Speaker 1: 0:03

Welcome to the healthy matters podcast with Dr. David Hilton, primary care physician and acute care hospitalist at Hennepin healthcare in downtown Minneapolis, where we cover the latest in health healthcare, and what matters to you. And now here's your host, Dr. David Hilton.

Speaker 2: 0:20

Hi, and welcome to episode four of the healthy matters podcast. I'm Dr. David Hilton, internal medicine physician, and your host of the podcast. Did you know that one in 100 people in the United States is experiencing an opiate addiction and of those just a small minority are getting the treatment that they need today. I'm talking with my friend and Kyle colleague, Dr. Charlie Resnikoff about addiction medicine and the opioid crisis. I work in downtown Minneapolis at a large safety net hospital. And Charlie has been my colleague there for the better part of 20 years serving our patients in addiction medicine. But I'm gonna let him tell you a little bit more about that. So first of all, Charlie, welcome to the

Speaker 3: 0:57

Show. It's an honor to be here. Thanks a lot.

Speaker 2: 0:59

Great to have you here. Yeah. Uh, tell us, um, a lot of people don't even know there is such a thing as an addiction medicine doctor, how did you get into

Speaker 3: 1:05

It? Yeah. Wow. Great question. And I, I mean, honestly, reflecting on it, I got into this profession the way I, I sort of hope anyone would get into a profession. I mean, I just sort of followed my passion. I did what I felt I was doing well, and it really worked out well for me. So, but I do have a great story. And actually this involves one of your prior guests, Megan Walsh. When I was an intern at Hennepin healthcare in 2002, one of my very first patients was a young man. Uh, we could just, let's just call him Joe, that wasn't his name who came in addicted to heroin back in that day, two, two heroin was largely among men. Heroin use was among men heroin use in Minneapolis was commonly north Minneapolis, more likely African American. So this was a young African American man came in with heroin addiction, but he had a murmur. And so you always worry, does he have a heart infection endocarditis from his heroin use? So they admitted him to the, a hospital. He was assigned to my team and he didn't have a heart infection. He had a congenital heart defect, which is a whole nother, separate, interesting thing, but he, his heart was okay, but in just the day that I got to know him, I sat in hi, sat in the room with him. And I really like listened to him. And I realized, and I connected with him and he told me his, you know, in his life and how his cousin was a drug dealer and his cousin had sort of pushed heroin onto him. And he really was trying to do the right thing, but felt sort of trapped by his addiction. And my heart just really went out to him and he, he looked me in the eye and he sort of promised me, I'm, I'm gonna do it. I'm gonna get sober. Um, and we, you know, he left and I thought that was it. Um, or three days later, and Megan was present for this Dr. Walsh. Um,

Speaker 2: 2:48

And let me just for, for listeners to the podcast, you wanna check out episode two where I talk with Dr. Walsh.

Speaker 3: 2:53

Yeah. Right. Exactly. Dr. Walsh is amazing. Uh, so Dr. Walsh was one of my senior residents at the time, so, and we were just walking down the hallway and randomly a phone rang. And the, the Huck, the administrator for that, um, area of the hospital picked up the phone and sort of said, yeah, yes, really well. Yes. In fact, Dr. Resnikoff is right here. And she said, who happened to be walking off? And then shes like happened to be walking by and Charlie. And she said, Charlie, come over and handed me the phone. And I picked up the phone and it was this guy, Joe, and he was crying and he said, I failed. I used drugs again. And I, I, I don't know what to do, what should I do? And I realized that I who cared a lot about him and wanted a good result for him. I had no idea what to say. And I had no idea what to tell him. And he here is this young man who was crying, asking for help. And I was unable to give him help. And it, and you know, ultimately I don't even know what happened to that young man, but it was like my profession calling. It was, it was, it just pulled my heartstrings. I said, there be a better way. We must be able to help people like this. And, and then that was the beginning and I started seeking out knowledge and how can I help? How can I not let this happen to one of my patients again? And then when someone asked for help, I want to actually be able to offer them real help. Holy

Speaker 2: 4:13

Cow. Yeah. That's how you got into addiction medicine. But it was, it was

Speaker 3: 4:16

A really important moment. I mean, there was many steps, right. But that was a big moment for

Speaker 2: 4:21

Me. There's a ton I could unpack with that. Um, uh, and, and that's an incredible story. I didn't, I didn't know that because now I'll tell, I'll tell listeners what Charlie's deal is now. He's the, he, he is part of a larger addiction medicine program at Hennepin where we work. There are other doctors, there's counselors, there's all kinds of there's nurses. It's a large program, but I do have to say that you're sort of become well known, not only in our organization, but in the state of Minnesota and indeed nationally about addiction medicine. So that little moment that you had with that young man has led to a, a heck of a career in addiction medicine. Now let's talk a little bit about the disease of addiction. Yeah. If you could. Yeah, because back then you said it was heroin. And if I remember back then, it kind of was a lot of heroin, but there's, there's a lot of things people get addicted to, and we forget about alcohol and then there's amphetamines and all that. Could you give us a little PRI if you will, about the disease of addiction, is this, um, what's the state of it in the world today? Sure.

