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NARRATOR: Behind every heartbeat is a story we can learn from. As we have for over years, Blue Cross and Blue Shield companies are working to use the knowledge we gain from our members to better the health of not just those we insure but all Americans. Some call it responsibility. We call it a privilege. "Second Opinion" is funded by Blue Cross Blue Shield.

 

NARRATOR: Funding also provided by the Louis S. and Molly B. Wolk Foundation, committed to the health and well-being of the Rochester, New York, community since 1982.

 

NARRATOR: "Second Opinion" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.

 

[ Applause ]

 

DR. PETER SALGO: Welcome to "Second Opinion," where each week we gather a panel of medical experts to discuss a real-life case. I'm your host, Dr. Peter Salgo, and I want to thank all of you in our live studio audience for being here. And, of course, I want to thank all of you at home for tuning in, as well. Our experts today are Dr. Louis Baxter, executive medical director of the Professional Assistance Program of New Jersey, and Dr. Lisa Harris, primary care physician from Our Lady of Lords Memorial Hospital. And now I'd like you to meet our special guests, Mary and Joe Mullin, as they share the story of their son, Patrick

 

MARY: Our son, Patrick, was born in . Three years later, he had a little sister, Maggie. We grew up in a great town, wonderful schools. Patrick was a great athlete, good student, good scholar. He went off to college, did very well, played lacrosse, had a great lacrosse career. After he graduated from college, he developed an illness that was severe, and he developed an addiction to pain medication. At the time, we didn't know where that journey was going to lead us.

 

DR. PETER SALGO: Well, I'm glad you're here with us, and thank you so much for joining us. Mary and Joe, again, I know this is a great sacrifice, I think, for you to be here. And I can't tell you how much we all appreciate it. Tell us a little bit about Patrick. I know you mentioned Patrick, but -- And I saw some of his baby pictures. I mean, cute boy, handsome young man. Tell me about him.

 

MARY: He was the light of our life when he was born. He was a happy baby, a happy child. His sister came along, and we had a really, very happy little family. And he was a very much eager, very enthusiastic child.

 

DR. PETER SALGO: I saw him holding his sister.

 

JOE: Yes.

 

DR. PETER SALGO: Now, you know, it doesn't come any sweeter than that.

 

JOE: True.

 

DR. PETER SALGO:  So tell me more.

 

JOE: He was a -- Mary mentioned that he was a good student. He was a history buff. He had -- In, I believe, second or third grade, he knew more about the Civil War than I ever knew, could tell you the Battle of Gettysburg. He knew how many civilians were killed, you know, one. But it was one of those things, that he was a history buff. He loved to read. He learned to read by reading "Calvin and Hobbes" comic books. That was how he really took off reading, and he really never put a book down. He would -- That was sometimes his solace along the way.

 

DR. PETER SALGO:  And he was a lacrosse player, right?

 

MARY: Correct. He played -- He started playing in elementary school. Joe was his coach, and he played all through junior high and high school, competed and went off to the Air Force Academy at first...

 

DR. PETER SALGO:  Okay.

 

MARY: ...to play lacrosse.

 

DR. PETER SALGO:  Did you ever have any concerns as he was growing up, prior to high school or through high school?

 

JOE: None.

 

MARY: No. We did not ever think this would happen to our family.

 

DR. PETER SALGO:  I know.

 

MARY: And we -- He was a good student. I mean, he did things in high school that high school kids do.

 

DR. PETER SALGO:  Like what?

 

MARY: He would drink. There was drinking going on.

 

DR. PETER SALGO:  Okay.

 

MARY: A little bit of smoking pot, but beyond that, nothing of any substance beyond that.

 

DR. PETER SALGO:  You know, parents say to themselves, "Look, my kid is in school. There's some alcohol. There's pot, but look at his grades."

 

MARY: Right.

 

DR. PETER SALGO:  And he's still playing great lacrosse, right?

 

MARY: And doing well academically.

 

DR. PETER SALGO:  Doing well. So no triggers right there.

 

MARY: No.

 

DR. PETER SALGO:  So, folks, you're hearing this story. Should something here have been worrying them or not? Lisa?

 

DR. LISA HARRIS: Well, you know, it's a very common story. And I think, you know, unfortunately, what we see is that we think substance abuse and drugs and alcohol are an urban problem or a socioeconomic problem with families that are poor. And it really is an equal-opportunity type of disease. It affects families regardless of socioeconomic status or education. And so the triggers are, you know, have things changed, what is he doing differently, and I think we think that alcohol and pot are benign. And they really are the entry drugs for other use. What was your first inkling that something was wrong?

 

MARY: Well, it occurred after he graduated from college. He developed an illness, an undiagnosed illness, where he was having severe vomiting. And they would come on. We didn't know when they would be triggered, but all of a sudden, he would eat a meal and dash for the bathroom and vomit.

 

JOE: Abdominal pain and vomiting.

 

DR. PETER SALGO:  Now, does any of this story worry you, either through high school, then he goes to the Air Force Academy? He was a dedicated young man. It was after 9/11, right?

 

JOE: Yes. He earned an appointment when he graduated in 2002.

 

DR. PETER SALGO:  Okay.

 

JOE: And he went from June to February, June 2002 of into February of '03 when he chose to de-enlist, de-enroll.

 

DR. PETER SALGO:  So you hear this story. What are you thinking?

 

DR. LOUIS BAXTER: Well, I'd like to say that it's very important to understand that we're talking about a chronic medical illness. And so if there is any family history of any substance use disorder or if there's any family history of any psychiatric illnesses, then that experimental use in the early teenage years should be very concerning. But, unfortunately, we all don’t know that. And so we're looking at what other children are doing, and if they don't have that predisposition, well, then it’s not a problem.

 

DR. PETER SALGO:  Right.

