In this episode Zach is first joined by Michael Lohan, father to Lindsay Lohan, who has dedicated his life to raising awareness about the opioid epidemic. He is 12 years sober and started a recovery center in Florida after spending 2 years researching evidence-based therapies for addiction that have long-term success. The two discuss Michael’s research on addiction recovery and his idea of “the missing component” to treatment. Following Michael Lohan, Zach speaks with Dr. Rajnish Jaiswal, the Associate Chief of Emergency Medicine at Metropolitan Hospital Centre and Associate Professor at New York Medical College. Zach and Dr. Jaiswal discuss trends in addiction that he has witnessed working as an emergency room physician in the Bronx and East Harlem, New York.
Welcome to Recovery Radio by Landmark Recovery with your host Zach Crouch. In this program we’ll discuss the root causes and treatments of alcohol and substance addiction, speak with experts in related fields and help navigate the road to recovery. Now here’s the host of recovery radio Zack Crouch.
Zach: Hi, I’m Zach Crouch and you’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. Listen, you can find us online wherever you get your podcast and don’t forget to subscribe to get the most up-to-date information from leading experts. We have guest Michael Lohan joining us on the show today. Michael Lohan father to Lindsay Lohan has been sober for 15 years. His life is dedicated to raising awareness about the current opioid epidemic.
He started a recovery center in Florida after he experienced addiction and sobriety himself and after seeing frustrations with patient relapses he decided to go out to study the industry. He spent two years researching evidence-based therapies for addiction that have long-term success. He now believes he’s found some of the treatments needed for profound and lasting results and is sharing those with patients in our audience today. Michael, pleasure to have you on the show. Welcome.
Michael: Thank you Zach. I appreciate it.
Zach: Tell us a little bit about your background and how you got involved in the addiction recovery field.
Michael: Do you have a couple of days? My background well in a nutshell I went to school to be an attorney and I winded working on Wall Street. All through growing up high school and college I never drank or did any drugs. I was into across in my education but when I got to Wall Street it was a different story. Everything changed. It was every single Friday when the bell rang it was more like a bell for a weekend of partying. I’m sorry.
Zach: I was just going to say it’s like the bell rings. It’s time to get going. It’s time to get drinking.
Michael: Absolutely. Well, I worked right on the floor. I had a seat on the exchange. It was crazy down there and it was a haven. I mean every single Friday, all the clerks running around with it. They had cocaine and everyone was out drinking. In the 80s that was a way of life so I was a weekend warrior. By the grace of God that only lasted from the time I was 21 till I was about 24 when I met Dina. Dina and I, we would go out and party ourselves over the weekend but then she got pregnant with Lindsay and all that nonsense stopped.
I was sober for quite a while and then after eight years Dina and I got separated. We only separated for a short period of time but I went back into partying with my friends again. Then we got back together and it stopped again but in 2005 I kind of had an epiphany. I was actually sober for seven and a half years at that point. Lindsey was shooting a movie called Just My Luck in New Orleans and something horrible happened on set. I got a random call from someone, from a blocked number and they wouldn’t tell me what happened just that she was in the hospital.
I kind of panicked and I couldn’t cope with it. I had a couple of Irish coffees. Not a couple, I had three Irish coffees and finally I found out what happened. I was kind of on a mission to go after the person that was responsible for Lindsay being in the hospital. I was drinking and I got my car, my cousin had a private jet and I figured I could get away with bringing a weapon with me on the plane. I was actually on a mission I was going to kill somebody.
By the grace of God and I say this literally by the grace of God on the way to the airport. I was doing 80 miles an hour and I hit a telephone pole. My heart stopped and they had to revive me. It was kind of a message to me that God gives life and takes it. That was not my job to take anyone’s life and he stopped me from taking someone’s life and took my own life and gave it back to me. I found that as my purpose to really help people with addiction problems. It was my only and my first DUI for some reason where most people only get probation I got one of three to four years in prison.
They sent me upstate New York. I appealed my case but by the time my appeal was heard 21 months later they got 21 months out of me but during that time it was a life-changing event because I got involved with Teen Challenge while I was in prison. I studied to go into the ministry when I got out I worked with Teen Challenge for about a year and a half two years.
Zach: That’s such a powerful story. I mean for all accounts you should probably be dead right now. Would you agree?
Michael: I see it in a totally different way. I mean I never thought I’d be doing what I’m doing today. After working in Teen Challenge for that year and a half I got into working for an adolescent program down in Florida called Inspirations. When I worked there I just felt there was a greater calling and because there were only so many treatment centers for kids out there. While I do think that that’s we need more of them because there’s probably only 10% of the treatment center of the country are dedicated to adolescents that’s really where it starts. That’s where we really need to focus a lot of our attention because right now all the treatment centers for adults are people that they have locations, they have families. There’s so much collateral damage.