Speaker 3: 5:23

A addiction is many things. First of all, it is genetic, at least partially, um, probably 50% or more, depending on the study of risk for addiction is your genetics. And you just can't help that. Now some of it's also your childhood, um, trauma and your childhood event, it's in your childhood. Uh, and then unfortunately, exposure to drugs too early in your childhood when your brain is still vulnerable. So a, um, an untimely exposure to drugs, trauma in childhood mixed with, uh, you know, a little bit of bad genetic luck and, uh, an addiction will result. So that's sort of where addiction comes from. Uh, you know, about 10% of people are either have an addiction or are at very high risk. So about one in 10 of us, 90% of us walk around and, you know, we like alcohol, but we could take it or leave it. Mm-hmm<affirmative>, you know, we, we could even eye, we, we receive opioids for medical reasons. We could take it or leave it 90% of us, but 10% of us are pretty vulnerable to addictions. So that's kind of the general prevalence and there's lots of different drugs that people get addicted to alcohol stimulants, like cocaine or methamphetamines, cannabis, you know, cannabis, addictions. Yeah. Marijuana. Addiction's a real thing. It's pretty mild, but it does happen. I think there's

Speaker 2: 6:41

A whole episode about marijuana. I would

Speaker 3: 6:44

Love, I would love to

Speaker 2: 6:45

Talk about that. Yeah. Okay. We're gonna park that one because you know, you know, you know, that's like in politics, you hear state legislatures talking about, you know, this is completely safe and then any other say, it's like the devil's

Speaker 3: 6:56

Work, you know? Yeah. You're gonna, we're gonna need to get political on that one.<laugh>, it's definitely a really amazing topic to talk about marijuana, but he, you know, there's all these different drugs and, you know, and, and opioids is one of, you know, six or seven different types of drugs that can all cause addiction. So

Speaker 2: 7:11

Can, can we, can we predict who, who those at risk people are because, you know, I prescribe opioids all the time, just stick with, just talk about opioids for a second. You know, that's, those are the drugs that, that, that we use for pain largely in the hospital. And I've prescribed a certain number of those over the years. How is there a way to know who for whom it's dangerous and, and who's at risk for becoming addicted? Yeah. There's

Speaker 3: 7:34

No perfect way to predict it, but there are a lot of known for risk factors. So what you can't say is you can never tell someone, oh, you're a hundred percent safe. Um, what, and you, and you also can't tell someone, I know you'll get addicted. Um, neither of those statements, you can never really say that that's too much of a generalization, but there are risk factors that help us sort of predict this is a high risk situation. This is a low situation. So childhood traumatic events, bad things happen to your childhood that are unresolved, or just generally untreated mental illness, other addictions, if you're drinking too heavily using other drugs in an addictive pattern, you're also likely to get addicted to opioids. Uh, there's some other adolescents being an adolescent when start opioids is a risk factor, you know, and I think it's not that complicated. You, you have an addiction, you're an adolescent, you've got mental health issues. Um, or you've got past trauma. That's unresolved. Those are the big

Speaker 2: 8:33

Ones I would say. Did we always know this because I've been practicing it roughly, as long as you have, you know, I don't know about 20 years ago, I don't remember us hearing this. In fact, I remember going to get my medical license here in the state of Minnesota. And at that time you had to go there and you had to like, prove who you were and all that. And when you first got it. And I remember being told, they handed like a manual, here's some manual of what it, what it takes to be a licensed doctor in our state. But here's the one thing we want you to know. Don't under treat pain. Yeah. Don't undertreat pain. And you do that by prescribing opioids. And I remember that message 20 years ago, and I don't remember them saying, well, make sure that you're looking into addictions too. Just make sure that you give a lot of opioids. Is, is, was that your experience too? Is this newer evidence that, that you're talking about now about risk factors in the like yeah,

Speaker 3: 9:23

It's new, there's two things I would say about that one quickly. There was, uh, a couple years ago, an incredible expose on our board of medicine. And I, I work with our board of medicine frequently now, and I have a greatest respect for them. However, there is a history there of a relationship between all, almost all state boards of medicines and the lobby that controls at the pain, the pro pane lobby mm-hmm<affirmative>. So, and that, that was recently published in the Minnesota medicine journal. It's a, it's a local medical journal. Mm-hmm<affirmative> um, and that's a fascinating thing to read. I think anyone could read that and I can send you a link to that later if you want it. But I think one of the best things about being in addiction medicine now is it is such an active growing field for good and for bad every week. There's a new article and new information. So what I'm telling you, what I just told you about risk factors for addiction, they really have been established maybe four years ago, and it's just constantly new information, new science. It's a very exciting time to be in this field because we're making incredible advances all the time.

