opioids in their blood, supporting the idea that they may have died from aspiration or asphyxiation of undigested food and gastric contents or stomach contents rather than from not breathing.

[00:07:46] This further supports the notion that some deaths that are solely the result of an overdose may not be categorized or cataloged as an overdose death, especially in older patients with preexisting respiratory problems.

[00:08:02] And they may be have a death certificate that says death by asphyxiation or death by aspiration pneumonia.

[00:08:12] Tuberculosis is another lung condition that is much more prominent in substance use settings.

[00:08:17] With a 26-time increased risk of contracting tuberculosis with IV drug use, which is even more of a risk factor than the severely immune-compromising HIV infection.

[00:08:33] And tuberculosis isn't something that will necessarily kill a person immediately, but it will lead to potential death in the relatively short time frame as well as severe potential complications in the long term.

[00:08:53] This shows you several ways that the kidneys can be adversely affected by an overdose.

[00:08:58] To put it in simple terms, if your brain is trying to decide where to send a limited supply of oxygen and nutrients, it's going to send it to your brain before it does your kidneys.

[00:09:11] It's going to sacrifice other organs like the spleen, the liver, less vital organs, to the preference of giving oxygen to the brain, the heart, and the lungs.

[00:09:24] The risk of end-stage renal disease, aka kidney failure in illicit drug use is almost 20 times higher.

[00:09:32] Whether that is from decreased oxygenation from less available oxygen due to not breathing deeply enough with an opiate overdose,

[00:09:40] or from potent constriction of the renal arteries that supply the kidneys from stimulants like methamphetamine or from severe muscle breakdown from methamphetamine or cocaine,

[00:09:55] which is also called rhabdomyolysis.

[00:09:57] With cocaine being implicated in a quarter of patients who present with rhabdomyolysis or muscle breakdown that overwhelms the kidneys,

[00:10:06] leading to what's called an AKI or an acute kidney injury.

[00:10:11] So, opiate addictions don't just negatively and directly affect the person using the opiates.

[00:10:18] These can also have serious adverse effects on newborns, causing what's called neonatal abstinence syndrome.

[00:10:26] According to the DHHS Agency for Healthcare Research and Quality,

[00:10:32] in 2008, the rate of neonatal abstinence syndrome was less than 3 out of 1,000 live births.

[00:10:39] But this more than doubled to 7 out of 1,000 as of 2016 and does not include other complications like spontaneous abortions related to drug intoxication or withdrawal,

[00:10:52] or other newborn complications that can arise from primary or secondary effects of drug use or withdrawal.

[00:11:01] Neonatal abstinence syndrome is also associated with a much longer hospital stay and a way more costly hospital admission, as you can see here.

[00:11:12] In 2013, Kentucky, of course, had the highest rates of neonatal abstinence syndrome in the country.

[00:11:18] And it's important to have nuance regarding this problem because if a pregnant woman shows up to the ER and is just totally stigmatized for her drug use,

[00:11:29] it may lead to her either not getting the care that she and her unborn child need,

[00:11:34] but it also might lead to her, reactionary-wise, abruptly stopping the drug use.

[00:11:41] And that abrupt withdrawal is much more likely to lead to a miscarriage.

[00:11:46] Because when the woman's body does not feel well in brain, the body will abort fetal development.

[00:11:54] If there's enough signals that are present telling the body it's not a good time for pregnancy.

[00:12:01] So we talked a lot about designer drugs and some of the difficulties with our legal system has in terms of regulating certain substances.

[00:12:11] Spice or synthetic marijuana is something that I am very familiar with in the area that I live.

[00:12:19] It is definitely not just isolated to Kentucky and surrounding areas.

[00:12:23] And it is actually nothing like marijuana.

[00:12:27] It causes central nervous system effects like agitation, coma.

[00:12:33] It can cause seizures.

[00:12:35] It also causes people to have this severe memory loss and movement problems.

[00:12:41] And I had a former colleague once told me that unlike regular marijuana,

[00:12:46] which partially blocks receptors that are critical to memory formation,

[00:12:50] leading to impaired memory with marijuana use,

[00:12:55] spice completely blocks that ability,

[00:12:58] which is evidenced by multiple anecdotal experiences that I've had with patients in the ER

[00:13:05] who can't even remember their names while they're intoxicated.

[00:13:09] They come in,

[00:13:11] they are Jane or John Doe's and they look frightened.

[00:13:16] They cannot participate in any sort of interview.

