Dr. Gadh and I review his evidence of the benefits of using low doses of lithium to reduce impulsivity that may lead to substance use relapse, as well as the use of low doses of (primarily) stimulants for untreated or undertreated ADHD in the addiction setting. The reality of our current drug epidemic is: WHAT WE'RE DOING IS NOT WORKING. These treatments, in addition to a holistic, individualized, yet comprehensive approach to treating physical pain and mental trauma, show tremendous promise in treating addiction, and hopefully can be part of our society's solution to the illicit drug epidemic, which has killed well over a million people since 1999, and is currently taking more than 110,000 lives annually.
Thanks for listening. For more social media content, check us out on all social media platforms @Renegadepsych. If you have any comments, questions or challenges to the information we've presented here, if you'd like to be a guest to the show, or if you have general comments, questions, or suggestions, email us at Renegadepsych@gmail.com and follow the link https://renegade-psych.podcastpage.io/ to our website for source material, transcripts, and additional links for my guests. If you feel passionate about our message and what we're trying to do, and you'd like to donate, you can also follow the link in the show notes to our website.
Disclaimer, this podcast is for informational purposes only. The information provided in this podcast and related materials are meant only to educate. This information is not intended as a substitute for professional medical advice. While I am a medical doctor and many of my guests have extensive medical training and experience, nothing stated in this podcast nor materials related to this podcast, including recommended websites, texts, graphics, images, or any other materials should be treated as a substitute for professional medical or psychological advice, diagnosis or treatment. All listeners should consult with a medical professional, licensed mental health provider or other healthcare provider if seeking medical advice, diagnosis, or treatment.
[00:00:00] This segment might be the most important and personally relevant segment of all the ones Dr. Gatden I recorded. It talks about low dose lithium's role in helping to treat addiction, which makes sense based on its apparent ability to reduce impulsivity, which I think is the reason why it helps to prevent suicide, but also may help an addiction because if the addicted individual can
[00:00:30] exist the initial impulse or urge, they're much less likely to continue using. Also what we're doing is not working. We are not adequately treating addiction in this country and it shows so obviously in the numbers of fatal overdoses every year.
[00:00:53] In 1995, there were somewhere around 10 to 15,000 fatal drug overdose deaths. In 1996, Oxycotton got FDA approval and you started to see the numbers increase in a very linear fashion for several years. By 2000 we were at roughly 20,000 overdose deaths. By 2010, we were pushing close to 40,000 overdose deaths.
[00:01:22] And then in 2014, we started to see fentanyl making its way into the entirety of the drug supply. In 2015, we surpassed 50,000 drug overdose deaths. In 2019, surpassed 70,000. In 2020 that number jumped up to 92,000.
[00:01:42] 2021 estimates are around 107,000. In 2022 and 23 estimates continue to rise. In overdose deaths represent just a fraction of the morbidity and mortality associated with illicit drug use.
[00:01:59] HIV, skin and soft tissue infections, bloodstream infections, endocarditis, strokes, heart attacks, kidney failure, liver disease and liver failure, depression and suicide, exacerbation of underlying mental illness including bipolar disorder and schizophrenia, decreased productivity in societal contribution, increased strain on the prison system, significant in debilitating nonfatal overdoses.
[00:02:29] The list of other complications goes on and on and on. What we're doing is not working. We have got to look at alternative options for treatment or we're going to continue to see these numbers rise.
[00:02:45] And ultimately a large fraction of our US population is destined to live a life that lacks meaning and fulfillment as consequences continue to pile up.
[00:02:57] So this segment is very important. Dr. Gatt and I talk about the use of low dose lithium as well as vitamin replacement utilizing MAT or medication assisted treatment treating both physical trauma or pain as well as emotional trauma or pain, working to deep prescribe and not replace an illicit addiction with an addiction to multiple prescription drugs.
[00:03:23] We talk a little bit about untreated or under treated ADHD and the disparities in ADHD diagnoses and discuss how it's important to address the stigma and discrimination in addiction treatment to give people the best chances at recovery.
