Mother Knows Death presents External Exams with Nicole and Jimmy.
On our first episode of Mother Knows Death, we talked about the death of Matthew Perry and this week his autopsy report was released, and since he had such a big history of addiction, I thought it would be perfect to talk to my friend doctor Bruce.
Hi, doctor Bruce, how are you good to be here?
Thanks so much for being here today. I first met doctor Bruce doing his podcast. Actually, I was on an episode of Weekly Infusion. That's when I first met you. And then you came to Philly and we went to the Motor Museum together. That was fun.
Wow, was great.
So let's tell them a little bit about your history. You have been an emergency room doctor for a majority of your career. And how did you get into addiction? How how will not addiction yourself into the specialty of addiction. What was it that was intriguing about that?
I mean, that's a good that's a good statement. How to get into addiction addiction medicine, most people are either codependents or recovering, So I was in the codependent. I got some great codependency stories. But anyway I was I did internal Medicine Training residency took boards and immediately during residency. This back in the eighties, there are a lot of guys that were like gung ho for excitement, moonlighting and
emergency department. So I was out in Riverside, San Ardanino County and there were a group of u sweek moonlight at Riverside County Hospital R And then once the I finished internal medicine pass boards and then some of the people at Loneo and said, hey, let's start an emergency medicine training program. And so it's like back then there weren't that many residencies it was in. It was sort
of a new area of sub of specialization. So we started the residency program and we had to pick an area that to teach, and I thought, well, drug overdose and toxicology, that's great interesting stuff. So I went to some meetings at UCLA. This is about nineteen eighty five, and the first lecture was I don't know if they called it sex, drugs and rock and roll, but it was a doctor in Addiction Medicine talking about youth culture
and adolescent addiction. And I was like blown away as I came there here about boring drug I mean, you know, not boring drug overdose and toxicology. And then this guy's talking about you know. You know at that time, the Grateful Dead was still touring and they had the docs that went with the Grateful Dead, and you know, and then you had it was all. It really meld the youth, culture, music, all these interesting things together. So I went up at the end of the lecture, I said, what is this
addiction medicine thing? And so I sort of started. I had some training, and I got a position doing addiction, adolescent addiction medicine out Redlins within a year, and I did it alongside of emergency medicine along the way and work with some great people at USC Adolescent Medicine Department and met Drew, doctor Drew. That's why I met him with k Rock and I was sort of his fill in by virtual keeping my mouth shut when he did love line for decades. And that's it and it's still
to this day. So I don't do emergency medicine anymore. I quit dury COVID because I'm not a first responder hero. I wasn't a hero. I was a whippie guy. But I'm doing a ton of so I do addiction medicine
for a large medical system. I'm still out in Redlands, Riverside, and a lot of what I do is around oh biate addiction use disorder they call it, and chronic pain or both, and use of bubernor feed or sab box on sebuitechs, which sort of segueing back into the webtopsy taxicology report on Matthew Purriy and coincidentally, you know, ketamine
is just coming to the UH. It's very popular for treating resistant depression and for chronic pain, and you know, looking at that whole receptor system and addiction, lots of exciting things happening. But since his report, I've gotten some I have a lot of chronic pain patients that are on buporphene, sabasa and Sevitech's transfer UH chronic pain, and they also get treatments with ketamine. And so some very very concerned patients, So like, oh my god, am I
gonna die? I'm getting my ketemie fusion. I'm on pupnorphy so and we'll get we'll.
Get into that because I have I actually have a lot of questions about that combination and if that's a common thing. But we'll we'll get into that a little in a little bit, but first I wanted to get started with just the basics of addiction because I don't really have anyone in my immediate family that struggles with addiction, and including myself either, so I don't know it on a personal level, so I do have questions about it.
I'm a parent. I know you're a parent too, and one of my biggest fears is like one of my kids is going to grow up and fall into one of these addictions. And I guess my first question for you about that is is this something that could happen to anyone? I mean, Matthew Perry said that when he was fourteen he started drinking alcohol, and by eighteen he
considered himself like a hardcore alcoholic. Is this something that could happen to anyone or do you think that there's some kind of like predisposing factors that make a person more susceptible to addiction.
Yeah, certainly there's biology, right, So first, if your father or mother alcoholic or first degree relative, and then there are issues with exposures. So if somebody starts drinking when they're fourteen, if they get if they have the availability of alcohol or drugs and they start using them, then you you know, then you stop the psychosocial development. You arrest that way, and it's a matter of becoming something
that's you know, that's routinely done. So I mean, adolescent's a great thing to talk about because if you have a very structured existence, if you're you know, if your home every evening and your parents are where what you're doing, and they know your friends parents and keep tractiving and you don't have that exposure. But what did it amoss to. There's you know, there's junk science around brain scans, but
if you look at people. They did a study where they took and this I'm just sort of generalizing it, but say twenty young adult males and they had a control group who had no first year rol as a were alcoholic, and then a group whose fathers were alcoholic and they were not yet really drinkers, got them all drunk, stuck them in a functional in orife. So we know the area of the brain the lights up with cocaine and her in the reward area in the midbrain. And
and it's statistically significant proportion. The first the sons of alcoholics had a lot more activity there. So I mean it's you know, it's sort of a gross representation of the biologic nature of it. But if I don't, you know, you can both be sitting having a couple of beers or whatever age and and what do you ask the other guy? Well, what does it feel like to you? And so you know, one way is to look at what part of the brain, you know, amount of dopamine release,
sorta tallerant neurotransmitters, activity in the rewards center. So we know that there's a different of there's a different reaction or activity from alcohol. So the fourteen year old like Matthew Perry, I don't know, is you know, And again, if there's a childhood trauma, if there's sexual abuse, physical abuse pre adolescence, that's another risk. There's a bunch these different riskpects. So there's no one one addiction, there's no
one addiction gene, but certainly the biology is there. And then if you figure, you know, I've had patients to say the first time I got drunk as a teenager, I knew that's what I'm you know, it was just like I never felt normal until that point, and I immediately and is often going after whatever substance it is, So that's a breaking and then it go ahead. So that's a very roundabout way partially answering your question.
Well, my question is, especially talking about that particular study, do you think that there could be some aspect of it not being biology but just nature, just just being around a dad. You saw your dad drink their whole life, and maybe some sort of center lights up in your brain because it makes you think of like a positive experience when you were a child or something.
Right, so you know there's conditioning, and certainly that would and then a dad that drinks with a certain effect or is you know, is the a binge drinker and abusive intermittently or is he a daily drinker and abusive every day or neglectful. It's so complex, but we know the you know, in the and then again what about bonding the first couple of years, attachment theory, So these things all come into play, and there's no doubt separating
them is difficult. But you're right, there's the there's pair of parental modeling, and then there's the genetics there and then there's the exposure. Pretty complicated, right, So do.