If we nip it in the bud when they’re younger they won’t have families, they won’t have jobs. At least before that happens we can actually make a difference but I got into adult treatment centers and I ran some and built some and owned some. I saw that people were still relapsing no matter how much I was doing. I mean my people got one-on-one therapy every day. They got EMDR, a lot of trauma therapy. They had nutrition counselling. I had a chef. I mean they lived in a beautiful 8 million home but no one was getting better. Most people are relapsing again.
A few years ago actually sold my interest in my treatment centers and I worked with a lot of people in Washington. I got very involved with NIDA and CAT and CADCA and SAMSHA and met a lot of neat people. We really looked at the medical side of treatment more than just the clinical psychological side because what we’re doing right now is we’re just talking to the brain.
It’s very cookie cutter. You go to a treatment center. You get detoxed and they’re only detoxing for what? Three or five days because insurance companies only pay for that but how are you going to deep detox someone properly on alcohol, benzos or even suboxone in three to five days? It’s impossible. People are going to treatment after detox and they’re still detoxing. They’re withdrawing treatment.
You can’t really get through to them and that’s the reason why people are relapsing. They don’t have enough. Their brain isn’t healthy yet to really understand the therapy that they’re getting.
Zach: I want to jump in for a second because you bring up a really great point. I had Daniel Amen on the show last week. Dr. Amen has written a bunch of books. Anyway, he talked a lot on the show about how to your point we aren’t really engaging in creating a healthy brain. We do things for the mind a lot of the times. We do therapy which is not to dis therapy or EMDR or any sort of trauma work.
It’s not about that but it is about recognizing that maybe we need to take a look at how what we’re doing to our brains and how we treat our brains all the way down to the vitamins and the supplements or the food that we eat on a daily basis, the sleep that we get, don’t get. If there’s things like have I had a traumatic brain injury, have I had a moderate brain injury, all these kinds of things and how that impacts people’s substance use problem.
Michael: Absolutely and what people don’t realize is not only the brain it’s the entire body and it’s even actually your stomach too because leaky gut syndrome is something that’s huge in addiction. Most of our receptor sites are located in our stomach not even our brain. It’s a food you’re putting in your system more than the other substances that really make a big difference but when you treat the body as a whole for pain or when you try to heal it and you get people to that place where it’s a healthy body and a healthy brain then you can do the EMDR, then you can do the trauma work.
It is necessary because even though you’re healing the body doesn’t mean that people forget all the things that happen that trigger them. You have to deal with the triggers at some point but we’re doing it too soon right now and that’s the problem. That’s why I just started a program I have an advanced medical detox down in Texas in Houston and we start that work early but then we continue, we added a whole wellness program called Stem Lift.
We do everything from cryotherapy. We do IV therapy. We do infrared sauna, TMF, IASIS which is microcurrent neurofeedback. I mean the IV therapies that we do using NAD and ketamine and some of the other things are absolutely amazing. It really helps to reshape the brain and we even use brain balancing foods that balance out your serotonin and dopamine so you don’t have those mood swings. Because we all well know that that drug use does affect your brain chemistry and that’s one of the biggest problems.
Zach: I want to come back to something you mentioned about catching at a young age like the folks that begin to use substances early on. You talked about how the family engaging the family is important. I’m curious in your time in working with families and even now in the work that you’re doing is there a holistic treatment for families that’s working and if so what would that look like?
Michael: It depends upon the issues that a family has. I mean dysfunction is dysfunction but it comes in a lot of different ways. Is there a holistic way of approaching it? I think the only holistic way of approaching family therapy is spiritually. To understand it family first and you need that bond. Look let’s face it. People can be your friends forever but when push comes to shove at the end of the day who’s more often than not who’s always there for you? Your family.
A lot of people lose that relationship with their family and that’s a bridge that’s broken that needs to be repaired. You need that family unity in order for somebody to not only get better but stay better because if you really look at it, I mean statistically I see more people have addiction problems because of family dysfunction whether it’s abuse or especially divorce.
I mean how many kids wind up using to fill that void when their parents get divorced. Then they grow up addicted adults and it all stems from divorce. It’s from their parents getting divorcing or going through one themselves. I mean that’s what people do. It’s human nature. You drown your sorrow and you numb your pain.
Zach: Well especially about the divorce piece I think it’s so important and critical to say this is that we are creatures of attachment. We also are creatures of doing what we know. I know that at least personal relationship family member of mine. Granted she was in a relationship that was physically abusive. She had to get out of it but she had to do a lot of work after that relationship to find out what was it that created this? What was it that I did? What was it that I didn’t do? What were the models that I grew up surrounding myself with that showed me that this was okay because this is something that went on in their life for a long time? I’m talking years.
What it was that she came to understand was that this was something that was sort of passed over, the physical, mental abuse that she saw in her family growing up? It was something that she never questioned because I don’t think that she probably felt empowered or was given permission to really question those things. Granted this was a case where obviously she needed to end the relationship but at that point also.