[00:03:43] Somebody get this guy some help.
[00:03:53] Tell me a little bit about low dose lithium in the addiction setting you've done that and you also have done some other holistic approaches as well as the use of low dose stimulants for ADHD can you talk about your work with that and what you found
[00:04:11] both of those were part of the larger treatment plan they were not singular lithium is not a panacea it is not a cure all it is an assistant I also recommended frequently vitamin B and D and C I didn't neglect when a patient needed suboxone when a patient needed hypertension treatment
[00:04:31] the three pillars that I walked in with and I told the leadership at CRW was guys hear me out if we treat causes of addiction simultaneously to the addiction itself we're going to have better results and this is how we do it holistically as well so we're doing both prevention and treatment and we're doing it evidence based and naturally and I said let's start with these three common causes one of the most common causes of addiction
[00:05:01] is pain physical pain or chronic medical illness simple example back pain it gets treated with opiates and then you're often running into a cycle of that but chronic medical illness that is under treated that leads to difficulty is a source of addiction
[00:05:20] the second is emotional pain that is trauma informed as we call it now so whether it's neglect trauma mistreatment abuse loss heartache right to my patients even that is frequently self-medicated
[00:05:36] we want to talk about that address that and finally it may be under treated ADHD because that can lead to economic pain as well as its own frustration we mentioned that the example of the difficulty of earning a living and rising today in America relative to the past people are up against a lot of wind but in this population at least in mine I see a lot of folks who don't have college degrees
[00:06:02] who sometimes don't have high school degrees who don't even have GEDs who have been incarcerated I've had trouble attaining and maintaining stable work environments and rising there so I tell them if you've had learning issues either young or maybe because of your substances have a lot of trouble remembering and executing on tasks
[00:06:24] I'm happy to help you while you're here and beyond in seeing if a small amount of stimulant will improve that this is not treating withdrawal this is treating something ideally that was recognized in present prior because these same individuals grew up in homes where their parents may have had addiction themselves may have had trauma themselves and displaced it may have had socio-economic issues
[00:06:49] and definitely were not as mindful about progressive practices back in the 80s and 90s about treating Johnny who's teacher said he has ADHD they just didn't trust him they said no so if some of my patients say yeah you know what I've had that diagnosis no one ever treated me I'm having trouble right now I say okay let me give you the ASRS scale right in front of me that's out of Harvard and Stanford
[00:07:14] you grade this you look at these 18 questions you tell me how many apply to you and where and now you know that I'm not just making diagnosis up because I am an adder all contract I want you to do well here and after so if this is present let's try it let's see what helps obviously if you're withdrawing from benzos we're going to taper that if you are dealing with opiate withdrawal we're going to minimize that by providing suboxone and then tapering slowly
[00:07:41] if there's psychotic effects we're going to pause on some of this stuff we're not going to give you stimulants and an anti-psychotic necessarily until there's a resolution and maybe not even then so we're just screening and treating responsibly when the screening is screaming okay now in that middle zone of emotional pain usually we'd give antidepressants
[00:08:04] and then more antidepressants and God knows what else right lemitol or depacote and I say look whatever you're taking is fine I will talk to you about dangers of too many eight
[00:08:14] typical in weight gain and we'll try to get you off that if you're willing and if it's unnecessary because most of the time that is what's going on people come in and flated from a great deal
[00:08:24] of potiopean oral lanzopean for some reason right and so I recommend this combination of vitamins minerals I take it myself you can try it take it
[00:08:33] to leave it and it includes low dose lithium not that lithium give them that presentation material to read is available you can look it up as low
