0:00

hi, everyone i want to give you a heads-up

0:02

that we mentioned substance abuse and

0:04

suicide in this episode please

0:07

keep that in mind as you're listening and

0:09

think about who might be listening with you

0:17

i was forty miles into a sixty

0:19

my backpack and feeling great

0:22

representing the fifty five year old lady

0:25

and , my wheel got

0:27

caught in some tram tracks

0:30

tracks i could think or react the i

0:32

was crashing into the pavement

0:34

the lot of

0:36

things hurt and i was scraped

0:38

up was badly i

0:41

did the thing we doctors do so often

0:43

pretend do is nothing but

0:45

the pain in my chest was something

0:48

in hadn't experienced before

0:51

every breath was agony

0:53

and it was getting worse i

0:55

was sure something was broke it was

0:58

, so hard to breathe that i started worrying

1:01

broken rib might have punctured my lawn

1:04

the your i waited

1:07

and , and waited

1:09

i finally got an exam and

1:11

after diagnosing to broken ribs

1:13

know punctured lung the doctor

1:15

off as we opioids said the pain

1:18

i wanted try tylenol first

1:20

because i know it's a really effective pain reliever

1:23

that my request was so unusual

1:26

it took was all like ages to

1:28

get the tylenol and by that time

1:30

the pain was nearly unbearable

1:34

and , was getting really anxious

1:37

i felt i had no other choice so

1:39

he took the opioid eventually

1:42

i left the hospital was seven days worth of

1:44

opioid medications second have

1:47

big consequences and i left

1:49

with not much guidance about how

1:51

to take them and no

1:53

guidance about how to stop

1:55

taking me

1:59

i'm shocked agenda and the cat

2:01

audio collective this is fun

2:03

that's chances are

2:05

at some point you or someone in your

2:07

life will take opioids their com

2:10

and a medical

2:12

the what are all the risks of opioids

2:14

are they as sect is as many

2:16

of us cynthia in

2:18

the episode what you need know

2:20

about

2:21

your options are shooting pain and

2:23

what to do with your prescribed

2:25

ofili

2:35

if you love body sas and want to support

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backslash

2:57

hi, oniony moon i mean here's

2:59

a site and i'm felix overhaul city

3:01

together we host afterhours a podcast

3:04

and the ted audio collective

3:05

we're friends and colleagues harvard and on the show

3:08

me discuss news at the crossroads of business

3:10

society and culture join us each week

3:12

as the catch up after work and see what's

3:14

trending share our father and

3:17

disagree with each other sometimes alaska's

3:20

apple losing it's mojo what's behind

3:22

the industry behind the chips george's

3:24

brawl struggling who's winning the sweeping

3:26

floors and to you for your information

3:29

check out after hours where ever you listen

3:31

to party

3:32

a get branded little bit as an anti opioid

3:34

zealot because i think that doctors

3:37

should describe opioids in a different

3:39

way than we currently do and certainly

3:41

differently than we did say ten or fifteen years

3:43

ago

3:44

dr david your link he started

3:46

his career as pharmacist now

3:49

he's an internist pharmacologist

3:52

and

3:53

talk to college just a deal with drug

3:55

related problems pretty much every day and

3:57

spend a fair bit of time doing research in this

4:00

the drug fifty as well so

4:02

we talk about opioids

4:05

and when hot a little bit about pain i

4:07

was hoping maybe you could give me a definition

4:10

of what using painter the international

4:12

association for the that he of

4:14

pain has formal definition and

4:17

in their definition is an unpleasant sensory

4:20

and emotional experience associated with

4:22

actual potential tissue damage

4:25

no were usually focus on making pain

4:27

go away is actually something

4:30

we need to survive

4:32

he tells you something is wrong you

4:34

stub, your toe, you burn your hand head on

4:36

the stove, you fell off a bike

4:39

and broke a rib pain gives

4:41

you a message that is time to rest for

4:43

cover and treat the damage it

4:45

warns you not to reinjure yourself that's

4:48

the sensory component but