You feel as if any drugs I mean, I sound like a commercial from the eighties when I was growing up. But do you feel that there's like gateway drugs, cigarettes, alcohol, or anything that starts a child because you have children that eventually turn into one of these addicts. Is there some kind of like predisposing thing that you might see prior to an addiction starting.
You know, again, it's that mood alterar effect. And obviously anybody that gets cocaine or heroin or methamphetamine and depends how much, but I mean get you're going to get that immediate rush and the euphoria, and once that part of the brain, the lizard I called the lizard brain, recognizes that, then you know, is it going to be available the next week, is it going to be a
year later? Because adolescence is a time when you you know, there's there's no rehabilitation if you haven't abilitated, if you haven't had the normal development that occurs. So the exposure piece of it again is if if a kid's is there a gateway drug? I say, whatever? Drugs like for me, I tried pop when I was fifteen. I hate it. It's like just and you know, it was not something I was going to get addicted to. But you get a kid with the biology where they get more you know, dopamiricus,
whatever it is that causes there's some euphoria there. That's going to be a gateway drug. So to me, it's at that age if you start having reward and euphoria from something that cut it's like if you if you just like with with sel, what's the problem with smartphones, what's the problem with online gambling? Is that immediate dopamine rush, whether it's you know, and kids watching what's the average agent for a kid watches porn in North America eight years old?
That is that real?
Yeah, I believe that's right, And I'm sure, I'm sure you know, I'm sort of generalizing a lot of stuff. But the bottom line is the more immediate the responses to a stimulus where you get dopamine, you know whatever dopamine make release of you know, these pleasure neurotransmitters, the and if a kid doesn't have uh, you know, they haven't built up any defenses, they haven't learned to, you know,
fend for themselves in difficult situations. You know that that growth the process of the three stages of adolescents early adolescens mid late. If they can't get through that, they you know, the student, the earlier they start, that's sort of where your psychosocial development arrests. So it gets very complicated. It's like a dysfunctional home, a using parent, pre adolescent abuse. No. I mean a lot of therapists will say, well, how is you know what what went on during your mother's
pregnancy with you? You know, was was it a veray? Was there a lot of stress? Was there high cortisol? All kinds of ways of looking at it to put you at risk. So but to me, I you know what's the worst drug. It's the one that the kid starts using in this day and age, I worry about poisoning. Right, It's like fentanyl, car fentelso, feneral, whatever these things are out there, these are there's this whole other uh, their expanse of risk that comes from just being exposed one
time in dying. So that that's the you know with my kids they're a little older now, but even even in their twenties, I say, look, it's one dose. You know, you go to a party and somebody says, hey try this pill or you know pot there's disagreement. You know that whether there's ventanyl in pot but definitely in cocaine, definitely any any pill you get, the x annex, the norcos,
the the oxycons. These these people there, whether they're cartels or whoever's selling drugs, they have pill presses that make identical pills to the pharmaceutical but they throw fentanyl in there. So that's the one thing with that I don't think we thought about as much prior to this whole fentanyl scourge is poisoning. And so how many kids they go to a party and friend says, hey, try this, you know, it's like they're dead.
Well, I think that's why I'm so scared because I was that kid, right like I've done. I did all that stuff when I was a teenager, and never like my older daughter she is, she's just a very she listens like if you say, don't try jougs because you can get you can get killed and stuff. She she listened to that. But I was that kid that was like, that ain't gonna happen to me. That's what's that's what's scary. Because you hear about this all the time on the
news and stuff. Parents just so distraw obviously because their kid wasn't even doing drugs really, just like trying something and they just died taking it once. It's so scary.
Yep. My friend of mine is mom. She passed away. She was like one hundred and one. But there was a delay of putting your plaque up or something. So they were at it wherever, you know, the cemetery of the Morchwark and they were at the marketing person's desk for something. But she said they had some sort of a video and it would show a picture for a few seconds and then the next one of these are people that had passed away. And she's a she's a
nurse and her sister was had a substance issue. So she was very, uh, you know, curious about all these young people that she saw. And they were sitting there for half an hour, she said, just constantly, and she said, you know, it seems like a lot of these people you have that have come through here or buried here are young. And they said, there's she said, it's just unbelievable how many young people come in with you know, drug,
fentmol overdose herself whatever. It's just but I hate, you know, pot. I'm pot is just it's it's no longer pot I mean, cannabis today is so potent, and it's there's so much disregard for it, and that's so what's you know, there's it's different now that it was when when it's you know, the eighties, things started to change when the cannabis, you know, all these strains that are and then the wax ninety percent THC. It's just a different it's a different actor and affixed brain development.
It. Oh. I had a situation with with edible weed that I I have never and I've tried some things in my life when I was younger and then I haven't. I haven't done anything since the nineties and except weed. And I took an edible weed too much of it, I guess, and I was like tripping, like I was on acid or something. It was insane. I thought that I was poisoned. It was. It was the most surreal experience and I'll never do it again. Obviously scared the shit out of me.
Yeah, well, you know, it's definitely it's definitely a different scenario than what was it. In the John Lennon's Harmless Giggle that he talked about pot it was like point five percent THC and you compare that to who knows how much THAC is and somebody l you just don't really know what you're getting.
But oh yeah it was I was I was like hallucinating. It was terrible. I didn't even know that we could do that to you.
Yeah, it's technically a hallucinogen. Yeah, and it's one of those things when when kids start doing that, when they're thirteen or fourteen, it's you know, the future is not very bright if you're smoking that kind of the view use that kind of pot every day.
Right, So yeah, it's definitely can't be good for your brain. So you you deal with all different kinds of addictions, but you you really you specialize in the opioid addictions. How as far as percentages of your patients go. Is that the most frequently used drug that people tend to abuse nowadays?
Well, you know it's still in high school, it's still alcohol, cannabis, right, pot and alcohol is still still almost common. Cocaines made a resurgence ketamine abuse, you know, specil k there's you know, it just depends in the age group. And you're getting so much more news worthy stories about fentanyl again the overdoses, the poisoning. But we see most in the hospital system I am. We're seeing mostly adults. And the question I have it's like, it seems like there's just much disregard
for alcohol and cannabis products in teenagers. I know, you know, a few decades ago, I was seeing a lot of kids coming in for alcohol and pot problems, and I don't know if they're graduating more rapidly to the you know, to methamphetamy and cocaine. But I just I don't see the referrals in our large medical system. So I'm seeing tons of adults and still you know, the older adults a lot of alcohol and the you know, a lot of opiate patience. See, part of it is retention and treatment.