[00:08:43] dose lithium I sometimes do it right with the patient fill them that they can buy this and I think they're comforted to know that we're looking at
[00:08:51] underlying causes we're offering podiatry dental help and yeah housing and vocational will come but what's the point of offering that if you're not going to maintain it
[00:09:02] so when we've done it this way number one it has not been abused we wanted to in New York state a lot of states who is providing scheduled two controls are you just going
[00:09:13] to take my adderol and then go take somewhere someone else's from a different doctor I can see that's happening it doesn't happen my patients over five years I have the data they did not do that
[00:09:26] and when that has happened we say we can't provide an early refill you know that it's literally happened a handful of times out of thousands of patients
[00:09:36] and when we do screen for it and sometimes 30 40% of the time that there's a learning disability we're able to see acceleration of achievement they get their GDs they go get their
[00:09:48] internships their certifications they earn money they stay there they elevate within that position they don't need to medicate themselves with dirty awful drugs that are worse than ever by the way
[00:10:00] it's the luck it even be alive with the amount of fentanyl and trink and God knows what that's contaminating this stuff but there's no way we can stop this at the border
[00:10:08] there's too much coming in you have to go to the demand side not the supply side I can walk by a crack deal or I'm not going to buy any because I don't want that
[00:10:17] the happier you make people with the low nose lithium with pride from work unless they will want to medicate themselves the less low they will be
[00:10:26] so that's how our system is very applicable everywhere else we have too much of the extremes again in the country about how we're treating addiction
[00:10:35] once I want to lock them up the old way that didn't work that's just a waste of money the other side wants to allow them to use drugs
[00:10:43] enable it not just allow it enable it make it easier incentivize it hell this is nonsense because they're not turning around and converting
[00:10:55] they don't offer you those statistics they tell you about lives saved with Narcan they don't tell you about lives changed they keep saving the same person over and over
[00:11:05] how ridiculous is that now I'm not saying let them die but I'm saying save them put him in a place and say this is how you will continue to do well
[00:11:14] but we're not going to give you a place to shoot up okay we are going to give you treatment for the thing that you want to shoot up with
[00:11:23] and that's free take this box on take this better method stop doing this to yourself
[00:11:29] yeah 80 HD is something that I think there is likely a genetic component and I think in the world that we live in with the
[00:11:38] amount of information we're exposed to with how often these things buzz and ring even if I'm not looking at it
[00:11:46] if I see the flash of light or here or feel the buzz my mind goes to trying to predict what is happening on my phone and who's trying
[00:11:55] to get a hold of me with that said I also think that low dose stimulants absolutely help productivity and with what you're saying
[00:12:06] you have a population that first off is already at a disadvantage because if they go to a provider and tell them that they think they have 80 HD
[00:12:18] they're immediately or a lot of the time going to be written off as drug seeking
[00:12:23] the other kind of fact in this conversation is people don't realize the racial disparity in stimulant prescriptions
[00:12:30] my co-residents and I working in Louisville notice that on one end of town
[00:12:36] ADHD was a legitimate diagnosis and low dose stimulants were an effective medication
[00:12:42] but on the other side of town that same hyperactivity that same impulsivity would probably more likely be diagnosis bipolar disorder
[00:12:50] absolutely right doctor but earlier than that they call it a bad kid
[00:12:55] absolutely I'm very interested in that prospect I tried it a couple of times during residency
[00:13:02] moonlighting at a outpatient addiction facility it's tough to say that I have any real anecdotal evidence on it
[00:13:09] I had a couple of patients that we were able to reduce the amount of methamphetamine they were using
[00:13:14] getting quantitative analyses on their urine samples every time
[00:13:19] and the reality of the methamphetamine situation in the United States is we don't have good treatment for it