4:51

pain is emotional and

4:53

psychological to worry

4:55

about pain and can amplify it the

4:57

longer i waited in the, er, the

4:59

more worried i got and the more

5:01

pain i felt think

5:04

it's been as been as and anxiety

5:07

as yeah

5:07

mean on that fire a

5:10

lot of pain as of a worrying about the future

5:12

thinking about know five

5:14

minutes from now or five days from now or five

5:16

weeks or five months from now was even be still

5:18

grappling with syndrome usually

5:21

once a treat pain our brain essentially

5:23

shuts off t message that

5:25

sometimes sad a whole system

5:28

goes awry

5:30

with chronic pain we think that pain signal

5:32

might be firing even when

5:34

nothing is causing it mike

5:36

computer virus has changed your brain

5:39

wiring

5:40

that means your brain ascending pain

5:42

signals when it meet

5:44

you

5:47

would have been cute or chronic we want

5:49

to avoid

5:50

for doctors like me relieving pain

5:52

is a big part of our job

5:55

can be created by different chemical signals

5:57

and receptors medications like se

6:00

then again tylenol or

6:02

nonsteroidal anti inflammatory drugs

6:04

like ibuprofen aspirin

6:06

and approx since primarily treat

6:08

pain bisecting enzymes that

6:10

produce pasta glance those

6:13

are chemicals said generate inflammation

6:15

and paint hope you

6:17

a street pain by targeting your opioid

6:20

receptor system business

6:22

opioid receptor system is very

6:24

sophisticated

6:26

very sort of highly evolved

6:28

and it's not just about pain relief it

6:30

plays role in mood and

6:33

bonding and whole host of other fact

6:36

nobody actually makes

6:37

known that bind okay i'd receptors

6:39

you've probably heard them the door

6:41

het can do them as natural

6:43

pain relievers oh periods are made

6:45

from the opium poppy plant or

6:48

synthesised in lab either

6:50

way to save my by these receptors

6:52

to

6:54

and this is part how these drugs

6:56

work mean in terms of their dogs reducing

6:58

and so well intentioned doctors

7:00

like you me we come along ambiguous

7:03

people morphine or oxycodone

7:06

or hydromorphone and the goal

7:08

there is to make sufficient feel better bi

7:10

bicycling the same receptive we're really

7:12

doing is we're sledding these receptors

7:15

with the concentrations

7:17

of chemicals yet

7:19

massively higher concentrations

7:22

then our indoors

7:24

opioids can provide more pain relief

7:26

that are endorphins can on their

7:28

own but here's

7:30

the big mess about opioids probably

7:33

part of reason why everyone in the hospital

7:35

was confused when i asked for

7:37

tylenol instead of opioids

7:41

there's

7:41

this mythical perception that there are best

7:44

strongest p relievers and there's just nothing

7:46

to back that up there has been dozens

7:48

if not more than one hundred studies

7:51

randomised trials comparing opioids to anti

7:53

inflammatories for acute pain in

7:56

know study or they soon to

7:58

be better if you almost every the when

8:00

you compare opiates anti inflammatories in

8:02

a proper rigorous design if

8:05

you senators when from a safety

8:07

or affect his perspective both you're

8:10

dot right

8:11

after your link hasn't come across single

8:13

well designed study that shows

8:15

opioids a more effective as

8:17

at treating acute pain and

8:20

brains

8:21

strains all the way that broken

8:23

bones said don't recall your surgery

8:26

but the next

8:28

set of

8:29

the way to our our best pain relievers

8:31

has huge effect

8:32

how we prescribing use of people

8:35

, often sent home after surgery with

8:37

more opioids and they report needing sometimes

8:40

twice as many and

8:42

some people who prescribed opioids after

8:44

procedure stay on them

8:47

you look at people who aren't on opioids the come to

8:49

hospital they have a gallbladder removed

8:51

or appendix removed a they have a

8:53

whole litany of different kinds surgeries but

8:55

it you then looked down the road say okay

8:57

some of these people when home

9:00

on an opioid still using an opiate

9:02

ninety one hundred ladies later it's

9:04

berries but somewhere between five and ten

9:06