So there's an opia called bupin orphis the box on Seviitex's ub solved, various names for it, and it's used you give it on a daily basis to alleviate craving. And those patients stay with you, so we see them every month every two months for refills and and they're retained in the program. So you know, with other drugs, generally you get them into treatment, they start working a program, you know, and you don't continue to follow them, so
you build up a lot of the opiate patients. It's it's much longer term.
So a patient would come to you that was either addicted to pills or even heroin, and the part of their treatment is for you to give them this drug that's kind of is it to kind of like wean them down off of it.
So bupernorphine is an opiate, and it was discovered in the sixties and trial. It's semisynthetic. It's derived from debane, which is part of something come out coming out of poppy plant, and it was trialed in the seventies. It was released in like seventy nine or eighty over here for pain. It was another pain opiate. They did didn't really know what opiate's where opiates went in the central
nervous system. They didn't discover the first opiate receptor until I nineteen seventy six, and then it was like, oh, this elop it's work. They'd bind to this receptor I think was the MWe receptor was the first one. And then in the eighties and nineties, much more understanding of different opiates worked more different parts of the brain, and this one buper and orphine. They noticed it had much less activity in this in the cent the brain, mid brain,
minimal binding in the respiratory center. The you know, all opiates, it's not really talked about much, but opiate suppressed the immune system. They decrease the hypothalamic pituitary axis that makes like testosterone. They decrease testosterone. And those are big things immune suppression, respiratory depression. And it turned out the buper and orphine had minimal like is a sole agent. If I if you put an ib in my arm and gave me more than the maximum dose, I wouldn't stop reading,
which is crazy for an opiate. If you add alcohol or you know, a value or something, it's a different story, but it's it's basically it's much safer. So they said, and if you have an opiate addict and they commit to treatment, you know, you could offer a method all which is a potent opia. They have to go to a clinic ticket every day to alleviate craving. They said, why don't we release this dupern urphene in a higher dose.
Four practitioners in their office can dispense it, and ideally you have the patient go to you know, night twelve step meetings, they have a therapist, you follow them every The recommendation at first was you see them every two weeks and every four weeks, but it was to alleviate craving and it didn't go to the rewards center. So this has been out twenty plus, about twenty one years, and it's it was very controversial at first because what people in the recovery field would say is duper and
orphiene suboxol subtexts, subs. You're giving an opiate for an opiate, you're not really clean and sober. And there's a lot of argument, how can you tell me that if you're giving an opiate to someone, they're not getting high on it. But a lot of studies were done and it and they determine the retention and treatment. There's huge difference in retention and treatment and the you know, the the overdose debts.
So basically right now, the standard of care is like one to three years on syboxa rebup and ORP or more when the patient's carefully monitored. And it's that's so an addiction medicine. When you're treating opiate addiction, can you take this it's a sublingual form. It's a it's a film or a tablet put under your tongue and could you take that and inject it and get high? Well, you can get high injecting ben a drill. I've had
patients that snorted prozac. I mean, certainly it's an opiate and if you misuse it, Uh, there are issues, but it has it really is revolutionized. And the reason is again I'm still totally totally behind. I tell my patients it's almost a requirement you have to go to work a program. You need to address issues in therapy depending on the patient, but definitely twelve step is a foundation.
But what this type of thing buprien orphin does is when once somebody has an opiate addiction, then what we find is the the the mid brain, the part of the brain that tells you to breathe when you and tells you to heat when you're hungry, drink when you're thirsty, the emotional areas, the messages when they once you have programmed those areas to get the opiate when they don't get and when you stop the messages up to the cortex and you can you could look at brain activity
on a functional MRI, and you can see when someone's in withdrawal, what's happening is there's a tremendous powd of nerve firing up to the cortex basically, which is what withdrawal is. It's the anxiety. It's you know, besides the the opiate withdrawal where you have diarrhea and vomiting and
abdominal physical symptoms. But you know when people say they don't have a choice, well, certainly everyone has a choice, but there's so much intense activity from it's almost like when some they've done studies look at dopamine levels and people that are detoxing from methem fatamine cocaine, and they've compared to people that are starving or are water super water deprived, and their dopamine levels are actually lower when they're when they stop or run a methamphatamine or coke
or opiate. So what is the drive to get water when you're water deprived or food when you're food deprived? I mean it over it's it sort of supersedes all other anything else you want to do. And that's the impetus or the stimulation from the mid brain up to the core tex the executive function area when some So it's not an excuse, but it's an explanation when some one becomes addicted and they use larger and larger amounts. When they stop, they're almost like a decorticated animal. That
executive functionary is not making the choices. So that's the beauty of bu periorphy for me, is it allows the individual. It sort of shuts off that you know, lizard brain overdrive to get the substance, and the person needs to take steps to maintain sobriety and they need to work a program and replace the time and energy they're spending getting the substance and being loaded with other activities. And but that's I think today it's pretty pretty well. It's
even in the twelve step community. It's much more accepted using bupern orphine for for opiate addiction. So and that's where you know, the I didn't treat Matthew Perry. And you're not supposed to diagnose or be the doctor for people dead or alive. But you know, I've gotten calls from patients that are you know, they're on bupernorphine. They had there was pupernorphine and the guys forensics and then the care atamine and you know, I'm not sure what else was in there body.
Well you were saying that with with withdrawal, there's physiological symptoms as well as you have these depression, anxiety and things like that. So he apparently he was given the ketamine treatments because he was having like severe anxiety. And is that is that something common that would be given to these types of patients is additional kademine treatments.
Uh so, I okay, So ketamine is It's not controversial. It's just there's a feeling that it's you know, like for anxiety my understanding and the way our medical organization does it. I mean for treatment resistant depression when nothing else has worked. They've even been studied with somebody is suicidal giving the ketamine infusion and again and then also for on pain patients, right, And there's the anxiety thing. I don't. I don't give ketamine there. I do work
with a lot. The other thing I do. I work with pain patients that are on opiates and their primary care wants them all for decrease whatever. And there's a bupert arphie the subox and is a higher dose for bupert arfine sort of first line if somebody needs a daily opiate. So I think he was on it for pain and addiction, but using it for anxiety. I don't really understand that that's a bona fide indication. Triguer is a resistant depression and chronic pain are pretty established, certain
kinds of chronic pain. But but in his case there's first of all, the the infusions that are given for pain and depression and the amounts that were found in this nothing to do with he had huge amounts in his system, like a week after his last his last Kenemy infusion, so those infusions are much lower dose. I think he had pulls in his stomach. There was abuse. So the problem with addicts if you find that something seems to feel good and work at a low dose,
then why not take ten times more. That's sort of, you know, the problem get into. I don't know all the details there, but the use of ketamine certainly, I used to be a doctor of raves and they'd have a tent and specifically people ken of means much safer. It doesn't affect a respiratory drive that much. You know, when you first give the injection, it can bump up your blood pressure. There they are various issues, but as far as you're breathing, it's it's not a respiratory depressant
like other like things like opiates. But when you mix it with you know, even though like I said, you put ourphans in opiate, it's it's quite safe in terms of respiratory depression. But when you start he I think he had some benzos like out of Banner Clowd opinion your system when you put other when you mix these things together, and then his ketemy was very high dose, then you that's when you get into real promise whether
he had cornary artery disease. When you use a lot of ketamine, you can you can spike the blood pressure, even get an a rhythmia. I mean, I Ketemine is a great thing for setting bones. It's a short acting thing. But I know when I in er days, you'd have somebody on a cardiac monitor and O two censor you'd have you know, I mean, it was like a critical care bad they were in it.
