← The Clay Travis and Buck Sexton Show
The Clay Travis and Buck Sexton Show
Wellness Unmasked: Navigating the Pain Management Landscape with Dr. Paul Lynch
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- [00:00]
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- [03:17]
Dr. Nicole Safire
Welcome to Wellness Unmass. I'm Dr. Nicole Safire. Today we are diving into a conversation that intersects two national health emergencies, the opioid epidemic and chronic pain. In 2024, over 80,000Americans lost their lives to drug overdoses. Now, this is a 27% decline from the previous year, and that's the steepest drop that we've seen in decades. This is absolutely encouraging, but we still have a long ways to go. Overdose remains a leading cause of death in adults among those aged 18 to 44 now. But I don't want to get into the weeds of the opioid epidemic right now because that is its own episode in itself. And to be honest, it is more than just one episode. We have to talk about the history of it, where we are now, and the future of it. We're not doing that today. Here's what we're doing today. What's often left out of the conversation is the fact that more than 50 million Americans, roughly 1 in 5 adults, are living with chronic pain. And of those, nearly 17 million are experiencing high impact chronic pain that actually limits their daily lives. Now, this is not just a personal burden, it's actually a national crisis. I wrote about it in my first book, make America Healthy Again, which came out in 2020. Chronic pain costs the U.S. economy an estimated 560 to $635 billion a year. Now, this is direct medical expenses, but it's also from lost productivity, more than the combined costs of heart disease, cancer and diabetes. Yet we rarely hear people talking about chronic pain. And I guarantee people listening to this podcast, there are some of you who are dealing with it. I'm dealing with it. I have talked to you about the fact That I suffer from an autoimmune disease, and I do everything I possibly can to fight that inflammation, Whether it's taking my biological injections to living a clean lifestyle, to exercising and doing other things that are targeted for decreasing inflammation. What some of you may not know about me is deep. During COVID December 2020, I also fell down my stairs. Yeah, that's right. I wasn't doing anything fun. I wasn't dancing or doing anything crazy. I was going down to grab some laundry, and I was wearing socks on my wooden stairs. And yep, my foot went out right from under me to protect my head. Because I'm married to a brain surgeon, and I've heard total nightmare stories about people falling downstairs and hitting their head, I instinctively threw my arm behind and protected my head. The good news is I did not hit my head, but I sacrificed my arm to protect it. By the time I got down to the bottom of the stairs, I knew that something was terribly wrong with my arm. I immediately had to have two surgeries to put the pieces of my arm back together again. But I found myself several months after that second surgery, still in chronic severe pain. And I found myself. I was back at work. I was going back to my daily life. But every evening, I was in such severe pain. I was taking motrin to get through the day, Tylenol. And then I was also taking pain medication in the evening time because I still needed to get on with my life. I have children, we have laundry. I have driving, we have to make dinner. And I needed to get some rest. And I found myself realizing that without taking pain medication at night, I wasn't sure I was going to make it. It was affecting me physically, it was affecting me mentally. So my husband and I decided that I needed to seek the help of a pain specialist. And that pain specialist decided to take me off of the pain medication. And he injected my joint with some medications to decrease the inflammation. And it took a few injections. But all of a sudden, I got my life back again. I was able to get through the day without feeling severe pain. I was back to exercising, and I wasn't needing to take any more medication. Now, not everybody is able to go and find a pain medicine doctor. They don't even realize they exist. And some pain medicine doctors will just continue to prescribe opioids and other medications. So how do we balance effective pain relief with responsible prescribing? How do we treat pain without fueling addiction? It was the treatment of pain that got us into this problem of the opioid epidemic in the first place. To help answer these questions, I'm joined by Dr. Paul Lynch, a double board certified pain management physician. He's the founder of multiple national pain clinics and a fierce advocate for safe, non opioid alternative. You're listening to Wellness Unmass. We'll be right back with more.
- [07:51]
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- [11:54]
Dr. Nicole Safire
Am happy to have on my friend, former colleague Dr. Paul lynch who has dedicated his career to treating pain. He's also founded US Pain with a clear mission in mind. So Paul, thanks so much for being with us on wellness unmasked.
- [12:07]
Ryan Seacrest
Dr. Safire, thank you so much for having me.
- [12:09]
Dr. Nicole Safire
Oh, we're going to be formal. Okay. I'll be Dr. Safire, you can be Dr. Lynch. So take us back to what initially drew you into pain management in the first place.
