12 Voices in 12 Hours - Hour 2 - Dr. Richard Blondell


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Twelve voices in twelve hours this is a special community discussion and hope feel like prevention on news radio 930 WP. Good morning WBN news time is 705. And our daylong conversation. On the calculate crisis is under way. This morning doctor Richard blonde Dallas joining us in studio he's with the university of buffalo a leader in the field of addiction medicine and let's start by getting your perspective on this where are we in this crisis or are we starting to get a handle on it. I think that crisis and has been getting worse it's not doing as bad as quickly. But I don't think we've turned the corner on this at all. You know we hear a lot of these numbers and in Erie county how deaths have decreased. Do you look at that as a a good indication of where we are or. Are there just so many more numbers to keep in mind when thinking about how many people are. Addicted to OP. It's well deaths due to OP ordered overdoses just one thing that you can look at. You also have to look at how many people overdosed. Received in our camp and didn't die. So there's still a lot of people who are overdose and they just don't shop is deaths because we're doing a little bit better job of pulling them back from the fire full. Is arcana offering. And a false security here or what do you see farrakhan's role in this. I don't think -- cam offers false security I don't think anybody goes out and intentionally overdoses. Knowing that there is in our camp right nearby to pull them back. You know that may that's the big concern. And maybe there's a case or two like that but is that a common situation. That's not policy. When. Did I guess that this. Auctioned may be goes back about five years or so when the started kind of really giving in the people's minds conscious that there is a problem. Here in western new York and really across the country. In those five years she mentioned that we thought made some progress that it's not getting as bad as as quickly and you say that any kind of I think maybe catches people off guard because they've been hearing some good things hearing. You know about a lot of these measures that have been put in place we just talked about. Prescribing practices with doctors how it's a little bit different. We're still getting bad though why do you think that it. Because there really haven't reversed the prescriptions we sort of halted the increase. But we we are still overprescribed. We still prescribed for times in my hope viewers that we did say fifteen years ago. You're it you're right we became really aware of the situation five years ago but it wasn't happening fifteen years before. So this has been going on since about 1990. So is just caught the public at publics attention recently. But it's been there for a long time and it's a long time common. Only since there's been. So many more overdose deaths particularly among. Among the children of people who have influence in our society. Have you come really aware of this but I'm here it's idea I practice in Kentucky. From 1985. To 2003. And I can tell you get began there. In the late 1980s. And it has spread across the country has grown worse nationwide. We have. Sort of limited the rise of them or prescriptions was fuels the separate. So they have leveled off. But there are no way near the levels of prescriptions they're rewriting. In the late 1980s. Still where we have to take this next and where we're doing move from here. We need we've been through this before we've been through an open it epidemic before it became the twentieth century. Ago. We know how to fix this epidemic. We know we need to do. This is heart do it. Hard to do you mentioned kind of a leveling off those pursuit but we're nowhere near where we war. And there's a lot of people who take these prescription medications to think. You know there's nothing else. They can work form what was working in the past before a you mentioned that this this perforation of OO PO. It's western practice forty years ago. This coming July. And in the late 1970s if I had written prescription for a month's worth of oak yours for any reason. I wouldn't cough and a pharmacist asked me you know what was I doing. And I remember distinctly I mean I I may be wrote 445. Prescription or viewers per year. And that it was usually for like three to five days for sprained ankle or broken bone. But I do remember 11 time I wrote for. A month's worth a 120 tablets over an open your boat load oh so you're for women who have and stage breast cancer had met us. As all of her body and yours and suffering and pension was near death. And I remember getting a half from the pharmacy question what I was doing. And I said well this this lady. From doesn't want to live she's in the end stages of brisket is OK we just need to write that I am a prescription. So that was the that was the level of suspicion we had back then now some sixteen or ghost of the Dennis. Get the wisdom tooth that is sixty tablets of lark no questions asked. No good can come from. So we need to get back. To where we were. Twenty years ago. Now at that time doctors were accused of under treating pain that we are being cool that we're withholding medication from people out of a fear that we might make people addicted. And we probably did under treat cancer pain people were dying. And we may be didn't treat post operative pain as aggressively as we sure but that's