[00:13:20] And sometimes they also will have these very strange difficulties with movement,

[00:13:27] almost like they get stuck in these particular positions for prolonged periods of time.

[00:13:33] Now, I don't have a way to confirm this,

[00:13:36] but one time I was out in Colorado with my wife and we were driving from her sister's house

[00:13:44] to a ski rental, ski equipment rental shop to return a bunch of rented equipment.

[00:13:50] We had used the last couple of days.

[00:13:53] We got to the corner of a major intersection at a red light and we saw a middle-aged man standing at the corner,

[00:14:01] bent halfway over to one side with his head kind of in this cocked position, not moving.

[00:14:09] I mean, the entire 20, 30 seconds we're at the stoplight.

[00:14:13] He's just standing there, not moving.

[00:14:15] I think he may have even been holding a sign.

[00:14:19] 30 minutes later, we drove back through that same intersection to find that same man still not having moved from that position.

[00:14:30] That's some scary stuff.

[00:14:33] I mean, being in that position for that long certainly is going to make you not feel good the next day when you wake up.

[00:14:40] But it's scary additionally because you got to remember this stuff is legally sold in head shops, in gas stations, in convenience stores.

[00:14:52] What scares me the most are teenagers considering it to be comparable to regular marijuana because that's what it's called, synthetic marijuana.

[00:15:02] And using it out of curiosity or trying to evade drug tests, which doesn't just isolate to teenagers.

[00:15:10] That could be other populations as well.

[00:15:13] And people thinking that they're going to get a similar effect to actual marijuana, which, by the way, is not all that natural anymore.

[00:15:21] But that's another topic for another day.

[00:15:25] People are dying from this stuff or worse.

[00:15:28] They're losing their minds completely.

[00:15:30] So why don't we illegalize it?

[00:15:34] Well, unfortunately, the FDA cannot proactively ban substances prior to them hitting the market.

[00:15:43] After the fact, once problems are recognized at a large enough scale, the FDA will ban it.

[00:15:49] But they can only ban one chemical formulation at a time.

[00:15:53] What you see above is the evolution of what's considered spice over time.

[00:16:00] With makers constantly altering its chemical structure to stay ahead of Johnny Law.

[00:16:05] And users constantly getting something new and potentially more dangerous with each new formulation.

[00:16:14] We saw this play out in April of 2018 in Illinois, where there were 80 confirmed cases of serious internal bleeding and 63 patients that reported spice use.

[00:16:28] And this was in a short period of time in Illinois.

[00:16:32] Well, it turns out the spice was cut with brodificum.

[00:16:38] I think that's how you say it.

[00:16:41] Which, if you've ever had a rat problem, is the main component in rat poison.

[00:16:46] And again, if you've ever had a rat problem, what happens is you give them this rat poison.

[00:16:54] And unfortunately, the rats start to bleed out internally.

[00:16:59] Until eventually, they will even explode, implode from the inside.

[00:17:07] So, not my favorite way to take care of the rat.

[00:17:11] Because then they end up dying in your house.

[00:17:15] And then they end up...

[00:17:16] Anyway, the rats rot.

[00:17:18] It's nasty.

[00:17:19] But when rats or humans ingest brodificum, it blocks vitamin K.

[00:17:26] Which allows us to initiate the cascade of clotting our blood.

[00:17:32] And is totally integral to stop internal bleeding or external bleeding.

[00:17:38] Of the overall 153 cases of this brodificum being in spice and causing internal bleeds,

[00:17:48] there were four deaths linked to this supply.

[00:17:51] Actually, when I showed this information to a colleague of mine,

[00:17:56] he told me he had seen a patient in his first two months of residency back in August of 2018

[00:18:03] who had an internal bleed after exposure to spice.

[00:18:09] Now, I've also seen some people have persistent psychotic symptoms for weeks to months

[00:18:17] or even seemingly permanently after exposure.

[00:18:20] Though it's unclear whether or not those people had undiagnosed or kind of genetic predisposition

[00:18:28] to a more severe condition like schizophrenia.

[00:18:33] Here's what one of those bleeds looks like on imaging.

[00:18:36] These are the kidneys with arrows pointing to spontaneous hemorrhages

[00:18:42] after synthetic cannabinoid or spice use.

[00:18:46] This is a 39-year-old presenting with blood in their urine, abdominal pain, and low blood pressure

[00:18:52] because of blood loss.

[00:18:54] A more potentially fatal or at least life-altering medical problem coming from illicit drug use

[00:19:00] is atrial fibrillation.