 

JOE: Well, we did discuss it, though, some of those. Not the psychiatric but the substance abuse. We did have those discussions with him about that, that –

 

DR. PETER SALGO:  What were they like?

 

JOE: I want to say almost typical parent-child in many regards. I would -- We both at times, but I specifically would ask him, you know, “This is going to get you in trouble long-term. “You know, "You've got to watch what you do, and you shouldn't be doing it in these years. “But, again, we thought it was basically the alcohol and the occasional marijuana. Didn’t see that a lot.

 

DR. PETER SALGO:  You know, it's really easy, with what doctors call the retrospectroscope, looking back, knowing the end...

 

JOE: Right.

 

DR. PETER SALGO:  ...to say, "Oh, my gosh. Look at that. “It’s not that easy. Let’s go back now to his story. The nausea, the vomiting, the illness, where did that lead you? What was that about?

 

JOE: Well, as Mary said, we didn't really know what it was about. It would come up. He would use hot showers at the very beginning to alleviate the pain and the vomiting, extremely hot showers. But when he was up --He was coaching college lacrosse, and he ended up in the emergency room. And they started to diagnose its gastro, GERD, reflux disease.

 

DR. PETER SALGO:  Gastroesophageal reflux disease, which is a disease of the esophagus, and you can diagnose that with an endoscopy.

 

JOE: Well, I believe they diagnosed it more on physical rather than any physical testing.

 

DR. PETER SALGO:  Okay.

 

JOE: Because of the vomiting, because of the pains, that’s what they ascribed it to. They did check his gallbladder, as well, at the time, and they said that was fine, that there were no issues there.

 

DR. LISA HARRIS: Was he drinking at that time, do you know?

 

JOE: Yes.

 

MARY: Yes.

 

DR. PETER SALGO:  And did they give him pain medicine at that time or shortly thereafter?

 

JOE: I believe shortly thereafter. They really started --I believe they started with Dilaudid.

 

DR. PETER SALGO:  Okay. So let's stop right there.

 

DR. LISA HARRIS: Yeah. I mean –

 

DR. PETER SALGO:  So now we've got somebody who’s been using marijuana, alcohol, has had repeated and intractable nausea, which responds to hot showers. And then they started giving him narcotics for pain. Any red flags going off?

 

DR. LOUIS BAXTER: Yes.

 

DR. LISA HARRIS: Yeah.

 

DR. LOUIS BAXTER: The Dilaudid starting off there is a giant red flag. In fact, with those types of illnesses, primarily the treatment goes towards resolving the issue rather than treating the symptoms.

 

DR. LISA HARRIS: Right.

 

JOE: Right.

 

DR. PETER SALGO:  Okay. So Dilaudid is a narcotic.

 

JOE: Yes.

 

MARY: Yes.

 

DR. PETER SALGO:  It is an addictive opioid drug. It's in the same family as morphine, heroin, and now he's using Dilaudid.

 

DR. LISA HARRIS: And I guess the question in my mind is, when he went to the emergency room with the vomiting, how much did the alcohol --What role did that have in playing in the etiology of his vomiting? I don't know that that was ever really, you know...

 

JOE: Right. I don't know that the, if you will, the long-term history came into play. He wasn't going to the emergency room drunk.

 

DR. LISA HARRIS: Right.

 

JOE: But he was working, in college. He was coaching, working, and going to school at the same time. And the working was as a bartender.

 

DR. PETER SALGO:  So he was exposed and had access to alcohol.

 

JOE: Yes.

 

DR. PETER SALGO:  And with this history, with the alcohol and marijuana history, would you have prescribed narcotics?

 

DR. LOUIS BAXTER: No I don't believe so.

 

DR. LISA HARRIS: Even without the history.

 

DR. LOUIS BAXTER: Even without the history.

 

DR. PETER SALGO:  Without the history.

 

DR. LOUIS BAXTER: Exactly.

 

DR. PETER SALGO:  Right.

 

DR. LOUIS BAXTER: Exactly. But the problem is, is that, many times when people show up in the emergency room, an adequate or a full history is not taken.

 

JOE: Right.

 

DR. LOUIS BAXTER: Everyone is in a hurry. They’re crunched for time, and so most of the focus, many times, will go to relieving the symptoms as opposed to eliciting a good history.

 

DR. LISA HARRIS: Exactly.

 

DR. PETER SALGO:  Now I understand that, at some point along the road, the diagnosis was changed to pancreatitis...

 

MARY: Yes.

 

DR. PETER SALGO:  ...which is an inflammation of the pancreas, which is characterized by severe pain, nausea, vomiting. All right? And it's associated with alcohol use.

 

DR. LISA HARRIS: Right.

 

MARY: He had had his gallbladder out prior to the diagnosis of pancreatitis.

 

DR. PETER SALGO:  Okay.

 

MARY: So the gallbladder was taken out, and we had hoped that that would be the answer, and it wasn't.

 

DR. PETER SALGO:  Uh-huh.

 

MARY: And then they continued on. He had pancreatitis, and he had a feeding tube.

 

DR. PETER SALGO:  Oh, boy.

 

MARY: He was in the hospital over the holidays. He came home with the feeding tube and had it on for about 30 days.

 

DR. PETER SALGO:  Because pancreatitis affects your ability to eat...

 

MARY: Yes.

 

DR. PETER SALGO:  ...and they were trying to feed him.

 

MARY: Yes.

 

DR. PETER SALGO:  And all this time, the Dilaudid, did he talk to you about using narcotics in addition to what was prescribed?

 

MARY: He did not talk to us about it. We were suspecting at that time that there was some usage going on that was abuse.

 

DR. PETER SALGO:  But did he admit to that at some point going forward?

 

JOE: Eventually.

 

MARY: Eventually, he did.

 

DR. PETER SALGO:  What was that like, when he told you that?

 

MARY: Well, that --When he admitted that to us, it had been after about years of lots of medical problems and things.

