SPEAKER_01: 0:01

Welcome to the Healthy Matters Podcast with Dr. David Hilden, primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, health care, and what matters to you. And now here's our host, Dr. David Hilden.

SPEAKER_04: 0:18

Hey everybody, it's your host, David Hilden, and welcome to a special episode of the Healthy Matters Podcast. This is episode three of season five, and today we're gonna talk about addiction. But this is a special episode because there is a room full of people sitting in front of me. This is our very first live studio recording of a podcast. And so today we're gonna talk about addiction medicine. For a long time, addiction medicine was seen kind of as a personal failure from a lack of willpower, maybe bad choices, maybe even a moral character flaw. But as it turned out, that could not be further from the truth. Addiction is a medical condition. It deserves the same attention, the same treatment, compassion, diagnosis, the same hope, the same support for patients and their families as any other medical condition. So today we're gonna dive into addiction medicine, what it is, why it matters, and how science, innovation, and humanity are helping people in their recovery every single day. So today I am joined by two of the best in the business, Dr. Lauren Graber and Dr. Charlie Resnikov from Hennepin Healthcare's Addiction Medicine Program. So as I said, we're recording live here with a studio audience in Hennepin Healthcare. And trust me, you're gonna walk away with a whole new understanding of what recovery really looks like. So let's get started. Charlie, Lauren, thanks for being here.

SPEAKER_02: 1:42

So glad to be here.

SPEAKER_03: 1:43

Yeah, I'm honored to be here.

SPEAKER_04: 1:45

So I've known you guys a great long time, and I appreciate you being here helping us out through this super important topic. So let's start us off, if you could. Let's talk about the scope of addiction medicine in the United States. How common is it? Who wants to take that one?

SPEAKER_03: 1:58

Uh I'll I'll start with this. I think there's a simple answer, and then there's a slightly more complex answer. The simple answer is 10% of adults struggle or are at risk for addiction. It's a ballpark figure. So I think that's a simple way of answering. How common is it? One out of 10 of us are gonna either struggle with addiction or be vulnerable to it. But there's a more complex version of the answer. That's like us and our risk. Society creates risks of addiction. I mean, you could imagine in the 1950s when sophisticated celebrities were smoking on films, and you could smoke in a in a restaurant in an airplane, and your doctor told you uh it was okay to smoke. Uh your doctor probably was smoking. You probably, yeah. Go get a cigarette. Smoking was way more prevalent then because society was different then. And now society views tobacco smoking differently, and rates have changed. So part of it is within us, 10% risk, and part of it exists within the society. And is this drug available? Uh, how does the society view the drug? What is the perception of the drug use within that society? And it's it's more narrow than the society, could even be the community, could be the neighborhood.

SPEAKER_02: 3:07

I was gonna say the one thing I'll add that I think is more like more generally speaking, we could talk about trends too. But one thing that's amazing about now, while we say 10% of people are susceptible or more at risk of having substance use disorders, a research study came out this last year that said one in three Americans is personally touched and affected by someone who is experiencing a substance use disorder. So I think for me in my training as a family physician, we're thinking about this larger unit. Each person who is having a struggle is affecting this larger, this larger group of individuals in their family, in their community. And how real and felt that is. That it's not even, it's not just this one person struggling, it's this whole network of humans affected and really feeling that struggle together. So that's a really important thing to think about, like even though it's one in ten, it's the impact of how this impacts all of us is so much deeper.

SPEAKER_04: 3:55

Before I let you go from that, Dr. Graber, so that is, I am an internal medicine doctor. I do a lot of diabetes, I do internal medicine. I wouldn't say that be the case for all my patients with heart disease. Why does it affect so many people outside of just the person who is living with an addiction?

SPEAKER_02: 4:10

It's so, so nuanced and so like dear for in how you care for somebody. When you in a system, you know, when someone is struggling with substance use, they are often the caregiver of other people, their elders, their children, they're and or having different responsibilities. And substance use puts you in this tunnel where it's so hard to see any other, any other path to make another decision because the desperation and the and really like if this shroud of where you are, it feels like your options are so limited. And so, in order for you to function in society and build those networks and care for different people, like it, it's just not, you're not able to do that. And the people around you, of course, see that. It means are, you know, how are you nurturing your children? How are you, how are you caring for your family? How are you showing up to work? All of those things become more challenging.