[00:19:02] AFib is a heart condition where the heart's conduction cascade

[00:19:07] starts responding to abnormal impulses and beats irregularly

[00:19:12] with the atria or the top chambers of the heart not effectively communicating or syncing with the ventricles

[00:19:19] or the lower chambers.

[00:19:21] And data from California, San Francisco from 2021 compared 24 million adult inpatient hospitalizations

[00:19:31] and emergency department visits from over a decade from 2005 to 15.

[00:19:38] identifying 100,000 meth use disorders, 50,000 cocaine use disorders,

[00:19:43] and 10,000 opiate use disorders cases.

[00:19:47] And identified that there was an 86% higher risk of AFib in meth users,

[00:19:53] almost a three-quarters or 75% higher risk in opiate users,

[00:19:58] and 61% higher risk in cocaine users.

[00:20:02] Now, AFib is in no way the only cardiac complication of illicit drug use.

[00:20:09] With stimulant users, including on cocaine and methamphetamine,

[00:20:15] I would regularly see people in the ER for blood pressures over 200.

[00:20:21] And chest pain or, you know, other symptoms of high blood pressure like blurry vision or feeling hot,

[00:20:33] feeling dizzy.

[00:20:36] And this puts a lot of strain on the heart muscle, especially with chronic use.

[00:20:41] And over a chronic period of time, the more strain that you put on the heart muscle,

[00:20:47] the harder the heart muscle has to beat.

[00:20:49] And you can get what is called abnormal or pathologic hypertrophy of that heart muscle.

[00:20:57] The heart muscle gets bigger and bigger.

[00:20:59] And not only does it have less room in the chest cavity,

[00:21:03] but it also, the different sides of the heart,

[00:21:07] can get in the way of the outflow tracks and lead to potentially even sudden death.

[00:21:17] Moving on, we also have a lot of different potential lung problems.

[00:21:22] Here we're talking about associated with smoking crack cocaine.

[00:21:25] So crack is just a rock form of powder cocaine.

[00:21:29] And I think at this point in history, it is pretty obvious and clear.

[00:21:34] I don't know that the U.S. government would admit it,

[00:21:36] but that the U.S. government helped to create much stiffer penalties for crack versus cocaine possession

[00:21:43] based on minorities and especially black communities being more likely to use crack,

[00:21:49] the crack form of cocaine with white users more likely to use powder cocaine.

[00:21:54] And despite the fact that they are the same substance,

[00:21:59] cut in a different way, penalties for crack cocaine were 10 times more severe.

[00:22:05] I would even venture to say that some of the cocaine intent to deal charges of powder cocaine

[00:22:15] were more severe than some of the charges for possessing crack cocaine.

[00:22:19] But that's all a topic for another episode.

[00:22:22] I just wanted to mention it here.

[00:22:24] Here, I just want to show you a few examples of some lung pathology from crack,

[00:22:30] which is typically smoked or injected.

[00:22:32] On the top left, you've got a 49-year-old man who couldn't breathe and became feverish after an IV cocaine binge.

[00:22:40] All of those white spots on this image are not supposed to be there as air should appear dark and the lungs should be full of air.

[00:22:50] Anytime it's not dark, that means that there are things impeding that progression of air getting deep into the lungs.

[00:22:57] Just like in a tree, the oxygen and carbon dioxide exchange occurs at the very end branches on the leaves.

[00:23:08] The top right shows what's called a pneumomediastinum.

[00:23:12] And the bottom left shows a spontaneous pneumothorax.

[00:23:16] Both of those, in layman's terms, are where air is escaping the respiratory tree and going to places it isn't supposed to go,

[00:23:25] causing increased pressures in closed cavities and ultimately impairing those leaves of our respiratory tree to exchange carbon dioxide and oxygen.

[00:23:38] And then the bottom right shows pulmonary fibrosis or chronic scarring of the lungs with long-term crack smoking history.

[00:23:47] This is in a 38-year-old female.

[00:23:50] Her lungs are shot.

[00:23:53] As you can see, the lung effects of illicit drug use are widespread,

[00:23:59] some being more acutely serious and others causing chronic breathing difficulties.

[00:24:04] How do you measure the harm associated with struggling to breathe?

[00:24:09] Something we do once every few seconds for our entire lives that then impacts that person in every minute of their life,

[00:24:18] for the rest of their life potentially.

