Episode 36

hello everyone finding peaks 2022. first for 2022. yeah i was counting down episodes in the past we’re counting up because we reached like 36. geez in 2021 and now we’re at one so it’s easy to start the county you guys are all welcome anybody who’s been following us in 2021 knows what i’m talking about absolutely and you guys have experienced what i’m talking about in real time for those who are joining us for the first time in 2022 jason friesma chief clinical officer clint nicholson chief operating officer and yours truly brandon burns chief executive officer of ossifer here we go 2022 rocky start yes in any case so we don’t lose the audience yeah diving into this episode for this year the thing that i wanted to discuss today was the opioid epidemic that’s taking place at the same time as this historical pandemic over the past two years uh of course covet 19 has taken 826 000 lives or something of that nature super tragic and unfortunate um happening alongside of that another 186 000 lives to the opioid epidemic which i think represents about what 23 24 of the covet 19 does so we’re talking about significant losses by comparison and you know given the pandemic i haven’t seen a lot about it as an epidemic taking place in the background and just wanted to remind you know viewers out there certainly family systems who are struggling with opioid addiction fentanyl heroin whatever the doctor prescribed at the end of the day whatever the drugs are called on the streets and so forth um just kind of talk about it out loud and then just reinforce with you know the general viewers as well too uh kind of how tragic this story is and what we’re witnessing and certainly we experience you know at uh peaks uh individuals coming into treatment struggling with you know opioid use disorder um as well as the consequences of it uh prior to or even after treatment in that regard so um in sort of kicking this off um you know clinically what have we seen around this as an issue and


kind of what’s our what’s our best foot forward and kind of as a as a small treatment facility with 36 beds you know to operate here in supporting such a large uh issue that’s taking place all around us


yeah so as you were kind of doing that intro brandon i i do think about how um when we conceptualize sometimes we talk about it clinically that the opposite of addiction is connection and so when we’ve been walking through this pandemic and particularly at the beginning of the pandemic when everyone was at home and isolated um it created a great deal of disconnection and we saw a huge spike i think not just in overdoses but certainly in suicide as well um and then what goes along with that is i do think increased access particularly to fentanyl um people i i’ve been talking to some of the young people that have come through peaks and just the ability to order fentanyl uh even through the dark web and have it delivered literally to your home press pills or whatever um has become commonplace that’s kind of a new thing and and the other thing i was thinking about when we were talking before the show as well is that there used to be a great deal of fear i think among among addicts about getting drugs laced with fentanyl and all that and now it’s literally a drug of choice i’ve i definitely have seen fentanyl becoming people’s drug drug of choice in a way that i hadn’t seen prior in my career and then obviously phenol so potent and and i’m positive the increase in fentanyl is leading to at least partially the increase in opioid overdoses how about you clinton life so i started the when the pandemic started i was still working in medication assisted treatment specifically for opioid addiction and so i i got to see a kind of an interesting transition time um as that as the pandemic hit as kovit hit access to opiates actually really became difficult so a lot of people entered treatment at that time a lot of people would start things like suboxone or methadone and it there seemed to actually be at least initially a moment of um relief right and because it seems like the like the opioid epidemic had kind of actually started to plateau and like the pandemic was gonna maybe even accelerate that a little bit um however as access to heroin went down is really what happened um the access to fentanyl increased and like jason was talking about fentanyl is nothing if not unpredictable you never know what you’re going to get you never actually know their potency it’s a relatively new drug on the streets so there i think there’s a lot of people still trying to figure out exactly what


like how to use it which uh makes may sound weird to the viewers but i mean there is this sort of like trial and error period unfortunately to air with fentanyl is to die i mean that’s just you’re gonna overdose so um it’s been a very uh i think we’re in a really scary time when it comes to opiates especially as jason was mentioning again that fentanyl becomes a drug of choice like that is just it’s dumbfounding to a certain degree that that would be your actual go-to when before like uh it is there was so much fear around it and to a certain degree fear can be really healthy in the sense that it keeps you alive um but as that fear starts to dissipate the risk of increased um opiate deaths and overdoses is is going to really start to um to escalate yeah yeah and and just to um kind of bring the viewers close to sort of the um oh god what what’s the word i’m thinking of here jason read my mind i’m working on it um close to the start the uh sophistication of the delivery of these drugs it’s not the word i’m looking for but it’s the next best word