twelve percent that's just an

9:08

astonishing sighs you figure

9:11

that you are you going for an appendectomy

9:13

already said to me though there's vasectomy at of

9:15

seven percent of men get vasectomy

9:18

and to get an opioid oh

9:20

on opioids you know three months later

9:22

festus mine bought

9:24

one study on opioid prescribing really

9:26

shocked me it found that young people

9:29

between thirteen and thirty who

9:31

get an opioid prescription for their wisdom

9:33

teeth removal were nearly three

9:36

times as likely as their peers

9:38

to be using opioids weeks or

9:40

months later the

9:43

why you have doctors turn to the weight so

9:45

often over the last few decades

9:48

just yearling points to a couple of

9:50

things first medications like

9:52

tylenol or leave have leave clear

9:55

don't ceiling a point

9:57

or giving a patient more will

9:59

not

10:00

prove their pain opioids

10:02

do not have not have dose

10:05

ceiling

10:06

and there are some situations

10:08

where medications with the dose ceiling

10:11

simply can't provide enough

10:14

relief

10:15

like some as an extreme pain maybe

10:17

after big surgery or

10:19

maybe even after couple of broken ribs

10:22

opioids might be the best option

10:24

for pain relief because you can increase

10:26

the dose is needed

10:28

not all been requires that approach

10:31

and yes opioids often

10:34

became the default treatment and

10:36

some of this was caused by the world

10:38

health organization

10:40

pain ladder you know

10:42

it had at the apex a pain letter

10:45

strung opiates at morphine and hydromorphone

10:48

buffalo that you week opioids and below

10:50

that in his claim it or isn't so what would

10:52

really means is three going replace last

10:54

but there's this perception that babies are actually better

10:56

because at top of the pyramids be do the work

10:58

better than the things below it

11:01

dr your length as doctors also

11:03

turn to opioids because of another common

11:06

misconception that they have limited

11:08

side effects

11:10

if you have a good medical student

11:12

with me and , say to

11:14

him or her hates you want to

11:16

put patient in pain medicine and you let's

11:19

think about some of the options in the first afloat

11:21

acetaminophen as one option and

11:23

your foot anti inflammatories is another when i

11:26

asked them to tell me what

11:28

to potential side effects of those drugs

11:30

are the i recently capable

11:32

medical student will identifies liver

11:34

problems with the city medicine and

11:36

they'll identify gastrointestinal

11:39

and kidney problems with a

11:41

inflammatory me and then he got

11:43

opioids the outlook he would

11:45

have side effects of opioids and most

11:48

capable medical students will say constipation

11:50

and cetacean to take too much didn't

11:53

fall , common sparta depression

11:55

is these and die but i for

11:57

many dogs i think that's kind of were

12:00

in

12:01

there's pretty long list of other side

12:03

effects sleep apnea osteoporosis

12:06

this depressed testosterone

12:09

levels increased risk of car

12:11

accidents falls and fractures

12:14

depression and paper

12:16

our sees yeah we're opioids

12:19

can actually worse and pay

12:22

people can also developed tolerance where

12:24

they need increasing doses to

12:26

achieve the same as set we

12:28

can turn increases the risk

12:31

side effects and

12:33

one other very important and

12:35

misunderstood side effect is one

12:37

you've probably heard

12:38

that physical

12:40

dependence dependence

12:43

an addiction i'm guessing

12:45

opioid addiction is a complex

12:48

medical disease or people asked

12:50

and continued his opioids

12:52

despite harmful consequences

12:55

when someone is physically dependent

12:58

on opioids it might not even

13:00

know there are dependent but their brain

13:02

and spinal cord their opioid receptor

13:04

system has adapted over

13:06

time to expect opioids

13:09

and when they don't take them they have symptoms

13:12

of withdrawal when

13:14

lot people don't know and

13:16

what lot of people need to know

13:19

is how quickly you can develop

13:21

opioid dependence