it. Nobody needs sixty Teva to market after recent into that right now nobody nobody. In studio with doctor richer blonde Dell. You were mentioning kind of this at the prescribing practices when it comes to open you Lloyds through routes. The last few decades how it's grown and right before we took a quick break there you mentioned going to the dentist and you know it's. One of those things that I acting kind of perks the ears of a lot of people who are of that age that was in two page there in high school. And then they start to get these prescriptions for pills that they soon realize our. May be in demand with some of their. Kids knew this. Before doctors did it seems how is that possible. You know you mentioned that. Adolescents do this before the doctors you know and do one thing that comes with our youthful mind and they have often great. Perception and they can see through things that others can't because. Often times are vicious not clouded by a lot of preconceptions. So they're very astute and and anybody who's had a teenager knows that if you try to pull over their eyes are pretty good like calling out. So there. They they sort of know what's going on I think the medical community sort of lives in this pollyannish type world that you know everything was going to be five and we kept Thomas ups and everything was fine. Only when it became really obvious. The missile awake after the fact that things work fine. But they don't do you see though that today it seems like. Dennis especially are not prescribing. That much of an appealing for wisdom teeth to come out some and some doctors won't write any. They've decided not to do this at all anymore have we swung may be too far the other side. Actually that. There are some physicians are Dennis maybe swung too far and have overreacted to this. And have not just limited their prescriptions to appropriate levels. But we are still way over prescribed way over prescribing I mean Americans consume ninety to 95% of the hyper color on a planet. We just don't have ninety to 95% of the pain out there we just don't. I was given a talk wants and a man came up there and I was. Telling about my concern with people who became addicted so he came up to me at the end of the talk and ask you a little cyst on his neck little tiny thing. He was concerned about being addicted you want to know what OP he can take. Following the surgery that was less addictive. And I told me don't need anything. Any civil what if it hurts and I said it will just it's gonna hurt a little bit you know you just have to tough this out. Forty years ago I went and practiced a lot of my patience with the World War II generation. They were tough cookies. And they could tolerate a lot of pain and in fact they were refused narcotics because what they thought it was a sign of weakness. And to put them on morphine was like in their mind. I'm gonna die so they wanted to stay off morphine as long as possible. Because they thought that was thrown in the towel and they didn't want this stuff. Now. One of the things it's fueling this epidemic is patient demand. And there's this perception out there that that we're gonna live an entirely pain free world than that we're going to be in this. Perpetual state of euphoria and everything's going to be fine feel good so it's not like. I'd imagine it's easy to kind of then. Slipping to from that World War II outpatient mentality like he spoke of two. Hey you know we can make this easier on you you know a lot of people are gonna say noted that but coming the opposite way now. Is where you're gonna see some friction. What do you wanna look at risk benefits now or what is the benefit of really snowing people with payments after wisdom tooth vs what's the risk. We know that if someone under the age of seventeen. It's one pursuit of just one prescription for an open even if it's a limited amount by politics one prescription. After the age of 23 either 33%. Increased chance of developing an addiction. So you have to look at what are what's the benefit. To that adolescent from five days of focused a little ankle sprain vs what's the risk. I was a parent and I had a sixteen Euro and I understood that risk and there's a little ankle spread I'd say it like it. Here's some ice which her ankle up here's some aspirin toughen up. Because I don't think it's worth the risk. Now if somebody had major surgery or bring broken broken bone you know that's another story but we're we're treating. Minor pain now with very potent drugs and it's totally inappropriate. Doctor until you saying that if you have opiates for wisdom teeth when your teenager. At that we'll still impact you if you're thirty years old absolutely. We notice. In fact we do little study BC MC and we went out there to the detox unit from people. In middle age and we asked them how did your addiction start. About 40% of them started they started their addiction started with their very own prescription for payments that was given for a legitimate purpose. Half of them for wisdom tooth. So 20% of the people at EC champs of the detection and it started there addiction with a prescription for wisdom to. So the question is is that worth the risk now when I was an intern and it was into problem. And I didn't have much money says that the VA hospital I'm on my dentist friends is willing to pull up for. So I mean hostile rounds my lunch hour when they're got to isn't T that got some Gaza amount Rebecca hostile finish threats that day. You know they