[00:13:25] medication-wise
[00:13:27] and I know you're saying that you're not treating it as a withdrawal
[00:13:30] but also know the brain does not like these rapid shifts in homeostasis or in what you're doing
[00:13:38] I do think there is merit so I would really like the opportunity to use more low-dose stimulants
[00:13:45] and see for myself what the impact is in that addiction setting
[00:13:50] yeah so two things first drug seeking and then methamphetamine as an example
[00:13:56] drug seeking is a discriminatory term just like addict is a discriminatory term
[00:14:04] you call them that you are labeling people we have to be better than that
[00:14:08] in a world that is becoming more I like enlightened or awakened but it's called woke now
[00:14:14] right we have to use words but we also have to act bravely
[00:14:19] I think sometimes too much has been placed on the words and not the actions
[00:14:23] what I'd say is they're not drug seeking they're relief seeking this is the option they have
[00:14:28] this is what they're going to take we as doctors have a obligation to educate them
[00:14:34] and say these are the boundaries this is why I can't give you what you want
[00:14:39] but this is what I will do for you this is what is reasonable
[00:14:42] and of course I have push and pull battles of patients who may want more than the acceptable amount
[00:14:48] and yet I also am opening eyes to the patients who have never been treated
[00:14:52] like the African-American population
[00:14:54] who may have a great deal of mistrust towards institutional medicine
[00:14:58] but if you provide the screening or apparently and talk about this matter of faculty
[00:15:06] it becomes easier for them to do their own research to think about it
[00:15:10] to not hard sell it within a few minutes either then the results will speak for themselves
[00:15:15] in terms of methamphetamine you're right that brain is now being shocked
[00:15:19] it's a tummy gun of dopamine that they've been putting into themselves
[00:15:23] and that is again what's available and it was treating not just ADHD
[00:15:27] but crippling depression and trauma
[00:15:29] it was lifting them higher than cocaine
[00:15:31] and it may have been even safer than what cocaine has in it now
[00:15:35] I think 50% of all street drugs are fentanyl-laced according to some samples
[00:15:41] maybe it's higher, maybe it's lower, that's a hell of a gamble
[00:15:44] so the method that I would say with methamphetamine is first and second
[00:15:48] methamphetamine is first stabilized, first insured, no psychosis
[00:15:52] first get to a place of them applying the low dose lithium as well
[00:15:58] because that will protect them partially
[00:16:00] to further brain damage
[00:16:03] we're trying to reverse brain damage using that
[00:16:06] as well as other vitamins they may need more than 150 even
[00:16:10] and after a couple of weeks of that do we even consider improving
[00:16:15] the dopaminergic component either with well butron or strutera
[00:16:19] or maybe in a setting like a hospital very structured
[00:16:23] to give them 10 milligrams testos of adorol
[00:16:27] or methamphetamine in the morning
[00:16:29] and that's all
[00:16:30] and just live with that for now, 10 milligrams
[00:16:33] that would be the dose for a starting dose for a child
[00:16:38] so you're not likely going to cause psychosis with that
[00:16:40] but if you see anxiety, sleeplessness, agitation, fix or psychosis
[00:16:46] then you know that's it
[00:16:48] you're going to see that right away
[00:16:50] but if you don't you may actually be able to get them to a place maybe
[00:16:55] to be able to say okay I know how to use this instead of going
[00:17:00] 100 miles an hour with no control
[00:17:02] I will apply this appropriately in my life
[00:17:06] so that I don't have to dip into that extremely addictive and powerful drug
[00:17:12] Right, we're pushing closer and closer to 30,000 deaths a year
[00:17:17] from methamphetamine
[00:17:19] and about half of those are due to being cut with fentanyl
[00:17:24] and people getting substance that prevents them from realizing
[00:17:28] that they have to continue to breathe
[00:17:30] but the other half of it
[00:17:32] this is not the same methamphetamine that is created in the trailer park
[00:17:36] that has relatively low purity historically in the United States
[00:17:41] this is cartel methamphetamine
[00:17:44] that is produced in very nice laboratories
[00:17:48] and the potency of this stuff is approaching 100%