13:23

the whole doctor some music on twitter is it how long as

13:25

it take for dependence happens when think these

13:28

i , the average was kind of seven or fourteen

13:30

days and that's not true

13:32

it happens within couple of days i had

13:35

some colleagues here my hospital and

13:37

after three measly days of

13:39

taken hydromorphone pretty

13:41

much around the clock they

13:44

second for stop it and they had

13:46

obvious they saw in

13:48

themselves obvious opioid withdrawal

13:50

they had a d i cram thing and diarrhea

13:53

and irritability and their hair

13:55

standing on and we would call it dope sickness

13:58

a person who was injecting heroin fentanyl

14:00

physiologically no different when you're given prescribed

14:02

opioid by a doctor

14:04

like addiction opioid dependency

14:06

be together stating doctor

14:09

yearling from members reading the story of

14:11

a bioethicist travis reader

14:13

who got a few sir the read after a to

14:15

hide after cycle accident

14:17

the too much mark he goes to see his

14:19

orthopedic surgeon and they and the orthopedic surgeons

14:22

is how you doing pretty well he probably should come down on

14:24

the pills there by this time he's on one hundred

14:26

and twenty milligrams of article on a day which

14:28

is quite lot he's not addicted he's

14:30

not crushing it fills up by rejecting that

14:32

started on different doctors he says do with the doctor

14:34

told to do so it was okay i'll

14:36

just i just paper myself he

14:39

recounts unable

14:41

to sleep spontaneous crying

14:44

he near the end of his taper that

14:47

any his life

14:48

it is a testament to just

14:50

how pernicious a problem dependence

14:52

is he wasn't addicted at all he

14:54

had just been an obvious for two months and

14:56

went through hell trying to come austin

15:00

that's a yearling says dependence is tricky

15:02

because it can make look like opioids

15:04

are doing lot to relieve pain in

15:07

reality your body has become

15:09

physically dependent on opioids

15:11

so when you stop taking them there are

15:13

changes the brain that produce symptoms

15:16

like nausea vomiting and

15:19

when it comes to masquerade

15:21

as ongoing benefit but

15:24

when you step back to thirty five thousand seat he

15:26

realized that does a sex they

15:28

largely in part because the patients

15:30

been an opioid

15:31

in other words pain during

15:33

withdrawal can be the result of the dependence

15:36

itself not sign

15:38

that the opioids were successfully

15:40

treating pain that imagine

15:43

how hard it is untangle those things

15:45

when someone is suffering and just one dot

15:48

heard

15:49

it gets even harder to do that when so

15:52

many

15:53

including doctors believe the mess

15:55

that opioids are the best painkillers

15:58

the whole picture whether oh the wait for helping

16:01

and how much damage the doing gets

16:03

muddled

16:06

mine for all these misconceptions about

16:08

opioids to evolve

16:10

when dot a yearling was working as a pharmacist

16:13

in mid ninety nineties he remembers

16:15

most okay prescriptions were for end

16:17

of life for cancer care and

16:20

think we're pretty rare

16:21

fast forward to see two thousand seven

16:24

five years and i

16:26

was an internist practicing at this hospital

16:28

in toronto where it's still an and

16:30

, was very common to see people

16:32

coming in in oxycontin

16:35

in particular that was the main target

16:37

led the charge on much

16:39

higher doses then we

16:41

would ever seen and in

16:43

ever seen back and to cringe anheuser

16:46

and hindsight at how i've practiced

16:48

say twenty years ago

16:49

the doctors and patients were in

16:51

a situation created by decades

16:54

of decisions and

16:55

colleen american society

16:58

is the find

17:00

by this

17:02

capacity for commercial enthusiasm

17:06

and , often find

17:08

ourselves kind of confronting and dealing

17:10

with the consequences ten

17:13

the fifteen or in case of the opioid

17:15

crisis twenty or

17:17

so years down the line more

17:19

about that after the break

17:29

god's own medicine is how

17:31

some each entry and like it's a tree

17:33