- [12:20]
Ryan Seacrest
Yeah, if you will allow me, I'll go all the way back to being nine years of age. And my dad is a therapist. He's a licensed clinical social worker and he was on the phone in the kitchen and he called me over to him and he wrote on a piece of paper to go next door and call 91 1. And my dad's patient had called him to say goodbye. He was the therapist. And she said he was the only person that ever listened to her and cared about her and he was the only one that would miss her. And so he kept her on the phone while 9 year old Paul ran next door. We called the police and my dad was able to save her life. But I felt like I was part of that. And I said that I've been kind of chasing the dragon to mix our metaphors here today of saving lives since I was nine years old. I always wanted to be like my dad. I wanted to be a psychiatrist. And all the way through school, I majored in psychology. In college, I matched in psychiatry. I'm not sure you even remember this story, Nicole. We used to talk about it, but I matched in psych. I was supposed to go to New York City, right? Kind of like you. I was supposed to be in New York for psychiatry. And I was about a month away from graduating and my mother in law was diagnosed with a severe form of cancer. It was pancreatic cancer, which I know you have a lot of experience with in your practice. And it spread to her spine. And so she had like seven fractures in her spine and she had a lot of tumor in her belly. The family asked me to help with pain control. I knew nothing about pain as a medical student, right? And so I just started researching and I would talk to the doctors in the hospital and I would use Google. And in the process I realized a couple things. One, she needed these fractures repaired in her spine. And I learned about a procedure called kyphoplasty, where we could blow up a balloon and restore height to the bones and take away pain. And I read about a procedure called celiac plexus block where we could literally block these nerves that went to her belly. And as I was reading about it, I realized that this was the specialty that I was, I was always supposed to, to be in. I just didn't know it. You know, I always wanted to treat mental health. Growing up, watching my dad and wanting to be like him. And then I realized that there was this specialty where I could treat mental health and physical health at the same time. And that was pain. And so I literally dropped out of my psych residency. I had no idea what I was going to do. It was a scary time, but I have a strong faith in God and I just prayed and I asked God to open the doors. And I won't tell you the rest of the story now, but I got into surgery in New York and then I did anesthesiology at NYU and became a pain doctor.
- [14:54]
Dr. Nicole Safire
I mean, isn't that interesting that you learned early on in the career because usually it's not until you've been in practice 5, 10, even 20 years that you see how intimately connected physical health and mental health really are. But pain is the forefront of that connection because chronic pain is one of the most debilitating things and affecting mental health so much. And obviously you have now dedicated your professional life to treating acute pain, but also chronic pain.
- [15:24]
Ryan Seacrest
Well, that's exactly right. And I think that for better or for worse, God gave me these experiences and I learned from them. You know, I like to talk about justifying the suffering. You know, the suffering that my mother in law went through was vast and what my wife went through and seeing that. But I feel like that out of that there was a silver lining that, you know, I think I learned what true suffering is. And it's not just physical suffering, but it's mental suffering. And I think I probably, I learned the mental suffering part for the first 15 years of, you know, believing I was going to be a psychiatrist. And then I learned the physical suffering probably over the last 15 or 20 years. And the thing that I really want to talk about today is that there's, there's a third part of it which is yes, you can treat the physical suffering and yes you can treat the mental suffering. And as a country we're getting a little bit better at talking about mental suffering. But we're really bad when it comes to addiction.
- [16:17]
Dr. Nicole Safire
Well, let's talk about that. Because when our quest to focus on pain, we thought we had the magic pill, the opioids, I mean, right. Which you know, decades ago when they first came to the market, all of a sudden we were finally seeing something that was helping people with their pain. And now we're still in the middle of an opioid epidemic. You've obviously been very vocal about non opioid interventions, but in your view, let's go back a little bit. How do you think we ended up in this opioid epidemic in the first place? You know, what did the medical community do wrong?