 

DR. LISA HARRIS: And was he abusing prescription narcotics, or was it street drugs or was it a combination of both?

 

MARY: Prescription he was getting, and then along with the Dilaudid, he was given Oxycodone and hyper—

 

JOE: Hydromorphone.

 

MARY: Hydromorphone.

 

DR. PETER SALGO:  So Hydromorphone, narcotic.

 

JOE: Right.

 

DR. PETER SALGO:  OxyContin, narcotic. Dilaudid, narcotic.

 

JOE: Right. Well, it got to a point where they would prescribe him medication, and the symptoms would stop, but he still had the medication.

 

MARY: Right.

 

DR. PETER SALGO: I heard a murmur over here, “Sure." What does that mean?

 

DR. LOUIS BAXTER: Well, what that means is that a lot of times, physicians will go for symptomatic relief as opposed to trying to elucidate what is the actual problem. And we see that often, that people that are taking opioid medications for long periods of time, and they start having what’s called breakthrough pain, but actually what it is, is that they're having opiate-induced hyperalgesia or opioid-induced pain.

 

DR. PETER SALGO:  Which is counterintuitive, right? You're giving these drugs to control pain, but the drugs themselves are either inducing pain, or he’s withdrawing from the drugs.

 

DR. LOUIS BAXTER: Absolutely.

 

DR. PETER SALGO:  And that can be painful, too.

 

JOE: Right. And that’s not anything we ever heard.

 

DR. PETER SALGO:  But that's a serious issue.

 

JOE: Yes.

 

DR. PETER SALGO:  So let me talk to the docs for just a moment. Here we have a young man, alcohol, marijuana, at least three different kinds of narcotics. This isn't a path you would’ve taken, Lisa, I'm assuming.

 

DR. LISA HARRIS: Well, I wouldn't have, but it's a very common path. And I think, you know, we have to give credit to the emergency room. They are not there to diagnose and manage chronic problems. They’re there to take care of urgent problems and try to alleviate those symptoms. And so it's important to have that relationship where the emergency room physician then refers that patient back to their primary who is aware of what's happening. And then it's really the primary's job to really start digging and find out what’s going on, whether –

 

DR. PETER SALGO:  Were there other options? Could they have avoided narcotics completely?

 

DR. LISA HARRIS: Absolutely.

 

DR. LOUIS BAXTER: Yes.

 

DR. PETER SALGO:  How?

 

DR. LOUIS BAXTER: Well, specifically with that diagnosis, they could have given medications that reduced the acid, could have asked if he was using alcohol, advised him not to use alcohol and to use non-steroidal anti-inflammatories for the pain management.

 

DR. PETER SALGO:  Okay. So if he's using these drugs and he’s actually admitted to you, at some point in this spectrum, that he's abusing these drugs, what are the signs? What are the symptoms that you look for, supposing he hadn't told them? You know? What do you look for here? What are the tips?

 

DR. LOUIS BAXTER: Well, the tips are that people start changing their behavior. If they're gregarious, then they change. They start changing friends. They become more isolated, and they become unbalanced in terms of, if they're normally jovial, they’re not so happy anymore. And so you start to see those little subtle changes.

 

DR. PETER SALGO:  Or not so subtle, really.

 

DR. LOUIS BAXTER: Right.

 

DR. PETER SALGO:  Parents are tuned into that. Did you see these signs? Did you –

 

JOE: Yes. I think we did. Yeah. He isolated, and he did change friends.

 

DR. PETER SALGO:  Okay.

 

JOE: He had a group that he moved away from...

 

MARY: Yes.

 

JOE: ...and then moved away from, you know, the local college friends.

 

DR. PETER SALGO:  And he kept coaching, playing lacrosse. I understand he went abroad.

 

JOE: Well, he went to London to work as a lacrosse coach through English Lacrosse Association.

 

DR. PETER SALGO:  And what happened there? What happened in London?

 

JOE: Well, once, while visiting his sister, his sister was doing study abroad in Spain, and they ended up in the hospital in Spain. He had an episode.

 

DR. PETER SALGO:  Okay. Of what?

 

JOE: The vomiting and the abdominal pain again.

 

DR. PETER SALGO:  Okay.

 

JOE: So we're not sure how that was treated medically, with what drugs or anything like that.

 

DR. PETER SALGO:  Okay.

 

JOE: But he –

 

MARY: It was a red flag to all of us, to see that.

 

DR. PETER SALGO:  And it happened again back here in the States, right, in Baltimore?

 

MARY: Yes. Yes.

 

DR. PETER SALGO:  And what happened therein Baltimore?

 

JOE: Well, because he was experiencing this --And we used to go all the time to the NCAA Championships, and we decided that if it flared up, we would go to Johns Hopkins Medical Center, figuring one of the best in the country. So, of course, after, I believe, the second day, there was a flare-up, and we ended up spending Sunday of Memorial Day weekend in the emergency room in downtown Baltimore.

 

DR. PETER SALGO: Okay. So he's at Johns Hopkins. This is a big, experienced place.

 

JOE: Yes.

 

MARY: And it was a busy Memorial Day weekend in the emergency room. So it was quite interesting. We had to come back to Rochester to work. So Joe went back to the hotel to sleep, and I stayed in the emergency room with him. And while he was there, he just got up. He found a shower and went in and showered again in the very hot water, and they were --The head nurse was not very well-pleased with him, disrupting her emergency room.

 

DR. PETER SALGO: But I understand that tipped the doctors to a diagnosis.

 

MARY: Yes.

 

JOE: Yes.

 

DR. PETER SALGO: What did they say?

 

JOE: I'm going to kill the pronunciation, but "cannaboid hypermesis."

 

DR. PETER SALGO: Or hyperemesis. You did not kill the diagnosis, but that means that he’s using a lot of marijuana. Right?