physicians refer to it that's

17:35

good way little is a medical historian at

17:37

princeton and the author as paying

17:40

a political history he says

17:42

for centuries opium

17:44

was used to treat all kinds of pain

17:47

and disease

17:48

let me give me an example you know in an atmosphere

17:50

where you have diseases associated

17:53

with diarrhea dysentery

17:55

and the loss of fluids opium

17:58

is incredibly powerful

18:00

not only as painkiller

18:02

but as an astringent it finds

18:05

the bowels so opium

18:07

is very crucial in a

18:09

in a cholera epidemic is

18:11

absolutely vital medicine right

18:13

for treating children for treating

18:16

young adults and for treating adults

18:19

as well

18:21

as we developed ways to break opium

18:24

down into different products opioids

18:27

became more and more widespread

18:29

and commercialized

18:31

god your wally says you can follow

18:34

that commercialization right

18:36

up to two days opioid crisis one

18:40

or did he gets pushes

18:42

started around world words if there

18:44

, lot of national pride

18:46

and pharmaceutical industry they

18:48

had just produced don't want to treat infections

18:51

on battlefield so

18:53

when drug companies hold out new pain

18:55

killers like general and proceed and

18:58

doctors were interested

19:00

modern medicine is always been

19:02

looking for the perfect alternative

19:05

to morphine the the non addictive

19:08

team killer right and so there's

19:10

a lot of enthusiasm for

19:12

the powers of synthetic chemistry

19:15

and pharmaceutical production to

19:18

produce that these new opioids

19:20

were

19:20

that's silly enticing because at the

19:22

time options for treating pain

19:24

were then it

19:27

one of them might be to

19:29

call in a neurosurgeon who

19:31

might i conducted

19:33

a bother me and the the weird

19:36

kind of logic here was that what

19:39

you were doing was removing

19:42

not the pain center

19:44

of the brain but you were removing

19:47

a part of the brain to reduce the

19:49

likelihood that the

19:51

patient would complain there

19:53

are companies also worked hard

19:56

to get more doctors prescribing these

19:58

painkillers they were a ploy

20:00

the drug rep to meet

20:02

with physicians are you know the

20:04

the kinds of things that we consider

20:07

today to be undue influence

20:09

on medical practice this

20:11

was heyday of that spectrum

20:13

of activities

20:15

right yeah so let's take

20:17

you all out for gall saying ends by

20:20

you whatever and hey by the way let me the tell

20:22

you on my on the park and sets right

20:25

the nineteen sixties it was becoming clear

20:27

that these new drugs could be

20:29

addictive

20:31

meanwhile i knew theory of pain

20:33

became popular that been is

20:35

subjective experience just

20:37

simply by all of us and

20:39

that treating it might require

20:41

a range of options not

20:43

just single pill or surgery

20:45

the

20:46

on to nico who is seen as one of

20:48

the founders of pain medicine in

20:50

the postwar era he

20:52

helped to create something that became

20:54

that model for many decades

20:57

which is be a multi disciplinary

20:59

pain clinic the

21:01

idea that to be really effective

21:04

that ballistic version

21:07

of understanding pain and treating it

21:09

you might need a psychologist you might

21:11

need social worker you next might need a surgeon

21:14

clinic model with theory for

21:16

with thinking it it started

21:19

to disappear

21:21

i've read some the studies nice clinics even

21:23

though they showed that outcome say kind

21:25

of thing from the record over time what

21:29

is it cost to maintain this

21:31

multi disciplinary

21:34

orientation towards pain it

21:36

, increasingly difficult

21:39

in an era of cost containment so

21:41

increasingly what you have to is

21:44

to be frank to be of search

21:46

for the quickest fix and

21:49

is this story coincides

21:51

story coincides nineteen eighties with

21:54

another set of trends and

21:56

that is the emergence after

21:59

federal level with a

22:01

sense that you know the market the

22:04

solve our problems far better

22:06

then government could