[00:24:23] Again, moving on, how about some GI or gastrointestinal complications,

[00:24:28] as well as GU or genitourinary complications of cocaine, opiates, cannabinoids, and or amphetamines and MDMA.

[00:24:39] This is a 41-year-old's liver who came in with two days of worsening right-sided abdominal pain

[00:24:48] and elevated liver enzymes on blood work after a week-long binge on crack, heroin, and meth.

[00:24:55] You can see abnormal ascites, which are fluid represented by the asterisk

[00:25:04] and thickening around the portal veins as well, or the blood outflow tract of the liver shown by the arrows.

[00:25:10] And when we have ascites built up, that means that our livers have been affected to the point of not doing what they're supposed to do

[00:25:21] or one of their functions, which is to make proteins.

[00:25:24] Proteins got to be in our bloodstream in order for transport of a bunch of other really important things that have to go into our tissues.

[00:25:37] And when we don't have enough protein, our fluid starts to actually leak out or extravasate,

[00:25:45] and then it accumulates in these abnormal areas.

[00:25:51] This is an unfortunate gentleman who developed what's called four-years gangrene,

[00:25:57] a rare but deadly infection of the genitals and areas around them,

[00:26:01] when he actually tried to pop an abscess in his scrotum after smoking crack.

[00:26:06] This required emergency surgery.

[00:26:10] Now, here, this is just kind of crazy to me.

[00:26:14] How much somebody's insight or how much their doctor providing the service,

[00:26:21] how much the insight can be knocked out based on the pull of the addiction.

[00:26:28] This is what's called narcotic bowel syndrome, where somebody's colon is paralyzed from its normal peristalsis,

[00:26:36] which is the rhythmic contractions of the GI smooth muscle that help us move poo through the GI tract.

[00:26:43] Opiates can paralyze the bowel's muscles and cause constipation so bad that it creates an immovable obstruction

[00:26:52] and eventually can lead to the rupture of the intestines and spilling poopy contents into our bellies,

[00:27:00] which is an absolute surgical emergency.

[00:27:04] Here we've got another example of a fecal impaction where poop is backed up throughout the entire colon

[00:27:12] in a 69-year-old patient on an implanted pain pump for chronic back pain.

[00:27:18] Now, look, I could easily fill another 300 slides with other complications related to illicit drug use,

[00:27:26] but I want to wrap up with a couple more pressing psychiatric issues,

[00:27:33] one of which is a huge problem, an emerging and progressively worsening problem,

[00:27:38] called meth-induced psychosis.

[00:27:42] So meth use is becoming more and more prominent year after year.

[00:27:46] And as we've discussed, the meth is becoming more and more potent year after year.

[00:27:52] This is leading to a new consideration, psychiatric diagnosis consideration,

[00:27:58] when somebody comes into the ER with psychotic behavior on methamphetamine or having a history of methamphetamine.

[00:28:06] Now, people who are acutely intoxicated on meth certainly can be psychotic and delusional,

[00:28:12] with the meth somehow convincing their brains that it couldn't be related to their meth use.

[00:28:18] Unfortunately, these delusions of persecution,

[00:28:23] often paired with auditory or visual hallucinations or illusions,

[00:28:28] don't always go away with cessation of the drug use.

[00:28:31] I can't tell you how many patients I've seen working in the psyche are who use meth for several months to years,

[00:28:39] and despite long periods of sobriety, still appear extremely paranoid.

[00:28:44] One time I walked a sober meth user who didn't meet the legal criteria for psychiatric hospital admission.

[00:28:54] I walked him outside.

[00:28:56] He wanted to get into the hospital because of these people that were following him.

[00:29:01] And I told him, I said, look, you don't meet criteria, but I will walk you outside.

[00:29:07] And we can look at what you're looking at together.

[00:29:11] He started to point to shadows in the distance.

[00:29:14] He was obviously fearful in talking about those guys waiting for me.

[00:29:19] But every time that we approached another shadow, nothing happened.

[00:29:23] There was nobody there.

[00:29:25] But he remained convinced that they were around the next corner.

[00:29:31] I ended up walking him nearly the entire way to the homeless shelter that was a few blocks away from the ER.

[00:29:40] Another former patient was convinced that the FBI had implanted a chip in his brain,

[00:29:45] and he could hear them plotting to capture and arrest him for months to years,

[00:29:51] with no movement towards conclusions that the non-meth-affected brain would have probably clearly and rationally gotten to within days to weeks.

[00:30:02] Nobody's come to get me.