Speaker 2: 10:33

Now, you, you, you mentioned pain. And I, and, and I had talked about that. We're not supposed to undertreat pain. It is also true, isn't it that, you know, people who are at risk for addiction or are actually experiencing an addiction, they have, they have that illness, they also get pain, right? So isn't, it is a balancing act, isn't it? You know, we used to call pain the fifth vital sign because we had to make sure we asked every single patient who walked in front of us. Are you in pain? How do you balance

Speaker 3: 10:57

That? Yeah, there's a great, uh, article a year ago, or so looking at the pathways to addiction and there's five pathways to addiction. I don't need to go through all of them, but one of them is actually undertreating pain because the person is so suffering that they seek out whatever they can to take care of their suffering. Another pathway to addiction is overtreating pain. Mm-hmm<affirmative> so it's really a rock and a hard spot, right? Like, and then, you know, and, and so you can both create an addiction by neglecting pain control and by overdoing it with the opioids. And so it's not, I think it was harder than advertised prescribing opioids for pain. We need to do it, but we there's a sweet spot and we really need to always be looking for that sweet spot enough, but not too much. And again, it's the 10% that are vulnerable. The 90% of us that aren't vulnerable, just we have our surgery, they give us a bottle of pills and we use one pill and then we're done. And, you know, that's been my experience and I'm just lucky not

Speaker 2: 11:56

To be vulnerable. I personally had the, my most minor little surgery in the history of the world about 10 years ago. And on, it was an outpatient thing I was in there, like for an hour, just a little orthopedic kind of thing. And I got 50 Percocets to go home with. That's incredible. I mean, come on. Yeah. I, I think I took one of them. Yeah. I, I don't think I needed any, but that was kind of the, the era we were in. So I'm talking with Dr. Charlie, Resnikoff here on the podcast about addiction medicine and the opioid crisis. When we come back, I'm gonna ask you a little bit about the effect of the COVID pandemic on people with an opioid addiction and let's make that connection. And then I'd also to talk to you a little bit about sort of the stigma of, of having addiction. So we'll be right back.

Speaker 1: 12:40

You're listening to the healthy matters podcast with Dr. David Hilton, have a question or a comment for the doctor become a part of our show by reaching out to us@healthymattersathcmed.org. Or give us a call at six one two eight seven three talk that's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 2: 13:05

And we're back today, we're talking about the opioid crisis and addiction with my colleague, Dr. Charlie, Resnikoff Charlie. And I go way back. We've done a lot of, uh, traveling together. We've been into conferences together, and I've learned just a ton about addictions from him as have most of us at, um, Hennepin healthcare in Minneapolis. He's sort of our go-to guy. And so we're talking about addiction in the opioid crisis today. And could you tell us, Charlie, how has COVID 19 in the last two years affected the opioid crisis?

Speaker 3: 13:35

It is such an amazing story and great question. Uh, the one thing I have to say to answer this is, and many of the listeners may know this, but the way the opioid epidemic happened first, 20 years ago, opioid use was heroin use primarily in urban areas, more like men, more likely African American. Then we had the over prescription of opioid prescriptions, Oxycontin, and the rest people have heard about it. You know, then from there, it transitioned from prescription opioids to heroin and that, and, and most recently it's transitioned from heroin to fentanyl. So fentanyl is an illicit, highly potent synthetic opioid that is cooked in China, or at least produced in China and shipped to America. And then it's just, it's, it's highly lethal. It's very strong, but

Speaker 2: 14:30

It's a drug we use all the time in healthcare settings, right? It's,

Speaker 3: 14:32

It's used in the operating room, in the, in the intensive care unit, in very controlled settings. It can be used in some other ways like a fentanyl patch. Um, so it can be used in controlled ways in the medical setting. It's not an, you know, a bad drug in and of itself, but as a street drug being used and dosed by people out on the street, not knowing what the specific potency they're ingesting, it's very dangerous in that way. So we're in the fentanyl air era of the opioid epidemic. Now

Speaker 2: 15:03

Are people seek, you know, I, I honestly don't know this are people seeking out fentanyl specifically, um, uh, through the, through the whatever channels or are they seeking out something else? And it's secretly, they're getting fentanyl.

Speaker 3: 15:15

It's both, there are now people who explicitly want fentanyl, which to me is crazy because it's such, if you just take a little too much, you overdose, but there are people out there that explicitly want fentanyl, but there's also fentanyl is being adulterated into anything and everything. Um, if you think you are borrowing a Percocet or a Vicodin from your friend nowadays, it could be a counterfeit pill with fentanyl in it. If you think you're ingesting a different drug, whether that be methamphetamines would be the most common, but even people are saying marijuana use, sometimes those other drugs are adult with fentanyl. So fentanyl is literally could be in any drug you ingest. And you're not a hundred percent sure what it is.