There’s so many instances too where adults are not, have not done their own work around their own selves and also the relationship to keep that relationship intact. If they did we might not have as many cases where kids to your point are trying to numb out with drugs and alcohol because hey, let’s face it like you said family is everything. There’s my point is there’s a lot of opportunity there for people to work on the relationship.
Michael: I totally agree and what we really have to look at and this is proof. Proof in the pudding. If you look at the correlation between divorce and addiction 15, 20 years ago, 30 years ago and you look at it now you’ll see that the divorce rate was much lower and so is the addiction rate. Go figure. I mean people could have been alcoholics. They could have used heroin or cocaine or whatever was around way back then but the divorce rate was lower.
There was less people resorting to using to drown their sorrow, numb their pain but today the divorce rate is so high. I mean people that’s what people are doing. They’re going out to try to appease themselves. I call it a broken heart syndrome. You have a broken heart and you fill that crack with all the wrong things.
Zach: Listen, it’s one of those things too where you grow up in different models. The household, these models and naturally young kids growing up especially once they hit puberty and adolescence. They start to look for things outside of themselves and models to fill in that void to your point. I got to tell you the models that we are giving right now outside of ourselves, outside of our home are not great. They’re just not.
Michael: No. It’s a well well-rounded healing process that we need. I mean I think the highest rate of recovery of any program in the world is Teen Challenge or faith-based programs like that. One of the reasons why I truly believe that because God is a big component of it but at the same time these programs are a yearlong. When you’re in a program and you’re sober for a year you’re going to heal. You’re going to heal physically. Your brain’s going to heal. Your body’s going to heal but you’re also healing spiritually.
When we talk about the mind, the body and the spirit that’s a true healing process. I mean it’s so overused to say oh, we heal your mind, your body and your soul or your spirit. No, you don’t. In 30 days you’re going to fix a year, five years, 10, 20, 30 years of addiction. Absolutely not, it’s not going to happen but when you take a year of your life and take that time you’re going to heal. I think that you have a much better chance of staying clean.
Zach: Michael, tell us about Teen Challenge a little bit briefly because I think a lot of people don’t know really know too much about that organization.
Michael: About Teen Challenge?
Michael: Teen Challenge was started in 1959 by Pastor Dave Wilkerson and it was a little church in Pennsylvania, 30 person church. Back then there was a case that arrived in the media that was a bunch of gang members that were in a place called Alley Pond Park in Queens and they assaulted and killed a handicapped person. These gang members were on trial and it was in the paper.
Pastor Wilkerson had seen the coverage of it and he saw that there was redemption in the eyes of these people so he went to court. He tried to get through to the guys in court but they wouldn’t let him. The court personnel wouldn’t let him get any other people. He actually went to the headquarters for this this gang and he was threatened there but he got through to them and started a program called Teen Challenge. It started off for teens but over the years it’s grown to over 680 locations worldwide. Now it’s for adults as well and they have a huge recovery rate.
Zach: We’ve got a location here in Louisville, Kentucky too.
Michael: The thing exactly costs nothing. They only charge what you can afford. that’s one of the biggest problems in the treatment industry now is that people do it for the money that way back when you had people like Knew Addiction that were opening up treatment centers and it was medically led or psychologists, social workers and psychiatrists but now you have business people and even Wall Street firms that are getting involved because they see the money involved in it.
That’s a problem when you put money before what’s right and you do it for the money you’re taking shortcuts and you’re trying to maximize your profit at the at the risk of people’s health and well-being. That’s why my program I do a lot with Medicaid and Medicare. I don’t turn anyone away. I want people that can’t afford treatment to get the best treatment they can.
Zach: Michael, tell us about your experience running a treatment center and seeing just one of the biggest pitfalls that we run into. It’s not really a pitfall but it’s a reality. It’s relapse. Tell us about your experience running the treatment center and seeing relapses. What did your research on the industry lead you to?
Michael: Simple. It’s one word it’s called greed. I got in it because I want to help people but then I brought some partners in from Wall Street that said that they cared about people and wanted to make a difference but when they saw the reimbursements and they saw the money they wanted to cut corners too. That’s really why I got out of the company that I started with my partners.
Zach: Tell me just for the second what you mean by that cutting corners. What does that look like?
Michael: All right so one of one of the things that I made mandatory is that out of the 30 beds that we had we would offer five scholarships per month out of those 30 beds. People’s insurance ran out if the insurance companies didn’t pay, we would keep them on until they were ready to leave. That was okay at the beginning but after the first six months or so when they saw that we needed a bed to make more money then they cut down on the scholarship.