SPEAKER_04: 4:54

Yeah, thanks for that. Thanks for that. Okay, trends.

SPEAKER_03: 4:56

What are you seeing? Well, I mean, I think a good, a very interesting good trend is that young people are abstaining from drugs at surprising rates. Alcohol, cannabis, a variety of other drugs. So that's a good trend. Um, I think there's also been year after year of bad trends with opioid overdoses, fentanyl overdoses that improved or maybe plateaued a bit. So I think those are good trends. Bad, worrisome trends, very potent purified cannabis, very potent synthetic drugs. I should say the young people who are using cannabis are using very strong cannabis. Marijuana. Marijuana. Synthetic drugs like methamphetamine and fentanyl are very hard to stop getting into our communities, and they're causing a lot of problems for those people who are exposed to them using them. Multi-drug people not just using one drug, but multiple drugs at once. So poly substance use, those are worrisome trends, I'd say.

SPEAKER_04: 5:59

What about overdoses? Um, we heard about the opioid pandemic, really. We heard about fentanyl. Fentanyl's been around for ages, but we've only been hearing about it in the last decade or 15 years about that. Is fentanyl and opioids still the primary overdose problem, or is it other things?

SPEAKER_03: 6:16

Yes. Well, you know, we should talk about alcohol and people overdose in a way on alcohol, and people get injured and even die because of alcohol for a variety of ways, and that takes more lives. That'd be the biggest one. That'd be the biggest. Tobacco and alcohol are the big ones uh in terms of lives lost, even with all the improvements in tobacco. I think it's still number one and alcohol number two. But for other substances, opioids are still involved in the majority of overdoses, and they had gotten, like I said, worse and worse and worse. And then they got a little better, and now maybe they're plateaued. It's still an unacceptably high rate of death. But, you know, if the good news, if we can take any good news, is a lot of our efforts seem to have slowed the rise in death.

SPEAKER_02: 7:04

And I would, as a the slight cynic in me, would also say that I think that while we want to credit a lot of the work that we that we do and interventions that we have and the amount of narcan or naloxone which reverses opioid overdose, I think there's also a huge part of the supply that really changes what people's experiences, the drug supply, I mean, and what people have access to. And so part of really being nimble in our field is being able to really adapt and try to reconcile and understand like what are people having access to? And how do we listen hard, change what we're doing to make sure that we're giving them the support that's really going to be effective with that ever-evolving picture?

SPEAKER_04: 7:41

It's changing really fast. Lauren, are you seeing different communities affected differently, or how does addiction manifest in the various communities we see?

SPEAKER_02: 7:50

I mean, the amazing thing about addiction, and something especially when I when I moved to working at Hennepin Healthcare that I found just striking, is that it is truly hitting all communities at similar rates. And so we see in our office at any given time, uh, we take care of nurses, lawyers, and folks who are unhoused, and people who are working construction and IT. It's amazing the swath of life experiences that people are experiencing, who've who've have substance use and people who've lost those, who've who no longer are able to continue those lines of work because of their where their substance use has led to. I think it's across what we see is it's incredibly diverse in terms of racial and ethnic identities, incredibly diverse in terms of ages. I think, you know, we know and call addiction a developmental disease. It truly is because people develop this, this happens and starts in adolescence. We we can see that that 99% of people start using and having difficulty with their use prior to age 25. But it is a lifelong chronic disease that people continue to struggle with and have different moments of success and struggle. That is kind of how it goes. And I'm never, you know, it's it's an amazing thing of all languages, all backgrounds in which we see people. And I think this hospital in particular, we we get that full range and diversity.

SPEAKER_04: 9:08

Could you talk about the connection, either one of you, between trauma or childhood events or your your growing up situation and the risk for developing an addiction?

SPEAKER_03: 9:17

Oh, it's it's complicated. The connection is there. Um, and it's a more than just a two-way street. Those who use substances, those who get intoxicated are more likely to experience trauma. Those who have trauma, especially unresolved trauma, are more likely to seek substances to help manage their some of the internal pain they're feeling. And addiction is genetic. So the parents may have addiction, they may have trauma, and the child grows up in that context as well. They both experienced some trauma as a sort of the second generation from their parents, but they also have inherited the genetic risk. So there it's very complicated involving multiple things. I'm, you know, I don't know, Lauren, you could probably make more sense of it than me, but I think addiction causes trauma, trauma causes addiction, and people that live together struggle together. I guess is how I would say it.

