In this episode, Robert and Dave take the conversation in a new direction to discuss the crucial issue of using controlled substances for medications for those in critical need. At the same time, they will be suggesting guidelines and safeguards to prevent addiction while still providing pathways to find maximum relief and equilibrium for those with chronic pain and long-term sleep challenges. The goal is to find the optimum quality of life, which often includes the use of medications to alleviate chemical or physical maladies our bodies cannot manage on their own.
This topic is more than personal to Robert as he pursued finding the right combinations of medications after a severe reaction to kidney transplant medications for nearly a decade. Through his experience, he provides tools to learn how to advocate for ourselves. It can also be invaluable to have somebody close to you that can guide the communication with doctors so we can best take care of serious life issues. The corruption of big pharma, as depicted in Dopesick, has created an understandable wave of panic throughout the country. Robert and Dave address the effects this has had on the way controlled substances are prescribed for those with chronic pain and long-term sleep issues, and how we can navigate our way at these critical times.
Note: Below, you’ll find timecodes for specific sections of the podcast. To get the most value out of the podcast, I encourage you to listen to the complete episode. However, there are times when you want to skip ahead or repeat a particular section. By clicking on the timecode, you’ll be able to jump to that specific section of the podcast
The Missing Conversation Episode 78.
Robert Strock (00:03):
What addiction really is, is when you’re using a medication and then you need more and more of the medication to have the same effect, and that brings you beyond the safeguard of what your doctor will tell you is the limit. And it’s only when you misuse the guidelines that you become an addict.
On this podcast, we will propose critical new strategies to address world issues, including homelessness, immigration, amongst several others, and making a connection to how our individual psychology contributes and can help transform the dangers that we face. We will break from traditional thinking, as we look at our challenges from a freer and more independent point of view, your host Robert Strock has had 45 years of experience as a psychotherapist, author, and humanitarian, and has developed a unique approach to communication, contemplation, and inquiry born from working on his own challenges.
Robert Strock (01:04):
Thanks so much for joining us again at The Missing Conversation where we do our damnedest to address the most pressing issues that the world’s facing today and what we’ve looked for the most practical, inspiring programs, innovative ideas, and people to support survival on our planet. Today we’re gonna start to look at the crucial issue of balancing using controlled substances, slash medications for those in critical need with especially chronic pain and major sleep issues, and at the same time create safeguards to prevent addiction. We will also take a look at what addiction really is, as it is so misunderstood by many of us, and define different psychological personalities that will help us make wiser choices for our own quality of life as it relates to what medications we consider when we’re suffering. I’d like to start off by introducing Dave, my partner at The Global Bridge Foundation and dearest closest friend for over 50 years.
Thank you, Robert. It’s great to be here. I know this particular subject is more than personal. It’s in my experience over the years, particularly with you, it’s been a question of quality of life and survival. And it’s hugely important because so many people have their own version of how they really move through this space, one way or the other, either by moving away from it in a way that’s not helpful or getting caught up in it in a way that’s not helpful. So, thank you for focusing on this and let’s go for it.
Robert Strock (02:52):
Very likely unknown to you that are listening is that Dave and I for decades have been at the forefront of a lot of close friends, family, and clients and giving guidance to how we can use medications, always with checking in with the person that we’re talking to’s doctors. But we’ve been so active, especially with pain control and sleeping medications and this issue is so important that we each learn how to advocate for ourselves and/or have somebody close to us that can guide us to really communicate with our doctors well so we can best take care of serious life issues that particularly come as we get older. And I would be remiss if I didn’t really start with what my experience was like when I watched Dopesick and Dopesick is a documentary that really tells the story of Purdue Pharma and how the country has lost literally hundreds of thousands of lives and addicted several hundred thousand people in a very short period of time.