When people’s insurance wouldn’t pay they sent them out to an IOP program. That’s not what I signed up for. I signed up to do the right thing. Funny to say but a lot of the people that were in the business back then with me are in jail now or they don’t have a license because they continue doing what they were doing even after I left. It caught up to them. God doesn’t look kindly on people that put money before someone’s life.
Zach: You may not be obliged to be able to talk about this but in terms of being in jail now was it something to do with I mean fraudulent billing or I mean how do those do?
Michael: Patient brokering. People came to my treatment center because of me. We didn’t have to do a lot of advertising but when I left they didn’t have a source for clients anymore. They got involved with patient brokering and then I found out one of the guys which a lot of people do do kickbacks with labs because they’re doing a lot of unnecessary labs they don’t have to do and they get kick back.
I won’t mention any names but one of the guys doing it got caught doing it. That’s basically the crux of it. It’s not a billing issue. Of course everyone’s going to try to bill for as much as they can but insurance companies are going to pay you what they think you deserve to get paid. You can build whatever you want per day on a daily rate. You’re going to get paid what the insurance company pays so you can’t cheat on that but when it comes to urines and it comes to patient brokering and all that kind of stuff they cross the line in a lot of ways.
Zach: You mentioned something earlier kind of coming back to this idea of advanced medical detox. I was curious what you meant by that. What is that and how is that different from say like just regular sub-acute detox in a facility?
Michael: First of all when you do what I do is it’s a hospital model detox and the reason why I do it out of a hospital is because when people come into treatment most people with addiction problems have co-occurring morbidity. They have co-morbidity issues like they have a heart problem or they have a wound problem like to get abscesses. They have pain problems. They have um liver disease, kidney disease.
The problem is when someone goes into a regular detox, sub-acute detox they don’t deal with those issues. When you’re in a hospital like mine and you have those issues we can help you deal with them at the same time. The other thing is when you’re in a hospital and we’re dealing with those issues we can get more days out of detox because insurance companies normally in a sub-acute level they only want to pay for three or five days of detox.
Like I said earlier you can’t detox someone on alcohol, benzos or suboxone in three to five days. It takes weeks or even a month to do so. What we do in our detox is not only do we get more time and do standard detox protocols whether you’re withdrawing on suboxone or Ativan or whatever else they’re going to use, lithium, depends upon the addiction but we also start neurotherapy.
We do IASIS or TMS. We do IV therapy with NAD sometimes ketamine. Then when they leave we continue with that process and do hyperbarics. We do red light therapy, ozone therapy, NAD which is you should continue anyway. NAD is amazing. I don’t know if you know what it is but look it up it’s called nicotinamide adenine dinucleotide but you mentioned it before that Doctor Amen had mentioned that but there’s a lot of great products out there that actually speed up that that detox and healing process.
Zach: You talked about holistic treatment and you’ve touched on it I think throughout our conversation today but what is that word. It has become sort of I don’t know mainstream might not be the way we put it but holistic treatment what does that mean to you?
Michael: What does holistic treatment mean? A more of a natural treatment method. Things that are more, they’re not assisted by drugs and different other things that they use that are addicting and narcotic. It’s more of a holistic well, you are asking me about holistic. It’s more of a natural process. Some people call it alternative medicine. It’s alternative medicine.
Zach: You talked to me a little bit about the missing component. What is that in your eyes? What does that mean?
Michael: The missing component is the medical side because all we’re doing, we’re really treating psychologically and clinically. We have therapists. The difference is instead of talking to the brain we’re healing the brain because that’s all we’re doing is talking to it right now. Do you really think that by talking to people about their trauma issues and so on and so forth it’s going to heal them and they’re going to get better? Absolutely not.
I mean if it did we wouldn’t have a 94% relapse rate because that’s basically what every place in the country does. I mean I can’t say that people and places aren’t moving toward this kind of a model and I wish they would. I don’t want to keep this for myself. I’m talking about it with you today so more people look into it and maybe they’ll get on board. Then this addiction epidemic won’t be as bad as it is.
Zach: Are there other examples of treatment centers, therapists that you’ve come across that that are using this holistic model that have seen success?
Michael: There are a couple. There’s one that I know of that does a lot of brain health. It’s in the Channel Islands in California. It’s called Pure Recovery. It’s Dr. Whitney. It’s her program. From what I understand she started off as more of a TBI, traumatic brain injury treatment center for athletes and first responders and even vets I think but she found out that after treating them for TBI and their brain injuries that all these guys that were on medication didn’t need it anymore.
By treating the brain she found out that their addiction issues were being appeased. That’s basically how it started for her. I mean I’ve done it through trials and doing a lot of doing a lot of research myself and actually applying it and seeing the efficacy of all the things we’ve been doing. It works. It works tremendously.
Zach: I’m curious to hear from you too Michael just for maybe even perhaps people who’ve been sober for a number of years but they want to try out a more holistic approach to living. Are there some simple things that that people can do? What would it be?