[00:17:53] depending on how much it may get stepped on
[00:17:56] by the time it goes from the border to Kentucky or to New York
[00:18:00] there's half of those deaths that are occurring because the methamphetamine is so strong
[00:18:05] that is leading to cardiovascular failings
[00:18:09] it is leading to strokes
[00:18:11] and if not death having permanent damage
[00:18:14] to their brains or to their bodies
[00:18:16] so the whole drug scene today
[00:18:19] it's a completely different environment than it was 10 years ago
[00:18:23] then it was 15 years ago
[00:18:25] we are in really the epicenter
[00:18:27] of where all of this started here in Kentucky and the region surrounding Appalachia
[00:18:32] you're clearly really well informed on that
[00:18:35] with that kind of statistic
[00:18:37] think about if you're a resident, think about if you're a doctor
[00:18:39] treating someone with methamphetamine addiction
[00:18:42] and if you fall prey to your own belief system
[00:18:45] discriminatorily and say no they're drug seeking
[00:18:48] I'm not going to give them a stimulant
[00:18:50] you are neglecting potentially life-saving care
[00:18:53] I don't know for what when the stats are that at high on usage
[00:18:58] leading to death
[00:19:00] if you can reduce that by giving them something that will not just prevent death
[00:19:03] but might actually enhance their
[00:19:05] sustainable, constructive life
[00:19:09] our treatment facility is ranked in the top 1%
[00:19:13] of all treatment facilities in New York state measured by a waycess
[00:19:17] it wasn't like that before I got here
[00:19:19] it was the usual
[00:19:20] I've been so high polypharmacy
[00:19:22] no treatment of those underlying conditions
[00:19:24] no notice let the run of the mill
[00:19:26] 50-50 almost
[00:19:28] and we got there by doing things that are bolder
[00:19:31] but also not cowboy
[00:19:34] this is not cowboy
[00:19:35] this is monitored
[00:19:37] this is screened
[00:19:39] and tested
[00:19:40] we don't have to be handcuffed
[00:19:42] by rules of the past
[00:19:44] and these dangerous beliefs
[00:19:46] really that prevent care
[00:19:48] right I would love to be able to use it a little bit more liberally
[00:19:52] but I also have to maintain my job
[00:19:54] because if I'm not there
[00:19:56] it is very unlikely that there's going to be any low-dose elithium used
[00:20:01] that's the struggle that I have
[00:20:03] both from a moral ethical standpoint
[00:20:05] but from a very realistic standpoint
[00:20:07] I've got to establish myself in this position
[00:20:10] before I feel comfortable being able to do that
[00:20:13] you show your work
[00:20:14] there's no issue
[00:20:15] this person was screened
[00:20:17] we are conservative on our dosing
[00:20:19] we're monitoring
[00:20:20] this is what this is based on
[00:20:22] the American Society of Diction Medicine talks about untreated ADHD
[00:20:26] as a common precursor for addiction
[00:20:29] so we're treating it
[00:20:31] that's all we're doing
[00:20:32] you can serve it
[00:20:33] don't worry about what he took
[00:20:34] worry about who he was prior to taking
[00:20:40] somebody get this guy some help
[00:20:45] thanks for listening
[00:20:49] for more social media content
[00:20:52] check us out on all social media platforms at Renegade Psych
[00:20:55] if you have any comments, questions, or challenges to the information we presented here
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[00:21:07] and if you feel passionate about our message
[00:21:09] and what we're trying to do and you'd like to donate
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[00:21:13] thank you
[00:21:14] this podcast is for informational purposes only
[00:21:16] the information provided in this podcast and related materials are meant only to educate
[00:21:19] this information is not intended as a substitute for professional medical advice
[00:21:22] while I am a medical doctor and many of my guests have extensive medical training and experience
[00:21:25] nothing stated in this podcast nor materials related to this podcast
[00:21:28] including recommended websites, texts, graphics, images, or any other materials
[00:21:31] should be treated as a substitute for professional medical or psychological advice, diagnosis, or treatment
[00:21:35] all listeners should consult with a medical professional
[00:21:37] licensed mental health provider or other healthcare provider
[00:21:40] if seeking medical advice, diagnosis, or treatment
[00:21:42] or put more simply
[00:21:43] you need help like this guy call your own doctor