Opioids, Alcohol, Tobacco, and Addiction | On Call with the Prairie Doc | May 16, 2019

Opioids, Alcohol, Tobacco, and Addiction | On Call with the Prairie Doc | May 16, 2019


>>ADDICTION COMES IN MANY
GUISES, FROM PAIN KILLERS TO
TOBACCO. “OPIOIDS, ALCOHOL, TOBACCO AND
ADDICTION” TONIGHT “ON CALL
WITH THE PRAIRIE DOC.”>>GOOD EVENING AND WELCOME TO
“ON CALL WITH THE PRAIRIE DOC.” ADDICTION HAS BEEN WITH US
SINCE HISTORY BEGAN. TODAY, ADDICTION CAN BE DEFINED
AS A VARIETY OF TERMS SUCH AS “BEING ADDICTED TO THE
INTERNET.” BUT THE ADDICTIONS FROM
CHEMICALS AND DRUGS WE PUT INTO OUR BODIES IS OFTEN THE
MOST DEVASTATING TO ONE’S LIFE.>>>FIRST, LET’S TAKE A LOOK AT
THIS WEEK’S PRAIRIE DOC QUIZ
QUESTION. TOBACCO USE IN THE UNITED
STATES IS HIGHEST IN: A) SOUTH. B) MIDWEST. C) WEST.
D) NORTHEAST. WE WILL HAVE THE ANSWER AT THE
END OF THE SHOW.>>>JOINING US TONIGHT ARE DR.
CRAIG UTHE OF SANFORD HEALTH AND DR. JOSHUA CLAYTON, THE
STATE EPIDEMIOLOGIST WITH THE
SOUTH DAKOTA DEPARTMENT OF
HEALTH. THANK YOU, GENTLEMEN, FOR
JOINING US.>>GREAT TO BE
HERE.>>THANKS FOR HAVING US.>>ADDICTION IS DIFFERENT THAN
HABITUATION, IS DIFFERENT THAN
DEPENDENCY. CAN WE GET INTO THE DEFINITION?
WHO WANTS TO TAKE THAT? JOSH?>>WELL, I MEAN, OBVIOUSLY
ADDICTION IS A MUCH MORE SEVERE
FORM. YOU KNOW, WHEN YOU’RE TALKING
ABOUT SOMEBODY WHO IS USING OR ABUSING DRUGS, MEDICATIONS,
THINGS ALONG THOSE LINES. I THINK, YOU KNOW, THERE’S A
LOT — A LOT YOU CAN SAY ABOUT, YOU KNOW, ADDICTION REALLY
BEING THAT NEXT LEVEL. IT’S SOMETHING THAT WE NEED TO
REALLY PREPARE FOR AND WORK WITH INDIVIDUALS SO THEY DON’T
REACH INTO THAT REALM.>>THAT’S RIGHT. AND THEN
DEPENDENCY, IF YOU LOOK AT
THAT, WHAT IS THAT?>>WELL, DRUG DEPENDENCE MEANS
THAT YOUR BODY IS DEPENDENT ON A SUBSTANCE TO HAVE AN
EFFECT. AND WHEN THAT SUBSTANCE IS
TAKEN AWAY, YOU’LL HAVE
SYMPTOMS. THE MOST COMMON SYMPTOMS WOULD
BE WITHDRAWAL AND TOLERANCE. WHICH MEANS, TOLERANCE MEANS
YOU HAVE TO TAKE MORE OF A DRUG TO GET THE EFFECT
THAT YOU WANT TO GET FROM THAT. AND WITHDRAWAL IS IF YOU DON’T
HAVE IT, YOU FEEL SYMPTOMS. IT MIGHT BE SHAKING, IT MIGHT
BE NAUSEA, THAT TYPE OF THING. BUT IF YOU’RE TAKING THE DRUG
THE WAY THE DOCTOR PRESCRIBED
IT, AND YOU’RE BEING DUTIFUL FOR
THAT, YOU MAY BE DEPENDENT ON
THE DRUG, BUT THAT DOESN’T MEAN YOU’RE
ADDICTED. ADDICTION, THE DIFFERENCE
BETWEEN ADDICTION AND DRUG
DEPENDENCE PRIMARILY IS A PERSON WITH
ADDICTION GOES OUT AND SEEKS
THE DRUG IN A WAY THAT’S GOING TO BE
HARMFUL TO THEM. A PERSON THAT’S DRUG DEPENDENT
MAY DEPEND, BUT THEY’RE TAKING IT THE WAY THEY’VE BEEN TOLD TO
TAKE IT.>>IT’S INTERESTING BECAUSE I
REMEMBER MY MOTHER WHEN I WAS A LITTLE BOY, WHAT
IS THIS HEROIN THING? OH, IT’S BAD, BAD, BAD, BECAUSE
IF YOU STOP IT, THEN THIS
TERRIBLE, HORRIBLE FEELING COMES OVER
YOU, YOU’VE GOT TO HAVE MORE OF
IT OR YOU WILL HAVE THAT TERRIBLE,
HORRIBLE FEELING, THAT MONKEY
ON YOUR BACK. AND I REMEMBER THINKING, THAT
WAS THE KEY, THAT WAS THE THING, THE DRUG DEPENDENCE IS THE
THING. BUT IT ISN’T. IT ISN’T
IT AT ALL. I MEAN, TAKE GAMBLING, THAT’S A
HORRIBLE ADDICTION, BUT THERE’S
NO WITHDRAWAL.>>RIGHT.>>EXCEPT THAT’S AN
EMOTIONAL THING. SO, AS A PRIMARY CARE
PHYSICIAN, I WOULD SAY 80% OF
WHAT I DO EVERY DAY OR DID EVERY DAY WHEN I WAS IN
FULL PRACTICE, HAD TO DO WITH THE EMOTIONAL
SIDE OF ALL THAT WE DO. WHAT WOULD YOU SAY, CRAIG, IN
YOUR PRACTICE, YOU’RE IN THE MIDDLE OF A
FULL-TIME PRACTICE, HOW MUCH OF EMOTIONS IS PART OF
YOUR PRACTICE?>>OH, A HUGE PART OF IT.
MENTAL HEALTH IS A VERY VERY
IMPORTANT PART OF ANY KIND OF HEALTH CARE
PROGRAM. AND WHAT WE’RE SEEING NOW, WITH
HEALTH CARE SYSTEMS IS, WE HAVE WHAT’S CALLED
INTEGRATIVE HEALTH CARE
SPECIALISTS, WHO ARE BEHAVIORAL HEALTH
SPECIALISTS, THEY’RE EMBEDDED IN PRIMARY CARES BECAUSE
THERE’S SO MUCH OF AN OVERLAY OF THE MENTAL HEALTH PIECE, A
PERSON’S HEALTH AND DISEASE. IF A PERSON HAS DIABETES, THEIR
ABILITY TO TAKE CARE OF THEMSELVES AND RESPOND TO
THEIR DIABETES IS DEPENDENT UPON THEIR MENTAL WELL-BEING. AND WE DO KNOW THAT PEOPLE THAT
SUFFER FROM AN ADDICTION, OVER 50% OF THE PEOPLE THAT
HAVE ALCOHOLISM, DRUG ABUSE
DEPENDENCE, LIKELY HAVE AN UNDERLYING
MENTAL HEALTH CONDITION LIKE
ANXIETY OR DEPRESSION OR PREVIOUS
TRAUMA.>>I MEAN, IF THEY DIDN’T HAVE
IT AT THE BEGINNING, THEY CERTAINLY GO INTO IT. BUT MY SENSE IS THAT THE MENTAL
HEALTH PROBLEM PROBABLY IS A BIG PART OF WHY THEY GO
INTO OR GET INTO THE ADDICTION.>>SURE.>>LET ME GIVE YOU AN
EXAMPLE. PERSON COMES IN, SAYS, Dr.