Michael: Personally, I don’t promote anything I haven’t tried myself. I’ve done literally everything I’m talking to you about. God knows at 60 years old, I have four older kids but I have a six and an eight year old. I need to prolong my life as long as I can. I want to stay alive. I do everything I’m talking about. Every single one and they work. I mean it takes time to do these things and you have to dedicate yourself to being to actually following this kind of a regimen but if you do you’re going to live a lot longer and you’re going to live a happier and healthy life.
There’s a product out there you might even look up. It’s called Enlyte. It’s a brain balancing food. You can get prescription grade or not but it actually balances out your serotonin and dopamine. It balances your endorphins. It’s one of the best things I’ve ever used in my life and I take it every single day. Guess what? It costs a buck a day. It’s $30 a month.
Zach: I had Dr. Amen on the show, previous podcast guest before us. I asked him. I said, what is causing the biggest problem in our country right now in terms of brain health? He said to me and I quote. He said Zach, you want to know something. The real weapons of mass destruction in this country are our food and diet right now. The approved diet in America right now. Blown away by that comment.
He also mentioned sleep being very important too. Have you found that people’s sleep regimen has as much of effect on mental health and in their use of substances as a lot of people?
Michael: Absolutely. He’s a 100% right. I mean sleep is huge and that’s why fibromyalgia is a real issue. There’s actually a company out there, a pharmaceutical company called Tonix that just came out with an amazing drug non addictive, non-narcotic that deals with sleep disorder and fibromyalgia. They’re finding that it worked a lot for people with stress, anxiety, depression and even addiction.
Now they’re working on two new products. They have a product that’s actually an abatement. It’s like Narcan for heroin but it works on cocaine. I don’t know if people realize this but 20% of all overdoses are due to cocaine. It’s arrhythmia or some kind of a cardiac arrest problem. They have a product that’s being used like narcan for heroin but it’s for cocaine. They have another drug that’s coming out to stop the cravings for alcohol but Tonix has great products and people should really look into it because sleep is a big problem. It really is. Nutrition and sleep are huge components of addiction.
Zach: Michael, how do they find out more about your programs?
Michael: You can go to, we’re not for profit. Our company is Matthews Hope. It’s matthewshope.org. My partner Larry Wedekind actually lost his son Matthew to an overdose. He started a foundation and then we made it into a treatment program. We’re located at St. Joseph’s Hospital down in Houston, downtown Houston but now we just opened up a PHP in the wellness component. They can reach us at 844 and hope. That 844-263-4673 or go to our website which is matthewshope.org.
Zach: Excellent man. Appreciate you coming on the show today.
Michael: Well, I appreciate your knowledge and doing what you’re doing because these kind of things and spreading a message like you are is really going to change the face of addiction. If you want to come on my radio show, I have a radio show on I Heart. I’ll give you a call and we’ll book a day for you to be on our show.
Zach: Love to do that. Thank you man. You’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. Listen, you can find us online wherever you get your podcasts and don’t forget to subscribe to get the most up-to-date information from leading experts.
We have guest Dr. Jaiswal joining us on the show today. Dr. Rajnish Jaiswal is the associate chief of emergency medicine at Metropolitan Hospital Center, an associate professor at New York Medical College. He’s an ER physician working in the Bronx, in East Harlem. He’s been there for the past 14 years helping patients with addiction, relapse and overdose. He is certified by SAMSHA in suboxone as part of the medication and addiction treatment MAT program. He also works closely with the emergency detox program in his hospital. Dr. Jaiswal we got a lot to talk about. Glad to have you on the show.
Rajnish: Thank you for having me Zach. A pleasure to be here.
Zach: Tell us uh about your experience in addiction medicine. How did you get involved in the recovery field?
Rajnish: I would say it probably started very much during my residency. I did residency in emergency medicine in the South Bronx. This was in about 2007. My hospital, Lincoln Hospital is one of the busiest emergency rooms in the country. We saw a huge variety of patients and a big portion of those were patients with substance use issues as well as people with intoxications.
What we noticed was that in the emergency department we were only able to sort of meet a certain aspect of their needs. Obviously if they came in acutely intoxicated we would provide supportive care to make sure that they’re doing okay. Then once usually they would sober up they would leave. It would start this kind of revolving door of patients just coming in and then leaving.
I think with the support of our department, our institution, Department of Health, a lot of agencies they’ve thought that finally that this also might be an opportunity to actually reach out to these people and offer some care. I would say early on through our detox programs and our social work we were encouraged to have these conversations about substance abuse and about detox with patients when they would sober up. I think that was probably the first sort of foray into this field of recovery.
Zach: You were a resident back in 2007. What has been the variety of substances that you’ve seen come through your hospital in that time frame? Has it just been sort of all over the place? Have you seen rises and falls and certain things and now they’re starting to come back?