SPEAKER_04: 10:14

What about what we used to call the social determinants of health? I've I've heard it called the social um conditions of health or whatever, because determinants sounds so like it's a predetermined thing. But what about the situations that people find themselves in? Does that affect how addiction shows up with them?

SPEAKER_02: 10:31

My, I mean, honestly, in terms of statistics, that doesn't necessarily mean there are higher rates among among those different populations. What it does mean is there are greater consequences of ongoing.

SPEAKER_04: 10:41

That is a great point. So it sounds like addiction affects all communities, but is there any connection between the social determinants of health or the conditions which people live and their addictions?

SPEAKER_02: 10:52

I think you're spot on, Dr. Hilden, because it is, while addiction is across all swathes of humans, those who experience the most detriment from it and who have the long-term consequences are certainly folks who are less represented in our in our communities and who have less access to care. Um, it is amazing, even across all socioeconomic classes, how few people get the medications that are shown to be effective in reducing alcohol use and shown to be effective in reducing opioid use. It's something like 10%. Even after having an overdose or having a hospital encounter, getting medications to people is one of those terrible things that we're trying to try to share out in the world about how to get those connections because it's so, so challenging to find people who are willing and comfortable to prescribe, talk about it, offer support, and also like share what could another path look like.

SPEAKER_04: 11:41

Here's a super easy question. If we were to treat addiction as a public health crisis, which it is, how should we be responding differently as a society than we are now?

SPEAKER_03: 11:54

Well, I I would look to other countries that have effectively turned the tide of drug epidemics in their in their own country. And what they have done successfully is number one, integrated non-stigmatized addiction care into all aspects of healthcare. So there's like open door policy. You can go into any clinic and talk about your struggles, feel not judged, and be offered options. And number two, as much as they can, remove legal consequences from addiction and so that you don't go to jail for addiction. That is probably symbolic of a larger movement in society to destigmatize addiction, treat it as a disease, and give access everywhere for the disease. And countries like France, Vietnam, Portugal have dramatically changed death rates by doing those things. And we have a ways to go to get universal access to non-stigmatized treatment in our community. Yeah. I love that.

SPEAKER_04: 12:54

Okay, I'm gonna switch a little bit to talk about the medicine of addiction. You know, like what's going on in the body? At the beginning of this thing, we said, well, it's not a character flaw, it's a medical condition. Okay, so let's talk about it like a bunch of doctors. What causes addiction in some people?

SPEAKER_02: 13:08

I think it it's a lot of different things. I mean, it's specifically when I talk and teach about opioid use disorder. I often talk about the fact that our bodies, you know, even from the moment we're born, are developed to create this like natural level of natural opioid endorphins that we have in our body that keep us steady, keep us stable, help us cope with the world. And there are moments when those levels go up a little higher. And, you know, that's that maybe was a time as a young person where you had a fabulous, a fabulous memory, a really great day. And the time when they're lower, when you're more isolated, lonely as a teenager. You can imagine some of those things. And so that there's this normal variation with it, but like we have this general level of opioids in our body. And then for some people, not everybody, but for some people, when you first try an opioid, it's an outsized, like hugely different response. Like a heck yeah, like totally different experience, far higher than that moment of like of joy that you'd had before. And especially if you've been through bad things, that might be the first blanket that you've ever had to help you felt like you could be safe and okay. And it's just this, it's a vastly different experience. And so I tell people, like, you know, when you have an experience like that, every human, every animal is like, I'm gonna do that again. And and you do, but it's not usually quite as good. And so then you're like, well, just take a little bit more and try to get back to that heck yeah moment. But what happens then is your body, when you when your body's been making its own opioids all those years and suddenly you're getting it from another place, your body stops making those natural opioids. So in the times when you're not using, suddenly you are lower than that low feeling as an isolated teenager. Your system is, your body is aching, you are devastatingly in pain, you can't stay still, can't get comfortable, overwhelmed by anxiety. And suddenly using becomes different in that you are using to try to get your body up to that normal baseline that you established your whole life before, so that you can go to school, go to work, get your kid, you know, take care of your family. Like it's about how do I feel normal again? And it comes nowhere, you're not going anywhere near that heck yeah moment of that moment that we people call feeling high or feeling. That's not, it becomes very quickly like, how do I get back to normal? And I think that that's really like when I think about like what does this feel like and how does this happen? I think it's very much like it's a body deficiency and people trying to take care of themselves, similar to how you know we know about people who have low thyroid levels, right? Hypothyroidism, take a thyroid supplement to so that they get back to those normal levels. People with type 1 diabetes don't have enough insulin. We give them insulin so that their body has that. In this way, I really see opioid use disorder in particular, but also similarly with a lot of different use disorders, is that people are trying to take care of themselves and fill that deficiency. And so that's where medicines in particular, like methadone or buprenorphine or suboxone, are life-changing medicines because they get you back to that baseline again. So you can be your human self, do the things that you need to do to be successful and to try to navigate that world.