And how this corruption created a wave of panic through the whole country. It affected not only all of us, but it also affected doctors. For those of you that have not watched Dopesick and have a stomach that can handle it, I would highly encourage watching it because as is the case with many extreme events in our lives when we’re affected by, whether it’s Me Too or whether it’s civil rights or any movement in our country, we have a tendency to then react and then oftentimes go to the other extreme and then become outta balanced again. And this can go back and forth. So a lot of what we’re going to attempt to do today is really look at the issue of controlled substance medications that are particularly needed for chronic pain and chronic sleep issues and at the same time be sensitive to the dangers of addiction.
Dopesick is really hard to watch because you see how devastating it is and it’s set in the Appalachian Mountains where mining and work is so frequently causing long-term pain. But it brings you to a world where you can really understand why we have to be careful at every stage that we aren’t supporting addiction. At the same time, if we’re supremely cautious and we become so strict with the regulations, then there are millions of people, at any point in time, that are in chronic pain or are chronically having very, very poor nights of sleep, both of which devastate, devastate the quality of life. So how do we find a balance where we can have regulating agencies which are active, how can we have them have reports from doctors, from pharmacies or anyone that prescribes medication. And find that balance of taking care of people that are in pain that can’t sleep and also enlighten these people that there are these options and at the same time not reinforce people that might misuse the system go to multiple pharmacies, multiple doctors, and become addicts.
So one of the keys to understanding addiction is that many people believe that addiction means, oh my God, I’m gonna have to use this medication for the rest of my life, I don’t want to do that. That means I’m a drug addict. That means that means that I’m gonna have this for life and that’s a terrible thing and it’s gonna make me sick or I’m gonna have side effects. And this, almost like a panic reaction, where what really is addiction? And it’s very important that you listen to this carefully, because even if you understand it, it’s very easy to have this understanding be taken over by other people’s views. So what addiction really is, is when you’re using a medication and then you need more and more of the medication so you have to keep taking more to have the same effect and that brings you beyond the safeguard of what your doctor will tell you is the limit. And you act outside of their influence and you don’t know to stop when you’ve hit that limit.
Now that limit also, in some cases, involves chronic use, but the medications we’re talking about, if they’re maintained within a certain parameter and aren’t overused, they can easily be used for the rest of your life, for most people. Now that’s not to say that a small percentage of people have side effects, but it’s crucial to understand, as is the case with me, I need to take medications for the rest of my life guaranteed to have my kidney survive from a kidney transplant. People that are diabetic are gonna need to use insulin for the rest of their lives. So it’s very important that you understand the same thing exists with opiates and benzodiazepines, which will explain more thoroughly that they have limits as to how much they can be used. So the guidelines need to be followed and it’s only when you misuse the guidelines that you become an addict. So, it’s important that you really try to see, as you go through the whole show, that we have covered it. If we haven’t, I welcome anyone to send in a request for further clarification.
Can you please distinguish between what we’re talking about here, which is a legitimate use of a medication controlled substance or otherwise versus the kind of addiction that comes through trying to suppress, repress, or otherwise deal with difficult situations, emotions, recreational activities and things of that nature that are what I think most people conceive of as an addict, as a, as a person that gets caught up.
Robert Strock (09:40):
Crucial question. There are a lot of people that will use benzodiazepines, which are drugs like diazepam or clonazepam and because they’ve heard it gives you a high, they’ll use it recreationally. Under no circumstances are we talking about using any of these medications, without careful doctor guidance. And not only guidance but that guidance will tell you you can’t use for your condition of pain more than X amount for X period of time. Or, if you’re 50, 60 years old and you’re sleeping three hours a night or four hours a night and you’ve experimented with the normal kinds of medications like Ambien and it’s not working for you or Lunesta or a number of ones, then you will need to consider using controlled substances and that is a healthy use because otherwise you’d be looking at potentially 20, 30, 40 years of being in an altered state of mind and really exhausted for the rest of your life when there is a solution. If you follow your doctor’s guidance and you aren’t afraid of using controlled substances. Controlled substances doesn’t mean that you shouldn’t use them. It means that you need to be careful to follow the guidance of your medical professional.