[00:30:03] I don't really have anything that they would want.

[00:30:06] They're spending a lot of time and theoretically money and resources on this.

[00:30:14] Therefore, this must be my mind playing tricks on me.

[00:30:18] This study of 1,430 individuals with meth use disorder from 2018 revealed that about 30% continued to have psychotic symptoms up to six months following abstinence.

[00:30:32] And some meta-analyses report even higher prevalences of persistent symptoms around 35%, 36%.

[00:30:41] It's such a bad problem that some of these patients eventually do get diagnosed with schizophrenia,

[00:30:47] which by nature in diagnostic criteria, it is not schizophrenia, which typically presents with negative symptoms or cognitive symptoms of impaired ability to think,

[00:31:02] impaired ability to socially interact.

[00:31:05] And this comes on over a couple of years as the human frontal lobe is maturing.

[00:31:10] So the time consistency is, it's not the exact same.

[00:31:14] I mean, you have some schizophrenics whose symptoms come on as early as 14 or 15,

[00:31:19] and others whose symptoms, negative symptoms don't come on until age 19 or 20.

[00:31:25] But it's a typical progression from negative symptoms for a couple of years.

[00:31:31] And then as the auditory cortex is coming into maturity,

[00:31:38] typically schizophrenics start to have auditory hallucinations or other delusions that exist in the couple of years after.

[00:31:49] And we call these positive symptoms.

[00:31:51] A study out of Thailand where methamphetamine use is very prominent revealed that 10% of all psychiatric hospital admissions were due to meth-induced psychosis.

[00:32:03] And almost 40% were diagnosed with schizophrenia due to the psychosis being persistent at five years follow-up.

[00:32:13] It almost, to me, looks more like a delusional disorder where there is psychosis,

[00:32:21] but it all revolves around the same delusion of being persecuted, being followed.

[00:32:27] But unlike a true schizophrenic, these people don't have as severe of negative symptoms.

[00:32:33] To me, I think that this makes this population more likely to act on their delusions and or hallucinations as they still retain the ability to make a plan and execute that plan

[00:32:46] due to their frontal lobe not being as adversely affected as a true schizophrenic patient.

[00:32:53] Sexually transmitted infections are at an all-time high in the United States associated with the rise in substance use disorders,

[00:33:00] including IV drug use as well as much riskier sexual practices.

[00:33:06] And, you know, things like gonorrhea, chlamydia, very easily treated.

[00:33:11] Herpes infection is chronic and cannot be gotten rid of,

[00:33:17] but also relatively easily treated and relatively easy to prevent outbreaks of that.

[00:33:23] The things that are scary are things like HIV, which can also be treated, but has very, very severe consequences if it progresses to AIDS,

[00:33:33] as well as syphilis.

[00:33:36] You know, syphilis is making a comeback, an infection that used to be a psychiatric problem

[00:33:42] because we didn't know it was related to an infection,

[00:33:45] but would progress over months to years to causing the person to have behavioral and psychotic changes.

[00:33:54] And eventually when it was decided or figured out that it was related to these spirochetes

[00:34:01] or this certain type of infectious cause, well, it became easily treated,

[00:34:07] but it also became a neurological problem and went to the neurologist for figuring that out.

[00:34:15] I was taught in medical school that I would probably not really see syphilis very often.

[00:34:22] And then right as I was being taught that, we were seeing this huge spike in the amount of IV drug use.

[00:34:30] And with that, we started to see a big increase in the number of syphilis cases

[00:34:37] to the point where working in an addiction facility,

[00:34:40] I one day saw two syphilis cases in the same day.

[00:34:44] Two people tested positive for syphilis.

[00:34:47] Again, easily treated, but it does not always get easily recognized

[00:34:53] or the provider, if they are not aware of this trend, may not even ever test for it.

[00:35:00] Um, it's not also all about just medical complications.

[00:35:04] There's so many other consequences like people being, uh, incarcerated,

[00:35:09] not being able to be around their kids and their families and their communities,

[00:35:13] kids being taken away from their parents and growing up in foster care

[00:35:17] due to the parents struggling with substance use.

[00:35:21] Again, somebody commits a crime.

[00:35:23] Somebody is violent towards other people.

[00:35:26] They should absolutely be incarcerated.

[00:35:28] incarcerated, but should we be incarcerating and tearing apart these families

[00:35:33] for all of these folks who are struggling in the throes of addiction?