SPEAKER_04: 16:10

So, Lauren, it's not volitional or it is. I mean, people can choose to or not.

SPEAKER_02: 16:15

You know, do you know what I'm getting at? I do. I mean, I think nobody chooses to have a substance use disorder, undoubtedly. I mean, are there moments of choice in the beginning when you're experimenting and and thinking of different things, or honestly, in that moment where you're just trying to take care of yourself in an extremely overwhelming and hard world? I mean, there's so many different reasons that people initiate. But when you develop a true substance use disorder, there is no choice. It is almost like primal desperation of how to, of how to take care of yourself. So I think people are really trying to make the best decisions with the with the stage in front of them. But it's a desperate, non-decisional, extremely brain-changed condition.

SPEAKER_04: 16:53

So that was like the best description of addiction I've ever heard in the last two minutes. That was really helpful to me. I've been practicing for 25 years. That was good. I mean, that was very helpful. You used a few words. You use substance use disorder, and you've used the word of addiction. What's the right terms to use? Is addiction the word we're supposed to use? In medicine, we use substance use disorder. We use we got there's 35 acronyms in these guys.

SPEAKER_03: 17:17

Yeah, what other words? I think well, what I do, and what I would recommend for a family member is to open-endedly, sort of non-judgmentally, ask an individual how they define their own use. Uh, so I will sometimes say, Is your relationship with alcohol healthy? So you have an unhealthy relationship with alcohol, and that may be how they want to define it for themselves, just because I want to have an open conversation, non-threatening conversation. So, I mean, the technical scientific term is substance use disorder. Uh, and that is the sort of, and it sounds technical. S U D. S U D. It's very technical, but I think a good way to communicate is to let them lead with the language and then match their language.

SPEAKER_04: 17:59

So, what do you guys do for a living? What does an addiction medicine specialist physician do? I've heard it said, Yeah, there ain't enough of you on planet Earth to care for that. The scope of the world.

SPEAKER_02: 18:10

I'm really glad for you to hear that.

SPEAKER_03: 18:13

Yeah, I I love my work, and it is part of what I love about my work is that it's highly diverse. And not just the types of people I see, but the situation they're in. And there are many people who I see who are experiencing severe consequences from their substance use disorder, from alcohol, for example. They're just not ready to change. And I go in and I talk to them and I express concern, and I am concerned, and they're not ready to take the step. So all I'm doing there is planting seeds for the future. Uh, and that could be disheartening to some. That's not disheartening to me because I've been around long enough that I see that sometimes those seeds grow. All the way to the other end of the spectrum. Last week I saw someone I've known for 19 years and is in recovery and is doing great. And 19 years ago, I could not have predicted that this person would have done so well. And now he's helping, he's a manager at work. He's helping his employees who he identifies are drinking on the job. So he's now helping others. All the way from someone not ready to change to someone helping others change, everything in between. And so it's it is both challenging at times, but really affirming at other times. And so there's some days I walk out of work and I am so almost giddy with having the opportunity to be involved in patients who are doing that well. And there's some days I work walk out of work and I'm worried uh for someone's health. So it's the whole spectrum. I don't know how you feel about it.