UTHE, I’M DEPRESSED. AND I FIND OUT THAT THEY’RE
DRINKING A SIX PACK OF BEER
EVERY NIGHT. AND I SAY, WELL, DO YOU KNOW
WHAT ALCOHOL IS, IS ALCOHOL A
DEPRESSANT OR A STIMULANT? USUALLY THEY’LL SAY, WELL, IT’S
A DEPRESSANT. I CAN EITHER PUT YOU ON A
ANTIDEPRESSANT, A PILL FOR YOUR
DEPRESSION, OR WE COULD HAVE YOU STOP
DRINKING THE ALCOHOL AND HAVE
YOU COME BACK A MONTH FROM NOW, BECAUSE I
HAVE A STRONG SUSPICION THAT
YOUR DEPRESSION IS NOT REALLY PRIMARILY
DEPRESSION, I THINK IT’S THE
DEPRESSING EFFECT THAT THE ALCOHOL IS HAVING ON
YOUR SYMPTOM. AND GUESS WHAT IS THE ONLY WAY
TO FIND OUT IF IT’S THE ALCOHOL
OR NOT? YOU HAVE TO STOP.>>YOU HAVE
TO STOP IT.>>TO STOP IT.>>I WOULD SAY THAT THE OTHER
BIG CATEGORY, THAT SAME STORY I’VE HEARD A NUMBER OF TIMES,
IT WASN’T THE SIX BACK OF
ALCOHOL, IT WAS THE AMBIEN AND THE
ATIVAN AND THE VALIUM KIND OF
MEDICATIONS. WHAT DOES THE PUBLIC HEALTH
DEPARTMENT FEEL ABOUT THE
BENZODIAZEPINES?>>OH, THE USE OF
BENZODIAZEPINES IS ACTUALLY AN
INCREASING AREA OF CONCERN FOR
US. YOU KNOW, IT HAS BEEN PRIMARY
FOCUS AROUND OPIOIDS AND THE PRESCRIPTION
MEDICATIONS AND SO ON. NOW WHAT WE’RE ACTUALLY SEEING
IS CO-USE OF OPIOIDS AND
BENZODIAZEPINES WHICH INCREASES THE RISK FOR
OVERDOSE FOR INDIVIDUALS WHO
TAKE TOO MUCH. SO, IT IS AN AREA THAT WE HAVE
TO BE COGNIZANT OF AND AN AREA
THAT WE HAVE TO LOOK INTO. I KNOW THAT THERE’S A LOT OF
WORK TO BE ABLE TO MONITOR SOME
OF THIS. YOU KNOW, WE HAVE A
PRESCRIPTION DRUG MONITORING
PROGRAM. AND THAT’S A PIECE OF SOFTWARE
THAT ALL DOCS WHO ARE PRESCRIBING BENZODIAZEPINES AND
OPIOIDS PUSH INFORMATION INTO, AND WE CAN — THAT HELPS US
IDENTIFY INDIVIDUALS WHO MIGHT
BE AT HIGHER RISK AND WHO WE REALLY DO NEED TO
REACH OUT TO. AND IT ALSO HELPS, YOU KNOW, AS
A FEEDBACK MECHANISM FOR
PHYSICIANS, TO KNOW, YOU KNOW, HOW MANY
OPIOIDS THEY’RE PRESCRIBING, AT WHAT LEVELS ARE THEY
PRESCRIBING TO MAKE SURE THAT
THEY’RE ABLE TO PROVIDE THE ADEQUATE LEVEL
OF CARE TO THEIR PATIENTS BUT NOT TO HAVE SOME OF THE ILL
CONSEQUENCES THAT MIGHT OCCUR
FROM OVERDOSE.>>THE BENZOS, I JUST — I CAME
OUT OF MEDICAL SCHOOL RIGHT WHEN THEY WENT, OH, MY
GOSH, WHAT HAVE WE BEEN DOING? WE’VE BEEN PUTTING IT IN THE
WATER. AND EVERYBODY WAS
DEPENDENT ON IT. AND THEN WE FINALLY GET
SOMEBODY OFF OF IT BECAUSE IT’S REALLY HARD TO GET PEOPLE
OFF OF THOSE MEDICINES.>>WE TALK ABOUT
BENZODIAZEPINES, WE’RE TALKING
ABOUT VALIUM, ATIVAN, XANAX, KLONOPIN, THOSE
ARE THE DRUGS NAMES PEOPLE
KNOW. AMBIEN.>>SOME OF THEM, THEY’RE NOT
OFFICIALLY BENZOS, THEY’RE
BENZOACTIVE, SO THEY WORK ON THE SAME
RECEPTOR. AND THEY’RE THE MOST COMMON
THING THAT’S PRESCRIBED FOR
ANXIETY. WE ALL HAVE A REASON TO TAKE
BENZOS, BASICALLY. WHAT HAPPENS WHEN YOU STOP IT,
YOU HAVE WITHDRAWAL ANXIETY. AND YOU GO, OH, MY GOSH, I NEED
TO HAVE MORE OF THAT ATIVAN.>>IN MARCH OF 2016, THE CENTER
OF DISEASE CONTROL CAME OUT WITH 12 RECOMMENDATIONS FOR
TRYING TO CURB THE OPIOID
CRISIS.>>YES.>>ONE OF THEM WAS
PATIENTS SHOULD NOT BE
PRESCRIBED BENZODIAZEPINES AND OPIOIDS AT
THE SAME TIME. SO, IF YOU ARE A PATIENT THAT
IS ON BOTH OF THOSE, YOU SHOULD GO AND TALK TO YOUR
DOCTOR AND SAY, I JUST HEARD THAT I SHOULD NOT
BE ON BOTH OF THESE MEDS, WHAT’S YOUR RECOMMENDATION. IF
A PERSON’S ON A BENZODIAZEPINE, WE RECOMMEND NOT JUST STOPPING
IT. IT CAN ACTUALLY BE
DANGEROUS TO STOP –>>I HAD A GUY — [ OVERLAPPING
CONVERSATION ]>>IT CAN BE DANGEROUS.>>IT’S
TERRIBLE. YOU’VE GOT TO BE VERY SLOW ON
THE TAPER, TAPER VERY SLOWLY ON
THE BENZOS.>>YEAH.>>IF YOU COMBINE AN
OPIOID WITH A BENZO, THEN YOU’RE GOING TO MAKE THE
MECHANISM OF DEATH FROM OPIOID
OVERDOSE DOUBLE. WHAT IS THAT MECHANISM?>>
YEAH. WELL, THE RESPIRATORY
CENTER FOR BREATHING IS SHUT DOWN, AND
A PERSON DIES FROM STOPPING
BREATHING.>>SUFFOCATE.>>YUP, YUP, YOU
LACK THE OXYGEN. SO, THEY TALK ABOUT THIS NARCAN
DRUG THAT’S NOW AVAILABLE. THE FIRST LINE THAT COMES TO
RESCUE, WHEN THEY COME TO A
PERSON THAT’S UNCONSCIOUS, IF THEY GIVE THEM NARCAN, IT IS
AN ANTAGONIST TO THOSE
MEDICATIONS THAT HAVE CAUSED THEM TO STOP
BREATHING. AND IT JUST DISPLACES THAT DRUG
IN THAT RESPIRATORY EPRESSION
CENTER AND LITERALLY WITHIN 10 TO 15
SECONDS, IT SAVES LIVES.>>THEY WAKE UP.>>LITERALLY. IT’S JUST BEING ABLE TO GET
THERE IN THAT FOUR TO SIX
MINUTES.>>IT’S AN OLD DRUG SO IT’S
RELATIVELY INEXPENSIVE.>>
YEAH.>>NO. THE MECHANISM OF DELIVERY MAKES
IT MORE EXPENSIVE. IT’S INEXPENSIVE BECAUSE YOU
CAN DRAW IT UP IN A SYRINGE AND GIVE IT INTERMUSCULARILY,
BUT THERE’S A NASAL SPRAY
THAT’S MORE EXPENSIVE. WE DO KNOW THAT THEY HAVE THEM
AVAILABLE IN SOME COMMUNITIES. FIRST RESPONDERS, POLICE FORCE,
SOME SCHOOLS ACTUALLY HAVE IT.
SO WE ARE GETTING IT –>>PEOPLE WHO ARE ON DOSES OF
THIS STUFF SHOULD HAVE IT MAYBE
IN THEIR HOME.>>YEAH. YOU CAN BE A FAMILY
MEMBER OF A PERSON THAT HAS AN
OPIOID ADDICTION AND YOU CAN GET A PRESCRIPTION
AND HAVE IT IN HAND. SO YOU DON’T HAVE TO BE THE
PERSON THAT HAS THE DISEASE. YOU CAN BE SOMEONE THAT’S A
GOOD SAMARITAN AND HAVE IT
AVAILABLE.>>HAVE IT AVAILABLE. AND I’LL
SAY AGAIN, IT BURNS ME, IT JUST MAKES ME VERY ANGRY
THAT PHARMACEUTICAL INDUSTRY
TAKING THIS OLD DRUG HAS JUST SHOT THE COST OF IT AS
HIGH AS THEY CAN POSSIBLY DO. SO THAT’S ONE MORE REASON WHY
WE HAVE HEALTH CARE COST ISSUES
IN THIS COUNTRY, THAT THEY’RE ALLOWED TO DO
THAT. ANY OTHER POLITICAL
COMMENT ON THAT?>>NOT A POLITICAL COMMENT.
BUT, I MEAN, I WILL SAY THAT
USE OF NALOXONE IS REALLY A GAME CHANGER’S DONE
A LOT OF WORK TO DO TRAINING FOR THOSE INDIVIDUALS TO WORK
TO MAKE SURE THAT THAT SOURCE
OF NALOXONE IS AVAILABLE TO THEM. BECAUSE, YEAH, ANYONE THAT
YOU’RE COMING — TAKING CARE
OF, IF THEY’RE UNCONSCIOUS, ONE OF THE FIRST THINGS THAT
ELSE WILL DO IS TO PROVIDE THAT
— EMS WILL DO IS TO PROVIDE THAT
DOSE — IF THEY’RE UNCONSCIOUS, WE KNOW IT’S NOT A NARCOTICS,
IF THEY DON’T RESPOND TO IT.>>THEY WILL RESPOND WITHIN 30
SECONDS, IF THEY DON’T, IT’S
NOT AN OPIOID OVERDOSE.>>SO OPIOID AND NARCOTIC ARE
THE SAME, WE’RE JUST GOING TO
— INTERCHANGEABLE. OPIOIDS, OPIATE. THEY GO TO THE
RECEPTOR THAT’S A PAIN RECEPTOR
IN THE BODY.>>IT’S INTERESTING, YOU KNOW,
I HAD A PATIENT WHO IS THIS
BIG, HUGE MAN, 25 OR SOMETHING, AND HE WAS
JUST UNCONSCIOUS IN THE GRADY
HOSPITAL, ATLANTA, GEORGIA. AND I SAID, I WANT NARCAN. OKE
ME TO DEATH FOR TAKING AWAY HIS
HIGH. THAT POWERFUL REVERSAL OF THE
NEU RECEPTOR. BUT THE OTHER INTERESTING THING
ABOUT NARCAN IS, THAT THEY WERE DOING BIG
STUDIES ABOUT PLACEBO EFFECT.
STANDARD PAIN. AND THEY WENT ACROSS THE BOARD,
YOU KNOW, TYLENOL, NARCOTICS,
ASPIRIN, YOU KNOW, ALL THE DIFFERENT
KINDS OF PAIN MEDICINES. AND THEN THEY — AND PLACEBO.