- [16:51]
Ryan Seacrest
Well, I think it actually comes from the good side of us. The positive side of being a physician is you want to help your patients. When, when I saw my mother in law suffering in the hospital, dying in pain, of course I wanted to give her opioids. She was dying with cancer and we wanted to Take away that pain. And people came along, you know, multiple times over the last hundreds of years saying that there was a new opioid that's not addictive. Right? Like, I'm not sure if you know this or if your viewers do, but when they released heroin, it came out in about the 1880s. Morphine, we were learning, was very addictive. We started using morphine a lot during the Civil War, and by the 1880s, we had, you know, thousands of people that were addicted to morphine, so they released heroin. The same people that make bare aspirin made heroin. And they said, it's just like morphine, but without the addiction. That was the. The advertising. And of course, we found out that heroin is very addictive. And then we thought the same thing was shocking, right? And then we. We thought. We thought the same thing about oxycodone, the same thing about Vicodin. And we went through this period in the 90s where the entire health care system came together and basically said, we can treat people with opioids and they're not going to get addicted. And it was a slippery slope, but it accelerated by the time I went to Medical School in 1998. I had a lecture on a Monday, and the pharmacology teacher said that opioids are a perfect molecule that won't damage one cell in the human body if used at the right doses. That's what they told me in 1998. And the next day I went to a lecture in behavioral health, and they brought in a heroin addict to talk to us. And he said he robbed the pharmacy, sat down on the floor, set off the alarm, and knew that he could get away. But he chose to shoot up one last time because the opioid was more powerful to him than anything, including his family and his God. He said that to us, and I said, how could this reconcile with the lecture that we got yesterday? And this was 1998. And so we went through about a 20 year period, call it 1995 to about 2013, where we basically told people that these meds were safe. And they are safe when used in the operating room by an anesthesiologist. They're safe when used at the end of life for someone who has cancer. They're not safe for people that just have low back pain and that. That doesn't mean we don't use it. There are some patients, you know, I say low back pain. I had patients that, you know, were blown up in Iraq and had shrapnel on their spine and were paralyzed and there. There is true suffering that we see every day in our pain clinics. What we need to be very careful about is putting someone who doesn't need to be on opioids on opioids, because the addiction problem really is real.
- [19:21]
Dr. Nicole Safire
Well, so what. I mean, there are still many people who are addicted. What are your thoughts on Suboxone, you know, widely used for opioid addiction treatment? You know, what are your thoughts on some of those medications?
- [19:32]
Ryan Seacrest
Yeah, so my goal with US Pain care is I want to save a million lives. And people say, how are you going to save a million lives? And the answer is to do what I talked about earlier. I call it try diagnosis. These patients that have mental health issues and mental suffering, they have physical suffering, but they also become addicted to the very pills that we're giving them to treat their physical suffering. Sometimes they get addicted to the pills that we give them to treat their mental suffering. I listened to one of your podcasts earlier this month on anxiety and adhd, and like, you talk about these medications. There's the flip side of it, which is we always are battling the side effects, which sometimes could be dependence and addiction. So for me, the way that I save a million lives is, number one, is we have to get really big market share, which I'm working on, going into all 50 states and working with some of the best doctors around the country. But once we have market share, I want to influence, if not change, the standard of care that if someone becomes addicted to the pills that we're giving them right now, what we do is we kick them out of our clinics. I'm an anesthesiologist. I'm not an addictionologist. And so someone would come in, I would write them Percocet because they just had knee surgery, and at week two or three, they're still hurting. Let's say I keep writing it at six weeks, let's say it becomes clear they're totally addicted to the meds. What most doctors will do is just cut them off the pills and kick them out, or send them to an addiction psychiatrist, which typically takes about 90 days to get in to see. And a lot of the people are out of network. They can't, you know, you can't afford it. My goal is to train anesthesiologists across the country in physical medicine, rehab docs and neurologists or radiologists or whoever I'm working with that if that person becomes dependent, you just treat it like a side effect. You don't act like it's a big deal. And the treatment is Suboxone. You know, you asked about Suboxone. If you take someone who has opioid use disorder, not just someone that's been on for four or six weeks, that's not a great example. What about someone that's been on for four or six years and they're taking 10 pills a day and they're going to the street and maybe they're getting fentanyl, which is widely available now in every city. If you put that person who has opioid use disorder on Suboxone, you reduce their death rate by 50%.
- [21:40]
Dr. Nicole Safire
And so how does Suboxone work for people who don't really know it, as people have heard a lot about naloxone, but not necessarily Suboxone.