SPEAKER_02: 19:39

I just I love I love talking about my work because I think people come up to me and they're like, how do you do that? And I always, it's like we we get the joy of seeing people through hard times and seeing the hope that there is on the other side. I mean, it's exhilarating. And I think what is my job on a day-to-day basis? It's it's so joyful because I just get to care and care hard wherever somebody is in that moment, you know. And I think it's a time, it's a we've created as a society an experience for our community members who have substance use disorders, a really, really, really horrible space. You know, they are our patients that we care for are used to, we drive by people in our cars. We, you know, walk over them on the streets. These are people who are so used to being ignored by society and they're so used to being treated horribly by healthcare providers and being asked, like, oh, you're just drug seeking, oh, you're looking for these different things. I mean, the way patients are used to being treated is just unbelievably hard. And so the joy that I have in my job to be able to be like, can I just take care of you right now? You're feeling miserable. Can I offer you an idea of something that might make it better? And maybe that's a cup of tea. Maybe that's like it's starting wherever they need me to be to help them get to that next place. And it's exactly, you see some people who are like, you know, you express care and you're worried, and they're like, I'm not gonna do anything. And you're like, great, I'm gonna see you tomorrow in clinic. Let's like part of me is like, we need to work. This is a relationship then. And I need to show you that I am trustworthy and that we can do this together. And then the other folks who are like, I just have a life-threatening situation that I'm here in the hospital. Like, this change needs to happen now, and I need, I need this next path to be different, and walking that with people for them to see how how their world doesn't have to be in that tunnel that we talked about before, that there's so many other paths that you can do.

SPEAKER_03: 21:26

Lauren, can I ask you a question? I I think, and I think you hinted at this. I feel that there is a unique form of, excuse me for saying this, almost intimacy between myself and my patients where they can be honest with me in a way about what's happening and what they're feeling. They sometimes can't tell their spouses these things and they sometimes can't tell their best friends these things or other doctors these things, but they can tell me. And I think that is a really powerful experience for me.

SPEAKER_02: 21:52

I think you're right. I do think there's times, you know, I walk into a room and I usually sometimes if I just say, Hey, I'm an addiction doctor, people are like, Oh, that's me. You know, there's this defensive, like, do I have addiction? Sometimes that people have. And so often I'll, you know, I'll be like, well, you know, I'm the alcohol and addiction doctor, and I support people and how they feel, how how they're doing in the hospital to make sure that you're not feeling sick here in the hospital, because that's hard. And usually that's like something that we can use to connect with people is like, nobody wants to feel sick in the hospital. You can help me with that? Okay, let's let's start talking about that, even before we start thinking about like what's that next step. But I do think that the for people who are so used to being who just have this idea that they're gonna be so stigmatized by their healthcare providers, be for me to come in and say that, they're like, you're gonna get it. You're gonna understand, you're gonna understand what I'm needing to talk about right now. And I think it's really it's a it's such a privilege.

SPEAKER_03: 22:38

And I bet you make eye contact in a way that some other doctors are a little nervous about.

SPEAKER_02: 22:42

Right. Well, and I and I can be like, I can be like, you're not grumpy and irritable, you know, because you're a miserable person. You're because you're in withdrawal and you feel sick. We can do something about that. I see you, you know, and we can like what what works for you? Let's do that. And giving the rest of our hospital team the permission, like, you can take care of this person. You can.

SPEAKER_04: 23:02

So we are going to take a short break. We are talking with addiction medicine specialist Dr. Lauren Graeber and Dr. Charlie Resnikoff from the garden spot of the country in downtown Minneapolis on the campus of Hennepin Healthcare, where we are all privileged to work. When we come back, we're going to talk about innovations in addiction medicine, what's working, what the future looks like in this space. So stick around. We'll be right back.

SPEAKER_00: 23:30

When Hennepin Healthcare says, we're here for life, they mean here for you, your life, and all that it brings. Hennepin Healthcare as a hospital, HCMC, a network of clinics in the metro area, and an integrative health clinic in downtown Minneapolis. They provide all of the primary and specialty care you'd expect to find, as well as services like acupuncture and chiropractic care. Learn more at Hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

SPEAKER_04: 24:07

And we're back talking with Dr. Charlie Resnakoff and Dr. Lauren Graber, two addiction medicine specialists at Hennepin Healthcare in downtown Minneapolis. Dr. Graber, I was gonna ask you, could you talk us through one of your patient encounters? What is it like to be one of your patients? Or maybe what's it like to care for one of your patients, is a better way to put it.