heard a little bit but it wasn't that bad I didn't need to go home for a week and get snow and lord. So here's here's the things is driving this epidemic. Number one. We have these potent drugs are promoted by the pharmaceutical companies. Number two we have doctors who now been taught like prescribed this stuff because it's a goat go ahead and we've got a number three patient demand. We got a number for. The insurance companies pay for all that stuff. I'm so in some ways the insurance company Dallas has subsidizes epidemic and number five the pharmacies that really. Not had the same level of surveillance. Arise prescriptions as they did say forty years. So they've backed up and boast five things have really all come together to contribute to making this epidemic. Now how to fix this epidemic we have to wait reversal. Twelve voices in twelve hours continues on WB yen and are in studio guest this hour doctor Richard blind down and we've been talking about some of the things especially prescribing. Practices so over the last of couple of decades that is. It resulted in where we are. Right now and see the old things you've been talking about says sprained ankles with some teeth coming outs you know being prescribed these opiate. Pain medication something that. I think a lot of people can relate to its normal every day practices that results in. An addiction that can lead to something like heroin. Problem. I think people though still have the perception when they hear about heroin or hear about being addicted to OP Lloyds. Of street drugs of crack cocaine now from the eighties of those things like that without realizing. Exactly. Who this epidemic is impacting. And it's happening all over and happening in streets where you might not recognize that there's drug problems going. Well that's right I mean this epidemic overall appearance like the crack cocaine epidemic. Really is fueled by the legitimate. Prescription industry rather than illegitimate prescriptions industry so this epidemic started with legitimate prescribed. Medications. I think the doctors have good intentions and the thought was that we are we treating pain. And we need to do a better job. We were told these medications for safe and non addictive. Turned out that that was not the case. So we've learned the hard way as I mentioned we've been through this before we went through a epidemic of prescription oh yards in early twentieth century. When non these were widely available you can get heroin without a prescription just about about your corner drugstore. And doctors. Had hypodermic needles and we're injecting people so there was another epidemic similar to this would be in the twentieth century. We sort of have forgotten the lessons that we learned and we repeated the same mistakes in the last part of the twentieth century and fortunately. And without paying the consequences. But having said that because we've been through this before and we sort of know how to fix epidemics. We we have the knowledge and the tools. To do damage control. To sort of try to repair the damage of the people who are addicted now. But the other big thing that we really need to do is prevention. And it is much much much easier to prevent somebody from being addicted in the first place. That is to try to treat them in reverse the course once or addicted. So when we dealt with any kind of epidemic whether it's polio or infectious diseases or whatever. The answer has always been prevention. Treatment. Is sort of like when prevention has failed so we need to have treatment to pick up the the pieces of the mess we made. But what we're really really need to do is hammered silence strategy of prevention so that we don't. Continue to prescribe people into addiction. So we need to go back to little bit about how medicine is practiced them in the 1980s when the use of prescription opiate medications. Was very judicious. And pharmacists and patients and doctors were well aware of what the risk word from these highly potent addictive medications. And we treated them with respect and we use and carefully. In much the same way that fire racecar cooks your food in these houses but we don't wanna sell her house and firing. So we have safety measures in place. To use fire safely. And appropriately for so you do something good things we want to do and I do some of the bad things like burn answer from house so. Analogous to this as our use of opus we need to be Smart. We need to understand how potent. And we need to. First couple laps. Twelve voices in twelve hours this is a special community discussion and open your age prevention on news radio 930 W. Beaten at all voices in twelve hours continues on deputy Ian with doctor Richard line Dell joining us live in studio talking. About a lot of things send including. Prevention which is I know is one of the things she wanted to touchdown when talking about how to reverse this trend we've been in for decades. It's not so much about treatment but prevention in your eyes. I think that's right. Once somebody has developed an addiction are treatments are imperfect and not often successful. So even in the best of hands. Maybe Torre 30% of people who haven't developed an addiction can get into long term recovery. So this is a chronic disease. There is no cure once you've got it. You've got it does note here there are treatments and there are things that can keep it that day. But once you you know world born with a cucumber. And once you make your brain