PLACEBO IS, YOU KNOW, 65%
EFFECTIVE. AND THEN THEY TOOK THE NARCAN
AND THEY INJECTED IT AND IT
REVERSED EVERYTHING, INCLUDING IT REVERSED THE
PLACEBO EFFECT.>>OH, MY
GOODNESS. WOW.>>SO THE FACT IS THAT OUR
BRAIN RELIEVES PAIN WITH
BELIEF, TRUST AND FAITH. ISN’T THAT AN INTERESTING –>>>BREAKING THE HOLD OF
ADDICTION OFTEN MEANS A
SIGNIFICANT LIFE CHANGE. FEW CAN ACCOMPLISH THIS ON
THEIR OWN. THEY NEED THE
ASSISTANCE OF OUTSIDE SUPPORT. THERE ARE A NUMBER OF
ORGANIZATIONS THAT OFFER A HAND
UP.>>YOU KNOW, WE HELP MEN WITH
LIFE-CONTROLLING PROBLEMS. SO, OFTEN IT TENDS TO BE
ADDICTIVE ISSUES, ADDICTION
ISSUES, ADDICTIVE BEHAVIORS AND SUBSTANCE ABUSE ISSUES. BUT
WE DO A LOT OF WORK WITH THE
COURTS. YOU KNOW, JUST KIND OF HAPPENED
THAT WAY, WHEREAS, THE JUDGES
AND THE PUBLIC DEFENDERS AND PROBATION OFFICERS KNOW
THAT WE’RE PROVIDING A
LONG-TERM ANSWER TO THESE BIG LIFE-CONTROLLING
ISSUES. BEFORE THEY’RE STUDENTS HERE,
SOMETIMES THEY’RE CRIMINAL
OFFENDERS AND THEY’RE IN TROUBLE WITH THE
COURTS, BUT IT’S NONVIOLENT
CRIMINAL CONDUCT THAT’S BASICALLY RELATED TO
THEIR ADDICTION ISSUES. OUR PROGRAM IS 16 MONTHS LONG,
SO THERE’S A TEN-MONTH FIRST
PHASE, IF YOU WILL, THAT THE MEN COME
IN RIGHT FROM THE STREETS OR
REHAB OR PRISON OR JAIL. AND THEY’RE DISCIPLED HERE,
THEY’RE MENTORED HERE, THEY
LEARN WHO THEY ARE, HOW TO ACT, SELF-DISCIPLINE’S
INVOLVED, AND AFTER THE TEN
MONTHS HERE, THE MEN GO DOWNTOWN TO OUR OLD
LOCATION, WHICH HAS BEEN
RENOVATED, AND THAT’S WHERE THEY HAVE THE
RE-ENTRY PHASE, WHICH IS A
HALFWAY HOUSE-TYPE OF STRUCTURE. AND THEY’RE THERE FOR SIX
MONTHS. SO THERE THEY GET A JOB IN THE
COMMUNITY, THEY HANDLE A BUDGET, THEY PRIORITIZE, WE HELP THEM
TO DEAL WITH REAL-LIFE PROBLEMS. ONE OF THE FIRST THINGS I LET
POTENTIAL APPLICANTS KNOW IS
WHAT WE BELIEVE. RIGHT? SO WE’RE CHRISTIANS, WE’RE
GOING TO GO BY THE BIBLE, WE’RE GOING TO TRUST THE WORD
OF GOD IS RELEVANT, AS WE
BELIEVE IT IS, AND WE KNOW RIGHT AWAY IF WE
HAVE A COMMON GROUND IN TERMS OF FAITH AND WHAT
WE’RE OFFERING. THE CURRICULUM AT TEEN
CHALLENGE IS DESIGNED TO HELP
THEM BUILD THEIR CHARACTER, HELP THEM FACE REALITY, HELP
THEM TAKE RESPONSIBILITY, APPLY BIBLICAL PRINCIPLES TO
EVERYDAY LIFE. YOU KNOW, SO WHAT THEY’RE
LEARNING IS NOT SO MUCH TO NOT
DO THE BAD STUFF OR THE WRONG THING, WE’RE
TEACHING THEM THE VIRTUES OF
DOING THE RIGHT THING. AND THE POSITIVE ASPECTS OF
BEING, YOU KNOW, A GOOD CITIZEN
IN THE COMMUNITY, BEING A SOLID FAMILY MEMBER. WE HELP THE MEN GAIN VISION, WE
HELP THEM UNDERSTAND THAT THEY
CAN PROSPER. WE JUST STARTED TO PARTNER WITH
SLEEP IN HEAVENLY PEACE, BUILDING BEDS FOR KIDS THAT
HAVE NO BEDS, WHICH I JUST AM
AMAZED TO FIND OUT THAT THAT HAPPENS
RIGHT HERE IN BROOKINGS. SO WE HELP THEM. WHEN IT SNOWS,
WE USUALLY TAKE A BUNCH OF
DUDES WITH SHOVELS AND GO DOWNTOWN AND SHOVEL THE
BUSINESSES. AND THEY LOVE US
FOR IT. AND I’M TELLING YOU, THE GUYS
DO IT WITH A GREAT AMOUNT OF
ZEAL, WHICH I’M REALLY PROUD OF THEM
FOR THAT. YOU DON’T EAT AN ELEPHANT WITH
ONE BITE, RIGHT? AS THE SAYING
GOES. YOU TAKE IT ONE BITE AT A TIME,
SO TO SPEAK, AND YOU JUST —
YOU DON’T QUIT. AND I THINK THAT’S ONE OF THE
BIG MESSAGES HERE.>>WELL, THANK YOU, MIKE, FOR
THAT FABULOUS STORY AND, OF
COURSE, ALL OF THE SERVICE THAT YOU
PROVIDE IN OUR COMMUNITY,
PARTICULARLY FOR THOSE BOYS. THOSE MEN WHO ARE CAUGHT IN
ADDICTION AND ESCAPE TO
RESPONSIBLE, WONDERFUL LIVES. WE TALK ABOUT OPIOIDS, IN
PARTICULAR, AND I’D LIKE TO
TALK ABOUT OPIOIDS, SOME MORE ABOUT THE DANGER WITH
OPIOIDS IN SOUTH DAKOTA, DEATHS, NUMBER OF DEATHS, WHAT’S
HAPPENING WITH OPIOIDS IN SOUTH
DAKOTA?>>SO WE ARE SEEING INCREASING
NUMBER OF OPIOID DEATHS IN
SOUTH DAKOTA. UNFORTUNATELY, LAST YEAR WE HAD
35 INDIVIDUALS WHO DIED USING
OPIOIDS. 28 OF THOSE WERE UNINTENTIONAL
AND, SO, THAT’S REALLY WHERE WE
ARE FOCUSING OUR EFFORTS. THE MAJORITY OF THOSE 28
INDIVIDUALS WERE USING PRESCRIPTION DRUGS AT THE TIME
THAT THEY DIED. WE DO — WE ARE SEEING
INCREASING USE OF THE ILLICIT
DRUGS, ILLICIT DRUGS THAT ARE OUT
THERE, HEROIN HAS ALWAYS BEEN
IN THE BACKGROUND, WE HAVEN’T SEEN A HUGE INCREASE
IN THAT, BUT WHAT WE ARE SEEING IS THE USE OF SYNTHETIC
FENTANYL.>>THAT’S COMING OVER FROM
CHINA, PROBABLY.>>UM-HUM. A LOT OF THAT IS SOURCED OUT OF
CHINA.>>AND THEN THIS
ELEPHANT FENTANYL.>>CARFENTANYL, YEAH.>>IT’S A
REAL DANGER, TOO.>>UM-HUM.>>THIS IS A CHRONIC ILLNESS,
THIS OPIOID — PEOPLE GET CAUGHT INTO IT AND THEY CAN’T GET OUT.
MOST ADDICTIONS ARE REALLY A
CHRONIC SCENARIO.>>I’M GLAD YOU BRING THAT UP,
Dr. HOLM, BECAUSE IT’S NO
DIFFERENT THAN DIABETES AND HYPERTENSION, PEOPLE DON’T
CHOOSE TO HAVE THOSE ILLNESSES.