SPEAKER_02: 24:25

I was gonna say I can express my my side of the story with that. I think, you know, I was thinking about a couple of patients that I worked with this week. I have one patient who came into labor and delivery triage. She's 26 weeks pregnant. And but I'd heard about her. I think I've I'd heard about her for about eight weeks before because her care team in the community, not related to hennepin, knew that this was a place where we're really working on, especially caring for pregnant and parenting people with substance use disorders. So I'd heard that there's this person, and you know, we're trying to get into care. And so I just say that because that's so common that people really want to get care, want to get treatment, want to have medication open options. And just because of how hard it is, life, all of the different pieces, like that takes time. And so the fact that she walked in this door, the OB team paged me, and I said, You tell her we're so glad you're here. And so I got to meet her. She just arrived in the hospital. I think I probably got there an hour afterwards, and she was really, really not feeling good, really not trusting of me, not trusting, really nervous about what medications options they were. And then as I dug a little bit deeper, really, really scared about how her baby might be taken away from her. And again, she's 26 weeks pregnant, so she's halfway, over halfway through the pregnancy, but like still pretty far from delivery. And just like that was the thing that's on her mind. And like, and I think a lot of the pregnant people I work with really have that. Like, I can't believe this has happened to me. I can't believe I'm doing this while I'm pregnant. Like, you know, all of this self-blame, shame, and really hard place. And so that's the joy I have in coming in and being like, let me tell you the fact that you showed up here right now and that you're open and interested in taking medications and talking with the team about some of the different treatment options and community supports, like, you're showing how hard you're working. That is what's child protective services, CPS. That's what those folks want to see. They want to know that you are trying, you are open to medicines, and you are trying to find a better path. And that's a nice part of my job is really this is, you know, I work a lot with child protection. We talk a lot about how to keep families together, how to support families that are wanting to parent together and really giving her that moment and that light.

SPEAKER_04: 26:36

What a privilege that you're doing that work here. Like so I've been here forever, you know, and a day, and we haven't been doing that work, to my knowledge, it with at least that intentionality, that we have a specialist who is treating new parents. How did you get into that?

SPEAKER_02: 26:49

Oh, I mean, isn't it just like life that you kind of tumble and roll into different things?

SPEAKER_04: 26:53

I totally, I'm doing a podcast. Never saw that coming.

SPEAKER_02: 26:57

I, in my prior life as a family physician, I did a lot of mom-baby care and well mom-baby group visits and primary care, really thinking about like how do all of us be the parents for our children that they need us to be? How do we go forward and really change all of us wanting to change what's the life of that next generation gonna be? And so I really that really resonated with me. And for years, my patients were talking about substance use and I had no tools. I didn't know what to do about it. You know, I try to connect people in different places. But honestly, it was when I moved to Minnesota and I was like, and I was like, okay, where's the team taking care of pregnant people with substance use disorders? It's really crickets. Minnesota, we have so much work to do in this area. And and I felt, you know, and and with some like fabulous colleagues at the university and also I was like just really putting together like what like what would it mean like for me to really take on then get that expertise in a different way? It's been that evolution that really like brought me to Hennepin and now is allowing me to develop and create this team and work with those across the state. I lead one of the Project Echo series on perinatal substance use, really trying to educate healthcare providers across the state, like, how do we all do this better? So that no matter where our patients are ending up in hospital, because I tell you, in this city too, like my patients are at every single hospital. And so, how do I support and assure that they're gonna get great care no matter where they land, and at least care that respects who they are and treats them with dignity and helps like look towards that space of hope. And so this patient that I saw this last week, you know, she was coming in a really dark place and she's still, you know, we're still working on getting her on the it's not perfect. It doesn't, it doesn't work right away in these first couple of days, but starting her on methadone, helping her transition so that she's able to finally feel better so that she can get to a treatment program and have some more secure housing, which is a part of her story in terms of how she's getting help.

SPEAKER_04: 28:42

Do you work with our primary care teams? Do you work with other other teams as well? Full disclosure, I remember zero from medical school on substance use. I don't even know if we had a class on it. Maybe we did.