And so that's when you would give it. When like if someone came in with a broken bone and you were trying to put it like something that you had to put them in an extreme amount of pain just to get them to like not be paying attention.
Yeah, propafall, milk, milk obamnesia, you know, the white stuff like those are much safer and kennemine. You know. The residency training program was on in the nineties. I think we're the first. I was just part of the faculty group, but we were probably one of the first people to
use it. It wasn't being used until the nineties and we started using it for the first study trial we did was for pediatric anesthesi in the emergency far because it's you know that the immersion phenomenon where you know, adults get it and they when they're coming out of it, they they have nightmares and they have to be sedated and stuff. Kids don't really have that Sowhach and basically
there's some secretion issues. Initially it's a very safe anesthetic, okay, but the anesthetic dose is much higher, you know what you're using for for depression and stuff like that. It's like, I don't know, half milligram per kilogram and then for IV and then for uh, you know, for the dissociative state you're up. You know, I don't know, two to four milligrams for killing. It's it's a much higher dose IV.
So when he was going to get infusions, obviously you weren't treating him. But if he was to get this like therapeutic low dose, would he feel high at all from that? Or that it's so low you wouldn't really even notice.
No, it's mood altering. And I've talked to some patients like the way it feels. Others are very uncomfortable. They don't like the way it feels feel they don't like the way it feels at all. And again, you know k holing. It was sort of a rave alternative drug, you know with m d M A raves and people would snort it and take it in pills, but those were usually much higher doses, and it was it's sort of like when you think of you know, PCP, like dissociative,
so you don't feel connected to your body. You could do anything to the body and you don't feel it because it dissociates your brain from the body. So it's that kind of ketamine PCP very similar. So when but what I'm saying, yeah, and I had a I have some very bright patients and I have some very down the line into the road with chronic pain patients and they have a lot of questions and I won those considering amputation and you have a very sort of a
rare cup CRPS complex regional pain syndrome. And he's looking into everything possible, but you know he's concerned with academy. He goes, you know, I don't want to get a lot of people say I don't want to get addicted, and you know, if it feels good, am I going to want to do it? Or there's the way it's given medically? You know, it's certainly a possibility, and if someone has an addiction history, it's not something you know, you have to be very careful with it.
Yeah, that's what I was wondering, like why if someone has such a strong I mean, he had such a strong history of alcohol addiction and then the opioid abuse that why would you Why would you give them a medication that's known to be abused. I guess that was one of my questions.
But you know, I may be ignorant. I don't know. I really don't know why they were giving it was it was he in such a state with his depression that it was considered sort of a last resort. Was it for some chronic I think, I know, I assume you had chronic pain issues, and yeah, I mean it would be a considerate, it would be something to take into consideration.
So his assistance said it was for a for depression and anxiety. But yeah, I mean he you know, he had multiple surgeries because he had val obstruction from the chronic constipation from the opioid abuse he had. He had a back injury, yeah, he had. He had multiple surgical adhesions. He was probably in pain for sure, so but that
wasn't reported as to why he was taking it. But you also see this thing with with celebrities and famous people that they get this VIP treatment that normal patients don't get.
Yeah. Absolutely, well, I was wondering that too. Right, There was a guy knew that was hired to be with a certain very famous rock musician and he would stay with the guy at the guy's place, and you know, they have so much power and money. The guy would get and this was back in the nineties, but these FedEx boxes would come with demroll in them and stuff, and the guy eventually, you know, died. But my friend
was very high powered interventional. He did interventions, and he worked with you know, Fortune five hundred companies and you know, various behaviors people on the board that developed drug or porn or gambling addictions, and you know, but he couldn't do anything because this guy, you know, the the hangers on and the you know, the gophers, and it undermines and undermines their ability to get treatment to stay sober.
So this episode is brought to you by The Grosser Room. If you love this podcast and you love my Instagram account, you will love the Grosser Room. Every week we have lots of cases of articles discussing celebrity deaths and high profile deaths. And since we are going on our fourth year, you have thousands of photos, videos and articles to catch
up on. Treat yourself this holiday season to gross do you think that because at the time of his death, people were in his life seemed to be a little bit shocked about it because it seems as if he had been sober for like nineteen months. Do you think My question is, why start a new drug instead of just going back to the one that you knew? Is it because of like shame and embarrassment to say, oh,
I'm not sober anymore. Or did he think maybe because he was allowed to get that treatment that it wasn't it wasn't bad. He just was taken a little bit more.
I mean it could be a number of things. He may exactly considered himself to still be clean and sober. I'm doing it. I'm taped. It really helped my depression. I'm going to treat myself. I don't you know, I don't know. Was he getting high? Sounded like he was. You know, he had quite a bit in a system. And there's look asked anybody that struggled with an addiction and what what was there? You know, they sort about stinking thinking right, It's like, what was how did you rationalize?
You know? Was it just e fit? I'm going to go get loaded or maybe I can get loaded and nobody will know because it's ketamine and I've already on it. I mean there's a who knows? And was it? Did he have a heart attack? I mean, was that or not? In any arrhythmia? And he's you know, in the in the hot tub. You're in the hot tub and you're you know, you're getting dehydra I mean, there's all all the speculations.
So yeah, I mean he had did you I don't know if you you saw the report, but he had he had emphysema, right, I mean, pretty extensive emphysema, spoke two packs of cigarettes a day, which you know.
Nobody ever wants to talk about how bad cigarettes are on the body. But there was that, and then he had uh in his lad he had fifty to seventy percent focal occlusion, which yeah, exactly, you're just I mean, he didn't have any fibrosis in the heart, so it didn't look like he had a heart attack as the immediate cause of death, but he was going to have
one soon basically, right. But but yeah, I think that he took the jougs and passed out, and then he had some signs that he drowned underwater, was take making some breaths underwater. So there was a little bit of not a lot though, there was a little bit of pulmonary edema with some foam, and he had in the petres bone some hemorrhage too, so they concluded that that was a contributing factor to his death.