just just you stop nodding but the sophistication of it when i think about there’s a gentleman in treatment during the pandemic kind of when we’re allowing letters and things to come into our treatment center and the gentleman that i have in mind got a card and it was addressed to him uh kind of from mom or it was from his grandmother in that regard it looked really benign and so our policies at that time was to open up these letters in front of our clinical team members and those sort of things read them out loud just to make sure there was nothing you know traumatizing or shameful or anything and that and we could process it in real time you know when he gets the letter and oh it’s from grandma opens it up and reads it back to the clinician and it sounds like just a small simple love you hope you’re doing well and then inside it there’s a really small packet of uh fentanyl uh in that regard and um and in that way you know grandma to be clear from the dark web but so the letter coming in just looks like this you know sort of benign instance from grandma and it has drugs in it and of course that’s a learning lesson for us at peaks you know at the end of the day to change our entire protocols about how letters come in at the end of the day but that’s kind of how clever it is at the end of the day um and how it’s operating all around us and so just be mindful of those sort of features within your own housing environment and so forth about how these drugs can be coming in because it could be very sort of elusive in that way absolutely um and so you know so we have this major problem of course fennel the epidemic taking place what is it in your guys’s experience at least in you know speaking with patients who are right in front of us each and every day that’s so alluring about this drug in particular by comparison to say you know maybe alcohol or whatever other drugs that are out there for these individuals what is the thing that’s like once they have ingested it we’re off to the races it feels like yeah i i mean i actually think that um opiates do two things they um help to kill uh physical pain but they also help to kill emotional pain right so there is a sort of dissociation that you achieve or a sort of distraction or numbing of emotional escalation that i think becomes the allure i don’t think that it’s a lifestyle thing anymore i don’t think that there’s a culture around it like there used to be i don’t think that there’s some sort of heroin chic sort of mentality that use that was really prevalent in the 90s and early 2000s i think that we are in a place of just escapism and the allure becomes a way to control your emotional environment when the actual external environment is so chaotic and unpredictable and that’s to me in my experience and speaking with clients that’s the actual hook right there is this ability to control your emotional space and to feel um or to numb out those feelings that you just that make you feel out of control kind of like a blanket of safety absolutely absolutely when it’s so immediate and it’s so complete yeah right it isn’t like somebody having a beer after a long week of work and feeling a little bit of a relaxation this is like complete absolutely dissociation from all of that um and i think that gives it a huge amount of power and i the other disturbing thing i’ve heard people talk about with this as well is um you know the the drug narcan which um can kind of interrupt an overdose um that that does give people like you know thankfully our society gives that drug away uh pretty freely um but it does create this whole other situation too where people then feel really free to push their boundaries as well with the drugs and and really almost i’ve i’ve even had a couple clients talk about intentionally overdosing to be saved by the narcan like the movie flatliners from back when i was a kid yeah and um and so there is this whole like it’s


it’s a new frontier i would say for sure um and i i think you said it pretty well clinton like you know i’ve been doing this since uh heroin was chic in the early 2000s um and actually it was like this opium den and we’re getting back to the 60s and it’s going to be so great and um and really this isn’t that this is people at home alone uh or on a street alone um and it is not a party and it is not a social event it is uh something that people do primarily alone or if they do it in groups it’s just for them to try to have some semblance of safety around it if you will but that’s what i’ve observed yeah yeah it becomes it’s emotional control and i think to some degree all substance use is i think that there is an element to that but particularly with opiates and in the past there’s been a certain level of predictability because not only like jason said is it is it sort of a complete emotional takeover but it was a predictable emotional takeover and now that predictability factor is starting to go away because you just don’t know what you’re going to get if you’re getting it off the street even if you’re getting it off the dark web you don’t know i mean now the big thing is pressed pills right that are made to look like oxycontin that are made to look like percocet that are made to look uh like you know like a hydrocodone that you would get from the dentist you know um but it’s but they’re just made to look that way and what you never actually know what is going to be inside of that so every single time you put something in your body you’re really i mean it’s this like russian roulette moment all of a sudden and um i don’t know being in the industry it’s it’s just it’s extremely frightening to think that there’s