- [21:48]
Ryan Seacrest
Sure. No, It's a great question. And I know your viewers probably can't see me, but I'm going to use my hand to demonstrate. So there's like a receptor in your brain called a Mu receptor. And if someone's taking fentanyl, let's just use Fentanyl example, because it's the drug that's killing so many people. 80,000 dead from fentanyl in 2023. So fentanyl comes along and it sticks in the receptor, and it's a perfect fit. It fits perfectly in the MU receptor. We call that an agonist. It agonizes or it stimulates the receptor and you get pain relief. Sometimes you get euphoria and you can get respiratory depression where you stop breathing. You also get other things like itching and constipation and stuff that no one cares about. But it's fitting perfectly inside this receptor. If someone overdoses, you can give them Narcan or naloxone, which a lot of people have heard about. I worked with the White House between 2014 and 16 to get education out there about how we can use Narcan throughout the country. This wasn't a thing, like, even 10 or 15 years ago. But now we have Narcan in the back of every ambulance. We have it widely available, and we know that it saves lives. And so where you have that Fentanyl stuck in that MU receptor, Narcan comes along. It's called an antagonist, and it's stronger than the fentanyl is. So it kicks it off. And now I'm putting my hand kind of partially in the receptor. The Narcan only partially stimulates the receptor. And so, and I'm not saying that. Well, I'm sorry, it completely blocks the receptor and it kicks off the Fentanyl. And so if you look at Suboxone, there's actually two molecules in it. One is buprenorphine, which is called an agonist antagonist. And so it partially agonizes the receptor. So if you give it to a patient who has severe pain, they will get some pain relief, which is a nice benefit of Suboxone. Not as much as fentanyl, but it might work 60% as well or even 70%. But here's where it gets interesting. It also blocks the receptor. So we call it an agonist antagonist. It will partially bind to the receptor, but it blocks it. And here's the part that most people don't know. It is 70 times stronger than fentanyl. 70. And so when people are afraid of, like, this fentanyl crisis, I tell them, listen, I'm not afraid of fentanyl. We literally need more Suboxone or more Buprenorphine, because it's like Godzilla is buprenorphine and fentanyl is this little baby bunny at a molecular level when you're talking about how it stimulates that receptor. And so what we do with Suboxone is we combine these two molecules, Buprenorphine, which will partially agonize the receptor and block it, and then Narcan, that's there. And a lot of people don't realize this. The Narcan, the naloxone that's part of Suboxone, is not even biologically active when you take it sublingually. So you take it under the tongue, it goes into the bloodstream, and the buprenorphine is working. But if you take it and shoot it up, because sometimes when you have opioid use disorder, people start doing IV drugs. If you try to shoot up the buprenorphine, it keeps you from overdosing because the Narcan is released and it blocks the receptor. So it's a brilliant drug. And when combined, like I said, it's a 50% reduction in mortality because it's so much more strong than the opioid.
- [24:46]
Dr. Nicole Safire
So you're using the Suboxone to treat the chronic pain as a means of someone who has already been addicted to it, or you're starting with Suboxone to begin with.
- [24:55]
Ryan Seacrest
So it's kind of a loaded question. We don't use Suboxone, typically. If it's just pain, we'll use a different. A different way to get the buprenorphine into the body. So one's called a butrans patch. You can just put a patch on and it gives you buprenorphine and it blocks your receptor and it gives you pain relief. But you don't, you don't get addicted and you don't overdose. It's almost impossible to overdose on buprenorphine unless you combine it with like alcohol or benzodiazepines or other sedative hypnotic agents. So for someone who comes in that just has chronic low back pain, a lot of my community is going towards buprenorphine as a treatment because it's so low risk. But if someone comes in and they have terrible, serious pain and they become addicted and they have full on opioid use disorder, this is a very easy diagnosis to make. There's 11 questions in the DSM 5. They have low or mild, moderate and severe. And if you take someone like my. My younger brother, by the way, was a heroin addict. And, and I can tell you a little bit more about that, you know, maybe later, but I. He has severe opioid use disorder. And he started helping me tell the story of kind of what he went through. He started on Percocet and then within about 90 days, he got addicted to heroin. And it lasted about 10 years where he was full on severe opioid use disorder. And so for someone like him, he has chronic pain. He had an overdose that was so bad in 2006 that he spent about 90 days in the ICU. He had about 26 surgeries. He was paralyzed from the waist down. It was terrible, Nicole. And when he came out back, for.
- [26:27]
Dr. Nicole Safire
Those who don't know the story. So what most people don't understand is they think of, well, we take Percocet, maybe wisdom teeth got taken out, they had the ACL from a ski injury. Most people can't comprehend how you can go from just taking post procedural opioids to getting heroin on the street. Like, they can't fathom that that happens to everyday people.
- [26:47]
Ryan Seacrest
Yeah. So thank you. Boyd's. You know, the data shows that if you smoke even one cigarette when you're in junior high or high school or as an adult, 65% of people will get addicted for at least a short period of time. Think that's crazy, right? 65%. It actually happened to me. My brother took me and we smoked a cigarette when I was nine years old behind a train station. And I smoked for a week. Every time, every chance I got it, sneak away and go smoke with my brother. My brother smoked for almost 10 years. He got addicted as a child and smoke all the way up through college. And then he finally stopped. If you look at the Lifetime prevalence of smoking in the United States, I think it's down about 15 or 20%. Those people are addicted. They can't stop. Right. And so alcoholism, it's about 17 to 20% of Americans will get addicted to alcohol at some point during their life. So if you take just those same numbers and said 17 to 20% of people who take Percocet might get addicted, that's probably not too far off the reality. There's some data showing it's as low as 4% or 10%. There's some data showing as high as 40. But I think the number somewhere between 10 and 20% of people are like my brother, they take the Percocet and they love the way it makes them feel. Listening to your podcast and stuff, you're very into mental health and you understand depression and anxiety. You take an opioid for the, for the right person or the wrong person, it might make them feel calm for the first time in their life. It might make them feel pleasure. When it stimulates that receptor that I talked about, it releases endorphins. Right. And so this person finally feels good and they feel no pain and they feel happy. And then they take a bigger dose and a bigger dose and a bigger dose over time. And before you know it, someone becomes addicted.