SAME WAY WITH ADDICTIONS. PEOPLE DON’T CHOOSE TO BECOME
AN ADDICT, THEY HAVE A
VULNERABILITY AND IT BECOMES AN
ILLNESS. IT’S A RECURRING, REMITTING
ILLNESS. THERE CAN BE PEOPLE THAT ARE IN
RECOVERY FOR A YEAR OR TWO AND
HAVE A RELAPSE. WELL, PEOPLE HAVE DIABETES,
THEY DO VERY WELL, ALL OF A
SUDDEN THEY HAVE HIGH SUGARS AND END UP IN THE HOSPITAL FOR
A PERIOD OF TIME. VERY
SIMILARITIES. SO DEALING WITH A PERSON THAT’S
SUFFERING FROM ADDICTION, AND IT’S REALLY SUFFERING, THEY
REALLY NEED COMPASSION, THEY REALLY NEED TO HAVE
PATIENCE, NOT EASY. AND AN UNDERSTANDING THING, YOU
KNOW, WHAT IF YOU HAVE A
RELAPSE? BRUSH YOURSELF UP, GET BACK UP
AND WE’RE HERE TO HELP YOU. HOW CAN WE HELP YOU IN YOUR
RECOVERY?>>BUT THE MAJORITY OF THESE
DEATHS THAT WE HAD IN SOUTH
DAKOTA ARE FROM PRESCRIPTION. IN OTHER WORDS, SOMEBODY’S
WRITING A PRESCRIPTION FOR THEM. SO THE ONUS IS ON THE DOCTORS,
REALLY, ISN’T IT? P.A.s, NURSE PRACTITIONERS,
DENTISTS. WHAT ARE WE DOING
ABOUT THAT?>>THERE’S SOME RISK FACTORS
THAT GO ALONG WITH THE
ADDICTION. IF A PERSON HAS, LIKE, FOR
EXAMPLE, SLEEP APNEA, YOU’RE AT
A HIGHER RISK TO HAVE AN UNINTENDED OPIOID
OVERDOSE DEATH. LET’S SAY IT’S FRIDAY NIGHT,
IT’S A PERSON THAT’S 60 YEARS
OLD AND THEY’RE DIABETIC, THEY HAVE SLEEP APNEA AND
THEY’RE TAKING FIVE OR SIX
OPIOID PILLS AND THEY ALSO TAKE A XANAX TO
HELP THEM SLEEP AT NIGHT AND THEY JUST HAPPEN TO DRINK A
BOTTLE OF WINE THAT EVENING. THAT COMBINATION –>>THEY’RE
GONE.>>– IS GOING TO LEAD TO
THEM DYING. NOW, NO ONE IS INTENTIONALLY
DOING THAT BUT I DON’T THINK THAT THE PATIENT IS AWARE OF
THAT THAT ADDED EFFECT IS
POSSIBLY THERE.>>I THINK THIS WHOLE SLEEP
APNEA STORY IS ONE THAT’S
REALLY SOMETHING THAT’S
HAPPENING. IT COMES WITH OVERWEIGHT. WE
ARE GAINING WEIGHT IN THIS
COUNTRY. AND WE DON’T UNDERSTAND IT,
REALLY. AND WE CAN BLAME THE LACK OF
EXERCISE, WE CAN BLAME THE
FAST-FOOD. BUT IT MAY WELL BE THAT IT’S
THE WAY WE’RE FEEDING OUR
CHILDREN. WE JUST DON’T UNDERSTAND IT. BUT I THINK WE’VE GOT TO TRY TO
FIGURE OUT WHAT WE CAN DO TO HELP RATHER THAN TO GO BLAME
BLAME BLAME BLAME BLAME.>>
RIGHT.>>WHAT ABOUT OTHER ADDICTIONS,
AND, I MEAN, OF COURSE, WHAT ARE THE MOST COMMON
ADDICTIONS IN THE UNITED STATES
TODAY? WHAT’S THE NUMBER ONE COMMON
ADDICTION, JOSH?>>TOBACCO. YOU KNOW, TOBACCO USE IS SO
PREVALENT, ESPECIALLY IN SOUTH
DAKOTA. WE SEE ABOUT 55% OF THE
POPULATION, YOU HAS SOME SORT OF CIGARETTE USE
AND THAT SORT OF STUFF. THAT IS SOMETHING THAT WE NEED
TO BE VERY CONSCIOUS OF AS WE TALK ABOUT ADDICTION,
BECAUSE THAT IS VERY PERVASIVE. SECOND TO THAT IS ALCOHOL. YOU
KNOW, WE HAVE A HIGH USE RATE
OF ALCOHOL. ACTUALLY, I GOT MY NUMBERS
MIXED UP. ALCOHOL USE IS AT 55%. SO I APOLOGIZE FOR THAT. AND
TOBACCO USE IS ABOUT 18, 19%.
>>YEAH.>>IN SOUTH DAKOTA.>>AND THE
REST OF THE COUNTRY, WE’RE
ABOUT THE SAME? 18, 19 IS MAYBE ON THE HIGHER
SIDE?>>FOR SOUTH DAKOTA, FOR
TOBACCO USE, WE ARE A FEW
PERCENTAGE POINTS HIGHER THAN AS FAR AS THE NATIONAL
AVERAGE. WE’RE VERY MUCH IN LINE IN
TERMS OF OUR ALCOHOL
CONSUMPTION WITH THE REST OF
THE COUNTRY.>>55%.>>55%. YEAH, HAVE
CONSUMED ALCOHOL WITHIN THE
PAST 30 DAYS.>>OKAY.>>IT’S KIND OF THE
FORGOTTEN SIBLING, WITH THE
OPIOID CRISIS THAT’S BEEN GOING ON, SO MUCH
ATTENTION HAS BEEN BROUGHT TO
THAT. BUT MANY MANY MORE PEOPLE DIE
FROM ALCOHOL-RELATED ILLNESSES THAN THEY DO FROM
OPIOID-RELATED ENCOUNTERS. SO, AGAIN, ALCOHOLISM IS HIGHLY
PREVALENT, BOTH BINGE DRINKING
AND DEPENDENCE. COLON CANCER, BREAST CANCER ARE
TIED SOMEWHAT FOR HIGHER RISK
FOR ALCOHOLISM. YOU THINK OF IT AS BEING
RELATED TO OTHER THINGS, BUT
IT’S ALSO RELATED WITH
ALCOHOLISM. SO THERE IS SOME LONG-TERM
EFFECT THAT IS ARE NEGATIVE
FROM ALCOHOLISM, BESIDES ALCOHOLISM AND LIVER DISEASE.
>>RIGHT. WELL, AND I ALWAYS
WANTED TO GO BACK TO TOBACCO. I WAS THINKING, WELL, I MEAN,
PEOPLE ARE DYING, SUFFOCATING
FROM OPIOIDS, BUT THEY’RE NOT SUFFOCATING
FROM TOBACCO. WELL, YEAH, THEY
END UP WITH –>>JUST SLOWER.>>– LONG-TERM
SUFFOCATION. I’VE JUST SEEN IT,
SEEN IT, SEEN IT. JUST A TERRIBLE KIND OF DYING
PROCESS.>>NICOTINE IS A HIGHLY HIGHLY
ADDICTING SUBSTANCE. SO WHEN A PERSON BECOMES
ADDICTED TO CIGARETTE SMOKING, e-CIGARETTES IS ANOTHER ISSUE
THAT’S OUT THERE, BUT THERE IS
HELP. YOU KNOW, IN SOUTH DAKOTA WE
HAVE THE SOUTH DAKOTA QUITS
LINE.>>YEAH. LET’S SHOW THAT QUIT LINE ON
THE SCREEN. WE DO HAVE THE QUIT
LINE. AND IT IS HIGHLY ADDICTIVE. THE
DANGER WITH SMOKING, THOUGH,
SEEMS TO OCCUR IN THE YOUTH. I MEAN, IF YOU GET PAST 21, 22,
YOU DON’T SEEM TO GET INTO
CIGARETTES, BUT BEFORE THAT, THAT’S WHERE
THEY GET HOOKED.>>WELL, AND THERE’S A REALLY
GOOD REASON FOR THAT. A LOT OF THE TOBACCO COMPANIES,
AS THEY GO INTO RETAIL WILL PUT THEIR MARKETING FRONT
AND CENTER FOR KIDS TO SEE. IT’S VERY TELLING THAT ABOUT
82% OF KIDS BETWEEN 12 AND 17
YEARS OF AGE KNOW WHAT
e-CIGARETTES ARE. AND OUR USAGE, THEIR USAGE IN
THAT POPULATION IS MUCH HIGHER
THAN THE GENERAL POPULATION AS
WELL.>>VAPING.>>VAPING.>>VAPING
AND NICOTINE.>>YEAH.>>IT’S SAFER.>>YEAH.>>AND IT’S TWICE AS ADDICTIVE
BECAUSE YOU CAN SNEAK IT.>>THERE’S A LOT OF SCIENCE
BEHIND QUITTING SMOKING. AND I’VE HAD PEOPLE THAT ARE
HIGHLY SUCCESSFUL, VERY
CONTROLLED INDIVIDUALS, THEY HAVE EVERYTHING TOGETHER,
AND THEY ARE UNABLE TO QUIT
SMOKING. AND THEY KNOW SOMEBODY ELSE
THAT JUST DECIDED ONE DAY, YOU KNOW WHAT, I’M NOT GOING TO
SMOKE ANYMORE, AND THEY QUIT, AND MY PATIENT COMES AND SAYS,
HOW DID THEY DO THAT? I SAID, WELL, THERE’S ABOUT 4%
OF THE POPULATION TO 7% OF THE POPULATION THAT
CAN QUIT COLD TURKEY. FOR THE OTHER 95%, IT TAKES A
LOT OF WORK. AND THAT’S WHERE THAT SOUTH
DAKOTA QUITS LINE CAN HELP. THERE’S NICOTINE REPLACEMENT
TREATMENT, THERE’S A PATCH, THERE’S GUM, THERE’S THESE
LOZENGES THAT WORK.>>THERE’S CERTAIN MEDICINES
THAT MAKES YOU –>>WELLBUTRIN, ANTIDEPRESSANT,
FOUND TO BE HIGHLY EFFECTIVE. IN COMBINATION WITH OTHER
THINGS. SO IF YOU CALL THAT QUITS LINE,
TALK TO YOUR PRIMARY CARE
PROVIDER, YOU SHOULD BE ABLE TO GET SOME
HELP AND REALLY HAVE A GOOD
CHANCE TO QUIT SMOKING.>>MOST EVERYBODY WHO HAS
SUCCESSFULLY QUIT, QUIT ABOUT 10 OR 20 TIMES
BEFORE THEY FINALLY GOT IT.>>RIGHT.>>YOU GOT TO KEEP
GOING AT IT. YOU CAN DO IT, YOU
CAN DO IT. I KNOW THAT SOME OF THE NICEST
PEOPLE I KNOW HAVE BEEN OR ARE
SMOKERS, AND THERE’S SOME NOT SO NICE
PEOPLE THAT NEVER SMOKE. SO IT HAS NOTHING TO DO WITH
WHETHER YOU’RE A GOOD GUY OR
NOT. IT HAS TO DO WITH HOW HARD IT
IS ON YOUR BODY AND YOUR FAMILY.>>YEAH.>>LET’S TALK ABOUT
BEHAVIOR ADDICTIONS, GAMBLING
ADDICTIONS. WE SEE THAT HERE, TOO, DON’T
WE? WE SEE IT EVERYWHERE. DO WE HAVE DATA ON THAT, JOSH?>>UNFORTUNATELY, THAT’S NOT
SOMETHING THAT’S EASY TO TRACK. YOU KNOW, WE SEE THE OUTCOME OF
INDIVIDUALS WHO DIE FROM OPIOIDS OR THE LONG-TERM OUTCOMES OF
TOBACCO USE AND SO ON. BUT GAMBLING ADDICTION IS NOT
SOMETHING THAT IS EASILY
TRACKED. SO, YOU KNOW, WE DON’T HAVE ANY
DATA AT THE HEALTH DEPARTMENT
ON GAMBLING ADDICTION.>>WE DO KNOW THAT IN THE BRAIN
THERE’S THIS RELEASE OF
DOPAMINE, AND IT’S IN THE MIDBRAIN, THAT
OVERRIDES OUR THINKING
PROCESSES. SO WHAT HAPPENS IS A PERSON
HEARS THOSE DINGS, THEY SEE
THOSE LIGHTS THAT ARE AT THE CASINOS, THAT
TYPE OF THING, THE REASON THEY
DO THAT, PART OF IT IS THERE’S SOMETHING
THAT REALLY RELEASES THAT
DOPAMINE IN THE VULNERABLE
POPULATION. WE DON’T HAVE A BLOOD TEST THAT
WE DRAW AND SAYS, OH, YOU HAVE
A RISK FOR GAMBLING ADDICTION. BUT WHAT HAPPENS IS A PERSON
BECOMES ADDICTED IN THE SENSE
THAT THEY GO AND THEY DO SOMETHING THAT JUST
DOESN’T MAKE SENSE THEY DON’T NECESSARILY WANT TO
DO T BUT THEY KEEP DOING IT EVEN THOUGH IT HAS SIGNIFICANT
NEGATIVE CONSEQUENCES IN THEIR
LIFE.>>SO, IT’S THIS, HOW ABOUT
LITTLE KIDS DOING THIS –>>IT WOULD BE THE SAME THING.