 

JOE: Well, we didn't know. In terms of what it meant, we had to come look it up. We thought it was just counter, as marijuana is often used to sooth nausea. We were told that this is the opposite of that, that if you smoke it, it creates the abdominal pain and the vomiting.

 

MARY: Is that the hyper or is that the cyclical –

 

JOE: No. That's cannabinoid hyper-- Yeah.

 

MARY: Because another diagnosis we were given was cyclical vomiting.

 

DR. LISA HARRIS: And, see, I think, you know, in all of that, people were not really listening to this story. So we have the benefit of listening to the chronicity, but that's what we should be doing are asking those questions. And the first tip-off was with the alcohol use and the development of pancreatitis and then using the cannabis to kind of alleviate some of those symptoms and now developing hyperemesis. This is not cyclical vomiting at all. And, you know, it's just unfortunate that people did not delve deeper into it.

 

DR. PETER SALGO: And, again, we're talking about the emergency room where they don't have any continuity at all.

 

JOE: Right.

 

DR. PETER SALGO: They're seeing him at one snapshot in time. Did he stop using marijuana after that?

 

JOE: Yes.

 

DR. PETER SALGO: But he didn’t stop using narcotics?

 

MARY: No.

 

JOE: No.

 

DR. PETER SALGO: Okay.

 

DR. LISA HARRIS: And I think that’s an important point, to differentiate between use, abuse, and addiction.

 

DR. LOUIS BAXTER: Absolutely.

 

DR. PETER SALGO: And I want to come back to all of that, but I know there's one more prescribed narcotic, Fentanyl.

 

MARY: Yes. He had a Fentanyl patch.

 

DR. PETER SALGO: Oh, boy.

 

JOE: Right. Now we talked about the pancreatitis, but it turned out, he had a perfect pancreas.

 

DR. LOUIS BAXTER: Absolutely.

 

JOE: You know? There was nothing wrong with --And it took us forever to get the test, and I don't recall the name of the test, but it was more than an endoscopy or a colonoscopy. It went in with a --It's only done locally, I believe, in one hospital.

 

DR. PETER SALGO: Okay. But we have a young man now who has been treated --Now I think we're up to four prescribed narcotics.

 

MARY: Yes.

 

DR. PETER SALGO: And was on marijuana and alcohol, and we haven't even begun to talk about obtaining narcotics outside the prescription pad. How common is this story?

 

DR. LOUIS BAXTER: This story is too common, and it's very sad. It always affects me. There -- From hearing the story, I can tell you that he developed his addiction some years ago, and it was just a matter of what substance was being used at the time. Addiction is a general brain disorder, and it doesn't really matter what the substance is. It's that people use substances to change their moods. And to see this unfold like this, it always bothers me very, very much. And, you know, it's common more than what we would expect and certainly more common than what it should be.

 

DR. PETER SALGO: This is, I think it's fair to say, every parent's worst nightmare.

 

JOE: It's worse.

 

DR. PETER SALGO: It's worse than that. I’ve seen the pictures, this little baby, this beautiful young boy, this handsome man, and he's disintegrating, isn’t he?

 

JOE: Yes.

 

MARY: In front of us. And we had no power and no control.

 

DR. PETER SALGO: I don't have words for this. So I think what I'd like you to do is just wait with us for a moment because, in every episode, “Second Opinion" looks for game changers, medical innovations that are making a difference. For drug overdose, a medical implant can be used to help patients manage their opioid dependence.

 

PATRICK SECHE: So the buprenorphine implant is that new advancement that we are very much looking forward to being able to offer our patients. Buprenorphine is one of the medications that allows us to stabilize people so that they're not experiencing withdrawal. Medication, as assistive treatment overall, is very effective with opioid dependence because of the physical dependence on the drug. So the more tools we can have in the toolbox, the better. So the buprenorphine implant is implanted in patients for a 6-month period of time. It can be implanted in their arm underneath the skin. Then the medication is time-released into the person's system. It’s the first medication-assisted treatment we have in the field of addiction that requires a procedure. So it's innovative in that it puts us closer to medical procedures. You know, this is a healthcare issue, and I think it’s very encouraging and promising that we've now made advances to where there are --You know, we're entering the world of procedures that can help people physically.

 

WOMEN: So he's finished our treatment and everything, our group treatments.

 

PATRICK SECHE: Yes. He’s finished his group treatment. He's going to continue to meet with a counselor. That will allow him to be able to have this job that takes him away quite a bit.

 

WOMEN: Okay.

 

PATRICK SECHE: We'll get him set up. So the buprenorphine implant, just as any other medication-assisted treatment that we offer for treating opioid dependence, is combined with counseling services, individual psychotherapy counseling services, as well as group therapy services that help enhance the psychological component of it as we guide people to engage in recovery. The advantage is there isn’t that decision to take the medication every single day. Being able to take care of the medication piece where they don't have to struggle with that decision on a daily basis or deal with things like maybe forgetting to take it and then ending up in a situation where they may, you know, get sick, feel sick and end up taking something other than the medication that’s prescribed to them. It takes that component out of it as we work on, you know, strengthening people with counseling and things that are necessary for engaging in recovery.

 

DR. PETER SALGO: And we're back with Mary and Joe Mullin, whose son, Patrick, started using alcohol, marijuana and eventually wound up, through a combination of factors, on narcotics, including some injuries that he had, and became addicted to the pain medication. So let me talk to our docs here just for a moment. What’s the mechanism? How do you get addicted to drugs? I mean, people take drugs. Some don't get addicted.

 

DR. LOUIS BAXTER: Well, you know, the whole thing of this is that you have to have a genetic predisposition in order to become addicted in the sense of meeting diagnostic criteria. I grew up with a lot of people that were using drugs in the 's and 's, and when they went off to college, they stopped, and they never picked up again. But then there are other individuals who go a long period of time never using anything, but when they do, everything changes for them, and they say, “Boy, I feel great. I’ve never felt this way before. “And those are the people that are susceptible, who have the disease, and the brain chemistry changes.