Speaker 2: 15:58

Well, forgive my ignorance. Why? I mean, why, why are, I don't know who makes this stuff, but why, why are people adult adulterating cause

Speaker 3: 16:07

It's so it's so addictive that once then, you know, it's like, why did caffeine, caffeine is getting put into everything these days? Cuz once you get, we're both drinking coffee right now, once you get, get the appetite for caffeine, it becomes your daily ritual. And so that it's mine, you know, me too. And you know, there's worse things than caffeine use, but my point is you put fentanyl in everything and soon people are gonna say, Hey, what was that? What was in that? I thought I was just using marijuana, but I felt relaxed and good and different, so, oh yeah, I can get you some of that stuff. So, so it's a way of getting more people hooked. Um, it's also fentanyls just cheap, um, at, so anyways, let me get this to the COVID thing. Where in the world is fentanyl made Wuhan, China get out Wuhan. China is where fentanyl is made. So the early days of

Speaker 2: 17:00

COVID like, you mean the pharmaceutical fentanyl? Yeah.

Speaker 3: 17:03

So in the, yes, the substrate, the chemical substrates used to create fentanyl of any type. Okay. And so some of that was coming through legitimate channels to become pharmaceutical fentanyl, but some of it was coming through, you know, illicit channels to become street drugs. Mm-hmm<affirmative> um, and at the beginning of the COVID epidemic, suddenly the major sort of global supply of this potent addictive street drug got disrupted, cuz Wuhan got locked down and sudden everybody's drug dealer was out of, out of supply. And so you had to go to find new drugs elsewhere. So everybody was just scrambling early on. It's an amazing story about the COVID opioid epidemic is at the beginning, was this mad scramble. Who's gonna supply me with drugs and meanwhile, everyone's on lockdown. So you're scared to leave your house, your drug dealers out of supply, or has a new supply. And you're desperate. And that combination of isolation and D desperation and an unknown drug supply resulted in total danger for people, you know, for people who are using opioids on the street, they usually will use the same drug day after day from the same source, from the same source. And they have a general idea of what it's gonna do and, and they use with friends present. So if they use tumor, my much someone can help them. Now they're using alone, they're using new drugs. They don't know how potent it is from a new source. Also they're more desperate. So they act more impulsively. It's a

Speaker 2: 18:39

Perfect storm of perfect storm badness.

Speaker 3: 18:41

Yes, it was a perfect storm. And what, and on top of it, all, every hospital system has, was, and is still kind of overwhelmed. So it's hard to go to a doctor you're a little reluctant to go to the emergency room cuz the emergency room's full of COVID positive patients. So you're reluctant to go ask for help addiction treatment centers. They're all in person as group therapy. You can't do group therapy when everyone could have COVID there's no testing. There's no masks back in those early days. So addiction treatment got shut down. Hospitals were over overwhelmed. People were isolated. The drug supply was disrupted. I mean it was a perfect storm for the badness that happened and the bad and it was bad. And you can just see the deaths rise starting in April of 2020. It just jumped and it's just gone on, uh, is

Speaker 2: 19:31

It still at higher levels? Yeah, it's at, you're talking deaths from opioid

Speaker 3: 19:36

Overdose. Yes. That's from opioid overdose it. And in addition to that infections from opioid use, which we've seen in the hospital and other consequences of opioid use that have been, you know, very problematic, but that's is the most important one. Obviously it's gotten better in some, I mean the, the, uh, it, the number of deaths have gotten worse. Many of our systems have adapted to COVID. So now we are able to offer treatment by video visit. Um, now we have some new tools in place to try to help people, but yet yeah. So we've adapted to COVID the best we can, but was really a perfect storm for, for risk for these folks.

Speaker 2: 20:15

What do you tell your patients who are struggling with everything? You've just said they're, they're scared of COVID they're, you know, hospitals and clinics are open up now people can get into them, but I, I imagine that it's gonna be a while before we get, or, or people feel, um, where we're back to where we were even before COVID with treatments. So what, what do you tell your patients who are struggling? Right? Yeah.

Speaker 3: 20:39

I'm so fortunately, one of the wonderful things that happened from the federal government and, you know, again, to be bipartisan in this case, both Republicans and Democrats did this together, um, is they changed how we deliver healthcare. So I can literally take care of someone only with a phone call. If, you know, if, if that's the only way I can reach them, we can do this over a telephone. Um, we can do video visit. And we also, now at Hennepin, we have the capacity to have you come in in person safely with the masks. Um, and so you can come and go and get direct care without, uh, with minimal risk of COVID. Um, and it's probably safer in our clinics than it is on the bus on the way to our clinics, frankly. Uh, so we can now take care of people. And I would say, I, it you've, you know, I would tell the person you've been through a lot would validate that, but I would also say when it's time for you to seek care, it is there for you. It is now safe. Um, don't let, COVID be an obstacle, but other things about isolation, um, how can you find community around you? Because, and someone with an addiction, that's a risk, someone who's isolated, um, without social connection, that's a huge risk if you have an addiction. And so I would say, find your community, put, you know, healthy people around you. I would make sure they have a Naloxone, which is the antidote to overdose. And nowadays as of six months ago, again, bipartisan the legislature in Minnesota, passed a bill, which allow fentanyl test strips. So if you're about to use a drug and you're not sure if fentanyl is in it, you can now test it at home. Just like our at home COVID antigen tests.