>>LOOK AT THEM. I SAW AN ADVERTISEMENT
YESTERDAY, HOLY TOLEDO, I WOULD
WANT TO FLY THAT AIRPLANE
THROUGH THAT BATTLE. HOW ADDICTIVE IS THAT, DO WE
HAVE ANY DATA ON THAT, WE DON’T
HAVE ANY DATA ON THAT.>>WE DON’T HAVE ANY DATA ON
THAT. IT IS HIGHLY ADDICTIVE. YOU LOOK AT YOUNG KIDS, THEY’RE
GROWING UP IN THE DIGITAL AGE, AND THEY’RE EXPOSED TO IT AT A
VERY YOUNG AGE AS WELL. SO, I MEAN, THAT SORT OF
EXPOSURE, YOU KNOW, PROLONGED
EXPOSURE OVER THE YEARS, AND IT’S NO
WONDER THAT INDIVIDUALS HAVE
DIFFICULTY PUTTING THEIR CELL PHONES AND
iPADS DOWN.>>YEAH. I HAVE TO SAY THAT IN OUR
HOUSEHOLD, WE DID NOT BUY ANY
OF THOSE DEVICES. AND I DON’T KNOW THAT IT SAVED
THEM. BECAUSE THEY WOULD GO OVER TO
THEIR FRIEND’S HOUSE, WE WERE
THE BAD PEOPLE, THEN THEY WOULD GO, YOU KNOW,
VORACIOUS.>>RIGHT.>>AND I REMEMBER, I’LL HAVE TO
ADMIT, I HAD A COMIC BOOK
ADDICTION.>>OKAY.>>I READ — THEY’D COME TO MY
HOUSE, I HAD EVERY COMIC BOOK,
EVERY SUPER MAN, YOU KNOW.>>WELL, AGAIN, IF IT TENDS TO
BE A PROBLEM IN YOUR LIFE, YOU
TRY TO CUT BACK AND YOU’RE UNABLE TO DO THAT,
THAT’S A PROBLEM. AND THAT’S WHERE YOU WANT TO GO
SEE YOUR PHYSICIAN, SAY, YOU
KNOW WHAT, HEY, I HEARD ON TV THAT
DRINKING TOO MUCH IS A PROBLEM. WELL, I TRIED TO CUT BACK, AND
I’M HAVING TROUBLE CUTTING BACK. I’M A GAMBLER, AND I’M PUTTING
MORE MONEY INTO A MACHINE THAN
I HAD WANTED TO DO. I’M DOING INTERNET GAMBLING AND
I’M DOING THIS AND I DON’T WANT
TO DO THAT. A PERSON TRIES TO CUT BACK ON
SOMETHING, IF THEY’RE UNABLE TO
DO IT CONSISTENTLY, THAT’S WHEN YOU HAVE TO HAVE A
WAKE-UP CALL, SAY, I NEED TO GO
TALK TO SOMEBODY ABOUT THIS.>>I’M IN TROUBLE.>>I MIGHT
BE IN TROUBLE.>>I’M ADDICTED. I THINK FACING THAT AND SAYING
THAT OUT LOUD IS A GOOD THING. LET’S TALK ABOUT ENTRANCE
DRUGS. PEOPLE WILL OFTEN TALK
ABOUT MARIJUANA LEADS TO THIS WHICH LEADS TO
COCAINE WHICH LEADS TO OPIOIDS,
ALL THIS, LEADS, LEADS, LEADS. WE DON’T HAVE ANY DATA ON THAT
EITHER, DO WE?>>I MEAN, THERE IS SOME DATA
OUT THERE. NOTHING SPECIFIC FOR
THE DEPARTMENT OF HEALTH. BUT, YOU KNOW, MARIJUANA USE,
YOU KNOW, ALMOST ANY SORT OF
SUBSTANCE CAN BE A STARTING POINT, I
FEEL, FOR A PERSON WHO MIGHT
HAVE SOME SORT OF ADDICTION OR, YOU
KNOW, IS THEN LOOKING FOR THAT
NEXT HIGH, LOOKING FOR WHAT
COMES AFTERWARDS.>>WELL, AND YOU’RE HANGING
WITH THESE KIDS THAT HAVE
ACCESS TO, THERE YOU GO. I
THINK IT’S A DIFFICULT ISSUE. LET’S TALK ABOUT THAT, THE
TRENDS IN BINGE DRINKING. I THINK WE’LL GO BACK TO BINGE
DRINKING BECAUSE OF THE ISSUE
OF ALCOHOL. WHAT IS BINGE DRINKING, BY
DEFINITION, CRAIG?>>SO, IT’S HAVING, FOR A MALE,
HAVING FIVE OR MORE DRINKS AT A
SINGLE SITTING. AND FOR FEMALES, IT’S HAVING
FOUR OR MORE DRINKS WITHIN A
SINGLE SITTING. SO THAT’S THE DEFINITION OF
BINGE DRINKING THAT WE USE FOR
ALL OF OUR SURVEYS, BEHAVIORAL RISK FACTOR
SURVEILLANCE AND SO ON. AND WHAT WE’RE SEEING IN SOUTH
DAKOTA IS THAT WE’RE ABOUT
17.5% OF ADULTS ARE BINGE
DRINKERS.>>AND THE PROBLEM WITH BINGE
DRINKING IS, YOU HAVE
CONSEQUENCES, IT MIGHT BE MOTOR VEHICLE
ACCIDENTS, IT CAN BE ALCOHOL
POISONING, YOU HEAR ABOUT THE COLLEGE
CAMPUSES — [OVERLAPPING
CONVERSATION]>>STDs.>>STIs.>>YUP. SO THERE’S ALL KINDS OF
CONSEQUENCES THAT CAN HAPPEN
WITH BINGE DRINKING. SO I COMMONLY AM ASKED, SO, HOW
MUCH IS TOO MUCH? THERE ARE HOW MANY GLASSES OF
WINE IN A BOTTLE? FIVE. WE KNOW THERE’S SIX BEERS IN A
SIX PACK.>>YEAH.>>BUT IN A BOTTLE OF WINE SO,
IF A PERSON DRINKS A BOTTLE OF
WINE, A MAN OR A WOMAN, THAT IS A CHECK FOR BEING A
PROBLEM. PEOPLE SAY, WELL, I WAS AT A
WINE TASTING PARTY, SO, YEAH, I DRANK A WHOLE BOTTLE, BUT IT
WAS AT A WINE TASTING PARTY.
THE SETTING DOESN’T MATTER. I ASKED MY PATIENT OVER A
12-MONTH PERIOD, SO WHAT I SAY
IS, IN THE LAST YEAR, HAVE YOU HAD FOUR DRINKS OR
MORE IF YOU’RE A FEMALE AND
FIVE DRINKS OR MORE AS A MALE, IN ONE SETTING, OVER A FEW
HOURS. WELL, ONLY IF IT’S SATURDAY
NIGHT, I’M GOING OUT FISHING
WITH THE BUDDIES, YEAH, I HAD A SIX PACK OF BEER,
THAT’S A RISK FACTOR. THERE’S A SECOND RISK FACTOR,
THAT’S HOW MUCH YOU DRANK OVER
A WEEK PERIOD OF TIME. THE RISK FACTOR FOR A FEMALE IS
MORE THAN SEVEN DRINKS IN A
WEEK. FOR A MALE, IT’S MORE THAN 14
DRINKS IN A WEEK. NOW, THE DIFFERENCE BETWEEN THE
MAN AND THE WOMAN IS TO DO WITH
BODY WATER WEIGHT. MEN HAVE A HIGHER BODY WATER
WEIGHT CONTENT THAN WOMEN, SO
IT’S DIFFUSED MORE. SO A WOMAN WILL COME UP TO ME
AND SAY, WELL, I ALWAYS HAVE A
GLASS OF RED WINE FOR MY HEART. YES, I’VE HAD A BOTTLE OF WINE
IN THE COURSE. I SAY, WELL, IF YOU ANSWER YES
TO BOTH OF THOSE RISK FACTORS, YOU HAVE APPROXIMATELY A 50%
CHANCE OF HAVING AN
ALCOHOL-RELATED DIAGNOSIS IN
YOUR LIFETIME. SO, I SAY, WHAT’S THE CONDITION
BEHIND THAT? IF A FEMALE SAYS TO ME, WELL,
BOTH MY PARENTS HAD HEART
ATTACKS IN THEIR 50s. WELL, HOW MUCH SUBSTANCE ABUSE,
ANY ALCOHOLISM, ANY DRUG ABUSE?