- [28:24]
Dr. Nicole Safire
But then how does that transform to going and getting heroin? Why? You know, they shop around to the doctors or like, I wouldn't know how to go get heroin.
- [28:32]
Ryan Seacrest
Sure. So I'm gonna, I'm gonna answer that through the story of my brother. So interestingly, the story I told you about my mother in law, that was in the spring, summer of 2002. I had what I call about a three or four month honeymoon period with the pain space where I was like, these procedures are great, These drugs are great. These opioids help people. I mean, I was a little suspicious because like I said, I saw the guy in medical school telling me rob the pharmacy was to get opiates. I was a little bit suspicious. And my dad, ironically, was a drug and alcohol counselor at the time. And so I did know a little bit about drugs, but I had like this four month honeymoon period in New York City. And this was kind of like ground zero of riding a bunch of opioids. You know, I worked under a guy named Russell Portnoy at Beth Israel Hospital who was part of some of this. My brother hurt his back. And in Oklahoma, where, you know, where I was going to medical school, he went to a doctor and they gave him Percocet and Immediately took away my brother's pain. But my brother had, you know, a long history of probably, you know, mental health issues as well, including depression, anxiety, and other things. And so I think for him, he felt. He felt good for the first time. But what happens is you get tolerance, right? And so you're a doctor, you understand this. But for your users, what tolerance means is that receptor that I talked about. Once it gets filled with a Percocet, your brain makes two more, and now you have three receptors. And so you go back to the doctor and say, I need a bigger dose. So they give you a bigger dose, and then you get six receptors, and then 10 and then 100. And they've done lots of research on this, but it's called opioid hyperalgesia, where they actually start having worse pain because they have more receptors. And so you get to the point where the doctor says, no, you can't have any more. This is crazy. You can't take 20 oxycodone a day. And if you've ever had, like, you know, if you ever go out drinking with friends, you might have that one guy that can drink 20 drinks, and it just doesn't affect them. That person will get cut off by the doctor. Say, I can't give you 20 oxycodones today. And then they go to the street, and you. You start buying pills, and then the pills aren't enough, and someone's like, hey, I can give you heroin. You can shoot it up and you feel better immediately, and you slip into it. And that's exactly what happens. In the old days. When I first started looking at this data, when my brother first overdosed in my bathroom, there was about 500,000Americans that were addicted to heroin. Today, it's 9 million that are addicted to fentanyl or opioids or pills. 9 million. This has all happened during my career.
- [30:54]
Dr. Nicole Safire
Well, so you keep bringing up fentanyl because there is a relationship between, you know, medical opioid dependence, but also fentanyl. And the new FBI director, Kash Patel, has said that it is going to be a priority to him to get the fentanyl off our streets because it's being imported in from other countries, and he's working on this very hard. What kind of impact do you think that will actually have on the opioid crisis that we are seeing here in the United.
- [31:19]
Ryan Seacrest
Well, I think it's. I think it's very important. I think that fentanyl. I like to teach this to people. We have two separate epidemics going on at the same time. And it's almost like a Venn diagram where they overlap a little bit. There is an opioid prescribing epidemic. There has been an epidemic in the way we've prescribed since 1995. Probably we've got better at it, but we continue to write more opioids than any other country in the world. And we have an epidemic of people becoming dependent on the very pills we're writing, which is a big part of my campaign to educate pain doctors to use less pills. And if you get someone who's addicted, you treat their addiction. That's how I make an impact in my space, in the fentanyl space, it's a totally different epidemic. You have a molecule that is micrograms, right? Not milligrams. Like when we had our cocaine crisis in the 80s. You remember, you'd watch the shows with Pablo Escobar, and they were shipping in planeloads of cocaine. And, like, you could see the plane coming and, you know, it's got cocaine, and it was actually very easy to fight in the big picture. Coat or fentanyl is totally different. It's sold not milligrams, but micrograms. It's very, very tiny. You can overdose on enough. Fentanyl can sit on the tip of a pencil, right? The tip of a pencil can kill you. You can sneak it in in diapers and dolls and food, and whatever you want, it is coming across our border. I live in Arizona, and we're one of the primary access points for fentanyl into our country. And so we need to have strong policies on fentanyl, whatever that is. And I think that our government can make a really big impact by focusing on fentanyl. From my perspective as a doctor, the biggest thing I can do is educate. Like, our kids need to know about fentanyl. Like, the good old days of going to a party and doing some pills in the 70s or 80s are gone. Any pill that you take could kill you. One pill, because they put fentanyl in pills, right? And so you can literally take it, and one pill can kill you. And so it's important for us to educate our high school students, our college students, to have Narcan widely available. We talked about Narcan earlier, can reduce or can reverse an overdose. And certainly our federal government needs to be looking at diplomacy with China and Mexico to cut down the distribution of fentanyl across our borders to go after cartels that are selling it. But, yes, I think that that that Cash Patel is going to make a big impact with his policies.