And to be clearer on that point, you just said if, if I’m correct, it isn’t that Lunesta or Ambien are not controlled substances, they’re just controlled substances at a different level than some people need to go to, to accomplish a lifestyle that’s gonna keep them in equilibrium.
Robert Strock (11:33):
That is correct. There are some sleeping medications that are not controlled substances but Ambient and Lunesta are on the very lowest end. People can use melatonin for example or they can use a number of, not what would be considered to be somewhat medium core or hardcore medications. They are rated on a one to five level and there are bodies, both national bodies and state bodies that are watching what anybody is taking in the country and especially thoroughly in California. So there is a central resource that is a monitoring body by the country and the state to make sure, as best they can, that people are not doing what Dave talked about is using it recreationally, which frankly they would have a hard time doing cuz no pharmacy is going to give these medications uh for someone that’s using it recreationally. However, the black market is very, very active in anything that is legal can easily be made illegal, uh, through other countries uh, or through other manufacturing on the part of a private party that is not an official pharmacy.
So again, I wanna reiterate that addiction is not using controlled substances or for that matter, any medication for the rest of your life. That needs to be completely abolished from your brain and that you need to recognize it’s only when you are using above the recommended amount to have the same effect and therefore you would have to change to a different medication because we can’t go beyond the recommended amount or else we are then addicts to that particular drug or that particular medication. Now one of the other, in some ways humorous, and in some ways very serious issues that is very helpful to deal with is that when you look at a medication as it’s advertised on TV, there’s a whole long laundry list. And I remember the first time I saw it, I laughed my ass off because okay, you can take this medication and it will help our arthritis, but it might kill you because of kidney disease.
It might kill you cuz of liver disease. It might kill you cuz of heart disease, but don’t worry about it. The long laundry list of all the potential side effects is enough to scare anybody if they don’t do this next level of what is being suggested, which is you need to investigate what the percentage of people are that have these side effects. And in these serious side effects, invariably it would have to be less than 1%, and in many cases less than a 10th of a percent or a hundredth of a percent, but the drug companies have to announce this so they don’t get sued. But that is a panic wave when you watch a commercial, it’s, it’s humorous to see all the conditions that it could cause. That might mean out of 10 million people, two people died of a heart attack and they weren’t sure, so they had to list it to protect themselves.
So I am encouraging you to look at the percentage of side effects. And so if you’re one of those people and one of those millions of people in the country that are having severe difficulty sleeping or are in chronic pain and you’ve tried the lighter level uncontrolled substances to help yourself and you can’t find anything that works, you need to consult with your doctor as to whether or not you can be a candidate for using these controlled substances for whatever period of time, including the rest of your life. And of course you’ll be monitored ongoing by your doctor for these side effects so that you can see that, oh my God, now I can sleep for the first time in five years or two years a whole night. And your whole quality of life changes. Or, if you’re in chronic pain, and your days are misery, you can’t afford if you care about your quality of life to not have this conversation with doctors.
Now one of the things that also needs to be mentioned is of course doctors are affected by this too. They are being watched by a national body that is statewide and nationwide. It’s the DEA and the and the DOJ, that’s the Drug Enforcement Agency, as well as the Department of Justice that has an ongoing record of all of us and all the controlled substances we’ve used. So the doctors or psycho-pharmacology or psychiatrists or pharmacies, they’re all being monitored as to whether they’re giving in an individual situation, something that’s questionable or in general, if they’re a doctor that’s prescribing these medications to a lot of people, they will be notified. And they also can go into the databases themselves and see whether you have been a drug abuser in the past, whether there’s any record about you, what other pharmacies might be prescribing medications.