NO, NONE. WELL, FOR YOU MAYBE A GLASS OF
RED WINE EVERY EVENING WOULD BE
HEALTHY FOR YOU. NEXT WOMAN COMES UP TO ME AND
SAYS, YEAH, I’M DRINKING A
GLASS OF RED WINE EVERY EVENING. DO YOU HAVE A FAMILY HISTORY OF
HEART DISEASE? NO, NO, MY PARENTS ARE IN THEIR
80s, THEY’RE DOING FINE BUT
THEY’RE BOTH RECOVERING
ALCOHOLICS. I’LL SAY, WELL –>>ANOTHER
STORY.>>– I’M NOT SURE THAT
GLASS OF RED WINE… THERE IS DATA THAT SHOWS, THERE
IS SOME FAMILIAL TENDENCIES
WITH ADDICTION. NOT EVERYBODY, BUT WHEN WE ASK,
TRY TO SCREEN PEOPLE FOR
SUBSTANCE USE, PREOPERATIVELY TRY TO SCREEN
PEOPLE FROM THE OPIOID
STANDPOINT, AND ONE OF THE RISK FACTORS IS,
DO YOU HAVE A FAMILY HISTORY OF A FIRST-GENERATION FAMILY
MEMBER WITH AN ADDICTION.>>>THE RELATIONSHIP BETWEEN
PROVIDING NEEDED CARE TO A
PATIENT AND THEIR BECOMING ADDICTED HAS
MANY MOVING PARTS. STRIDES HAVE BEEN MADE IN
BRINGING SOME OF THEM UNDER
CONTROL.>>THANKFULLY IN SOUTH DAKOTA,
WE HAVE THE SECOND LOWEST
OVERDOSE DEATH RATE IN THE COUNTRY, BUT WE’RE NOT
IMMUNE. AND EVEN ONE CASE IS
TRAGIC. DOCTORS HAVE DONE A MUCH BETTER
JOB OF PRESCRIBING LESS OF THEM. SO PRESCRIPTIONS ARE WAY DOWN.
BUT, UNFORTUNATELY, OVERDOSES
ARE STILL WAY UP, MAINLY BECAUSE OF ALL THE
STREET DRUGS AND EVERYTHING, BUT SOME OF THESE PEOPLE GOT
HOOKED IN THE FIRST PLACE WITH
PRESCRIPTION MEDICATION. YOU KNOW, BY FAR, MAJORITY OF
MY PATIENTS DON’T WANT TO HAVE
ANYTHING TO DO WITH THEM. AND MOST PEOPLE WHEN THEY DO
HAVE THEM USE THEM CORRECTLY. BUT THERE’S CERTAIN PEOPLE THAT
THERE’S SOMETHING IN THEIR
BRAIN THAT GETS TRIGGERED, WHERE WITH THE REWARD CENTER OR
SOMETHING THAT THEY JUST CAN’T
GET ENOUGH OF IT. AND THEY’RE ADDICTED. AND
THAT’S THE SADDEST PART ABOUT
IT, IS THEY COULD GET A PAIN
MEDICATION FOR A VERY
LEGITIMATE REASON, BUT THEN THEY WANT MORE, EVEN
WHEN THE REASON SHOULD BE DONE. UNFORTUNATELY, YOU KNOW, SOME
PEOPLE MIGHT NOT BE TELLING THE
WHOLE STORY REGARDING THEIR
PAIN. AND, YOU KNOW, ALMOST ALL THE
TIME I DO THINK THEY DO HAVE
SOME PAIN, BUT IS IT ENOUGH TO WARRANT
STILL BEING ON THIS DANGEROUS
MEDICATION? AND, SO, THEY MAY START TO LIE
ABOUT THEIR PAIN, MAKE UP
INJURIES, DO THINGS TO MAKE IT LOOK LIKE
THEY’VE HAD AN INJURY, THEY MAY LIE ABOUT WHO THEY’VE
GOTTEN A PRESCRIPTION FROM IN THE PAST OR WHAT IT WAS
OR HOW MUCH IT WAS FOR. THEY MAY LIE ABOUT LOSING THEIR
MEDICATIONS, THEY MAY LIE ABOUT SOMEONE STEALING THEIR
MEDICATIONS OR LOSING THE
SCRIPT. THAT’S WHERE, THANKFULLY, WE’VE
MADE SOME PROGRESS IN THOSE
AREAS BY HAVING A CENTRAL WEBSITE YOU
CAN GO AND FIND OUT, OKAY, WHAT PRESCRIPTIONS HAS THIS
PERSON HAD FILLED AND FOR HOW
MUCH AND FOR WHEN AND BY WHOM. AND GET ALERTS REGARDING THAT
OR TO RAISE SOME RED FLAGS. UNFORTUNATELY, IT IS HARD TO
GET RID OF PAIN MEDICINES THAT
ARE UNUSED. SO MANY TIMES SOMEONE MIGHT
HAVE GOTTEN PRESCRIBED A DOZEN
OR 30 PAIN PILLS AND THEY ONLY NEEDED A FEW OF
THEM AND THEN NOW WHAT DO YOU
DO? AND, UNFORTUNATELY, PEOPLE TEND
TO HOLD ONTO THEM AND HOARD
THEM FOR THAT DAY IN CASE THEY MIGHT NEED IT.
UNFORTUNATELY, YOU CAN’T JUST
BRING IT BACK TO THE PHARMACY RIGHT NOW AND YOU CAN’T JUST
BRING IT BACK TO THE CLINIC
RIGHT NOW. AND YOU CAN’T JUST BRING IT
BACK TO THE HOSPITAL RIGHT NOW. SO, WE’RE WORKING ON IT SO THAT
IT WOULD MAKE SENSE THAT YOU
COULD.>>WELL, BEAUTIFUL ANSWER BY
ANDREW ELLSWORTH, A FAMILY
PHYSICIAN FROM OUR COMMUNITY. SO, WE’VE TALKED ABOUT
DIFFERENT KINDS OF ADDICTION. WE HAVEN’T SPENT A LOT OF TIME
ON COCAINE, METHAMPHETAMINES,
THE UPPERS, WE’VE GONE TO NARCOTICS,
OPIOIDS, WE’VE GONE TO DOWNERS
WITH THE VALIUMS AND THE BENZODIAZEPINES BUT WE
HAVEN’T TALKED ABOUT THE UPPERS. AND I’VE HEARD THAT — MY
STUDIES SHOW THAT OF ALL OF THE
DRUGS, THE MICE WILL SIT THERE AND
PUSH THE BUTTON UNTIL THEY’RE ABSOLUTELY DEAD
FOR THE COCAINE OR THE
AMPHETAMINE OR THE METHAMPHETAMINE AND IT
JUST TAKES AWAY ALL SENSE OF
SANITY. I MEAN, WHAT’S YOUR TAKE ON
THAT, JOSH?>>WELL, YEAH, I MEAN, THE USE
OF AMPHETAMINES IS A GROWING
CONCERN. WHETHER IT’S PRESCRIBED, YOU
KNOW, FROM YOUR DOCTOR OR
WHETHER WE’RE TALKING ABOUT SOMETHING THAT YOU’RE
GETTING OFF OF THE STREET, SUCH
AS METHAMPHETAMINE. YOU’RE SO CONNECTED TO THAT
DRUG AND SO DEPENDENT ON IT, AND, UNFORTUNATELY, UNLIKE SOME
OF THE OTHER DISCUSSIONS WE’VE HAD AROUND ALCOHOL AND
AROUND OPIOIDS, THE SINGLE THING THAT CAN KIND OF BE DONE FOR
YOU IS LOOKING AT COGNITIVE
BEHAVIORAL THERAPY. THERE’S NO DRUG TO HELP YOU OFF
THAT DRUG.>>NO. I’VE HEARD THAT THE DESCRIPTION
OF METHAMPHETAMINE IS THAT IT USES UP THE JOY THAT
YOU WOULD HAVE HAD TOMORROW AND THEN YOU USE IT AGAIN AND
— SO, ALL OF THE FUN AND THE
JOY IN LIFE IS BEING PUSHED BACK TO
THIS MOMENT. SO WHEN YOU’RE OFF OF IT,
YOU’RE WITHOUT JOY AND IT TAKES
MANY MONTHS, SOMETIMES, TO FIND THAT JOY
AGAIN.>>IT IS A CHRONIC ILLNESS,
AGAIN, IT’S PART OF ADDICTION. AND WHEN YOU’RE DEALING WITH
THAT TYPE OF ADDICTION, WITH THAT KIND OF GRASP THAT IT
HAS ON THE INDIVIDUAL, THE INPATIENT RESIDENTIAL
TREATMENT FACILITIES ARE
ABSOLUTELY ESSENTIAL. SO YOUR TREATMENT CENTERS WHERE
YOU GO FOR THREE WEEKS OR FOUR
WEEKS IS ABSOLUTELY ESSENTIAL. AND THE ADDICTION THAT GOES
WITH THOSE DRUGS ALSO HAS A
SOCIAL ASPECT TO IT BECAUSE IT OVERTAKES YOUR
LIFE. WHEN YOU GET OUT OF TREATMENT
FROM COMING FROM A METH
ADDICTION OR A COCAINE ADDICTION, YOU
HAVE TO CHANGE YOUR LIFE IN
MANY WAYS, NOT JUST STOP THE DRUG. YOU MAY HAVE TO CHANGE THE WORK
YOU DO, YOU MAY HAVE TO CHANGE
THE PLACES YOU GUY, YOUR SOCIAL
–>>YOUR FRIENDS.>>FRIENDS MAY
CHANGE. THAT’S ASKING A LOT OF
AN INDIVIDUAL. THINK OF THE ENVIRONMENT THAT
WE HAVE AND THE ROUTINE THAT WE
HAVE AND THE COMFORT WE HAVE.>>THE CIRCLE OF FRIENDS THAT
YOU HAVE.>>IT’S THE SAME THING FOR THE
PERSON THAT’S IN ADDICTION,
DESPITE THE ADDICTION. WHEN THEY LEAVE THAT ADDICTION,
NO LONGER TAKING THE DRUG, YOU’RE STILL VULNERABLE TO THE
DRUG, AND YOU STILL NEED THAT
SOCIAL SUPPORT. YOU NEED THAT SURROUNDING LOVE
THAT’S REALLY REALLY ESSENTIAL. SO, THE RESIDENTIAL TREATMENT
CENTERS FOR ADDICTION ARE
HIGHLY VALUABLE. WE HAVE NOT TALKED ABOUT THAT. SO, A LOT OF TIMES, THAT’S
NEEDED TO KIND OF GET A PERSON
GROUNDED, GET THEM OFF THE DRUG. SOMETIMES WHAT’S CALLED AN
INTENSIVE OUTPATIENT PROGRAM
CAN BE EFFECTIVE, CAN BE SUCCESSFUL WITH ON TOP
OF IT COGNITIVE BEHAVIORAL
THERAPY, THAT TYPE OF THING. BUT IT’S, AGAIN, THAT ADDICTION
JUST GETS AHOLD OF YOU.>>IT BRINGS TO MIND, AGAIN, IN
MY MIND, I’VE HAD A NUMBER OF
SHOWS WHERE WE TALKED ABOUT THE COST
OF HEALTH CARE IN AMERICA. ALL OF THIS MONEY THAT’S SPENT
ON HIPS AND KNEES AND BRAIN
SURGERY AND CANCER THERAPY AND WHATEVER
IT MIGHT BE, A LOT OF MONEY, A
LOT OF MONEY IS SPENT. BUT THE MONEY THAT IS SPENT OR
IS AVAILABLE FOR MENTAL HEALTH
IS REALLY MUCH SMALLER.>>WE’RE TRYING TO CHANGE.