Rajnish: I mean I would say that there’s definitely kind of phases where we’ve noticed that one or two drugs tend to predominate over others. I mean I would say that alcohol has always been a perennial favorite in terms of for where people and that hasn’t changed that much. The other substances have varied. When I was starting residency we were still seeing a lot of maybe heroin and even methadone overdose. That has now changed over the recent few years. I would say that more synthetic drugs are coming into the market.
We had K2 which is the synthetic marijuana and then now we’re seeing synthetic fentanyl which is occasionally popping up as well. I would say the majority, the opioids are still a big chunk of our patient population especially with our community but we’ve definitely noticed other drugs sort of come and go as well.
Zach: Are you guys doing any kind of bridge program in your ER? Are you familiar with those?
Rajnish: Our sort of options for recovery through the emergency room even though they’re much better than what we had before we’re still limited in terms of things that we can offer. Right now for patients who come in requesting detox what we usually do is we will connect them with a detox team and bridge might be one of the treatment options for those patients depending on what their situation is. There’s a host of other criteria but we’re unable to do it directly through our department as of now. We are able to connect them to people who can offer that service.
Zach: I’m kind of curious to hear from your perspective when someone comes into your hospital. Let’s just say that they’ve been there and they’ve overdosed maybe several times. You know that this is likely to happen again but one of the things that they mentioned to you during your course perhaps in the meeting with them is that they really want to do an abstinence-based program of recovery.
Their chances of a really negative outcome are really high given that they’ve survived three overdoses. How do you approach that conversation with them differently maybe to get them to think about an alternative like MAT?
Rajnish: It’s been very challenging. The whole field of recovery requires a lot of patience and dedication. Emergency doctors are usually tend to known, we like to do things quickly and get instant results. That’s why kind of we work in emergency medicine but sometimes we do have to be patient. That’s why I have a lot of respect for my colleagues in this field because sometimes things just do take their time.
I would say it’s a kind of a different host of conversations that we have now. For almost every patient who comes in with a substance abuse or an overdose or just an intoxication we offer resources for detox if they would like to consider it. We usually will not depending on what the patient’s mindset is we usually start with offering resources to tell them these are options available to you right now and later on if you would like to do with them.
That usually becomes a starting point for the conversation. Obviously people who voluntarily walk in to our emergency department requesting detox those conversations start slightly differently but what we try to do is and that’s something that we’re continuously working on is that we’re trying to offer programs for as many substances and for as many patient populations as we can.
That is where sometimes the challenges but at least now through our emergency detox team and through our department and having resources in the health and hospitals network we’re able to at least connect people to the right fit so to speak. Even though we might not be able to do it at my hospital we might be able to connect them with people at another hospital in the system that might be able to offer them the thing that they need.
Zach: Do you see more of your, I guess more of your traditionalists. What I’m saying that I mean those people that have used traditional approaches to treating substance treatment and are people with substance use. Typically that’s an abstinence-based route and those can be therapists, psychiatrists, even MDs. Do you see them coming around more in your area to, I know SAMHSA’s just got a ton of evidence around how opiate use disorder is best treated with MAT. Do you see a lot of those people coming around in that approach now?
Rajnish: I would say it’s mixed. Unfortunately we see a lot of substance use in a younger population as well but then sometimes that does lend us the opportunity to try and offer different types of treatment for them and sometimes they might not be open to MAT right off the bat but they’re willing to try some other modalities of treatment first. Then maybe graduate to MAT.
The resources that we have MAT is probably the main one. We don’t have a lot of ancillary support. Obviously in the literature there’s a lot of different ways that you can at least initiate detox. We don’t have all those resources available to us. MAT is probably the sort of bread and butter of what we have but we definitely are able to connect people to other resources as well. If people want to enter a program with us usually the conversation is had that it will be an MAT based program.
Zach: Okay. How many people are in your program right now?
Rajnish: Unfortunately once Covid hit us we had to actually shut down the emergency, the detox program to the emergency room because it was basically to protect those patients because the last thing we wanted for someone is to come to the hospital to get help with something and then they get Covid and obviously we’ve made a bad situation worse.
As of now for the past eight months the program has been suspended at least in our facility. I believe that Bellevue might have their program still open under limited hours. Before Covid on any given day we usually would have about I think eight to ten people as inpatient detoxes. Then our psychiatrists and addiction folks are also doing a lot of outpatient detox work as well. Depending on bed availability and resources I would say about eight to ten people at a time our department is usually able to do. Sometimes even more.
Zach: You work in an ER in New York you mentioned to me that you’ve seen a rise in addiction in young women. What do you see and why do you think that is?
Rajnish: Speaking to some of my other colleagues in this field this rise is not just a sort of a local trend. It’s backed up nationally as well and in fact even internationally where things like smoking, alcohol and recreational drug use has been rising in younger women. I think there’s a probably a host of reasons why this has happened. I think probably access is one thing that probably wasn’t as easy for perhaps women to access medical drugs or other substances before whereas now it seems to be a lot easier for pretty much anyone to get their hands on drugs like this.