so much risk out there right now um and again it doesn’t seem like the the level of risk the level of risk is outpacing our response to it and our ability to respond to it effectively yeah yeah i mean it you know there’s no doubt that you know anybody who’s coming into a treatment center certainly is suffering in their own ways um other drugs give a little bit more space and cushion though right if a relapse takes place on the other side of programming and whatever that looks like you know if it’s alcohol um you know certainly there’s a variety of patient demographic who it could be immediately detrimental for but for mo for the most part most people can have a few stumbles on the other side of it and you know for individuals who leave you know treatment with us like i do have and maybe it’s a sense among all of us but just more fear about those individuals even if they’re on medication-assisted treatment or whatever the protocols are that they’re leaving treatment with because you just don’t know what that next thing is going to be and then it’s you know i think about the you know narcan and the use of it you know in people actively exploring what those limits are and then having that sort of buffer right there if somebody has an archon next to it that exploration is scary and there’s also this preventative measure as well too and you know for the audience i think i just wanted to review kind of like what that feeling was and i think the emotional aspect of it and the blanket that we feel because when you watch it take place and i have um opioid addiction and you know my family and history around being in front of it and seeing people you know use needles and so forth but i think a lot of people on the outside look at an individual who does this and you know they maybe are shooting it maybe they you know snort it however they’re ingesting it but there’s this sort of immediate um kind of just like nodding off and then falling over and you know my experience of people who don’t understand it or close to it are like why would anybody live like that look look at what they look like you know it’s very tragic to look at somebody who is going through that as an experience but wildly at the same time right they’re experiencing this emotional safety and this warming blanket all around this very euphoric event so what looks really sad and tragic to us is oddly quite comforting to the individual from their own internal suffering which makes it a just a wild sort of experience to be on the other side of it at the same time and certainly sad and so uh you know just kind of a follow-up into that is you know we talked a little bit about it before we you know launched into this episode but are we experiencing from the patient demographic that we see different from you know maybe meth and alcohol and pot or whatever the case might be a certain sort of vulnerable a vulnerability of the individual that we can maybe highlight from who might be more susceptible to it and i know that’s probably a big ask is a question you know by comparison to you know the diversity of the patient demographic who comes through who experiences these issues with fentanyl and opioids and so forth but um you know is there anything that we can maybe look out for to think that you know maybe i’m more susceptible versus somebody else or is it something much different than that hmm i mean god if i if i had a really good answer to that question i mean we would be in a totally different place if we could actually be able to sort of have those predictions i mean emotional vulnerability yeah for sure i think that puts anybody anybody who’s in an emotionally vulnerable state is at risk for substance use in general for opiate specific i i mean we’re all over the place now you know i think that um you know part of opiates again in general it’s not just the sort of psychological addiction there’s a physiological component as well it’s there there’s so many contradictions in opioid treatment uh like when you when you’re out when you first get out of treatment is when you’re actually at your most vulnerable for overdose you know you wouldn’t think that but because your tolerance is decreased and you still have you have low coping skills and ability to manage triggers you know that moment in between uh those those first 90 days are just so it’s such a high risk moment which is why at peaks we really really push medication assisted treatment because it’s something right it’s a one blanket to help people it’s it’s not a blanket rather it’s a tool for people to help manage those triggers it’s another coping skill there is actually a physiological medication sort of protection that’s there but generally speaking it’s i i wish that i could say yes this type of person is the one that’s at high risk so make sure that you watch out for that but it’s just not a real thing i i at least not in my experience i don’t i don’t know what it is yeah i don’t i don’t know how predictive it can be but i do think at the same time i think it’s a great question because uh i’ve absolutely worked with people that you know they’re they’ve never done a drug in their life they’re my age and they blow their knee out and have surgery and start to take opiates and it it has such a great dissociative effect that they get hooked on it at an older age but i certainly you know the younger demographic would be who we would see the most uh with an opiate addiction but but i’ve absolutely seen people where it’s almost like a hand slipping into a glove when they have an opiate for the first time and they all they want is more even if like they have a perfectly functional