THERE’S NOW CALLED VALUE-BASED
HEALTH CARE, MEANING THAT HEALTH CARE
SYSTEMS ARE REIMBURSED BY HOW
WELL THEY TAKE CARE OF THE PATIENTS,
NOT BY HOW MUCH THEY TAKE CARE
OF THEIR PATIENTS.>>THAT’S THE THEORY.>>YES.
>>THAT’S THE FUTURE.>>YEAH.
WELL, WE DO KNOW THIS. IF A DIABETIC IS BEING TREATED
FOR THEIR DIABETES, AND IF THEY
HAVE UNDIAGNOSED DEPRESSION, OVER THE COURSE OF ONE YEAR,
THE COST OF CARE FOR THAT
DIABETIC WHOSE DEPRESSION IS NOT BEING TREATED IS FOUR
TIMES NORMAL. NOW, IF YOU TAKE THAT PATIENT
HAS DIABETES AND YOU DON’T
TREAT THEIR DEPRESSION AND THEY HAVE A SUBSTANCE USE
DISORDER, GUESS WHAT THE COST
OF CARE INCREASES? 11 TIMES MORE EXPENSIVE.>>
DOES NOT SURPRISE ME.>>
THERE’S A REASON TO INVEST.>>YOU KNOW, BY GOLLY, THE
MONEY THAT WE COULD SPEND, IF
WE SPENT ON MENTAL HEALTH AND ADDICTION BEING PART OF
THAT WHOLE BAILIWICK, THAT’S
MONEY WELL SPENT.>>YEAH.>>IT WOULD SAVE OUR
SOCIETY –>>IT’S AN
INVESTMENT, NOT AN EXPENSE.>>THAT’S RIGHT. AN INVESTMENT.
>>IT’S AN INVESTMENT.>>I THINK YOU NEED TO FOCUS ON
HAVING IT BE VERY MUCH
INTEGRATED WITH, YOU KNOW, THE CURRENT, YOU
KNOW, SYSTEMS THAT ARE OUT
THERE. YOUR MEDICAL SYSTEM. YOU KNOW, WHAT WE SEE,
UNFORTUNATELY, IS A LITTLE BIT
OF SILO BETWEEN THE TWO. AND IF YOU HAVE SOMEBODY COMING
IN FOR AN APPOINTMENT, AND YOU DON’T HAVE THAT MENTAL
HEALTH PROFESSIONAL IN THAT
SAME CLINIC, THE LIKELIHOOD OF THEM GOING,
YOU KNOW, TWO BLOCKS DOWN THE
WAY FOR THEIR MENTAL HEALTH
SERVICES IS MUCH DECREASED. YOU’RE HAVING A LOT MORE
DIFFICULTY TRYING TO GET THEM
IN.>>I’VE HEARD THAT THE BIG-BOX
STORES ARE REALIZING THAT
MENTAL HEALTH CLINIC WITHIN THEIR STORES ARE WORTH
DOING. MY SENSE IS THAT WE WILL SEE
THE WAY, THERE’S GOING TO BE A
CHANGE IN HEALTH CARE COMING, THERE
HAS TO BE. AND THEY’RE GOING TO REALIZE
THE VALUE, THE INVESTMENT IN
MENTAL HEALTH AND ADDICTION IS EXTREMELY
IMPORTANT THERE. I WANTED TO ASK ABOUT M.A.T.
TELL ME A LITTLE BIT ABOUT THAT.>>IT STANDS FOR
MEDICAL-ASSISTED TREATMENT. SO, WHAT THAT IS, THERE’S A
DRUG OUT THERE CALLED
METHADONE, WHICH IS ONE OF
THEM, –>>LONG, LONG.>>LONG ACTING,
YUP. AND THEN SUBOXONE IS
ANOTHER ONE. BUPRENORPHINE IS THE GENERIC
NAME FOR THAT. I HAVE A SPECIAL DEA LICENSE
THAT I RECEIVED YEARS AGO THAT ALLOWS ME TO PRESCRIBE
SUBOXONE FOR ADDICTION. IT’S A PAIN KILLER AND YOU CAN
PRESCRIBE IT AS A PAIN KILLER
SHORT TERM. BUT TO PRESCRIBE IT AS A
BARRENT FOR ADDICTION, YOU NEED
TO HAVE A SPECIAL LICENSE. THERE ARE SOME DANGERS THAT GO
WITH IT, IT’S A CONTROLLED
SUBSTANCE, SO THEY WANT EXTRA TRAINING
WITH THAT. THE WONDERFUL THING ABOUT IT
IS, IT DOES NOT HAVE THE SAME
ADDICTION PROPERTIES, SO THE CRAVING THAT A PERSON
HAS WITH MAYBE TAKING CODEINE
OR TAKING HEROIN IS DIMINISHED IN THE PERSON
THAT GETS ON M.A.T. SO WHAT WE’RE DOING NOW, WE’RE
TRAINING PHYSICIANS TO BECOME
M.A.T. CERTIFIED SO A PERSON WHO IS ADDICTED TO
AN OPIOID, ADDICTED TO HEROIN, CAN COME INTO THE M.A.T.
CLINIC, THEY CAN BE TRANSFERRED
FROM THAT OPIOID TO SUBOXONE.>>THEY DON’T HAVE THE CRAVING.
>>NO. BUT THEY HAVE TO BE NOT TAKING
THE MEDICINE, SO THEY HAVE TO
BE GOING INTO WITHDRAWAL TO COME INTO THE CLINIC TO GET
IT. AND THAT’S WHERE IT BECOMES
SOMEWHAT COMPLICATED. WONDERFUL
DRUG. MY PERSONAL PREFERENCE IS TO
GET PEOPLE OFF THE OPIOID AND
ON NO CONTROLLED SUBSTANCE, IF
POSSIBLE. BUT THERE ARE CASES OUT THERE
WHERE A PERSON HAS TRIED AND
TRIED, HAS NOT BEEN ABLE TO GET OFF
THEIR OPIOID, THEY NEED TO GET
ON THAT SUBOXONE. IT SAVES LIVES. I KNOW I HAVE HAD PATIENTS ON
IT THAT WOULD NOT BE ALIVE
TODAY, THEY WOULD HAVE HAD A DRUG
OVERDOSE DEATH, IF THEY HADN’T
GOTTEN ON THE SUBOXONE.>>I HAVE ALSO, FOR YEARS WAS
PART OF THIS METHADONE, TRY TO
MAINTAIN, TYPE OF A THING, BUT IT IS A
TOUGH DRUG BECAUSE SOMETIMES
PEOPLE WILL RETAIN IT AND THEN THEY’LL
GET HIGHER AND HIGHER DOSES
BUILT UP, AND THEN THEY SUFFOCATE TO
DEATH. SO, MY SENSE IS THAT’S A TOUGH,
THIS METHADONE CLINIC IDEA,
TOUGH IDEA, I LIKE THE IDEA, NO OPIOID, GET
THEM OFF OF ALL OF THOSE, DO
WHAT YOU CAN TO GET THEM INVOLVED WITH A
DIFFERENT LIFESTYLE. YOU KNOW, THE TEEN CHALLENGE
THING IS 16 MONTHS. I MEAN,
IT’S A LONG TIME. AND IT’S AN AMAZING HOW THEY
HAVE MENTORING BECAUSE THESE
YOUNG PEOPLE WENT THEIR WHOLE YOUTH NOT
BEING AWAKE, NOT HAVING A
CHANCE TO LEARN WHAT A MAN SHOULD DO, WHAT KIND
OF A PROTECTER A MAN SHOULD BE, YOU KNOW, SHOULD BE,
RESPONSIBILITIES OF BEING AN
ADULT MALE. I THINK THAT’S SOMETHING TO
LEARN. WE’VE GOT JUST LIKE A
HALF A MINUTE LEFT. TAKE-HOME MESSAGE, JOSH?>>I MEAN, I THINK THE BIGGEST
THING IS WHETHER YOU’RE TALKING
ABOUT TOBACCO, ALCOHOL, OPIOIDS, THE BIGGEST
FOCUS IS TRYING TO GET, YOU
KNOW, HELP AS EARLY AS YOU CAN
GET IT. REACHING OUT TO A FAMILY
MEMBER, REACHING OUT TO YOUR
PRIMARY CARE PHYSICIAN AND GETTING INTO THE SYSTEM.>>
CRAIG?>>ONE OUT OF TEN INDIVIDUALS
IN OUR SOCIETY IS AT RISK FOR
ADDICTION. THAT MEANS NINE OUT OF TEN ARE
OUT. AND WHAT WE NEED IS THOSE NINE
OUT OF TEN TO SAY, YOU KNOW
WHAT, WE DON’T SAY JUST GET OVER IT,
WE SAY, I DON’T UNDERSTAND WHAT
YOU’RE GOING THROUGH, I WANT TO HELP YOU, AND WHAT
CAN I DO SO THAT I’M NOT
CONTRIBUTING TO YOU GETTING
BACK INTO THE DRUG.>>VERY GOOD. THANK YOU, GUYS.