Speaker 2: 22:18

Oh my God. We're gonna be testing everything at home. Yeah. We got pregnancy tests. We got COVID we got fentanyl test strips. Yeah.

Speaker 3: 22:23

But I mean, people don't know what they're taking, so it's a way of letting people know what they're taking. So, so

Speaker 2: 22:29

Say more about that. They test the drug. They're about to take, to see what

Speaker 3: 22:33

It is. Yeah. So like, if you know, I'm not condoning these behaviors, but if someone borrows a pill from someone else or someone wants to use a methamphetamines or a drug, that's not an opioid, a drug that shouldn't cause an overdose. A but they say, boy, maybe there's now there's fentanyl and everything. So maybe I oughta just test this for purity to see if there's fentanyl in it. And so they can now legally do that at home, uh, in Minnesota and the fentanyl test strips are out there. A number of organizations are distributing them. It's not a perfect test, but it does tell you if this potent lethal OB is present in whatever drug you're about to do. That's a,

Speaker 2: 23:12

That's a great development. Yeah. You, you touched on something. I wanna, um, some drugs are more addictive than others. Yeah. Tell us what are they, what are the, what are the ones that worry you most?

Speaker 3: 23:22

Yeah. Well, it's, it is not just the drug, but how you use them. And people might be surprised to know that smoking is the quickest way to get addicted because it goes from this drug outside your body, a drug in your hand, and then you inhale it. It goes to your lungs then to your heart, then to your brain, it's the fastest track from outside your body to inside your brain, inhaling something,

Speaker 2: 23:44

Inhaling exactly how nicotine gets

Speaker 3: 23:46

In. Exactly. And, and so three seconds it's in your brain. If you inhale it, I mean, it's quick. And so inhaling a drug is the, uh, smoking or, or vaping are the quickest ways to get addicted tobacco. Uh, maybe the most addictive drug there is it's still incre nothing is more well engineered than a cigarette. It is the most perfect tool, uh, in, they know how

Speaker 2: 24:15

Deeply you, you inhale. They know how much is in there. They know how often you're gonna, when you're gonna smoke your next one. That's they know all that.

Speaker 3: 24:22

Right. They know it, it is a perfectly engineered device for getting you addicted to tobacco. So a cigarette is truly a well-engineered addiction device. So,

Speaker 2: 24:30

So nicotine tobacco, maybe one of the, oh yeah. Most addictive things. What about alcohol?

Speaker 3: 24:36

Um, alcohol. So there there's, there are some great charts on this and I don't know if you have show notes, I can get you some of these charts, but the, the next one, let me, you go to the next one, which would be smoked methamphetamines or smoked cocaine. Um, those are next in line, the meth, methamphetamines and cocaine sort of go straight to the addiction center of the brain and boost dopamine, which is like one of the, one of the addiction, neurotransmitters. So they sort of directly hijacked the, a addiction center of the brain. So smoked meth, smoked cocaine, um, alcohol, you know, again,

Speaker 2: 25:18

It's probably the most used of all the substances, but so there's might be a lot of people who are addicted to alcohol, but there's a lot that are, yeah. The,

Speaker 3: 25:27

The most likely drug for someone to be addicted to is alcohol, but you know, 70, 80% of us drink. Um, and so the prevalence of alcohol use is really high. The availability of alcohol. I mean, you can get alcohol anywhere, so that kind of changes. So the total number of people with an addiction tobacco, I think is still number one, cuz tobacco's 20% of Minnesotans, maybe 17% by now of Minnesotans. And then more like 10% or 9% have alcohol use disorder. So in terms of like com how common is it? Alcohol is very common, but it's not as addictive as the smoked agents. Um, and then heroine would be, so we go tobacco methamphetamine, cocaine, and then heroin. And then on down the list would be something like alcohol and then even farther down the list would be something like marijuana, even though people smoke marijuana, it is less addictive, but it is still addictive. It's just less so

Speaker 2: 26:22

Related to that. Do people, um, who have a, is there such a thing as an addictive personality? In other words, do you know someone who might be addicted to, uh, opioids also might be addicted to gambling or sex or overeating or anything else? That's more of a, you know, a behavioral thing there is that a true thing?