 

DR. PETER SALGO: So let me ask a couple of very quick questions. And you said this before. Is there a permanent biological change in your brain? Does this cause, effectively, a brain injury, if you will?

 

DR. LOUIS BAXTER: It can be considered a brain injury, but it's not necessarily a permanent change.

 

DR. PETER SALGO: Okay. And we always hear that alcohol and marijuana are entryway drugs for harder drugs such as narcotics. Do we still think that?

 

DR. LISA HARRIS: Well, they can be. Not necessarily. And as Lou mentioned earlier, there are people who use and just take medications and take other substances and don’t really have a problem, per se. There are people who abuse, which means they’re overusing the medication. And then there are those that are dependent, both physically, physiologically, and psychologically on the medications. And those are the ones that are predisposed. So it's very difficult to try to determine by talking to someone where they fit in that genre.

 

DR. PETER SALGO: All right. But now we're going to talk about Patrick because, from 2012 right through until the present day, Patrick’s drug abuse became all-consuming...

 

MARY: True.

 

DR. PETER SALGO: ...for you, for him. Tell me about it.

 

MARY: Around, I think it was -- I don't remember exactly the year, but about 2 or 3 years ago, I think it was 5 years ago, the chemical makeup of the oxycodone that he was using changed, and they reformulated it. So prior to that, he had been crushing it and inhaling the smoke from it. When they changed the formulation, you couldn't do that anymore. So that changed the formulation. So he then switched from the prescription medicine that he had prescriptions for, that we were monitoring with his physician. We kept them under wraps. We gave them out to him. But then he switched from that, and he switched to heroin. And I have a vivid memory of my son standing in the living room, saying to me, "You know, Mom, it’s the same chemical makeup in heroin as it is in the opioids. “And I just -- My heart sunk because I knew we were in trouble.

 

DR. PETER SALGO: Why was heroin the buzz word that blew the roof off for you two?

 

JOE: Well, for me, it was the way I was raised. You know, in the 60's and 70's, when I was in high school and college, heroin was the drug that you just never, never, ever --You know, I never, ever knew anybody that knew anybody that used heroin. It was that perceived as a dangerous drug. I believed that you use it once, you're addicted. That’s the way I was raised, and that's why when we got into that discussion that, "Yeah, I'm using heroin because the pills have been changed, and it's cheaper. I don't have to spend $80 for a pill. I can go spend $6 for a bag, “and –

 

DR. PETER SALGO: I think that's important here, that we always read that people are broke because they're buying drugs, but heroin is actually cheap...

 

JOE: Dirt cheap.

 

DR. PETER SALGO: ...cheaper than prescription drugs. They’re just using a lot of it.

 

JOE: Exactly.

 

DR. LISA HARRIS: And I think that’s an important point, you know, particularly in New York state with I-STOP where physicians have to check to see how often prescriptions are being filled, if they're monitoring or using prescriptions as prescribed. We’ve now switched from prescription medications to heroin because it's a lot cheaper for people to get heroin than it is to get the prescription from the doctor.

 

JOE: I always have said that they've taken care of the supply, you know, basic economics. They’ve controlled the supply, but they haven’t touched the demand.

 

DR. LISA HARRIS: Absolutely.

 

DR. PETER SALGO: So tell me about what happens now. Does Patrick get help? Does he go to rehab?

 

MARY: That summer that this all started to fall, for us, the change to the heroin, began a long summer. And we tried in the beginning to try to control him, watch him all the time and not let him go out. And he was –

 

JOE: Get him to counseling.

 

MARY: Get him to counseling. We put him into a detox facility, and the detox facility only helped him meet other users to continue on. And he started going to Narc-Al An and AA meetings. He was going to meetings, but haphazardly. And I began --Joe and I were having a big difference of opinion about what was going on. And Joe was further convinced that Patrick was an addict, even with the opioid addiction, and I was putting my head in the sand and believing it was not that bad, that it was okay.

 

DR. PETER SALGO: He went to jail.

 

MARY: Well, that's part of our story. So that summer, I began going to Al-Ann and for me, Al-Anon is a support group for families who have alcoholics in their lives and drug addicts. So I started going there. I started going in July. And I learned with Joe's help. Together, we came up with a –

 

JOE: House rules.

 

MARY: ...house rules, and we said if we found any heroin in his possession, in our house, we would ask him to leave. And then, within a month of me going to that first meeting, a month later on, it was in August. He came home. He looked high. I looked -- He went upstairs. I went in his backpack, and there was heroin there. And we called him down, and we said, “You must leave now.” And that's when his journey really started to get serious. He ended up breaking and entering into our house to try to get money to do it. He stole a bike from someone, and he ended up in jail. And we, as parents, we had told him that if he ended up in jail, we were not going to bail him out, that he would have to live with the consequences of his action.

 

DR. PETER SALGO: So he's been in jail. I can't imagine the pain you’re going through and, I imagine, the pain he’s going through.

 

DR. LISA HARRIS: And it's so hard because we want to try to rationalize how we can help people. And sometimes we try to use tough love and other things, and it's so complicated and so interdigitated that you're at a loss as to what to do.

 

JOE: And there's no roadmap for you as a parent.

 

DR. LISA HARRIS: And it's individualized.

 

DR. PETER SALGO: There's no instruction manual. This is your boy

 

JOE: None. Exactly.

 

DR. PETER SALGO: This is the boy you raised.

 

JOE: The boy you've been taught from years before even conceiving that you’re to protect your children, and now you leave them in jail for -some days.

 

DR. PETER SALGO: And so he's in jail. What happens when he gets out?