Tell me about the Petro's bawn thing, so.
You can see hemorrhage in that bone in drowning cases, but it's not like if you see it, that doesn't mean the person drowned, but that along with other gross findings, could indicate that he drowned. But he didn't have like typically if a person just primarily drowned, you would see a lot of foam in the airway because of their last breaths. But he was probably already his respiratory rate was probably already so low when he went into the water,
so that's why there wasn't that much of it. And obviously he had super high levels in his blood that you would see in a patient that was under anesthesia, and in his stomach contents as well, they found they found remnants of it, so which means that he took it, you know, shortly before his death, a high dose of it.
Right and you get that sort of that adrenaline blood pressure spike, and that's when you're gonna get your a rhythmy is and you know you don't have to have a heart attack for as you know that that'll do you in real really quickly too. So but is.
Ketamine treatment is that FDA approved right now too? For other than anesthesia like these it's all Flabel.
It's all flabble proved. Yeah for me for trigger resistant depression and pain.
It just seems like it's like, you know how like goes epics in the news right now every day it's it's like ketymine is I think Christy Tiagan said she did it and one of the housewives or something. It's like it's like the all the rage now all the celebrities are doing ketymine treatments.
Oh yeah, it's the ketymine clinics are booming, doing a booming business. So the that's the problem with something to get strendy, it's you and people with addictions again you want to quick fix. And there's also talk about well it's just like the ayahuasca circles and that can rapid opiate detox where you go in and get an IV of Narkian and reverse it and now you're not an addict anymore, or ayahuasca circles and uh, you know, you
get the super loucinogenic experience. And it's I mean generally these things occur biologically, genetically over time related to it. It takes a long time. Well they don't always take a long time to develop an addiction, but usually it's it's a complicated, long term process, and recovery is too. It's one day at a time, but it's you know, you just got to, you know, sit back and listen and accept that it's going to take a lot of restructuring of your life. It's very doable. Sobriety is you
know a lot of people fail and they'll relapse. I mean this guy, really, what was he in detox sixty times or something like that, So that's.
A yeah, that was one of the questions I was going to ask you, is there a point where someone I hate to say this, but is there a point where someone's brain is like damaged, beyond prepared for them to ever kind of have a normal life after struggling with an addiction like this. I mean, there was a point where he said he was taking fifty five pills a day, which is mind blowing to me because I've taken one percoset and like thrown up all night.
Right. But so again, I had a patient and I know this is the case. He was taking over one hundred narcos a day, right, And because I saw there was now he was ordering some on the internet. He was going to doctors, but he's stole my patient. He's on he's been on. You know, he's an older guy. He's been on box own for for some years. He does have sever c OPD chronic pain. Well you know one bars to know is and one bar ridiculo opasy blah blah blah. So he's really got paint and he's
been stable. But if you gradually increase your tile and al you know, the tilodol in there is what's going to do again. But if you gradually increase your tilool and your liver has the ability to you know, produce more of the enzymes that metabolize it. Eventually though the kidneys, you get to a certain I know, it's like kill how many kilograms of the see of benefit have gone through your kidneys and then book they're done. But so it sounds crazy, but over time people develop a tolerance
and there you go. So it's it's it's true. I mean one, you know, when I've had every everybody's had an oracle or a tunnel codeing boy, I'll tell you what. That stuff can make a nauseous real quick, and you you just but it's like patients I've had there drinking you know a couple of liters of bodka a day for years and there by all it's not good for them, but you know that it occurs over time, it's gradual.
And when one of these patients that has the opioid addiction is used to getting high off of let's say, vike it in her percoset, and then they go to you and then they get this like subutext drug. Do they are you saying that they still kind of feel the high, but it doesn't give them that that feeling that they need to increase it more and more, which would which would lead them to overdose. They still feel high right when no.
No, no no. So so basically you're supposed to be off about any opiate for twenty at least twenty four hours when you start upern No. Orpheny's a box subject. Why is that because even though it doesn't people say, well it's a partial stimuli or powerful agonist, it's it just works differently attaching to the opia receptors. So but it's it like has the most attraction of any opiates.
So if I've been taking four or ten to orco a day, whatever, and I put some box on subutext under my tongue it's going to displace all the percocet or oxycodone or hydro codone. And even though you're attaching to the receptor, the opiate receptor, it stimulates it differently, so your body perceives it as withdrawal and gets super
sick a withdrawal. And the other situation. If you stop somebody's opiate's for twenty four hours, they're going to be in withdrawal and then you give them the upper from the subject text sub box or whatever, and within minutes they withdrawal abates. So it it's it's sort of you know, it's not intuitive at explaining, and it's like, so it's a partial agonist or is it a block you're oh,
it's a blocker. Well, it attaches the receptor, but it you know, it starts withdrawal, but you can treat withdrawal, you know what I'm saying. It can be a little confusing, but it's uh, you know, it's an opiate. It has a high high affinity for the recept or, so it will displace any other opiate and when it does so, then your body feels like it's in withdrawal even though it's it's attaching. But if you wait for somebody to be and withdrawal and you give it to them. It
will resolve the withdrawal within minutes. So the lesson so I said, people can inject it, Okay, Like I said, when you start injecting things, it's not like taking it properly. So the art. You know, I've heard all the arguments against, oh it's an opiate, you're you know, you're not sober, you're not clean when you're using. But if you take it properly, now they say one to two percent of people will say, uh, oh it makes me relax, it
gives me energy. So those are people that you probably don't want to use the box on or up an orphine and recovery. So it's it's one of those things. It's just like some people will take I mean it's not a great analogy, but some people will say, yeah, I took you know, I took motoring and I got a mood alterary effect. So a variety of things can give you a mood alterary effect, and some people get very attached to it. So but it's very rare. It's
very rare that you know, buprin orphine. I've had patients take double you know there they try to get high on it. They'll take the maximum thirty two milligrams a day, they'll get the prescription take sixty four milligrams a day. And I mean, I've had that happen and you can't give them an early refill and they commit, and I say, well, so what did you feel? Well, it didn't work. I didn't get high, and you know, it was a waste of time and I'll never do it again. Whatever. So
it's and it's again the binding characters. We're in the you know, the ventral tegmental area whatever, the midbrain reward areas. It has very little activity there.
So if so if a person like myself took that drug, what would would would I feel anything?