Speaker 3: 26:41

Well, you know, we, we would always be careful about calling it a personality. I, I you're right, but you you're, you know, so we would be careful about that. There are definitely patterns, both people who have a single isolated addiction and that's it they're addicted to, let's say opioids. Um, and they don't struggle with, or they have alcoholism, but they can take their opioids just fine without problem. So plenty of people have an isolated addiction that doesn't cause all sorts of other addictions, but there are also plenty of people that have multiple addictions and there are all sorts of unique patterns. There is a pattern of gambling and alcohol. Um, so that, and what happens is they get sober from alcohol<affirmative> and the gambling gets worse. Hmm there's there's a pattern of eating, eating disorders and alcohol. Um, and as you know, and those two inter interact with each other in the same way, and then there are people that are, have multiple addictions or seem very vulnerable to many different types of addictions. There's the, the genetics of addiction is very complex. Uh, it's almost so complex that it's honestly not really useful because we haven't figured it all out yet. So we know that it's genetic, but there's probably in, in many, many patterns of genetic. Um, uh, I don't want to say defects, but genetic variations that can cause addiction there's many patterns of it. Addiction, vulnerability. Uh, so yeah, there are people that have multiple addictions. There are people that have addictions to substances as well as behaviors. And then there are people that have only a single addiction and it doesn't become anything else other than that one addiction.

Speaker 2: 28:18

So it's so, so are we okay with our coffee

Speaker 3: 28:19

Then? I I'm hoping. So

Speaker 2: 28:21

<laugh> most expensive cup of coffee I've ever had in my life. When with Charlie Resnikoff in Washington, DC, he wanted to introduce me to the pour over coffee or something like that. We walked all over all, all over DC and we found a cup of coffee. It was eight or nine bucks or something took like eight minutes to make an, I think it was the best cup of coffee I ever had. Um,

Speaker 3: 28:40

We were paying for the ambiance in the cafe. Oh, of

Speaker 2: 28:43

Course, of course it was all about the experience. Um, I'm talking with Dr. Charlie Resnikoff addiction medicine specialist at Hennepin healthcare, um, where I work here in downtown Minneapolis. Uh, before we let you go, Charlie, I wanna talk about the last two bits. I wanna talk about the stigma around addiction and then what treatments are available, where do we, it's still the case? Is it not that people are, are that there's a stigma associated with addiction, right? Comment on that, if you could.

Speaker 3: 29:13

Yeah, boy, I mean, there's a, so I have so many strong feelings about this. Um, the, the first is I feel that it is my job and it is our job not to wallow in frustrate. It is, there is stigma, but I don't wanna spend my time, you know, complaining about stigma. What I wanna spend my time is going out and educating and reversing the stigma and, you know, combating, combating it without complaining about it. Because I, I think sometimes we spend all our time, something doesn't go our way. And we say, ah, it's stigma, it's stigma. It's an, it becomes an excuse for failure. So I personally will never use the fact that this is a stigmatized de disease to be an excuse for me to throw my arms out and say, here we go again, here comes the stigma again. Um, because then we always feel like we're the, we're the neglected, uh, youngest child, the youngest child, we're the neglected youngest child, you know, whereas cardiology's the, you know, the big, the, you know, the, the big kid who gets the straight a glamor one. Exactly. Everybody, nobody questions, the cardiologist and people who have a heart attack, you know? Yeah, exactly. Always us. Exactly. So, but, but that said, so I'm, I'm always reluctant to go there, but that said, um, when, when we don't understand things as a society, when there's not enough education, we stigmatize it for sure. Number two, when we don't have good treatments for things, it becomes stigmatized. And I just think addiction medicine is in a spot now where cancer used to be like, used to not say the word cancer. Like that was a bad word, the C word, the C word, or you whispered it, you know? And, and the reason is because it was a really bad thing to have, cuz we didn't have treat nowadays. It's amazing. And it's getting better all the time. You know, oncology is amazing. Um, tuberculosis used to be called consumption. Right, right. Like it was a personality, not tuberculosis is just a disease, you know, and it, it, and it's a, it's a treatable disease. And um, depression, depression was very stigmatized and not talked about like, um, the Kennedy's sister rose was, uh, hot, you know, institutionalized for depression I think. And um, we didn't talk about it. And then, you know, whatever you think of Prozac Prozac and all of its descendants, all the new antidepressants now primary care docs can start taking care of depression more safely. And now depress just part of life that we can understand and talk about. But there was a process of this disease sort of our knowledge and our treatments of it grew. And as that happened, naturally, the stigma falls. And so I, I am confident that over time as, as our, as community knowledge and as treatments improve, the stigma is going to fall. But how does that help someone today? Um, you know, all I can say about it today is I treat all sorts of people from very successful business people, um, all the way down to someone who's struggling to find housing on a daily basis and is, has a lot of financial children, housing struggles. I treat the full spectrum, every race, every national background, men and women. It is a addiction is a very democratic opioid addiction is a very, uh, egalitarian disease. I'm not making it political. It's a very egalitarian disease. So it can happen to anyone that looks like anything. Um, and so it could happen to you. Um, but you can access treatment in a way that's private, confidential, protects your dignity in all those ways. So I wouldn't let your, uh, I wouldn't, I wouldn't have any listeners let their preconceived notion of who has an addiction affect their personal choices or maybe their ideas about