22:09

that what we needed was to relax

22:12

but relations and controls

22:14

and allow the market flourish

22:20

like mind boggling new policies

22:22

policies that release some new

22:24

opioids into the market before

22:27

we could learn much thou

22:28

hast will you have our new

22:31

phenomenon like erupted

22:33

consumers truck africa and

22:36

house house

22:39

not to stand in way

22:41

of drug production but to let

22:43

drugs come onto the market

22:46

to solve the problems of

22:48

american of and will

22:50

figure out in the aftermath how

22:53

much a problem is much the

22:56

got caught in for example if one of the most

22:58

cried opioids on market when

23:00

it for

23:01

and out regulators didn't follow due diligence

23:03

regarding the manufacturer is claim that

23:05

it lol likely to be addictive

23:08

well that was naive

23:10

from the outset entered different regulatory

23:13

environment might have looked askance

23:15

at that that

23:16

once again companies marketed

23:18

these new opioids especially oxycontin

23:21

aggressively to doctors i

23:23

remember it so to start to your link

23:26

the big messaging that was out there

23:29

was at the risk addiction was less than one percent

23:31

with chronic opiates therapy so

23:34

why didn't ask the

23:36

pain thought leaders of times how do you know

23:38

that as turns us the essence for it was abysmal

23:41

was was it was actually largely based on single

23:44

size sentence letter to the editor in back

23:46

issues of us nineties into in the journal

23:48

medicine that the that single one

23:50

hundred word letter to the

23:52

editor was cited as evidence

23:54

that addiction was a rare consequence of opiates

23:57

here so it's kind of amazing in high season they were

23:59

approved but they were and

24:01

we now had

24:03

we authorization and and lots of expert

24:05

endorsements to go ahead and

24:07

prescribe opioid in way that we had

24:09

never really done before

24:12

big push to let drugs onto the

24:14

market without much oversight lead to

24:16

what doctor yearling calls a

24:18

decades long experiment on

24:20

the north american population after

24:24

experiment some nineteen ninety

24:27

nine to twenty nineteen half

24:29

a million people in united states

24:32

died from opioid overdose

24:35

it's the story of this

24:38

up on seemingly and disturbing

24:40

mix of how capitalism

24:42

and the desire for profit could

24:45

flood communities with the substance

24:48

and how long it takes kind

24:50

of recognized what's been going on and

24:53

then try to hold the actors account

24:56

wally says the blame for the opioid crisis

24:58

catch shift from ,

25:00

patients to add doctors

25:03

and then finally to drug companies

25:05

and consultants who helped them turbo

25:07

charge sales sales

25:10

general's across the country are trying to

25:12

hold the drug companies drug and

25:14

getting big settlements out of some

25:17

of lawsuits and fortunately

25:19

i haven't seen much of a plush

25:21

to use this money to find multi disciplinary

25:24

pain clinics even though

25:26

we know they work well

25:28

yeah so this is one the most unfortunate

25:30

things i think about the opioid

25:32

crisis i do think that big

25:35

years of the sixties in nineteen

25:37

seventies in which you see

25:40

this broad embrace

25:42

the multi disciplinary

25:45

ways of thinking about pain there's

25:48

a lot to be lured by reflecting

25:50

on fact that the reason why

25:52

that path was not followed not

25:55

because followed allowed increasing

25:57

lead narrow economics

25:59

and there's to really

26:02

inhibit the underlying

26:05

true truly expansive

26:07

understanding of what pain is and

26:10

how we might create system

26:12

that serves people in pain for

26:14

better than we do today

26:17

we need an approach to be that considers

26:19

the bigger picture that means

26:21

taking a step back from opioid

26:24

receptor then

26:25

looking at keen holistically

26:27

because , as highly individuals

26:30

are experience as it is affected by many

26:32

factors genetic spain

26:34

and other areas of the body stress

26:37

anxiety and past trauma