And that is a really good thing. It’s that’s been developed over the last number of years. So there are these safeguards that are already in place that can be used. But the key issue is that your psychiatrist, your psycho-pharmacology, even your pharmacist will all be very conservative because they’re afraid of being sued and it’s not crazy or irrational on their part. But it highlights why you need to think for yourselves because there are a lot of psychiatrists or psycho-pharmacology understandably, that will always prefer to try other things and there are a portion of them that will simply not use controlled substances. So you need to be a partially your own doctor and recognize that if you’re one of those people that have a chronic issue, you can’t afford not to represent yourself and have a deep conversation with your doctor or psychiatrist or psycho-pharmacology. You might even ask them, are you someone that doesn’t prescribe this to anyone? Now there are many general MDs that will not do that and that’s somewhat appropriate. They will refer you to a psychiatrist or a psycho-pharmacology to consider that. But it’s even more complicated than that because some of those will also be very restrictive. So you’ll, you’ll need to do some of your own education.
And to add to that list of common people would be doctors that specialize in pain management.
Robert Strock (18:36):
Absolutely. As a matter of fact, that’s a really crucial point that psychiatrists and psycho-pharmacology don’t deal with pain medications. That’s a completely different classification than psychological issues. So, if you’re dealing with sleep, they will deal, deal with sleep issues. But you really are dealing with pain doctors, if you’re dealing with pain medication. So that’s a very important thing to understand. For example, if you’re going to a psychiatrist and you’re dealing with pain, you’re going to the wrong doctor. You appropriately would be seeking out the guidance of a pain doctor. And there are plenty of pain specialists and Dave and I have both been through this for a number of decades, and pain doctors in general—if you’re a pain doctor, excuse me for saying this—but if you’re a good pain doctor, I think you’ll agree with me that there are a fair amount of pain doctors that are not really extremely balanced themselves. So you are going to have to shop around to find a pain doctor that is really sensible and balanced. And if all the doctors I’ve tried to find, a good pain doctor is one of the hardest doctors to find.
And to amplify that, even to get to the point being in pain where you get to the pain doctor means that you would’ve identified and diagnosed the cause of that pain, which could take another specialty or two. That is it’s yes, I want to be out of this pain and maybe there’s an immediate relief that’s needed, but also that the source issue needs to be identified and managed.
Robert Strock (20:16):
Right. And to concretize that if you have a pain that’s from a spinal fusion or any other kind of spinal issue, then you will likely need to have a current MRI and then you’ll likely have to have an evaluation from a spinal specialist and they may decide to do what’s called a nerve root block or they may decide to do something to burn a certain nerve instead of having pain medications. So there are a number of areas like this that involves, as Dave was saying, the rest of the medical profession. Now one of the areas that I think is really good to understand, to see how America has ping ponged from one end of the spectrum to the other end of the spectrum, even though in this area they’ve largely been on the more conservative end. In 1970 I went to England and visited the St. Christopher’s Hospice.
And the reason why I went there was because I heard mind-blowing feedback that St. Christopher’s Hospice, which was treating hundreds of patients at a time, was a humongous room, with living room furniture and curtains all on the same floor. And they were able to treat final stage patients that had less than six months to live that were dying of cancer and 98% of them were able to die pain-free. And the reason why they were able to do that is they studied the pattern of pain and if the pain came every four hours, they timed it. So the pain medication they gave the patient would kick in in three hours and 50 minutes and they would keep tweaking it as time would go on. And what they discovered, which is utterly shocking, is that in the end when they tracked the end of time of the six months they had, or the four months they had, they realized that they used less pain medication because they were, not only having to treat the pain before, but they were also treating the fear and terror of the pain, which itself caused more pain.
And so very ironically, when you are sensitively using pain medication and you don’t have to deal with the fear of the pain, then you may very well be able to use the same amount of medication or perhaps even less, like was the experience with St. Christopher’s Hospice. Now when I visited there, it was proven to me this humongous room with families able to sleep, able to close the curtains. Most of the people had the curtains open during the day and they were not bombed out. You might think, oh well the way they did it, they just bombed them out. Great. They couldn’t even say goodbye. No, the people were actually alert, which was completely amazing to see people not screaming and yelling or not just zoned out and just passed outta the bed. As I walked the room over the several hours I spent there, there were very, very few people that were sleeping, they were interacting with family.