Speaker 2: 33:09

Their loved ones. And if any, uh, any of the listeners were so fortunate to get to see you or one of your colleagues, I know, uh, um, uh, the impact that you and your team have made here at, at Hennepin. And, and I know our healthcare systems, at least getting a little better nationwide. Yeah. I'm talking to Dr. Charlie Resnikoff addiction medicine specialist, and we've been talking about the opioid crisis, how it relates to COVID 19 and, and, um, addictions in general. Um, thanks for being on the show. Do you have a couple more minutes? Could take a question or two? Sure. Okay. So let's kind of jump to a little impromptu session of Hilton's house calls. That's the, the segments where I answer, uh, questions. And although I haven't, uh, kind of given you any warning, we have some questions that came in from listeners about addiction. Great.

Speaker 3: 33:52

Bring on. All

Speaker 1: 33:53

Right, guys. Now this is a question from Carol in Eden Prairie, and she's wondering Dr. Resnikoff, do you have any self help recommendations for anyone with their addiction or addictions outside of quitting cold Turkey, if they're opposed to getting professional help.

Speaker 3: 34:08

Wow. Thank you to Carol for such a thoughtful question. Um, again, Carol's asking what people can do on their own if they think they're struggling with an addiction. Yeah. I have a number of, of a number of things. The first thing is it is really important to have and maintain healthy relationships. So, you know, we all have unhealthy friends who take us out and we drink too much or whatever, but it's really important that we all maintain our relationships with healthy friends, sober friends, friends that you can do sober activities with. So how can you continue to have connections to healthy people in your life? People who care, the people who love you and care about you, regardless of whether you drink or not, or regardless of whether you use drugs or not. Those are the people that are gonna be your foundation going forward. So keep your connections. I think that's number one. Um, number two, who triggers to use drugs, come in one of three varieties, number one, um, people, places and things, um, objects in the world that trigger you. And that could be an individual that could be driving down a road. You see your favorite bar and you pull over and go into your bar. Maybe just don't drive down that road. Um, that could be, if you, you smoke marijuana, the pipe, if the pipe is sitting out, you're gonna wanna fill it and use it. So remove those objects that trigger you. That's number one, number two, unwanted emotions. So you're anxious, you're stressed. The holidays do this to people you're anxious. You're stressed that distress, unwanted emotion you have, you don't know what to do with it. So you use drugs. So start developing other techniques to manage that unwanted, those unwanted emotions and the final sort of at home tip. Do it yourself. Tip is being self aware of your thoughts because we talk ourselves into things. If it's food for me, oh, I'll just have a little bite. I'll just look at that brownie there. I have no idea what you're talking about. I'll just, I'll just cut off a quarter of the brownie. I won't eat the whole brownie. Well, you know what, I'm talking myself into it, but you know, if we can talk ourselves into something, we can also talk ourselves outta something, but we need to be self aware of what our brain is doing our narratives in our mind. So I would say people, places and things, managing your unwanted emotions and managing those that self-talk you do that lets you talk yourself into or out of an unhealthy behavior. Do those things and stay connected to your community. Read up on addiction from rely resources. I think that would be a good start. Some of those are tips for all of us. Yeah. Those are are good tips. Yeah. It's, addiction's really about managing reward. Um, how do you get rewards in your life and are you seeking and receiving rewards in a healthy way or an unhealthy way? And that's true for all of us, whether, you know, whether we have an addiction or not, um, we all, you know, need a little joy in life. Um, hopefully that joy comes in in a, in a healthy package.

Speaker 1: 37:05

Thanks for that. And here's one from Tina in Woodbury. I recently had knee surgery and was prescribed oxycodone. It is helping with the pain. However, I'm curious about how much I should be taking and how long I should be taking it for I'm leery of addiction. Is there a certain guideline or rule I can follow to help me?

Speaker 3: 37:24

Great. Yeah. This is a great question. First of all, knee surgeries can be pretty painful. So that's one where people are routinely put on opioids and that's that's okay. What's oxycodone. Oxycodone is a standard opioid prescription. It's pretty universally, you know, there's not a lot of drug interactions. There's not a lot of precautions around it. It's a very standard opioid pain medicine to be prescribed. And, and, and it's the active ingredient in Percocet, right? Yeah. And Percocet, it, you know, it's actually the active ingredient in Oxycontin, which got a really bad, of course, for separate reasons. This oxycodone you've been prescribed has not got the same risks as a high dose Oxycontin pill that caused all those problems. Um, you know, I think most surgeons would say at least the first week, um, you're gonna be taken some, uh, some oxycodone, I think also to be self-aware that if, if you have a personal history of addiction, it might be a little more of a risk. Not that you shouldn't take any, but you just need to be self-aware of the risk. If you have a personal history of a mental health issue, such as anxiety or depression, and it's symptomatic for you now, like you're really anxious or depressed right now, there's a little more of a risk. Again, you can still take these meds, but you just need to be aware. Um, and then, you know, I, I think finding a timely way to discontinue them is gonna be a judgment call on your part. And it'll be a little bit of trial and error. And most people who don't have an addictive history who don't have an untreated mental health issue are gonna be able to navigate that just fine. They're gonna be able to trial and error, try off of them, see if they can get by off of them and basically take themselves off at the appropriate time. If you do have some mental health symptoms or some addiction history in, in yourself, or maybe a first degree relative, you might need the guidance of a primary care doctor, or even the surgeon to say, Hey, it's time to stop. And I, I would just encourage you to really have open dialogues with your providers if you're worried it's going on too long. Um, but yeah, if, if it's working for you right now within a week of the surgery, for sure, maybe a little past a week of the surgery, use it. If you need that, do some trial and error on whether you can get by without it, uh, and, and trust yourself in that way. I would say, I like what