- [33:27]
Dr. Nicole Safire
You know, it's interesting, you said overdose and I hear a lot of people say, you know, we do talk about overdose and when we find people unconscious or when they die because they've taken too much of a dose of a medication that's caused the respiratory depression and being unconscious or even death. But the reality is with a lot of these young people who are taking these medications, they don't even know that there's fentanyl in it. So they're not overdosing on it, they're being poisoned with it and it's killing them. And so I wonder if changing even the verbiage that's used to just remind people that these kids who are going out and who are overdose, quote, unquote, overdosing, they are taking something which they don't even realize what it is. One, they're not asking questions, they're taking like unlabeled pills because that's what people still do apparently. And you know, the mindset needs to change. But I think it's really interesting with us pain, you know, you're talking about how patients shouldn't just be cut off. So we're already saying we have an over prescribing situation of opioids. It's much better now than it was a couple of decades ago, but it's still happening. You obviously know more than anyone. But the problem is when a physician gets uncomfortable thinking someone may be addicted to pain, as you said, they get cut off and they get just kind of sent out into the world. And do you think that that's kind of what pushes them to then go and find street level opioids because they can no longer get it from, you know, from a medical professional? And is that perpetuating and making this opioid crisis even worse?
- [34:57]
Ryan Seacrest
It's very insightful what you're saying. It's 100% true. And there's been multiple papers written on this. The CDC has acknowledged this. We had guidelines that came out in 2016 and states across the country started making laws on how much you could get and started shutting people off. And doctors started getting in trouble and getting sanctioned. And the CDC came out with another report four or five years later saying, hey, you guys way overreacted.
- [35:22]
Dr. Nicole Safire
We're not saying that you're going to lose their licenses.
- [35:26]
Ryan Seacrest
Yes, that's exactly what happened. And our federal government, I think, did a bad job of navigating this entire thing. And I don't know if your viewers know this, but up until a Year and a half ago, you had to have a special license just to treat addiction. There were 2 million providers, doctors, nurse practitioners and PAs in the country. But only 50,000 people could give you Suboxone if you got addicted. And I have fought against that for 10 years, worked with the government, educated everything I could. They finally changed that about a year and a half ago. And so now every single provider in the United States can actually write Suboxone. So part of what I'm advocating for, I mean, I'm an anesthesiologist. Like when we put someone to sleep, we might give them 25 different drugs. We titrate them off or titrate them on. We titrate them off. Like we know how to use these medications. Someone comes in and they're addicted to an opioid, I can help them, I know how to get them off of the med. One of the things that we're teaching is called a Suboxone micro induction where you give them 4% of the final dose the very day you meet them. I call it treat them when you meet them. And so if someone looks at me, if you said, hey Doc, I'm addicted to these opioids, I feel like I'm out of control. I want some help. You could literally stay on your Percocet and I'd say here, you're going to take 4% of your stable dose and that's about 0.5 milligrams of Suboxone. Means you actually have to cut the strip and it gets a little bit complicated. The next day you take 8%, the next day you take 12. It's not that different from me on what I do, putting someone to sleep or waking them up. I can titrate on this life saving molecule. And once you get to about 50% of the dose, you can just stop your opioids and you're good. I'm encouraging every anesthesiologist in the country, by the way, about 50% of pain doctors are anesthesiologists like me. I'm saying, listen, if you put someone to sleep and wake them up, you can put them on Suboxone and treat their addiction. And by the way, I'm not asking every anesthesiologist and every pain doctor to become a full on addiction psychiatrist. I'm asking them to stabilize their patient, get them into behavioral health, get them into a psychiatrist, but fix the problem, treat them when you meet them, especially.
- [37:22]
Dr. Nicole Safire
Fix the problem that they may have caused in the first place.
- [37:25]
Ryan Seacrest
Right, exactly.
- [37:27]
Dr. Nicole Safire
Here's my Question, and I'm sure you're going to get, you get it from critics is, are you just replacing one addiction for another? Are people ever going to get off the Suboxone?