pickled it can't go back to me if you can protect. So ultimately. The way to address this epidemic is through prevention. The analogy that I use is a river. And in that in the river there are children drowning. And you are walking by you jump in the river and you try to rescue these kids. And pull them to shore but they're just too many of them and you can't. Save them now unfortunately. Another person comes by and yelled the other person c'mon and how we save of these children are drowning. And the other person says no you keep doing that I'm Margot upstream. And find out whether phone in the river in the first place. And that's what we need to do this opiate epidemic is to look upstream and find out how are people getting addicted to in the first place and preventing that from happening. So I talked about the five things that contributed to the epidemic. So we need to do at least five things to undo it. Number one. We need to rein in the pharmaceutical companies who are heavily promoting these drugs. As being safe and effective. And perhaps we need them. Asked them or require them to pay up to sort of fix some of mass that they've helped to make its. You know Purdue made billion dollar day. Pushing tax accountant and that enrich the company's executives the settlers to a large degree and maybe they should. Give back some of that money and help fix the mavs. Number two pharmacies. Are in a position to be able to flag patients as to who is becoming addicted and who's over prescribing and so forth and so. Perhaps they could be a little more proactive and others one pharmacy here that will not fill a prescription for more than seven days. I'm new prescription. Patients need to be educated that you know. It is not possible for the medical community due relieve all paying for all people all the time and a little some pain is going to be expected. Following surgery wisdom teeth. Whatever. Doctors certainly need to prescribe. More wisely. And missed the Center for Disease Control has come out with guidelines for wise prescribing. Doctors need to be educated. About what those guidelines. And required files. Then finally health insurance companies process all the data. They know who the patients are they know who's buying the drugs they know which pharmacies overs over stocking them. They have those kind of data. And they could be powerful using that those data that they have they can be a powerful force in helping to readers. Prevent reduce this epidemic. So those are some of those and abroad to win those are some of the things that we need to do but we are not going to be able to treat our way out of this epidemic. We're not going to be able to arrest our way out of this epidemic. And we're not going to be able to. Successfully treats. The people who were inadvertently prescribed into addiction so we really need to prevent them from becoming depicted in the first. Twelve voices in twelve hours continues doctor Richard line down is joining us live in studio you know. OP Lloyds may be not son. Seriously did you mean we're not document harrowing yet but. Just. Mobile Lloyd whether it's a prescription or maybe something that's just kind of floating around a group befriend something kids are going to have to. Deal with probably at one point or another. In their lives a growing up when they reaches a certain way it's gonna guess there's maybe not a lot of thirteen year old is listening to us right now but their parents are. What are some of the things they can do. To help their kids. Parents to play and very important role in helping to immunize feature their children. Egg against falling prey to these drugs. The first thing that I think parents can do is look at their own family. If there's a family history of alcoholism or drug addiction. And it runs in the family particularly if one of the child's parents had an alcohol or drug problem one time. That child is at a particular increased risk. So there are some things they can do is one just educate your child about the family history and say you know uncle Freddie. Had an alcohol problem an aunt Tillie. Had a pill problem in your father you know pillow drinking problem when he was younger and he got that taken care so therefore you. My child are at increased risk just by your genetics so you can't necessarily do what all of your peers do. Because they may not have that genetic risk the way explain it is if there's a blond hair and blue eyed fair skinned girl. And she's gonna go on spring break when the offer. Cecilia and origin friends or African American friends and are gonna go to Florida together and hang on the beach. The blond hair blue eyed girl NiSource onscreen because she's not going to be able that take the same sun that the other kids are. So and an analogy to that is somebody has that family history of drug or alcohol problems is like a blonde hair blue haired kid. And the expert rather than sun exposure is exposure to drugs or alcohol it's not gonna have the same effects we need to tell your child about the increased risk. Here's what we now. And we also need to know to have them delay the onset of using these drugs so we know for example. That if a child has their first drink eight drink before the age of fourteen as an adult they got a 5050 chance of becoming an alcohol. If that person waste of 21 to have their their first drink the risk of alcoholism is five to 10% we notice so. There's a couple of things that are delaying the answer we also mentioned that even just