SPEAKER_02: 28:52

You know, I think it's a real deficit in medical school education. It's really like there's really a day dedicated to substance use and how to address and support people. And it's so nuanced, you know, because it's so much about conversation and different pieces and often embedded like within our psychiatry training in different places. But so I do think that's a deficit. And that's part of what's been really exciting for us at Hennepin is to really be able to collaborate and work much more broadly across the state and education efforts. We do a lot of course with the medical school. We have rotating residents and fellows in our on our team all the time, really trying to like get people to be comfortable to have that conversation. And I think that we're trying to make inroads in how to do that. There's so much more for us to do. I mean, that's why when I when I talk about like, you know, how do we take better care of pregnant and parenting people? Well, it's like, well, you know, we can't do much worse. Why don't we try to pull ourselves together to do even a little bit better? And how do we do that in a space collectively and using each other's shared knowledge that we can really build that different vision?

SPEAKER_04: 29:47

So, Charlie, I've known you for 20 years. What are you doing now that is different from what you were doing 10, 15, 20 years ago?

SPEAKER_03: 29:55

Well, I I think one of the good things that came from COVID. Is that we really examined telehealth, telemedicine, even telephone visits with patients. And by doing that, we lowered barriers so that people who couldn't get to the clinic physically or who have mobility issues or just forgot their appointment can still have their appointment by telemedicine. And it is so much fun. Every Wednesday afternoon, I have a telemedicine clinic. It is so much fun to call or have a video chat with people. And so I think that is a huge innovation. And it's it's actually old technology. It's the telephone. Um, but it's used in a new way, and it improves their engagement in the healthcare system and it improves their outcomes. And it's really meaningful, I think.

SPEAKER_02: 30:43

So there's a lot of new innovations in terms of medicines. And I'm, but one in particular I wanted to highlight is the sublicade injection, some of these long-acting injections, right? What's that injection? The med, there are a lot of different medicines that we use for addiction medicine. One of the primary ones is buprenorphine or suboxone, which usually is taken under the tongue. Actually, it dissolves. You don't even swallow it. So that's strange already. So educating patients about that. But in the last several years, there's these long-acting injectable forms of it, um, where you actually give an injection under the skin and it lasts for ready for it? 30 days. 30 days at therapeutic doses and it hangs out in your body for much longer. That in a world where substance use is often really chaotic, there's so many different things going on. Whether you're an early parent, whether you're a fresh adolescent who's very impulsive anyway, having a medication that you don't have to remember to take all the time that's in your body already is life-savingly different. It's life-saving too because remember, this medicine, if you have bubinorphine in your body and you take any other type of opioid, it bounces it off. So it really reduces people's risk of overdose. So even in that impulsive teenager who's like, okay, maybe I'll try it again and see what it feels like, it doesn't have the same reward. And it protects them from overdose. I mean, that's an amazing gift that you have for people who are potentially in impulsive spaces. So those long-acting injectables have transformed my practice and really, and now, especially with research coming out about how safe it is for pregnant people, how safe it is for young kids, like this is, and I say kids, I mean adolescents, this is a really, really transformative option for meds. I think the second thing that I think is a really innovative space for innovation, I would say, and I hope we can make this happen, is that methadone, we know, is an incredibly effective medicine in the era of fentanyl. And a lot of studies show even more effective than Suboxone and buprenorphine, that people stay engaged in care longer and have longer periods of abstinence. And so my wish and innovation is that we can get better access for people to methadone, that it isn't just the few places, you know, in the state of Minnesota, we've got we've got a handful of methadone clinics here in the Twin Cities. But I tell you, you drive outward, it's impossible to get people from all different communities to access to methadone. So it would be my dream in innovation. And there's even a study that we're doing here at HCMC that's allowing, like piloting this to have clinic-based methadone distribution and working with our pharmacy partners will mean that more people around this bigger state will be able to have access.

SPEAKER_04: 33:12

So I can I ask you to respond to this. Our addiction medicine clinic is in a building that was built during the, I was gonna say the Eisenhower administration, but I think it was more like the Calvin Coolidge administration. It's old. It's in a back alley. Literally. The patients have to walk in a back alley to get their substance use disorders treated. Where we have plans. We have great plans, and we have we have blueprints now. We have a new space that literally used to house the CEO of the hospital. That is where the hospital administration used to be. Faces the park. It's gonna have windows, it's gonna have glass, it's gonna have a beautiful entrance that is dignified. What do you see as one of the physicians who's gonna work there as what we need to be doing in a clinic? And what has henna been doing to better serve the needs of our patients in that clinical setting?