Or probably? Well, okay, it is an opiate. So if you're opiate naive, and it depends on the dose you took, it's just like if you eject did it? I said, if I injected into myself, would stop my breathing? No, if it was a sole agent. Now, if I had a few beers and you inject the dose, but if you if you took eight milligrams, I mean we start somebody that's in withdrawal, will give them two four milligrams under the time. And if if I just did that right now, I probably initially I get you four. Okay.
I've had patients tell me there were big pot smokers. They had a bunch of THC in their system. They came in for induction and and afterwards to say, you know, doc, that stuff I did get a you know when I had the UH when I was using pot. And again, you have patients that you get them off the fantinel and and you know you're you're working with them and there and you drive testament. It comes back for THAC. You don't want patients to We're sort of harm reduction.
That's my philosophy. I mean, I don't want to smoke a plot. But IVE had patients tell me if I'm smoking some potent pot and I'm taking subox and I do get a buzz, and that's not good. So but it's just in and of itself. Ninety eight percent of people do not get a mood alterary effect when taken within the DOSA drains. It's proved.
Now, does this drug help with pain? Oh yeah, yeah, so why so my obvious question is then if this is safer, why isn't this drug that is?
That is a great question, and I for my uh so, here's what happens now. The pain physiology and the you know, pain fibers and pathways and different types of pain are really really much better understood now than they were even you know, five ten years ago, right, and super a lot of complexities there. It turns out the uprenorphine, you know, if you if you have pain in your foot or your back or your hand, the fibers go to your
spinal cord. The dorsal in the back of your spinal cord has transmission nerve centers and sends the signal up. So buprenorphine blocks pain more in the spinal cord, right much not so much up in the brain. Sort of a crude way of explaining it, and that doesn't have
as much activity the respiratory center. But it's so currently according to the medical literature, if someone needs a daily opiate chronically for bonafide pain, whether or not they have an addiction history, then the first line medications be pan orphine. Why isn't Why isn't that done? I I was talking to somebody today. I've talked to people at other academic centers. I was talking to somebody at a ivyly programmed back East today for about an hour, and we we share
the same frustration. It's if it's first line, if it's a first of all safety, first hipocratic codes, right, So I don't I've been paying medicine in my facility, large organization on Wednesday. Third, I'm not a pain doctor. I just get referred paying doctors say hey, can you see uh, you know, mister Smith, he's been on one hundred milligrams of morphine and forty and oracle for twenty years and we've tapered him now the pain's unbearable, or you know,
we need to detox this for whatever it is. I just get patients that are already on opiates and it's buper and orphan is safer opiate? Yes, So what the literature says, it's we're not starting people on opiates for chronic pain. Not a good not a good medication for chronic paint, right, But if someone's already on it, it's like, why not if it's safer, why not at least try to switch them and then either tape them off the orphine or you know, if they do need a chronic
alpiate use puper arpi. But there's a lot of a lot of paint specialists that are boards. Now I'm not a board certified paint specialist, so I get into it with some of these guys.
Uh.
It's then one of the reasons is because it's the first thing if you say viewper orphane people, I don't know what that is, but the average person has heard of the box on right sub attexts. But well, that's an it's an opiate for for addicts, right, Well, it's it's a big pronorphine. That's the opiate. Well, well an opiate. It's an opiate, and that's for addicts. And if you're given that to pain patients, then yeah, you're a quack. I mean, I've gotten called it. I d you know.
I've got probably one hundred and fifty patients that I'm with the paining physicians. I'm not going out recruiting people. I don't I don't start it in rare cases. There's a low dose view transpatch. If the primary care for paining physicians says I think this patient does need an opiate, then you know I will work with them. But I'm
not out there starting paying patients on it. But anybody who's listening to this, if you are on it, if you're on dorac or you're on morphine, it's just you know, if there's a if there's a dangerous or there's a like I use the example if I talk to doctor and they say, if you have a patient on anodor on it's it's a great medication, cardiac medication for certain rhythmis, but it is rough, rough to manage, sort of toxic,
you know, not toxic. But so what I tell them if they're a safer anti arrhythmic came out and it was documented just the physiology of it, the pharmacology of it. It's safer, does the same thing. And five years from now, you still had them on amiodoro. What would your defense be. There's no defense, so.
Ill just like a stigma of the drug. Basically exactly so right.
And so I was talking to somebody at one of these university programs because I was I was in fear of losing my job because they said, you're an addiction medicine doctor, why do you have forty people on this for chronic pain? And I said, well, they were sent to me. They were on morphine, fentanyl, whatever, and they
told me to detoxible, you know. And this when this stuff came out in the higher does form of the sabbox armount in two thousand and two, a lot of us got And it wasn't just to me, obviously, it was a lot of anybody that did addiction medicine and worked in a medical system. You know, I work with an integrated pain program, so we have psychiatry addiction, clinical pharmacy, physical medicine, psychiatry addiction about world. So they'll say you're the one you this pay. We don't want this patient
on the opiates. Can you tape or detox them? But a lot of the patients would say to me, to other doctors working in pain clinics, hey that buw pernorphine stuff work great for my pain. I could think straight, I could function again, and I didn't feel like I was taking anything. So when you switch people about, you know, there's a are a great article in the doc is uh,
you know, published a lot. He says, a third or third the third of people on chronic alpiates that need to be on on or felt a need to be on something that strong for pain. A third of them, it's life changing to put them on to be port orphy. A third it's you know, it's okay, may not be as well received. And a third issues. It's an opiate nause at dizziness, you're tired before it helps the pain. So you know, I'm a therapeutic nihilist. I think get
the less meds the better. But if you're gonna then again, I just work with paying positions and we try and get people off the opiates. But if they're you know, there's a lot of people committing suicide too, because the six seven years ago does CDC said get people at ninety or less mmy morphine milligramma clobeland So one milligram of oxy conton I mean boxy code on is like one and a half a morphine. One a hydrocode on or an oorco's like one a morphine. Want to dilaud
it is like four morphine. So you calculate what your equivalent in morphine milligrams is and if they're over ninety, oh got a taper. Well what if they were? You know, I had a layers one hundred and forty miligrams of morphine for twenty years she's seventy years old. And suddenly the doctor's like, I don't lose my license. I gotta get you blow a ninety. No talk about risk benefits.
So in the literature it does. It says, look definitely over fifty mm e fifty miligram's equivalent of morphine, the risk of respiratory depression is you know, there's a higher death rate, So you certainly not only want to get him blown ninety, but under fifty. And opiates are not a great chronic pain medication. But in the in the interim, if they need to be on an opiate, or if they're on one and you want to get them off it, why not switch to something safer. So that so that's
my my arm. It's not for everybody, but it's you hit it on the head. But there's there's a stigma. And one Ivy League ACTA the mission who I contacted because I was like, I'm gonna get fired for what I'm doing, but I think I'm doing the right thing. He said, you know, he said, I said, why is this? And this is probably six seven years ago. I was talking to this guy and he said, well, look at the money. The big form of puts into viupern orphine.