 

JOE: Well, fortunately, we mentioned that he had earned the appointment to the Air Force Academy, the United States Air Force Academy. And, as a result, he took the oath to become a cadet, which is the lowest rank. So when he de-enlisted, he got papers. He got the DD 214.And that opened a door for him. There’s a process in Rochester and in Syracuse called drug treatment court. And in Rochester, they call --There's also a version, Veterans Drug Treatment Court. And by having those papers, the discharge papers, and having been at the Air Force Academy, he was allowed to process through that drug treatment court.

 

DR. PETER SALGO: They test your urine.

 

JOE: Every time you go in.

 

DR. PETER SALGO: And?

 

JOE: Well, for Patrick, his first visit, he was still in handcuffs and a jumpsuit because he was still in jail. When he was released from jail, he was released to the local veterans outreach center, called Richards House. And at Richards House, they do drug testing. They can do it daily. They can do it multiple times daily. And he was tested repeatedly while he was at Richards House. And at Richards, they also have a program of counseling and treatment to help you fight that addiction.

 

DR. PETER SALGO: Okay.

 

JOE: So he progressed through that, but eventually he did relapse. He was moved into not assisted living, but sort of a –

 

MARY: Sober living maybe.

 

JOE: ...sober living arrangement, under the auspices of the veterans outreach center. And he had a hard relapse with that.

 

DR. LOUIS BAXTER: A problem that I'm having here is that I’m hearing that he's had pieces of treatment. And a full treatment experience for addiction is important. Without a full treatment experience, people do not get well. A full treatment experience is detoxification, then rehabilitation counseling, and then follow-up. And in these modern days, we have medication assisted therapy. He sounds like he would have been a good candidate for some of that.

 

JOE: Well, through the Richards House, I think he got the first three elements. He was not placed on, like, Suboxone or Vivitrol until later.

 

MARY: Later on.

 

JOE: But he detoxed in jail, and then through the --The rehabilitation was really at Richards House. He had work assignments. It wasn't like, "Come sleep, and you're good."

 

DR. LOUIS BAXTER: Right. But my point is that the rehabilitation has to be specific for that person. So if he had a rehabilitation that was not at the proper level for him, it was ineffective.

 

JOE: But where is that available today anywhere?

 

DR. LOUIS BAXTER: Well –

 

JOE: For the general person on the street, for me, the parent, where --You don't hear that. You don't see that. The rehab facility he went to along the way in 2012 was 7 days. Thank you very much.

 

DR. PETER SALGO: Seven days?

 

JOE: Seven days.

 

DR. PETER SALGO: ...to treat decades of trouble.

 

DR. LOUIS BAXTER: That is not rehab.

 

JOE: Right. Right. But –

 

DR. LOUIS BAXTER: That's not rehab.

 

JOE: No. I -- We understand that.

 

MARY: I guess what we're wondering is the course of action. We felt fortunate that he had what he had, that he had some good work, but he kept relapsing and having success but relapsing. He ended up going to New York City to what I consider the more restrictive halfway house

 

JOE: Samaritan Village.

 

MARY: And he did well there. He ran in the New York City Marathon. He had two jobs. He did well. But when he got done with that, he and another guy from the house were just placed in --They moved into an apartment. There was no follow-up visits.

 

DR. LOUIS BAXTER: Right.

 

MARY: There was no testing.

 

DR. LISA HARRIS: And that's really what you need to have happen. And so there are some primary care physicians that can do that for you, that can help him with, “Do you have a sponsor? Do you have a phone list? You’re going to come get random urine drug screens.” And that's how you build it up.

 

JOE: Right.

 

DR. LISA HARRIS: You can do that through primary care.

 

JOE: If he were still in Rochester, that would have happened through the Veterans Treatment Court, because he was still --Even when he was released into New York City, he was still under the control of the Veterans Treatment Court.

 

DR. PETER SALGO: Let's do this. Let’s back up for a second. Can you outline what it should’ve looked like? What is somebody who gets optimum treatment getting? What is that process?

 

DR. LOUIS BAXTER: Okay, well, this is what we would love to see typically, and our medical specialty, the American Society of Addiction Medicine, we’re trying to place this at the feet of mainstream medicine, but what should have happened is that, at one point when he was having all of those ER visits and getting multiple medications, as Dr. Harris said, it would've been perfect if his primary care physician referred him to an addiction medicine specialist. When people have other complicated medical problems, they are referred to a specialist, and the same thing should happen to people with substance use disorders. That addiction medicine specialist would've then evaluated, made a clear diagnosis if it is just use, misuse, abuse, or dependent. At that time, if dependence or even abuse was diagnosed by criteria, then using the American Society of Addiction Medicine patient placement criteria, he would've been referred to the level of care that he needed. That’s very important because some people are referred for outpatient treatment when they need intensive or they need residential or they need hospital-based long-term. So, in incidences where people are referred to the level of care that’s least, it’s doomed for failure.

 

JOE: Yes.

 

DR. PETER SALGO: You know, I look at these parents looking at me, and they're hearing what ideal treatment was. They know Patrick didn't get it.

 

JOE: I'm not sure many people get it. I just don't –

 

DR. LISA HARRIS: I would agree with you.

 

JOE: I just don't see it out there today.

 

DR. PETER SALGO: There isn't a parent on this planet that wouldn't do anything to keep their kid healthy...

 

JOE: That's right.

 

DR. PETER SALGO: ...and to break this cycle. And we're not done with this story. But, as you listen to this, my heart is breaking, to know maybe there was a better path. And what I want to do now is, I want to talk to some of Patrick’s friends who are herewith us in the audience, so, Yana, Sean, you were with Patrick when he was homeless. Tell me about how you worked with him and helped him out at that time.

 

YANA: Well, Patrick had come to our front door after he had gotten out of the hospital, I believe. And there he had begged the staff to get him a bed in inpatient, and he begged and pleaded from what he told us, and there was a bed lined up, but it was the emergency room, and it was the middle of the night, and they couldn't keep him, so they let him go. And that morning, I believe, he was on our front door just needing help. So we tried to link him with anyone that we could. Sean helped him with the veterans outreach center; connect with a homeless shelter until something else could be found.