[00:35:39] I mean, I certainly agree that people should have their kids taken away in some situations,

[00:35:46] but I think we've got to really emphasize the treatment side of things

[00:35:51] much more than we have in the past and stop just demonizing people for being bad parents

[00:35:59] because they're addicted to drugs.

[00:36:01] Let's help people and help them be able to raise their kids,

[00:36:05] which is most of the time the most suitable environment for that kid.

[00:36:10] Oh, of course, Kentucky has some of the highest incarceration rates in the country.

[00:36:14] Um, here you also see a nearly 10% drop in workforce participation over 15 years.

[00:36:22] Decreased work leads to decreased contribution to society,

[00:36:25] leads to decreased fulfillment with life or feeling like what you're doing with your limited time on this planet

[00:36:31] is lacking an inherent meaning or importance.

[00:36:35] And again, I think all of these contribute to the risk of depression and suicide.

[00:36:40] Um, we talked about the risk of suicide previously,

[00:36:43] but what about all the immeasurable impacts of different degrees of depression and hopelessness

[00:36:51] or the secondary impact on the people that rely on those persons struggling with addiction?

[00:36:57] How do you measure the stress of a mother worrying about whether her son or daughter is going to overdose and die on a nightly basis?

[00:37:05] Or a young teenager trying to navigate life without the compass of an adequately functioning parent?

[00:37:11] Or all of the kids who spend time in and around illicit use

[00:37:16] and the unsafe environments that use tends to produce?

[00:37:21] It's really hard to measure and put a number on all of these things,

[00:37:25] but I'm hoping this series is helping to emphasize just how fucking serious these problems are

[00:37:34] and how important it is for us to devote so many more resources to stemming the tide of the drug epidemic.

[00:37:43] We were able to create a vaccine within months of the COVID pandemic hitting,

[00:37:47] which if you've listened, you know, I'm a bit skeptical about it.

[00:37:51] But my point is, how have we not produced more effective measures in the way of tackling and reducing the impact of this crisis?

[00:38:01] Why are we not devoting a bevy of resources to the war on drugs

[00:38:07] and instead continuing to wage this war on drug users?

[00:38:12] Look, I get it.

[00:38:14] When I'm evaluating somebody who is high on meth, who is withdrawing from opiates,

[00:38:19] or who has absolutely shit insight into how bad their drug use is

[00:38:24] and what consequences it's causing in their life

[00:38:28] and how it's not going to allow them to find fulfillment and meaning in their life

[00:38:34] outside of these moments of intoxication,

[00:38:37] it's extremely frustrating.

[00:38:38] And I can sense myself feeling angry, wanting to be dismissive of some people.

[00:38:44] But there are so many people out there that want help.

[00:38:48] There are so many levels to this that maybe I can create some sense of wonder or curiosity about sobriety,

[00:39:00] even in that dismissive person.

[00:39:02] Every single person struggling with addiction has a damn story.

[00:39:08] Some of these stories you could never even imagine yourself surviving,

[00:39:12] much less thriving after having gone through some of the traumatic things that these people have gone through,

[00:39:20] after having certain biologic mental illnesses that are never treated appropriately.

[00:39:26] These are people with stories, with reasons why they find themselves in the pits and the throes of addiction.

[00:39:35] Our job is not to judge them.

[00:39:38] It is to support them.

[00:39:41] Much like we would support the diabetic who has blood sugars in the 600s

[00:39:46] and eats a thousand McDoubles and small fries a day, despite being advised not to.

[00:39:52] We still treat that person.

[00:39:54] We still try to make an impact on that person.

[00:39:57] Our job is to keep trying to find ways to reach people and make system-wide changes

[00:40:04] that will help prevent this problem from happening,

[00:40:07] instead of scrambling to address the mess of complications and consequences

[00:40:14] after shit has already hit the fan.

[00:40:17] We'll talk more about some of these proposed solutions in the last episode of the series.

[00:40:22] Thanks for listening.

[00:40:50] Thanks again for watching.

[00:40:55] If you're passionate about the subjects that I discuss on the channel, do me a favor and like, comment, subscribe.

[00:41:05] Do whatever you can to make your voice heard.

[00:41:08] These are problems that must be addressed in our society.

[00:41:12] If you have any questions, comments, or concerns, I want to hear them.

[00:41:18] Feel free to reach out on social media or email us at renegadesyke at gmail.com.

[00:41:26] If you'd like to be a guest of the show or you have a connection to somebody that you think would be a good guest, let us know.

[00:41:34] Thanks again for listening.