Speaker 2: 39:46

You said about sort of the mindfulness bit, you know, don't just mindlessly take it, um, on some schedule indefinitely, you know, after a few days or a week or so ask self, is this the time when I can start? When I don't maybe don't need this,

Speaker 3: 39:59

Actually one of our colleagues, Dr. Shao, maybe you I'm sure you've spoken to her in the past. She has incredible advice for people taking medicines of all sorts before you take that pill, whatever it is, pause and be mindful. What is this? Be grateful that medicine is a solution for you, but also be mindful of it. And I just think that's such great advice. That's outstanding

Speaker 2: 40:22

Advice, Charlie. Here's an interesting question.

Speaker 1: 40:25

All right. This one comes from Jose in St. Paul. He has a question about CRAO and was curious if you have an opinion about it or other drugs that are considered to be sort of an offramp from some of the heavier drugs.

Speaker 3: 40:37

Wow. Great question. UMRA is, uh, a drug that activates the opioid receptor. So if you struggle with opioids, you might equally struggle with Kram. Um, it is currently available people get it on the internet, people get it from, you know, smoke shops, things like that. Uh, it's not anything that we would recommend, honestly. And the reason why is because we have a few medications that have really good evidence in science to help people either wean off or just beyond maintenance that said, we understand that people out there in the community are trying these things. So it, it's kind of one of those it's, it's, it's new, there's not a ton of science on it. It is a mild opioid. So you are still on an opioid. You're just on a milder one. So if people go about doing that, you know, so be it keep in mind that there are scientifically proven evidence based type alternatives to it. And also keep in mind that some people do have a problem with cram as well. So, and that, that's kind of what I would say to Jose, um, is to, if you're going to proceed, proceed with caution, uh, understanding that this is sort of a bit of a home remedy and not within the world of medicine, seems like

Speaker 2: 41:54

Pretty good advice to me. Yeah. There are

Speaker 3: 41:56

Things that work, there are things that work. Um, and the only other thing I would say to that is if you're really struggling with opioids, you know, there's not a cure. IFRA was a cure. We would know about it by now. So there are treatments, but if you look, a lot of people are looking for an easy a cure and, and that's just, it's just not out there. And anyone promising you an easy cure, just do this one thing for, you know, three weeks or a month or something, and then you'll be cured and done with it. Move on with your life. Well, you can try those things, but also you have to be a little skeptical. This is a, this is a hard disease to cure, but there are, there are treatments for it.

Speaker 2: 42:33

Thank you, Charlie. I've been talking with Dr. Charlie Resnikoff, he's an addiction medicine doctor at Hennepin healthcare here with me in downtown Minneapolis. It's been great having you on the

Speaker 3: 42:42

Show. Thanks a ton. Oh, it's been awesome being here. Thank you. So

Speaker 2: 42:45

That's all for today. I hope you'll join us for our next episode where we'll answer the question. Has anyone ever died of a broken heart? We hope you'll in us. And in the meantime, be safe, be healthy and be well.

Speaker 1: 43:00

Thanks for listening to the healthy matters podcast with Dr. David Hilton, to keep up to date with the latest in healthcare and your health. Subscribe to this podcast on Spotify, apple, Google, or wherever you get your podcasts for more information on healthy matters or to browse archive, visit our website@healthymatters.org. And if you have a question or comment for the doctor, email us at healthy matters, HC M E d.org, or give us a call at six one two eight seven three. Talk to catch all the latest from Dr. Hilton and the healthy matters podcast. Follow us on Twitter at Dr. David Hilton. If you enjoyed this podcast and would like to support us, please leave us a review and share the healthy matters podcast with your friends and family. The healthy matters podcast is made possible by Hennepin healthcare in Minneapolis, Minnesota, and engineered by John Lucas at highball executive producers are Jonathan Camuto and Christine Hill. Please remember we can only give general medical by during this program. And every case is unique. We urge you to consult with your personal physician. If you have more serious or pressing health concerns until next time, be healthy and be well.