- [37:35]
Ryan Seacrest
It's a great question. I'm glad you asked it. So when we first realized that methadone could save lives, there were methadone clinics in the 1970s. It was massively controversial because methadone is a full agonist, right? Methadone is a very long acting opioid. And especially like the 12 step crowd. I grew up with my dad, who was an addiction counselor. I used to go to 12 step meetings and listen and learn. And they were all about abstinence, right? It was like, God is going to help you, your higher power. You don't have any substances. And that became the standard of care in treating alcoholism. But then they had this molecule called methadone. They realized if you showed up every day at a clinic, you could take methadone once a day and you wouldn't go do street heroin. And it was very, very controversial. And that continues to be fought for years and years and years. When Suboxone came out, it kind of changed the narrative because Suboxone is not a pure agonist. It kind of blocks the receptor like I talked about. It does stimulate the receptor a little bit. It is a scheduled drug. So there's a little bit of what you're talking about. But now the data started coming out, and the data is that if you're on suboxone, there's a 50% reduction in death rate. There's not another drug that I can think of, and I've asked maybe 100 doctors now. I cannot think of another drug that has a 50% reduction in mortality. The chemotherapy drugs aren't even close, right? So the heart drugs aren't even close. You're not reducing someone's death rate by 50% when they have heart failure with any drug. And so as we look at the data, it is clear that abstinence does not work with opioids. If you have severe opioid use disorder, like my brother, he will never come off of this drug, and he should never come off of this drug, because if he does, more than likely he'll be back doing drugs within days, if not weeks. And so when I talk to people like that, I understand the idea of abstinence. I think it works really well with alcoholism. But in the opioid space, when you're addicted to opioids, the data is very clear. If you look at an abstinence Group versus a Suboxone group at five years. If you put someone on Suboxone and leave them on, 80% are not doing drugs. The abstinence group is like 25% success. And so I lean on the data, which is Suboxone save lives and it works better than abstinence.
- [39:38]
Dr. Nicole Safire
Well, I'm always all about the data. Show me the data. Well, I think, I think it's great. I think that, you know, we're still in the middle of an opioid crisis. I think people don't talk about it as much. It's not getting as much media attention. But you know, what you're doing with us, pain is you're making sure that, you know, we're trying to stop causing even more problems and potentially helping those who are on it and not giving them the stigma and making sure that you're taking their physical and mental health account. I think it's great. You know, the world of pain is extremely exciting. You know, as an interventional and breast radiologist, I love the idea of, you know, nerve ablations and some non medication pain relief items. Do you still talk about some of this stuff or do you do this stuff or are you kind of just focusing on this right now?
- [40:25]
Ryan Seacrest
Well, I, my goal is to reduce suffering and I am a pain doctor to my core. I love the procedures that we do. Like the procedure that my mother in law needed, the kyphoplasty. It was so close to my heart that you could literally in like a 10 minute procedure, take away someone's suffering by fixing a fracture. It blew me away that was even possible. Like that procedure made me want to become a pain doctor. My approach to pain is all about holistic care though, right? I think that we've gone way too far with interventions, way too far with surgery, way too far with pills. And I think, I think you'll agree with me. I think it's a holistic approach. I think the best thing I can do for my patient is to get them mentally healthy. Right. I encourage all my patients to talk to a therapist. I talk to a therapist. I want them to talk about, you know, what makes them happy, what makes them sad, what are their goals. I want them to lose weight, I want them to have appropriate diet, I want them to look at their supplements and how are they doing with vitamins. I want them to do physical therapy. If they get addicted, I want to treat their addiction. And yes, we have all these crazy cutting edge technologies now where we can take away suffering. What I want us, pain care to be is that we're not just an interventional based practice. We're not just we give you pills. I want us to treat the whole person. And I think that's where we really will help human suffer.
- [41:44]
Dr. Nicole Safire
So, two, two part question, you know, what advice would you give to, let's say, start with young doctors who want to help people who are in pain without feeding into this broken system?