one prescription for an open it increased the risk. A subsequent addiction by 33% as an adult. So when your child. Is given a prescription for an open right you have to really ask is this worth it is the pain really that bad. The other thing is is that if you do have medications on the house and your child is over prescribe sources say they get thirty or sixty pills or wisdom tooth and that. It takes to. You gotta get rid of the rest of them is taking the pharmacy. And give back thing or drug day or. I put a little Clorox in the bottle. Dissolve the pills. Double back. Throwing out the trash really some people say flushed out hooked at that all these pharmaceuticals and up and water supplies that's really matter but I think either. So those are some of some of the things can do it as an individual. Now if you have a family history. However driver driver problems you have to be very careful about it the doctor gadget or the dentist gives you these prescriptions and recognize that you have this risk. So they only take him if you really really need them and then get rid of surplus. And tell somebody else about that because sometimes what happens is is that. Some of the gets these pills and I think I'll just save them for a rainy day and I might be sprained my ankle again and I'll just keep them in the medicine cabinet. And then sometimes you just have a bad day. And in that taking one and that's how it starts. And one. Can start. And one concern twelve voices in twelve hours continuing you know we've talked about a lot of things some them want it kind of cycle back to something. We talked about the very beginning giving a lot of comments here. About addiction about old Buick medications. The way they are prescribed and some push back on some things you said earlier that. This is what works that if you're in real pain. You need this medication. What is your response to the people who push back and say this is the medication nine. Well that's true for people have severe acute pain. There's nothing that works better than open doors for keeping short term so postoperative pain for example broken bones they were very well. As long as people take them as long as campaign and they'll continue to take them once pain goes away which is the problem so about. 10% of the people. Most of the people in the pain goes away this uptake of the pills. About 10% of the people pain goes away this'll take the pills so that's that's the issue now for chronic pain. OBI is not so good. So they have summerall and their treatment of chronic pain but they're not the deal and so there are other things that we need to do is treat chronic pains of not just to rely open eyes. For all for people with chronic pain so I talked about acute pain maybe five to 10% of the people that would trigger an addiction. For chronic pain we know that long term usable for dealers over I'm 24 weeks. May trigger addiction Summers in 25 to 50% of people. Which means that about half the people can take popular so long haul and you OK with that and so you may get push back from people. Well I'm on these medicines I had on any bad effects are good for me that's fine. But just because it works that way and one person. Doesn't mean it's gonna work that way at everybody and I'm here to tell you in my practice I see a lot of patience. Who were prescribed opiates. And development problem not right away. So easily these people are taking opiates from like 33. To five years before the wheels come off and on this problem. And so wants some he's been on open yours for chronic pain for three to four years and they become addicted I can tell you that is one difficult. I outpatient treatment problem and and reversing that this is not easy at all so. Just because of one or two people say it works for me that does not necessarily mean that applies every person on the planet so. Every patient is different and what's different about them is or genetics we know for example that there's a gene. That changes how people could receptive works to make the drug buying more tightly to that that reset those people at risk for an addiction. We also know that there are families that don't make enough of their own natural painkillers endorphins. And those people are at risk for addiction. So in the future what we've got more of the stuff figured out with the jeans are where they are what they do we may be actually do a blood test. And give somebody a the odds of developing addiction wouldn't that be great before people start pain management to know what the odds are addiction. When a baby's born and where they maybe they can take this blood tests and they would now they take a little sample them. Blood from the umbilical cord run this up and tell parents your child's at risk for this this this disease now. We have the ability summit now and we do some of that genetic testing for likely PKU. Sickle cell disease. So we're gonna go and these ethical issues is how much were gonna do that what people are gonna do with the information on and on information. So we know that for instance Huntington's Korea than the disease that killed Woody Guthrie. We go that we can tell who's gonna develop this disease so. Does he ever seventeen year old wanna know that they're gonna have this disease in that. So these are some of the other. Social things that we have a kind of work through but the science will get us there and we have to be prepared to stone you know how we gonna handle this and racial we're gonna do it.