I think the overall in general society has also been more permissive now of allowing women to smoke and drink in public. It doesn’t seem to have a stigma with it so perhaps there’s some changing kind of behaviors in that as well. I think biology plays a role as well because men and women metabolize these drugs differently. In some cases it’s been shown that women are more vulnerable to a drug craving and are sometimes more likely to fail detox programs because the biology sometimes is not in their favor.
Again, I’m sure there’s a host of other socioeconomic reasons and psychosexual reasons and stuff but I can definitely say just anecdotally based on my experience the number of women who come in intoxicated is now not unusual to find in our emergency department. Even 10 years ago that wasn’t the case. If we had a big population of intoxicated patients I would I’d say 90 to 95% were male. Now it’s probably you know 80% or sometimes even 75% so it’s definitely noticeable.
Zach: Is there a greater rise that you’ve seen among a certain socioeconomic status, class of people or even race?
Rajnish: I would say I work in East Harlem right now and we serve the East Harlem community which is predominantly African-American and Hispanic. Most of our patients are sort of from that demographic but I would say even within that demographic yes, alcohol and then recently K2 has been like two of the biggest sort of substances that at least I’ve noticed in my patient population where tends to predominate a lot of the patients who come in for intoxication. Obviously sometimes things can change as I said like depending on what’s available in the market and what’s happening but I would say those two are still right up there.
Zach: I asked that question a lot what is K2 and I don’t know a whole lot about it. What have you noticed about, what does this do to people? Can you shed any light on what the literature says about the substance and its effects?
Rajnish: I mean it is basically synthetic marijuana. Normally marijuana is grown in a field and from the plant. Then that’s where you source the marijuana from, from the plant itself. Now, what they’ve been able to do is they’ve been able to sort of recreate something that is very similar to that in the lab. Instead of going to the plant they’re now just going to a chemistry lab and they’re able to kind of create a substance that mimics a lot of the same reactions that marijuana would do.
Cannabis is obviously the formal name for marijuana. These are known as cannabinoids in the sense that they are similar in terms of the reaction that they produce in the body but they’re obviously not from the plant itself. You can call it synthetic marijuana. You can call it K2. You can call it as a fake weed. There’s a host of other very colorful names out there on the street.
It has been “sold” or marketed to the patients as the safer choice of marijuana. It’s all the good effects of marijuana without the side effects. That’s been how it’s been pitched to a lot of new users and it seems to have gotten traction.
Zach: It’s not to be used for consumption is that correct?
Rajnish: Absolutely. I mean the whole reason that it has been created because there’s no reason to make it otherwise. It has been manufactured purely to sell to a population that would probably use it either recreationally or otherwise. There’s absolutely no reason for it to exist otherwise. There are some places where like cannabis, some cannabinoids are being explored for possible medical or medicinal use but again that’s a small population of people that are trying to do that. That being said it still doesn’t really have a significant pharmaceutical impact. This was created mostly for recreational consumption and to sort of maybe fulfill a market where marijuana was not available or was not being sold for some reason or the other.
Zach: I’m curious to hear just because you are a scientist. Obviously you’ve dealt a lot in chemistry and in your training but these synthetics are they just kind of passed around? Obviously these are, are there patents on these kinds of things? I’m sure there’s different strengths and whatnot but I mean you don’t really know what’s going to happen I guess when you take this stuff.
Rajnish: Absolutely and the thing is that there is so these are obviously, they have as I said colorful names like spice and joker and stuff like that. They’re in a very colorful attractive packaging again to sort of appeal to a younger demographic but no absolutely not. Even though the person who you’re buying it from will tell you how safe it is, how wonderful it is, how it has no downsides at all but absolutely there is no reason to think that these are safe for consumption.
There is a very, very high incidence of contamination in a lot of synthetics which is sometimes inadvertent but sometimes intentional. People can get really, really sick from these contaminants as well. Up until even last year there was an outbreak where people were having excessive bleeding because of a contaminant in the K2. It caused a few deaths in very young people as well as made a lot of people very, very sick. These are not “safe” medications to take at all and anyone who tells you otherwise is not being truthful.
Zach: Tell me about that. In terms of an intentional contamination what would be an example that comes to mind?
Rajnish: I think you know cutting with fake products to basically give more profit to the dealers. It’s nothing new. People have been using medications or talcum powder and stuff for like heroin, cocaine all the time so it’s not unheard of to have contamination in these even in the synthetic market. The ones that come from manufacturers that are packaged and labelled obviously the chances are a little bit less because there is some sort of “quality control” but the ones that you might buy open packet or which are just bought on the street they could be completely full of stuff that is extremely harmful for you but it kind of looks and smells and tastes like the drug that you’re buying so you end up using it after all.