26:39

to name a few and we

26:41

all respond differently to pay

26:43

the treatment for

26:45

and some people feel eighty glad

26:48

each and nauseated when they take opioids

26:51

and others going to opioids

26:53

really help with their can so

26:56

where we go from here

26:58

dr yearling says the first death

27:01

is understanding that opioid

27:03

use is a spectrum the

27:05

people on on one end of spectrum

27:07

have opioid addiction and they need

27:10

access to things like buprenorphine in

27:12

methadone and supports and employment

27:14

and housing stuff like that

27:16

in the middle of the spectrum there are people

27:18

the have been on opioids for a while

27:20

and are dependent on them cutting

27:23

them off suddenly would create horrible

27:25

withdrawal symptoms when

27:27

i had species in hospital

27:29

it's not five minute visit and but i to

27:31

i pull up a chair i sit down

27:33

the bedside we talk for maybe an

27:35

hour symptoms more about

27:37

the potential benefits of

27:39

a very very gradual

27:42

patient , opioid opioid

27:45

will engage in a tapered over the span of months

27:48

sometimes even years and it's

27:50

amazing how often their pain and called

27:52

and playful actually improve when it's done

27:55

in thoughtful way

27:56

the last part of the spectrum is people

27:58

who aren't on opioids that might be

28:00

one day and that's a lot

28:02

of us

28:04

though if you're offered opioids there

28:06

are a few things you can do to make

28:08

sure you're getting responsible care

28:12

first ask about alternatives

28:14

to opioids the like tylenol

28:16

nonsteroidal anti inflammatory drugs

28:18

muscle relaxants and physical therapy

28:21

there may be more sex is safer

28:23

ways of treating your pain second

28:27

just opioids art

28:28

best option for your pain

28:30

sure your doctor has plan to taper

28:32

you awesome you shouldn't

28:34

just be handed be handed like i

28:36

was and sent away to manage

28:38

it on your own

28:40

i would say that it's

28:42

like flying a plane ride you wouldn't take off

28:45

he didn't know how to land

28:47

i knew about the risks as dependents

28:49

so i made my own plan for

28:51

tapering and i asked my partner

28:53

keep me on track it's easy

28:56

to be forgot solar confused when you're in

28:58

pain but i only need

29:00

to do that because i'm dr they

29:02

shouldn't have to figure it out on your own

29:05

bird if you or loved one

29:07

are prescribed opioids ask for

29:09

know lox own to

29:11

the lockdown can were first than opioid

29:13

overdose like i said

29:16

it can be easy forget if you've taken a dose

29:18

and you never know who in your household

29:21

can take your metics so

29:23

no lox own can literally save

29:26

life

29:27

when i ask for naloxone the er doctor

29:29

looked me like was asking for a ticket to

29:31

marks with it should be

29:33

standard

29:36

understanding what opioids can

29:38

and can't do and the risks

29:41

is as important as knowing what your car

29:43

can can't do and risks

29:45

of driving

29:47

and we've gotta do better job as giving

29:49

everyone the rules as the road

29:52

the information they need to make

29:54

informed decisions and get

29:56

responsible pain treatment

30:07

if

30:10

you or someone you know is struggling

30:12

with substance abuse or thoughts of

30:14

suicide the substance

30:16

abuse and mental health services

30:18

administration helpline administration free

30:21

confidential and available twenty

30:23

four seven at one eight

30:25

hundred six hundred six

30:27

for three five seven that's

30:30

one eight hundred six hundred six

30:32

four three five seven

30:38

next time body sas we take on

30:40

a particularly debilitating

30:42

kind of

30:44

so excruciating i

30:46

couldn't get out of bad

30:48

you do with your back hurts

30:50

and how to avoid back treatments

30:53

scam

30:59

forty

31:04

seven brides event

31:11

had litter media argue

31:14

mitchell johnson ponzi rights

31:16

credit cards as quints van

31:19

den chang any case

31:21

and roxanne high last he be

31:23

wang as are sound designer and next

31:25

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