 

DR. PETER SALGO: A homeless shelter. So here's young Patrick, good home, Air Force Academy, college, coach, homeless shelter.

 

YANA: Correct.

 

DR. PETER SALGO: What were you guys thinking when you looked at Patrick at that time?

 

YANA: I think we both just really wanted him to get well. Seeing him the way that we saw him, there's just pain. There’s so much pain with addiction.

 

DR. PETER SALGO: Mm-hmm.

 

YANA: And to see him hurting as badly as he was was really hard to see.

 

DR. PETER SALGO: Now, you've had your own journey with addiction. You can help us a little bit. What is it like from the inside? You perhaps better than anybody right here knows what Patrick was feeling. What is it?

 

YANA: It's being in a prison. It’s like living in hell. I keep thinking of this song as the show is going, and it's "My First Drug Dealer Was a Doctor.” You know, by 12 years old, for anxiety and depression, I was prescribed benzodiazepines and all sorts of things, and it's really just not being able to cope, you know, being a teenager, having the school stress, and it just progressed to where I had no power and no control. And there was so much pain and shame and guilt, and it was almost like an out-of-body experience where I could see myself acting in these ways that I wasn't raised, you know, to be immoral. I was raised with values, to be respectful, and I could just see this demon of a person.

 

DR. PETER SALGO: Public view of somebody who's addicted is somebody who's having fun, enjoying the drugs, feeling good.

 

YANA: Mm-hmm.

 

DR. PETER SALGO: That's not what I'm hearing.

 

YANA: It's not fun. Once you become addicted, it’s a need. Even with substance use disorder before it becomes a dependence, it becomes not fun at some point, and it becomes just a way to get by.

 

DR. PETER SALGO: Now, Sean, Yana, you’ve got an organization.

 

YANA: Mm-hmm.

 

DR. PETER SALGO: Tell me about that.

 

YANA: Well, we have started a program called ROCovery Fitness, and it's a peer-led, sober, active community in Rochester, New York. And it provides a safe place and a nurturing environment based around recovery about wellness and health and fitness.

 

DR. PETER SALGO: And how large is this group? It’s growing, I hear.

 

YANA: It is. In just over 2 years, we’ve connected with approximately1,000 people in recovery and their families in Rochester and the surrounding area.

 

DR. PETER SALGO: That's remarkable.1,000 people.[ Applause ]

 

YANA: Thank you.

 

DR. PETER SALGO: Do you consider yourself recovered?

 

YANA: I am recovered. No, I don’t. I consider myself to be in recovery, and this is something I have to work on a daily basis. I’m not recovered. I have a chronic health condition that needs treatment, and I know that for myself that, once I consider myself recovered, I'm in big trouble.

 

DR. PETER SALGO: Okay. Let’s go back to Patrick. Let’s bring it up to two months ago. Two months ago, Patrick was living where?

 

MARY: Patrick had had, since Sean and Yana helped him last summer, he got into treatment. He went to a halfway house, did well, came out, lived in a halfway house. And when he was involved in the halfway house, he started volunteering at the Zen Center of Rochester.

 

DR. PETER SALGO: That's a religious center.

 

MARY: Religious center and he found much peace there. And so, when he was ready to leave the halfway house, he went to live at the Zen Center to work for them, and he found great peace and great support with the people there. He was very much involved, and we had a wonderful Christmas with him and our family, and we treated him like an adult that was living in town. We didn't see him all the time. We would go out to dinner. We’d have him over. We thought we were living. He was doing well, and we were --It was a very happy thing.

 

DR. PETER SALGO: And then there was a Sunday night into a Monday morning.

 

JOE: Right. There was a weekend. I had spent Friday afternoon with him. We did a couple errands, took him to lunch at a friend's restaurant. That weekend, there was an AA conference in town, and he went to that conference, by all accounts was okay, was good. Sunday, he went, and he worked. He volunteered at the ROCovery Fitness there, you know, in terms of cleaning and working to get it open. And what we've heard through there is that, that night, he was off a little bit. He wasn't himself, so to speak. And his sponsor tried to reach out to him, and one of their friends, Yana and Sean and a couple other people reached out, and he had sort of gone dark. He’d gone off the grid. And Monday afternoon [Sighs deeply] we got a phone call.

 

MARY: We got a phone call from one of Patrick's really good friends hoping that he would be at our house, and he wasn’t, so we looked at each other and were scared out of our minds. But we went to bed, and the next morning, Tuesday morning, March the, we got a call that he had passed away at the Zen Center, and we're not really quite sure how it all transpired, but one of the things that was contributing to this was, he had gotten a tax return, so he had money in his pocket, and, for Patrick, money in his pocket was always a little bit of a danger.

 

JOE: Right.

 

MARY: And we thought he was doing well with it. Joe had spent the day with him getting a bike and doing good things, but it must have been too much for him, and I know that his friends tried so hard to find him. They sent out police that they knew to go look for him. They couldn't find him, and they found him the next morning dead of an overdose at the Zen Center.

 

DR. PETER SALGO: Gone?

 

MARY: Gone.

 

JOE: Yes.

 

MARY: Gone.

 

JOE: We got the phone call you never want to get, quarter to 6 in the morning. And knowing what we knew from the Monday phone call, when the phone rang, we both knew what it meant.

 

MARY: But then something wonderful happened, which we really don't expect to be able to say that, but that evening, all his friends gathered at the ROCovery location, and there must have been 60 to 80 people there, and they all sat around the fire house, and they talked about our son, and we found out that, even though we were viewing him as in so much trouble and all the bad things, we found out that he was doing wonderful things even in and out of recovery. He helped people. He brought people to ROCovery. He brought people to meetings. He tried his very best, and they went around the room, and they told us what wonderful things he had done for them, and then we got to tell them what wonderful things they’d just done for us. And for us, we are so very thankful that we had that opportunity, and we still have this opportunity, that we have a place that will remember our son, and we can go and speak about him because the one thing that happens when someone dies is, people stop talking about your children, and they’ll never do that for us. They’ll keep talking to us.