Where is it. It's like ninety nine percent for use for addictions, And he said, unfortunately a lot of doctors get their information from drug detailed people or you know, you watch TV. Well, there's not much subox on being advertised on TV, but just the information out there disseminated to doctors that they hear about buper or FI, they're in about subox owner and get I get referrals. Can you talk to mister Jones about subox on And I'll go, no, I can talk to him about BUEPERI ORFI.
Yeah, so you just basically have to rebrand it. We'll then contact them and say like, let's call it something else and it's.
It's off label FDA approved subbox on sebutexts for chronic paint. Right. And the problem is in this country, the higher dose forums are subox on subutex. So like medic here, DHHS put out a a sort of a pain management bulletin. I think it was twenty seventeen or eighteen or twenty nineteen September, but basically they then a flow diagram and they say said, well and this is dj HSS and
then the VA and Department of Defense in January. But basically their guidelines where if somebody needs to be on an opiate, you know, try and get them off the opiate. Ope. It's not great, it's really not good for chronic paint. But go with bupern orphy if to either detox them or if you choose to maintain them at an opiate.
Medicare does not pay for the higher dose forums. So you have somebody that's sixty six years old, you've gotten them off their their you know, fentanyl patch and their oraco and then they go to fill the prescription and the farms. He goes, oh, you got Medicare Part D. You have to have an addiction diagnosis for us to pay for your box or cyber detext it's and.
They just want people to die so they don't have to pay for them anymore.
That's well the theory the government.
Yeah, that's a whole other, a whole other episode.
Bruce, Yeah, get Burger, get Kennedy on here. I'm sure that guy's got some mark.
Interesting.
You need a contrary and you need a shit stir.
But yeah, I mean that would be that would be fun actually to hear that. But I think that. I mean, I'm one of these people that are just like, yeah, there's the whole entire time you're talking about this, I'm like, there's there's absolutely no reason except these barriers of and it has to do with money being made, right, Like that's how I look.
Well, I'm telling you, I guarantee you. I don't know how many people you have listening with this thing, theirs or his drop, but you will get just a shipload of that doctor doesn't know what he's talking about, or he's he's a shoal for the drug companies. That's the worst you know, I have had. If you go to drugs dot com, I mean there's a billion pages, but there's one there that says your paring should not be
used for pain. It's a terrible paint drug. So when I get a referral, you know from the pain doctors, probably off three or four to more Wednesday, and I spent and you know, my organization's great. They give me an hour to talk to them, and then I will spend an hour and I don't know what I'm getting. Some of them are fit to be tied if had theopia tapered. Others are I don't know who you are. I don't know what this medication you're talking to me
about is. And I'm like, I don't know if I canna get you know, punched in the face or yelled at.
But I say, well, you know there's They say, well, they said you're talking to be about the box on it, and and I'll say, I want your family, anybody has your nose in your medical business, I'll talk to you about this medication, but I explain what I tried my best, like we were talking about today, how it's different, how it's better if you're not on any oopiah blah blah blah, and and I've had family members and then else I
won't prescribe it until a week later. I'll say, I want to meet with you again in the family, bring questions. And it's it's really a shame. It's there's so much misinformation and you know, people that are suffering and paint I'll tell you what, Yeah, it's it's really one of the most underserved communities of patients in medicine. I mean, you know, because it's so frustrating for doctors adding what
do you do with these people? You know, you can't give them hope it's They have something called the Beer's List b E E R S. I think it's a doctor beers. It's kind of your drinking beer and it's been around since the nineties. The beers List for medications you shouldn't get people over sixty five. Yeah, there's antibiotics on there. It's muscle relas, smooth muscle relaxes. Oh, it's it's it's really the hands of pain physicians are are
more and more time. That's why things like ketamine infusions. You know you're able to do that. You know you're not sending them home with it. Well in some cases they have, but that's available to anyway. I'm rambling.
No, this is really this is really good information because I think that a lot even I just did a post on on my website, The grocer Room, about Matthew Perry's death, like more just a dissection of the of the autopsy report, and a couple of people had made comments under there that they are chronic pain patients and they took they were taking uh a hydro codone every day, like the one woman had said that she was taking three a day, And that kind of surprised me because
I think it's it's almost a perfect drug that it could have the effect of the opioid but not make a person addicted as addicted to it maybe and high and able to function. I don't I don't see why you wouldn't go with that like sabutext or so yeah, right right, I.
It's interesting. Yeah, yeah, I've had I've had pain. Special to say, well, they can only use for pain if they have an addiction. They can only use it for pain. If they don't have an addiction, they can It's just.
Okay, yes, it's it's it's really weird that they that they would want the patient to take the other one that could potentially give them addiction. You don't want to wait till a person gets the addiction. Maybe you want to prevent them from getting it.
The other one is kreatim. You've heard of kreatum, right, No, I've never heard of that.
What's that?
Kreatim? I you know, I mean we've been seeing that for years and years. So Creative is a it's sold as a tea or a powder or a pill, and it's derived from a plant that's similar related to the coffee plant, and it is a it's sort of like tramatol. It's it binds the opia receptor, the merror receptor, but it also has NSRI activity, norp an effertser antonin reuptake like effects or or symbalta. So you know, tramadol is an interesting opiate. And if you take towards trama you
have a seizure. Right, Why is that? Well, it's because it's like you know, effects or is a NORP an efforts ser atona reuptake inhibitor. So you take a bunch of effects or and you get too much adrenaline your brain, you have a seizure. So this this creative stuff, you know. I mean it's available in head shops and a variety of places. It's still legal, but it's new receptor opiate. It has opiate activity and n sri I activity. So it's considered by a lot of people to be an herb.
It's herbal, it's safe, and it's oh we see, we're seeing more and more of it in terms of it's it's like an over the counter tram It all basically, oh.
My, go as far as the opiate, and this is something you could just get at like a place that sells vitamins, or something.
Unfortunately, Yeah, you go, you go to the places at Selly, the bonds and the and the vapes, and yeah, but it's it's an opiate. It's bad. It's bad news. And then it's perceived as it's sort of like, well, it's Eastern medicine. You know, you you doctors are prescribing all these other things, and it's it's not dangerous. But I've had you know it. Then I had a patient spending
fifteen thousand bucks a month for his creative. You get tolerance, you get into into major, and then when you stop, you get antidepressant withdrawal, right, because it's it's got just as much activity as taking effects or some ball to those kind of those kind of prestique the NSRI thing, so creat them. That's the other obiit that that we're seeing.