Zach: You mentioned a couple people died from this. In terms of any sort of legal recourse that that those people might have had. Have you heard anything further about that?
Rajnish: I don’t know too much about legal resources. I’m pretty sure at least the way that it is right now I wouldn’t be surprised if there’s not much legal recourse just of the ways things are said but again I would have to do more research before I make even an educated guess about this. As far as I know sort of legal recourse or lawsuits against manufacturers usually have not been in favor of the plaintiff. In the synthetic market, I am not absolutely sure. I haven’t heard about it but it doesn’t mean that it’s not happening or it’s not a plausible option.
Zach: There’s a place here in Louisville, Kentucky and there’s several places that sell. I’m sure you’re familiar with it, Kratom. Is that something that when it’s used responsibly is an alternative to coming off of opioids? Have you had any information that you’ve come across that’s led you to believe that?
Rajnish: I haven’t directly had an experience. My experience has been sort of limited to the options that we have in our department and in our hospital. For opioids for a long time methadone was a medication that our outpatient and inpatient people used for opioids. Now suboxone is also being used quite frequently. Outside of those two actually I personally don’t have that much of an experience because those are the sort of meds that we work with within our system especially in the emergency department.
I know there are quite a lot of other options available pharmacologically but as far as I know methadone and suboxone are still the first line. Any other medication would either be second or third choice but I don’t have much experience beyond the first line to be honest.
Zach: Have you had much experience with Vivitrol?
Rajnish: No, I don’t think so because we haven’t seen that much in our patient population and it’s usually not been in our discussions so unfortunately not. Obviously geography also plays a role in the substances being abused and the options being given. What’s popular on the east coast might not be in the south or on the west coast. Different regions might have different experiences.
Zach: You’re in the ER. I’m sure you see just about every type of impacts pretty much all levels of socioeconomic status and gender and ethnicity. What’s been your experience seeing discrimination though within hospitals or even as I was alluding to over the legal system?
Rajnish: I would say that bias in in healthcare like in every other field or in society and especially unconscious or implicit bias it’s something that we’re only now beginning to realize as a factor and as a determinant. In that aspect healthcare is no different and the field of recovery and the addiction is no different either. As we continue to understand these sort of blind spots we realized that how we approach a patient might be different depending on their race or their gender.
The words that we use might be different. They say that words really do matter especially when you’re speaking to someone who is considering recovery. Words like addicts and abuser tend to have like negative connotations and might actually repel the person from taking further actions because they feel that they’re being judged even before the person has got to know about them.
Obviously the person on the other side is quite most likely not feeling this at all but the perception of it itself can be quite detrimental and devastating. We definitely within healthcare overall and not just in physicians and providers are trying to understand these aspects of implicit bias. Then to answer your question we noticed that and I’m sure I’m guilty of it myself again because it’s more of unconscious thing.
A male patient is probably likely to receive more support than a female patient even though we might not be doing it consciously. A person of color might get less sympathy than a person who is white. These are things that we are only beginning to understand and we’re actually looking for. That’s why we’re noticing that yes this is an issue and this is a problem.
I think the legal system all over the country I think it’s pretty well established that it looks upon less favorably towards people of color and then on women versus men. All of those aspects are pretty perceptible even in recovery.
Zach: Do you guys do some sort of training within your ER on issues like around cultural sensitivity and stuff? If so what does that look like?
Rajnish: Oh absolutely. New York Health and Hospital it’s one of the largest public hospital systems in North America. We have a huge population of patients that we serve and a big army of doctors, nurses, ancillary staff. Health and Hospital has been on the forefront of trying to address issues like bias implicit or otherwise, diversity and a host of other socioeconomic factors.
We frequently go training in diversity in recognizing bias, in understanding socioeconomics of our community. These can be through lectures, through seminars as part of our continuing medical education and a host of other ways that we try and start the conversation. We try and inform our employees and our colleagues. As we come across more research and more data we try and share that with everyone as well because our institution that has a huge commitment to eliminating bias and discrimination and racism. This is a crucial part of that process where we make sure that all our employees are uh are undergoing training and are able to understand the extent of the problem.
Zach: Fantastic. Dr. Jaiswal, it’s been a pleasure having you on the show today. Please keep up the good work in New York and stay safe out there.
Rajnish: Thank you very much Zach. It was a pleasure to speak to you. You guys are doing amazing work as well so I wish you all the best. Absolutely stay safe. I hope your friends and family have a good holiday and I wish everyone well.
Zach: Listen, if you know someone struggling with an addiction and you’re searching for answers visit us at landmarkrecovery.com to learn more about substance abuse programs that are both saving lives and empowering families. Until next week, I’m Zach Crouch with Landmark Recovery Radio wishing you well.
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Dec 25, 2020
Posted in: Podcast