 

DR. PETER SALGO: I normally would ask something here. I don't even know where to go. You’ve seen this. You’ve seen this. We’ve all seen this. Do you have anything to say?

 

DR. LOUIS BAXTER: The only thing that I can say is that it bears out that addiction is a brain disease because no one wakes up in the morning and says, "I think I'll become addicted. “And throughout those instances where your son had structure, he was able to stop using, but something has to change in order to effect behaviors, going out, and if this is truly a brain disease, as we have great evidence that tells us, we have to do something to treat it. And just like any other chronic illness, I liked the --Is it Yana?

 

MARY: Yana.

 

DR. LOUIS BAXTER: I liked what she said. She said that, no, she's not recovered. She's recovering. And that's so true with all chronic medical illnesses. A diabetic is never cured. They’re always a diabetic, and they stay well as long as they do what they need to.

 

DR. PETER SALGO: Something that occurs to me is, he was doing better.

 

JOE: Yes.

 

DR. PETER SALGO: He may have been off drugs for a while.

 

JOE: Long time.

 

DR. PETER SALGO: People who are clean and then go back and take a dose have reset their tolerance. They may not know it, Lisa.

 

DR. LISA HARRIS: That's correct.

 

DR. PETER SALGO: So he takes a dose that may not have killed him while he was a heavy user.

 

DR. LISA HARRIS: That's right.

 

DR. PETER SALGO: And it does something he doesn't expect.

 

JOE: One of the things that we don't know is, in the Western New York area, in Buffalo specifically, there’s been a large increase of fentanyl-laced heroin, and when we talked with the medical examiner here locally, they said they took fluids and blood, but we won't know for five to six months as to whether it was. And that's standard knowledge, really. We learned that in family counseling, that they relapse back to the last dose.

 

DR. LISA HARRIS: Right.

 

DR. PETER SALGO: And fentanyl is, in terms of dose,1,000 times worse.

 

JOE: Right.

 

DR. PETER SALGO:  Order of magnitude.

 

JOE: In Buffalo, it's my understanding that it's just --There's a whole –

 

DR. LISA HARRIS: It's pretty much permeated the state. We’re seeing it in Broome County. You know, we're seeing it certainly in Monroe County. So it's everywhere. And what I would say to you is, what strength and what fortitude you all have and a moving story. [ Applause ]

 

DR. LOUIS BAXTER: And I'd like to add to what Dr. Harris said, is that you did absolutely everything correct.

 

DR. LISA HARRIS: You did.

 

DR. PETER SALGO: You did. We’ve all seen this. You’re wonderful, loving, supportive parents, and a disease took your child, a disease no one wants to see.

 

JOE: No.

 

DR. PETER SALGO: Nothing. I’m just going to ask you two each, give you a moment, if you have any advice. You’re both experienced clinicians. You've seen folks. A piece of advice for parents watching this broadcast.

 

DR. LISA HARRIS: Be aware of the subtle changes, and don't be afraid to confront your child and to be that really tough advocate that you're not going to take no for an answer. You’re not going to take any excuses, and you're going to advocate for the highest level of care for the treatment of this chronic disease.

 

DR. LOUIS BAXTER: And I think that it's very important for parents to understand that you are dealing with a disease and that it's not your fault. [ Applause ]

 

DR. PETER SALGO: I don't know if there are words sufficient to express our gratitude for your being here.

 

JOE: If we help one, it's a plus, if we help anybody.[ Applause ]

 

DR. PETER SALGO: It's just extraordinary. And here's Mary and Joe's advice to parents who are dealing with a child with addiction.

 

MARY: Our advice to parents who suspect their children of using drugs, particularly heroin and opiates, is, first of all, don't be ashamed, and be open to open your eyes to see what's going on. Be aware of how your child is acting, if their moods are very different.

 

JOE: I would also add that you have to ask for help. There’s no playbook. Every child is different. Every event is different. You have to ask for help, whether it's your priest, whether it's friends who might have been through it already, but especially counseling. There are excellent drug and addiction counselors out there that can help, that will help. Don’t be embarrassed because it’s not about you. It’s about saving your child, your loved one, your spouse. It’s about saving their life. The other thing I would Addis that, as we went through our journey with our son Patrick, there were times where we questioned each other. We almost let that get in the way, and what you have to does realize that it's not about you and your spouse. It’s really about, "What are you doing for your child? What are you doing for your loved one?"

 

MARY: But you also said it’s important to maintain the relationship.

 

JOE: You have to maintain that relationship, but you can’t get -- You have to work through that. Don't let that tear you apart because then you lose sight of the real problem. You have to work to keep that relationship together.

 

DR. PETER SALGO: Lisa, Lou, again, thank you so much for being heretic want to thank our studio audience for being here again, and thank you for watching. Remember, you can get more second opinions and patient stories on our website at secondopinion-tv.org. You can continue this conversation on Facebook and Twitter, where we are live everyday with health news. I’m Dr. Peter Salgo. I'll see you next time for another "Second Opinion."       

 

NARRATOR:
Behind every heartbeat is a story we can learn from. As we have for over  years, Blue Cross and Blue Shield companies are working to use the knowledge we gain from our members to better the health of not just those we insure but all Americans. Some call it responsibility. We call it a privilege. “Second Opinion" is funded by Blue Cross Blue Shield.

 

NARRATOR:
Funding also provided by the Louis S.& Molly B. Wolk Foundation, committed to the health and well-being of the Rochester, New York, community since 1982.

NARRATOR:
"Second Opinion" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.