I can't wait to look into that more.
That's really krri ato nver don't.
We're not trying to push it. We're trying to tell you not to do it. It's not good, all right, So to wrap this up, all right, go ahead.
So the last thing is, so do an adolescent addiction medicine. You know they'd send you out. They used to send me out with this guy that was a character aer And I remember they'd send us all kinds of school, but I was reading all the prevention literature. It turned out kids in especially middle school that got you know, when they they'd have the drug record cop come in or whatever and they pass around the pod.
Or their T shirts and everything, right.
But when they pass around like this is what a joint looks like, they had this this thing in a box and it said, here's a needle, here's a joint. So they found that we kids got information and we're they were essentially desensitized, and those lectures there versus not getting information, they their drug usage would go up. We would put them more at risk because they were desensites, like, oh, that's what a joint looks like, Oh that's LUs do you exct?
So yeah, like you're actually teaching them how to use drugs.
Yeah, it's like, uh, you know, they're they're naturally any kind of fear they had was sort of dissolved and they're like, oh that doesn't yeah right, all right, Well.
So if you had My last question for you is if you had like a magic wand and you've seen all these people addicted to two opioids is something. I mean, obviously we might have already talked about this, that we have this one drug that you don't think is being utilized as well as it should be. But is there anything else that's like blatantly obvious that's going on with either just the government's response or how we've gotten to this point that I feel like it's worse than anything
I've ever seen. I mean, you know, you're familiar with Philly. We have a huge problem here, like huge in Kensington Just Street and in Camden to where my husband works. Just I go to visit my husband at the firehouse and there's just people lyned on the street, standing up, nodding off, and it's it's just terrible. How how did we get to this point? And how do we go away from it?
Well, I mean, you know, you can get into the politics of it, but the permissive Yeah, I was talking to there's no there's no fundamental objective truth. It's like I was talking to somebody that was in some sort of social service thing and I said, well, somebody psychotic and they're running down the road naked thinking that their God, wouldn't it be better if they were on medication and sort of put in some sort of mandatory Well maybe they're happier that way. You know. It's like wait a second,
So the bottom line is homeless. Here's the simple solution, addict. Forced treatment of the addiction, or the recognition of the metal health addiction. That's what you gotta treat. You give them needles, you give them a safe place, you give them drugs to use. That's insane. That's effing insane. So we know what it takes. We know what's a problem with these people. That's not capitalism. I saw some moron from San Francisco. It's capital capitalism. They're freaking addicts. They
have a drug addiction. Ask any addict. The only thing that saves of drug court getting locked up, you're decoruicated. You know. It's like when you have those frogs and you pit them and they still move around. That's what these guys are. Once you're addicted, especially math, high potency stuff, math and coke and opiates. They they can't choose, and then you put them in there, out of the street their own try diagnosed. I mean there's psychiatric issues. They
have health issues. By that, I mean physical issues, but psychiatric addiction you can't. You have to step in and mandate or give them a chance where they can. So anyway, that's that's the bottom line with holelessness. And I don't know why you know these arguments that it's it's finance, its inequities and financial things. People have psychiatric ANDD or addiction, addiction D or psychiatric and you know you don't, you know, you can give them all the money in the world,
all the food. It cracks me up when they distribute turkeys at Thanksgiving to the hallless pot relation.
Yeah, it is crazy. You're you're just like you're you're missing the point people. I mean, feels good in the moment, you know, yeah.
Exactly, Yeah, No, I mean, do you have to have compassion? But if you know, if you know that if you stick their head in a brain scanner, which you can't reduce everybody down to a lab animal, but once they've been that intense stimulation of their reward center drug reward drug, they can't. They can't. It's like somebody that's starving and there's food there, are you know, are they going to put clothes on or eat the food? Are they going
to you know what I say, It becomes there. It's an existential thing, right They talk about existential crisis, like they got to get the drug. They can't make the choice themselves. And uh so almost popular if I had a magic wand you're to get these people to help them they really need and mandated.
So okay, it's interesting you have like a really different because like right now, I just went outside to go get my mail and it feels like it's about to snow. It's freezing outside here in Philadelphia area, and you guys have like this beautiful weather all the time. Michelle told us it was like seventy and sunny and ol and you have you have people that are are flocking to live there, a huge homeless population. We we do too here, but not anything like what you guys have. It's just
different here. But the I don't know if you've seen there's there was this one I don't know if it was a YouTube or Instagram account that was called Kensington Beach and it was this guy that was just going and filming all of these people. It looks like the zombie apocalypse. It is just it's insane what's going on in Philadelphia area right now? And I don't I don't necessarily think that that they're that it's a huge homeless situation, and I mean there's definitely a lot of it, but
not anything like we're seeing in California. But the drugs. I mean, there's people there that have necrotic legs, wounds, open wounds with maggots on them, just on the street nodding off. It's just absolutely insane. What's going on there?
Right? It's like where does compassion?
Uh?
What is real compassion for someone? Sometimes?
You know, yeah, and giving them clean needles is not helping them, I mean obviously, like it's just not helping them.
No, say that's yeah, and certainly they've been maybe they were victims of the system at one point. But you just talk to people that have been homeless and then got sobriety and got mental health care. They're not going to be endorsing safe injection places and you know, providing providing shelter, let them live in. You know, here's a place they can sleep. But you're not treating their addiction or their mental health issue. You're really just you know, you're contributing to their demise.
Yeah, and who cares if I mean, who cares if they're using clean needles though, because if there if they're never going to have a quality of life, Like, what's the difference if they get HIV? Really think about that. If they're just going to be living like zombies on the street, who cares if they get infectious diseases? If they're never going to have a good quality of life. I mean that the ultimate goal should be for them to have a good quality of life.
Yeah, well, pathologists are seeing stuff they haven't seen in one hundred years, right.
A lot of oh yeah, I'm here in some crazy.
Yeah, well they didn't. The system caught things early enough. But these people are there, you know, they're the diseases are It's it's sort of like a fourth World nation where things just there's no intervention for it, you know.
Yeah, it's incredibly sad. Thanks so much for being here with us today. This was great. It's very informative because this is so outside of my normal realm of knowledge. And uh, you taught us a lot. It was really good.
Oh well great, any any you know, bad feedback you get about me, Please don't tell me. I'm very sensitive to criticism.
All right, boys, I'll talk to you later. Thank you for listening to mother. Nos Death As a reminder, my training is as a pathologist assistant. I have a master's level education and specialize in anatomy and pathology education. I am not a doctor and I have not diagnosed or treated anyone dead or alive without the assistance of a
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