- [41:55]
Ryan Seacrest
Yeah, that's great. Number one, if you want to be a pain doctor, I suggest that you, that you go to a fellowship and you learn these procedures you're talking about. Because some of these procedures really blow me away. Like it's spinal cord stimulation. The data and the research on it has gone to the next level. There was a study published in JAMA about two years ago that if you have severe painful diabetic neuropathy, placing a very small electrode behind the spinal cord, it sounds crazy, but we can place a small little electrode in the epidural space that that has 90% reduction in pain from diabetic neuropathy. And it does it by blocking the pain signals on the way to the brain. And so if you want to be a pain doctor, I think number one is you do a fellowship and you learn these advanced techniques that you talked about, radio frequency ablation and spinal cord stimulation. Number two, I encourage doctors to really become a good pharmacologist. Like again, I'm an anesthesiologist, we use medications all day. I love the pharmacology of how, you know, a muscle relaxant works and a neuropathic medicine works and how antidepressant works and to really understand those medicines, not to lean too heavily on opioids, to look at all the other type of medications. And then I really encourage doctors to understand mental health. I'm trying to make a lot of changes in the system, but one is I want all pain physicians to have obligatory training in mental health. They need to understand depression and anxiety. Every patient that I've ever met who's had pain, you know, for five years or 10 years, they have some sort of depression or anxiety. And we don't focus on that enough. We don't focus on the mental health. So for young doctors, I just want them to understand a holistic approach which includes the procedures, it includes the meds, But a lot of it is mental health and diet and exercise and all the other stuff.
- [43:38]
Dr. Nicole Safire
And the second part of the question is, what about for the everyday person, you know, myself, anybody else listening who deals with some sort of pain, whether it's acute pain from an injury that just happened or some form of chronic, chronic pain. Like what do you suggest that they do?
- [43:52]
Ryan Seacrest
Activity. I know it sounds crazy, but when you're hurting that. What I want people to do is get active. I want them to go to physical therapy first. And I want them within, you know, limits to understand how bad is the injury and how much can I be active. Range of motion, right? You hurt your shoulder, the best thing you can actually do is start to do shoulder exercises and to build up the muscles, right? To get a good doctor when, when pain persists beyond two or three or four weeks. Imaging, right? Like you're a radiologist. I like to do imaging early and.
- [44:26]
Dr. Nicole Safire
Often because insurance companies don't always agree with us.
- [44:30]
Ryan Seacrest
I agree and I, and I fight them all day long because I think that early diagnosis is key. I think, you know, so imaging is a big part of it when I teach my docs. And I'd say the same thing to my, my friends, like, it's the five finger approach. My first finger, my thumb is diagnosis. We have to make a good diagnosis. And that's usually imaging and a good physical exam and sometimes neuro studies. Number two is I want to find out what medication is right for you. And I'll tell you as a pain doctor, I always start with diet as a medication, right? Like what are you eating? Are you eating vegetables and fruits and, you know, your gut health and all this. Number three for me is, is there some sort of physical therapy that I can do for you and that includes massage? Will send people for massage, physical therapy, chiropractic care. Number four, I start talking about mental health, right? I say, hey, you know, are you depressed? Are you anxious? If my patients say no, I'm like, I still want you to talk to someone. I think you might actually have. I just. It's okay. Like, we want to destigmatize mental health. And then the fifth thing is, is there some sort of intervention? Is there something we can do to change the tissue or radio frequency or smoke or stem or a surgery? But I try to do that fifth. I start with the first four things.
- [45:35]
Dr. Nicole Safire
Well, Dr. Paul lynch, you are the founder of U.S. pain Care. It is a bold endeavor. I am grateful that you have included me on your advisory board and I am so excited to see what you do with this.
- [45:47]
Ryan Seacrest
I am too. Dr. Safire, you have been a wonderful friend for many, many years. I love the work you do. I'm a big fan and thank you for having me on today.
- [45:55]
Dr. Nicole Safire
Thanks for joining us. More coming up on Wellness unmasked with Dr. Nicole Safire.
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- [50:26]
Dr. Nicole Safire
Thank you Dr. Paul lynch for your insight, your compassion and your relentless pursuit of solutions that heal without harm. As we heard today, this is not just about reducing overdose deaths. It's about transforming how we understand and treat pain in America. Dr. Lynch's goal is nothing short of bold to save 1 million lives by revolutionizing pain care, expanding access to innovated non opioid therapies and advocating for policy change that puts patients first. For me, I am eternally grateful for pain Physicians like Dr. Lynch who was able to get me off pain medications. I wish I could say that the trouble with my shoulder is in the past, but the reality is I will be undergoing a third shoulder surgery here in the next couple of weeks, but I already have a pain plan mapped out because I do not want to find myself again being reliant on pain medications. I will keep you informed as I go through this next chapter with this next surgery. I will keep you up to date all along the way. If you or someone you know lives with chronic pain or you felt the impact of the opioid epidemic, know that there are people like Dr. Lynch working every day to bring relief, hope and a better path forward. If you or someone you love is living with chronic pain or if you felt the impact of the opioid epidemic, know that there still are people like Dr. Lynch working every day to bring relief, hope and a better path forward. Thanks for listening to Wellness unmass on America's number one podcast network, iHeartrade. Follow Wellness unmass with Dr. Nicole Safire and start listening on the free iHeartradio app wherever you get your podcasts and we will catch you next time.
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