>>THANKS.>>THANK YOU.>>>AND NOW, FOR THE WINNER OF
TONIGHT’S PRAIRIE DOC QUIZ
QUESTION. TOBACCO USE IN THE UNITED
STATES IS HIGHEST IN: A) SOUTH. B) MIDWEST. C) WEST.
D) NORTHEAST. AND THE ANSWER IS B – THE
MIDWEST. WE’LL BE RIGHT BACK AFTER THIS.>>EXTRA, EXTRA, READ THE
PRAIRIE DOC PERSPECTIVES WEEKLY
ESSAY IN YOUR LOCAL NEWSPAPER! OVER 55 NEWSPAPERS ACROSS THE
STATE OF SOUTH DAKOTA INCLUDE
ESSAYS WRITTEN BY Dr. RICK HOLM, COVERING A VARIETY OF MEDICAL
AND HEALTH-RELATED TOPICS. ASK YOUR LOCAL PAPER IF THEY
PRINT “PRAIRIE DOC
PERSPECTIVES.”>>ADDICTION CAN BE DEFINED AS
THE COMPULSIVE REPEATED USE OF
A DRUG OR SUBSTANCE, SUCH AS ALCOHOL, OR PERFORMANCE
OF A BEHAVIOR, SUCH AS GAMBLING. DEPENDENCE IS DIFFERENT,
OCCURRING WHEN REPEATED USE OF
A DRUG, SUCH AS HEROIN, RESULTS IN PHYSICAL DEPENDENCE
WHICH CAUSES AN UNPLEASANT
FEELING OF WITHDRAWAL WHEN THE DRUG IS STOPPED. ADDICTION AND DEPENDENCE CAN
OCCUR SEPARATELY, ALTHOUGH THEY
OFTEN RUN TOGETHER. AT 5 YEARS OLD, I WAS A
THUMB-SUCKER. I RECALL NOT BEING PROUD OF IT
AS MY FOLKS SEEMED
PROGRESSIVELY UPSET ABOUT MY
“ADDICTION.” THE PROCESS THAT FINALLY HELPED
ME QUIT WAS WHEN I WAS TOLD I
WOULD NOT VISIT MY GRANDMA IN MINNEAPOLIS UNTIL
I STOPPED SUCKING MY THUMB. I REMEMBER MANY STRUGGLED
ATTEMPTS AT QUITTING BEFORE I
FINALLY SHOOK THE MONKEY OFF MY
BACK. ADDICTION IS A HUMAN CONDITION
THAT CAN AFFECT ANY ONE OF US. THE PEOPLE IN THIS COUNTRY ARE
CURRENTLY CAUGHT IN A TERRIBLE
MAELSTROM OF OPIOID ADDICTION FROM WHICH
HUMAN BEINGS OF ALL AGES, RACES
AND ECONOMIC STATUS SEEM UNABLE TO ESCAPE. TWICE AS MANY PEOPLE SUFFOCATED
TO DEATH FROM OPIOIDS LAST YEAR THAN DIED OF
VEHICULAR CRASHES. SOMETHING LIKE 23.5 MILLION
PEOPLE IN THE U.S., ABOUT ONE
IN EVERY TEN OVER THE AGE OF 12, ARE
ADDICTED TO ALCOHOL, DRUGS, OR
SOMETHING. OF THOSE ADDICTED, ONLY ONE IN
TEN WILL EVER GET HELP. ONE EXPERT STATES THAT THE
FINANCIAL AND EMOTIONAL TOLL OF
ADDICTION IS GREATER THAN THE COMBINED
CONSEQUENCES OF DIABETES
MELLITUS AND ALL CANCERS PUT TOGETHER. THINK OF ALL THE LUNG DISEASE
AND CANCER THAT RESULTS FROM
SMOKING, THE CIRRHOSIS AND LIVER FAILURE
AS WELL AS THE DEMENTIA THAT RESULTS FROM ALCOHOL, THE
DENTAL PROBLEMS FROM
METHAMPHETAMINE USE, AND ALL THE SOCIAL CONSEQUENCES
OF ADDICTION, INCLUDING
ACCIDENTAL VEHICULAR CRASHES, SUICIDES, HOMICIDES, CRIMINAL
BEHAVIOR AND INCARCERATION. DESPITE ALL THIS DOOMSDAY TALK,
I THINK WE HAVE ROOM FOR HOPE IF WE REALIZE THAT NONE OF US
ARE IMMUNE AND EVERYONE SHOULD
TAKE PRECAUTIONS. WE SHOULD START WITH AN
OPEN-EYED AND HONEST APPROACH
WITH OUR YOUTH, TEACHING THE TRUTH ABOUT
ADDICTION WITHOUT MAKING
ADDICTIVE BEHAVIORS A
“FORBIDDEN FRUIT.” OUR COUNTRY DESPERATELY NEEDS
AFFORDABLE ADDICTION AND MENTAL
HEALTH TREATMENT OPTIONS, AVAILABLE TO ALL, WITHOUT THE
NEGATIVE STIGMA, AND OFTEN UNHELPFUL
INCARCERATION, THAT CAN FOLLOW. SPENDING FOR PREVENTION AND
TREATMENT OF ADDICTION WOULD SAVE US ALL SIGNIFICANTLY MORE
THAN IT WOULD COST. WE ALSO NEED MORE RESEARCH TO
BETTER UNDERSTAND ADDICTION AND WHAT INFLUENCES ADDICTIVE
BEHAVIOR, EVEN THAT AS
SEEMINGLY BENIGN AS SUCKING
ONE’S THUMB.>>>A BIG THANK YOU TO OUR
GUESTS, CRAIG AND JOSHUA, FOR
VOLUNTEERING TO COME TO OUR STUDIO IN YEAGER HALL ON
THE CAMPUS OF SOUTH DAKOTA
STATE UNIVERSITY. THE EXPERIENCE THEY BROUGHT WAS
KEY TO TONIGHT’S PROGRAM.>>>THAT DOES IT FOR TONIGHT. FROM ALL OF US HERE AT “ON CALL
WITH THE PRAIRIE DOC,” UNTIL NEXT TIME, STAY HEALTHY
OUT THERE, PEOPLE.>>FROM ASPIRIN TO OPIOIDS AND
EVERYTHING IN BETWEEN, BENEFITS AND SIDE EFFECTS FROM
DRUGS, MAKING IT BALANCE, NEXT TIME “ON CALL WITH THE
PRAIRIE DOC.”>>ALL OF US WANT OUR FAMILY,
NEIGHBORS AND FRIENDS TO HAVE
THE ABILITY TO MAKE APPROPRIATE DECISIONS
ABOUT THEIR HEALTH CARE. TO DO SO, THEY NEED ACCESS TO
INFORMATION FROM RELIABLE
SOURCES, LIKE Dr. HOLM AND HIS GUEST
PHYSICIANS. HELLO, I’M STEPHANIE HERSETH
SANDLIN, AND I SERVE ON THE
VOLUNTEER BOARD OF DIRECTORS OF THE
HEALING WORDS FOUNDATION, A
501c3 ORGANIZATION ESTABLISHED TO SUPPORT THE WORK
OF THE PRAIRIE DOCS. WITH YOUR CHARITABLE DONATION,
YOU CAN HELP THE FOUNDATION CONTINUE TO OFFER FREE AND EASY
ACCESS TO THE ENTIRE LIBRARY OF PRAIRIE DOC HEALTH EDUCATION
PROGRAMS. THIS MISSION IS SO VERY
IMPORTANT TO RURAL COMMUNITIES
AND RESIDENTS, IN PARTICULAR, ACROSS SOUTH
DAKOTA AND NEIGHBORING STATES. PLEASE CONSIDER A PERSONAL OR
CORPORATE GIFT. JUST GO TO PRAIRIEDOC.ORG TO
FIND MORE INFORMATION ON HOW
YOU CAN HELP. THANK YOU.>>MAJOR FUNDING FOR “ON CALL
WITH THE PRAIRIE DOC” HAS BEEN
PROVIDED BY:>>AVERA IS A PROUD SPONSOR OF
“ON CALL” ON SOUTH DAKOTA
PUBLIC BROADCASTING.>>LARSON MANUFACTURING IS
PROUD TO SUPPORT “ON CALL
TELEVISION” AS IT CONTINUES TO OPEN DOORS
FOR IMPORTANT MEDICAL
INFORMATION.>>AND BY THE SOUTH DAKOTA
FOUNDATION FOR MEDICAL CARE, THE MEDICARE QUALITY
IMPROVEMENT ORGANIZATION FOR
SOUTH DAKOTA.>>AND WITH THE ONGOING SUPPORT
OF THESE INDIVIDUALS AND
INSTITUTIONS…

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