There was tremendous involvement. So I went back to the United States hoping that hospice at that point was doing a similar thing, but they weren’t. And through the years they’ve gotten better and better and better. And I would still say, to the best of my knowledge, I’m sure there are many exceptions, cuz obviously I’ve only visited a small percentage of hospices that the majority of the hospices are giving much better pain care and are anticipating it and are flexible, but they’re not doing the same thing of doing it before the pain exists in general and the degree of clarity isn’t understood as well and they are still more afraid of being sued by family or by someone that’s involved. So, it’s still a very careful area. Now what ended up happening there is that ended up being the good news in hospice where it actually did enlighten, which is what we’re trying to do with pain medications for chronic pain, not for terminal pain and also for chronic sleep issues.
We’re trying to have that not be a boomerang effect. But what happened in this situation is that with Purdue Pharma and Oxycodone, it created such a panic wave that in addition to the fear that most people had before it started of using controlled substances because of being seen by themselves and others potentially as addicted or really using medications to run away from their pain, they were trying to lead it to an understanding that this is an absolutely healthy use of these controlled substances. And from my vantage point, I view it as the pinnacle of intelligence and health and pursuing a quality of life when otherwise it absolutely would not be that way. I even analogize it to my clients and friends and family to it being like vitamins that your body needs help because your chemistry and your urology is screwed. The only way to unscrew it is to balance it with the assistance of chemistry being added to your chemistry.
So we need to retrain our own brains and not just mentally, not just on an insight level. This needs to be a passion inside you that says, you know what, whether it’s when I get older or when I’m younger, cuz there are a lot of young people that go through surgeries that cause pain, that that go through conditions that have chronic pain. So it’s virtually certain if we’re older and we don’t die suddenly that we’re gonna be in some situation that is either sleep deprivation or ongoing pain, whether that’s arthritic or otherwise, I’m just mentioning arthritic, that’s one of the more common ones that we need to see this as a very viable and sensible and intelligent option and then know that we are going to follow our doctor’s orders. And that does not make us an addict.
To complete one of the important things you said or amplify it. What you saw at the hospices in England was so skillful, was beyond even what I consider to be the best of the skills or maybe matching hopefully some places in the US of not really over-medicating, not under-medicating, not chasing the pain, but getting with the patient’s feedback. And this is not just for hospice, but for everything, to find your sweet spot where you have the maximum freedom. You’re not over-medicated, but you’re not under-medicated and chasing your pain and a misery.
Robert Strock (27:57):
What Dave is highlighting, which is not let’s say intuitively obvious, is not only not over-medicating, in many cases this will lead to a stabilization of medication or maybe even a lessening of medication cuz all of us naturally are afraid of severe pain. And you may or may not have thought about it, and I am strongly suggesting you think about it now that your fear of not sleeping, for example, is gonna make you not sleep. Your fear of having pain is gonna make you take more pain medication. If you follow the guidance and find that sweet spot as Dave said, that midpoint, then you’re really hitting the pinnacle of your intelligence and utilizing that for your quality of life and old age and aging itself can be seen in a different light. I’m not saying it’s gonna solve every ache and pain, but it’s gonna take the severity and even the fear of severity.
When you start to move toward those years, it’s gonna reduce that what we’re talking about is great news, if it’s followed intelligently with the use of your doctor and your doctor that is specialized in the area that you need specialization. And as Dave mentioned, again, it may very well require doctors that are outside the realm of pain or outside the realm of sleep. And it may in involve MRI’s and investigating your whole body to see if there are other solutions. So, I’d like to wind this episode up and really encourage you to join us because we’re gonna be getting into a lot of understanding as to how to apply this to yourself and also help you see and understand your own psychology better to see what your tendencies are, to be able to work with those tendencies to optimize your quality of life and reduce the level of fear and carelessness. Thanks so much for your listening and I hope you’ll join us for the following episode or episodes.
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