SPEAKER_02: 34:01

I feel, I mean, it's a golden time to be working as an addiction physician at this hospital right now, because I think the priority that the hospital sees in being able to treat people with dignity is really coming through in these new, in the new plans of where a new building will be. The fact that it is going to be close to, I mean, that really the epicenter of where people are entering the hospital, that this is a place that you are welcome, you are respected, and that we're gonna care for you. It makes a huge difference. You know, I think that where our clinic has been and the tours that we've given for people around, like people come through and and like scrunch their nose.

SPEAKER_04: 34:32

It's like you have US Congress members looking at the place and they scrunch their nose.

SPEAKER_02: 34:37

It's true. I mean, and it's like, and but and and in many ways, I'm I'm so grateful that they feel that way. Guess what? Our patients do too. And so, how do we create a space if we want people to feel welcome, to feel cared for? That physical space means so much. I mean, you were saying like it's gonna have windows. Our current place has no windows. So this is like that's a big deal to be able to do this and to be able to do it in a way that's so centralized and be able to really help us access and connect our patients to care in the larger places. It's very, very, very exciting.

SPEAKER_04: 35:06

I can't wait to see a hammer flying and nails going and paint going on the wall. That's gonna happen soon. This Hennepin Center for Addiction is gonna happen soon. So, Charlie, what do you see for the future? What is your hope for the future of addiction medicine?

SPEAKER_03: 35:23

It's two answers. Number one, we have excellent tools. We are just not consistently applying them throughout our system. So there's part of the future is just using the tools we have in a better way so that people have access to them wherever they go, so that people have really refined access to the best treatments and tools that we already have in place. So I think we would go really far if we just did that. If we just took our existing treatments and used them better. But there is a lot of research into new medications, new treatments. Um, there's a lot of excitement on the horizon. And, you know, they're just sort of throwing everything at the wall and seeing what works. And dozens and dozens of new pharmaceuticals are being tested for addiction. And I think we're gonna have some exciting breakthroughs in the next five to 10 years. Really game-changing breakthroughs. I'm I'm hopeful for that. So that's kind of where I see things going.

SPEAKER_04: 36:21

I'm gonna ask you both the same question. What do you wish every person listening to this episode would understand about addiction and recovery?

SPEAKER_03: 36:29

I think anyone struggling with chemical use, substance use, you don't have to define yourself as addiction. Find a professional you can talk to honestly and explore your options. I guess I would say that. And anyone who's a loved one of someone struggling with substance use, help them to the extent they're ready to be helped in a non-judgmental way to do the same. Find a professional who can hear them non-judgmentally and offer them options. And I think that that would be my message. What a great message.

SPEAKER_04: 36:59

Okay, I'd like to get your thoughts on it, Dr. Graeber, just like Dr. Reznikov.

SPEAKER_02: 37:03

I think if every person listening to this podcast, I think considered addiction with compassion and understanding of how it is a medical condition, so similar in some ways to long-term cancer, hypertension, diabetes, and that people are able to weave in and out of good times and bad times and times where their medications and are working really well, and times when it doesn't, that this is a place that ultimately it's an incredibly human space to be, and to hold that flame for people is incredibly, incredibly powerful.

SPEAKER_04: 37:35

I think that's a great message to leave us with. At Hennepin Healthcare here in Minneapolis, we have some of the finest physicians, advanced practice providers, addiction counselors, nurses, administrators who are helping us to achieve a future of addiction medicine. This is where it is happening clinically, scientifically, in research, and the communities of our state are gonna be all the better for it. I want to thank you both for being on the show today. Glorin, thanks for being here. Thanks so much for having me. Charlie, thanks for being here. Thank you. And thank you to our live studio audience. You have sat through. You have sat through our first efforts at doing this, and so I appreciate you coming out. And listeners, I hope you've picked up something that you found informative, and I hope you join us for our next episode, which will drop in two weeks' time. And in the meantime, be healthy and be well.

SPEAKER_01: 38:29

Thanks for listening to the Healthy Matters Podcast with Dr. David Hilden. To find out more about the Healthy Matters Podcast or browse the archive, visit healthymatters.org. Got a question or a comment for the show? Email us at healthymatters at hcmed.org. Or call 612-873-talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas at Highball. Executive producers are Jonathan Comito and Christine Hill. Please remember we can only give general medical advice during this program. And every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.