happy life but i’ve watched people ruin their lives kind of later in life too post-surgery or with some irresponsible prescribing at times too but but if we could say like oh well anybody post-surgery is it risk it’s it’s not yeah which isn’t i mean the majority of people aren’t yeah like the majority we’ve all had surgeries and yeah i’ve been prescribed medication for the pain and we’re fine you know like you come out on the other side without any with nothing to worry about nonetheless in fact a lot of people are really resistant to it they’re like ah i get sick i get nauseous yada yada so i think that you know addiction in general is this sort of like biopsychosocial uh hodgepodge of factors right i think that it there’s so many different variables that go into it and um opiates are no different i just i do think that opiates have an element another element of risk involved though because of the um the physiological addiction addictive qualities i mean their withdrawals are so painful and so extreme and happen very quickly you know so the physiological dependence often times outpaces the actual psychological addiction so you you can kind of get caught and before you even realize it your body is already telling you that you need more before your mind is is actually asking for it or wanting it so that to me that’s that does lend to an increased risk yeah well speaking of the the vulnerable populations maybe we can you know sprinkle a little flavor of vulnerability on it or who’s more likely to succeed post-treatment or interventions of matte medication-assisted treatment if you’re for the viewers out there you can look up the the united studies the national institute on drug abuse i think they have great uh end values as far as the participants in the studies and the outcomes that they’re following but it there seems to be this median age of about 33 years old and you know we talk about the gentleman who you know busts his knee doing whatever you know ends up in the hospital gets you know loads of opioids gets addicted in the process uh those individuals are seemingly um like wildly successful 65 percent or higher for the united studies on matte regiments and you know they live a life free of opioids beyond that uh in that regard but the age below 33 i mean it’s like a cliff it just drops you can look at the the charts it just literally falls right off it’s almost like they’re not even showing up to the studies you know one day into it two days into it and so forth and you know my reading of that is like we have this event that causes the individual to actually be on the opioid and then we have this other event i don’t feel emotionally safe i’m you know just emotionally not well and don’t feel safe in this world and so i take it for the first time to maybe quell this different type of pain or i’m doing it because my buddy told me to do it i’m getting high uh in that regard for the first time and so maybe anywhere in there for you know you guys where you see that difference between the young adult and the older adult as far as medication assisted treatment post treatment as far as success goes or are we still seeing sort of a just a hodgepodge now with the fentanyl because it’s so much different than heroin and all the other you know opioids that have come before him no i think those studies are actually pretty reflective of what happens i think the older you are one the more coping skills you’ve developed throughout time the more stable uh the more stable the sort of like psychosocial factors that we mentioned earlier actually have become you have more access to family friends and are just again i think a more able to engage in the world um even when there are even when facing difficulties i think when you’re young if the younger you start the less coping skills you have the less resources you have access to the less experience you have navigating when life falls apart because as adults we all know that life just constantly is falling apart and the older you are the more time you’ve had to recover from that you have that experience of being able to recover i think that the the medication like suboxone or methadone i think that those are just going to they increase the ability for opiates to not be the factor that brings you down uh or it it makes it less likely for opiates to be that that crumbling moment in your life um however when you’re young and you’re emotionally vulnerable and you’ve already gone through this experience and you have loc you don’t have the coping skills to navigate these sort of difficulties um the chances of going back to that old coping skill which would be opiates whether it’s heroin or fentanyl or other prescription medications i think is just that much higher i mean that would be my experience i don’t have much to add to that i think you yeah really well so and and going out here as well too i think that you know one of the major challenges of opioids in general was that this industry through its abstinence-based model really naturally stigmatized the process for individuals to really create that space like when i think about suboxone for example right you know if you get a you know the the a case of like well i want to use today you know even if you stop taking suboxone right you really have this preventative 24 36 hour maybe 48 hour window um where you know the whether you’re you know intravenous user intramuscular you know whatever the ingestion method looks like in that regard we really have this protective moment uh in place you know vivitrol as well too as another drug that creates these really long time flights uh sublicate injections as well too that reduce those when we’re triggered those moments to immediately sort of use and it seems wild that we stigmatize that for so long as an industry you know through that abstinence-based lens and i think that also led to some shaming events for those individuals experiencing something wildly different than somebody maybe you know right or wrong on meth or whatever the other drugs might be in that regard so you know really just wanted to advocate um for these drugs and these methods moving forward because the notion here sometimes is like oh they just want to keep being high and i think that’s just language that we just got to do away with because i would even if somebody is seeking it for that reason it’s seemingly better than seeking fentanyl to be high and also gives us an opportunity to continue to save lives one day at a time in that regard and you know if your loved one is out there struggling with you know opioid addiction or fentanyl or otherwise and they’re proximate to you um you know reach out to your local you know authorities as resources so that you can locate narcan and have that in the cupboard because it is literally life-saving and within seconds can change and overdose into somebody breathing again and getting their functioning back and all that sort of stuff so really just want to advocate for having that in the cabinet if you’re close to somebody who you know has that particular addiction um or is vulnerable to it in that regard and um you know with that said any kind of last thoughts around that for you guys or


i mean it’s hard not to be a little scary and alarmist about it i do think there’s a lot of good solution out there but i i know kind of to wrap it all the way around how we started the episode like when people come in with a fentanyl addiction um it certainly captures my attention because it is literally about saving a life because to your point um it could be any moment that that person uh doesn’t make it and that is the case with a lot of drugs but it’s urgently that case uh with fentanyl i i don’t know why i feel like saying that warning yeah i guess yeah i i think that there should be a sense of urgency yeah you know in fact i think that we lost a little bit of the the momentum because of kovid and the pandemic and what we’ve actually seen is those two things have just continued to elevate and escalate together we have to stay vigilant and like you said brandon we have to change narratives around what it means to get treatment and the types of treatment that are available medication assisted treatment is the gold standard for opioid treatment and that’s based on data and science and research and decades of study so as an industry we have to be more open and we have to and as a society i think that we have to again continually work on eliminating that stigma around what it means uh what opiate treatment is and in particularly medication-assisted treatment because because this is um yeah you just don’t get many chances you know like if you it takes one one time yeah and you’re gone absolutely and you know just kind of carrying out here as well too for the you know i i think alarmism is appropriate here it’s um it’s a tragic drug that can end the life quite immediately and we don’t have our uh peaks tags on us right now but i think the sec if if somebody is not breathing or um you know whatever the medical condition looks like um or uh we think that you know they’re moving in that direction and pass here at peaks recovery the i think it’s like the second bullet point of other than are they breathing the next thing is to put narcan or distribute narcan in that moment now even if they’re not on opioids like we’re just going to check that box super quick because we only have seconds you know if not you know barely minutes yeah you know in that regard to revive them so even for us anybody who you know sort of has um that symptomology is looking like they’re passing away passing out or whatever the case might be almost the first thing we administer is narcan check that box first and then move on to the next protocols i mean that’s how um that’s how much it’s alarming us each and every day at you know peaks to pay attention to in that regard so um so with that uh we thank you all so much for taking a little bit more time than we normally take up with our viewers but this is a big topic um and it’s kind of at least in my experience gone this is sort of the way side um with the pandemic you know kind of um you know being right in front of us in the media but this epidemic is real uh it’s big it’s scary and it’s taking a lot of lives uh along the way in that regard so hopefully this has been informational um giving you guys tools and resources to support it in your lives and certainly reach out for help if you know somebody who’s struggling with it um because it is a uh it is a tragic drug that’s taking lives uh every single day here uh in america so uh with that uh it’s hard to go out with a little more energy because talking about opioids is uh a challenge so in that regard for all those first viewers of 2022 um questions thoughts ideas future topics you’d like us to discuss here you can reach out to us at finding peaks at peaksrecovery.com certainly look for us on the social medias uh the twitters the facebooks the instagrams uh i’m always forgetting the tick tocks what the kids are using these days uh in that regard and um yeah i haven’t done an outro in a while so i might be missing something but in that case doesn’t matter i’ll fix it in the future appreciate y’all joining us hope you all have a great new year and we’ll see you again soon you